Terapia con Láser de baja intensidad para reducir el dolor en la artritis reumatoide y la osteoartritis : una revisión sistemática

Introdução: Os tratamentos para artrite reumatoide (AR) e osteoartrite (OA) devem diminuir dor, modular inflamação e diminuir deformidades. O LLLT é um biomodulador e pode auxiliar no quadro clínico destas. Objetivo: Analisar os parâmetros mais comumente utilizados para a diminuição das respostas de dor em pacientes com AR e OA em ensaios clínicos controlados e não controlados. Método: Trata-se de uma revisão sistemática com busca de artigos em inglês, português e espanhol na: PUBMED, SCOPUS, LILACS e Web of SCIENCE, entre 2006 a 2018. Foram utilizados os descritores MESH. Critérios de inclusão: avaliação da eficácia do LLLT nestas populações, verificação da dor antes e depois do tratamento, ensaios clínicos controlados e não controlados, publicados integralmente. Foi realizado o cálculo da dosimetria do laser e análise de média, mediana e moda da energia por ponto e energia por tratamento. Resultados: Incluídos neste estudo 3 artigos de AR e 16 de OA. Em relação à dosimetria, apenas um AR apresentou redução da dor, sendo este com a maior dose de energia. Já na OA, a maioria dos artigos apresentou diminuição da dor, e com variabilidade na dosagem aplicada. Alguns tiveram poucos parâmetros apresentados, tornando impossível calcular a dosimetria. Conclusão: há evidências científicas para reduzir a dor relatada em pacientes com OA de joelho, principalmente com doses de 6 J por ponto e 48 J aplicadas no tratamento diário. Para as outras articulações afetadas com OA e AR, seria importante a publicação de mais artigos científicos com melhor qualidade metodológica e descrição da dosimetria.Introduction: Treatments for rheumatoid arthritis (RA) and osteoarthritis (OA) can reduce, modulate inflammation, and reduce deformities. Low-Level Laser Therapy is a biomodulator and may aid in the clinical picture of these conditions. Objective: To analyze the parameters most frequently used to determine the responses of patients with RA and OA in controlled and uncontrolled clinical trials. Method: This is a systematic review with search of articles in English, Portuguese and Spanish in PUBMED, SCOPUS, LILACS and Web of SCIENCE, of articles published between 2006 and 2018. MeSH terms were used. Inclusion criteria: evaluation of LLLT in the evaluations, evaluation and evaluation of the period, controlled and uncontrolled clinical trials, full publications. The base date of the energy dosimetry and the analysis of mean, median and mode of energy per point and energy per treatment. Results: Three articles on RA and 16 on OA were included in this study. Regarding dosimetry, it was one of the most recent of the pain, being this one with a greater energy dose. In OA, most of the articles presented are of importance, with variability in the dosage applied. Conclusion: There are several reports for patient studies purposes, mainly with doses of 6 J per point and 48 J. In the joints affected with OA and AR, it would be important to publish more scientific articles with better methodological quality and description of dosimetry.Introducción: Los tratamientos para la artritis reumatoide (AR) y la osteoartritis (OA) pueden reducirse, modular, encender y disminuir las deformidades. El LLLT es un biomodulador y puede auxiliar en el cuadro clínico de éstas. Objetivo: Analizar los parámetros más frecuentemente utilizados para determinar las respuestas de pacientes con AR y OA en ensayos clínicos controlados y no controlados. Método: Se trata de una revisión sistemática y la búsqueda de artículos en Inglés, portugués y español en: PubMed, SCOPUS, se utilizaron LILACS y Web of Science, entre 2006 y 2018. Los descriptores de malla. Criterios de inclusión: evaluación de la LLLT en las evaluaciones, evaluación y evaluación del período, ensayos clínicos controlados y no controlados, íntegramente. La fecha base de la dosimetría de energía y el análisis de media, media y moda de la energía por punto y energía por tratamiento. Resultados: Incluido en este estudio 3 artículos de AR y 16 de OA. En cuanto a la dosimetría, fue uno de los más recientes del dolor, siendo éste con una dosis mayor de energía. En la OA, la mayoría de los artículos presentados son de importancia, con la variabilidad en la dosificación aplicada. Se han tenido pocos pocos parámetros parámetros parámetros presentados presentados. Conclusión: hay una serie de informes para fines de estudios con pacientes, principalmente con dosis de 6 J por punto y 48 J. Las articulaciones afectadas con OA y AR, sería importante la publicación de más artículos científicos con mejor calidad metodológica y descripción de dosimetría

Cognitive stimulation in older adults: an innovative good practice supporting successful aging and self-care

The project Cognitive Stimulation in Older Adults: Intervention on Cognitive Frailty and Promotion of Self-Care (in brief the ECOG project) arises in a context of worldwide demographic aging, and is fostered by the need to provide a sustainable solution to the progressive increase in the prevalence of age-related cognitive impairment. The main goal of the ECOG project is to promote active citizenship in old age through the empowerment for autonomy and self-care. Namely, the ECOG team is working on the development of evidence-based programs and tools that promote gains in health in cognitively frail and cognitively impaired older adults from the community. It is also working on the transfer of ECOG products to the practice of health and social care, promoting active involvement of geriatric care institutions in the implementation of the ECOG programs and tools, and ensuring appropriate training of professionals. Finally, the ECOG team is deploying a digital platform to reach out to the broadest audience possible and support the remote access and scaling up of the ECOG products. The impacts expected at an individual level include improvements in cognition, functionality, and autonomy of older adults, with simultaneous reduction of depressive symptomatology, and increase in quality of life of both person cared and his/her caregiver. Regarding societal gains, we anticipate an increase in life expectancy and significant postponement of institutionalization associated with geriatric problems. We also believe that the wide implementation of the ECOG products will reduce the costs of interventions for cognitively impaired citizens, contributing to sustainability and efficiency of health systems

Órteses para o paciente com osteoartrite do polegar: o que os terapeutas ocupacionais no Brasil indicam?

Órteses são consideradas a primeira linha de atuação para o tratamento de disfunções causadas pela osteoartrite (OA) da articulação carpometacárpica do polegar. Entretanto, não existem estudos que investiguem as preferências e indicações de órteses por profissionais brasileiros. Objetivo: Identificar os modelos de órteses indicados por terapeutas ocupacionais para pacientes com OA do polegar, bem como as barreiras encontradas para o uso deste recurso. Métodos: Estudo exploratório transversal, realizado através de questionário eletrônico com terapeutas ocupacionais brasileiros. Os dados obtidos foram analisados por meio da distribuição, frequência e porcentagem das respostas. Resultados: Participaram da pesquisa 52 terapeutas ocupacionais de todo o Brasil, atuando junto a pacientes reumáticos. A maioria das indicações foi de órteses sob medida (81%), envolvendo mais de uma articulação (83,7%). Políticas institucionais e ausência de materiais foram as principais dificuldades para 48,1% dos participantes. Conclusão: A indicação de órteses para pacientes com OA se faz presente na prática clínica de terapeutas ocupacionais e torna-se importante o incentivo a estratégias que permitam o aperfeiçoamento e difusão de ações de reabilitação junto a esta população.Orthoses are the first line of action for the treatment of dysfunctions caused by osteoarthritis (OA) of the carpometacarpal joint of the thumb. However, there are no studies that investigate the preferences and orthotics prescriptions made by Brazilian health professionals. Objective: To identify orthotic designs indicated by occupational therapists for patients with thumb OA and the barriers encountered to use these devices. Methods: Cross-sectional, exploratory study conducted by electronic questionnaire with Brazilian occupational therapists. Data were analyzed using the distribution, frequency and percentage of responses. Results: 52 Brazilian occupational therapists who treated patients with rheumatic diseases participated in this study. Most of the participants indicated custom-made models (81%), involving more than one joint (83.7%). Institutional policies and lack of materials were the main barriers for 48.1% of the participants. Conclusion: The prescription of orthoses for patients with OA is present in the clinical practice of occupational therapists, and it is important to encourage strategies to the development and dissemination of rehabilitation actions for this population

Doença do Refluxo Gastroesofágico em Lactentes: análise global / Gastroesophageal Reflux Disease in Infants: global analysis

Objetivo: analisar as vantagens e as limitações dos tratamentos conservadores, farmacológicos e cirúrgicos disponíveis para a doença do refluxo gastroesofágico (DRGE) em lactentes, a fim de criar material atualizado acerca do tema. Revisão Bibliográfica: DRGE é uma patologia causada pelo retorno de conteúdo gástrico para o esôfago. O quadro clínico nessa faixa etária é variado e inespecífico, porém, há algumas particularidades, como regurgitações frequentes, acompanhadas frequentemente por vômitos propulsivos, recusa da alimentação, irritabilidade e baixo ganho ponderal. O tratamento consiste em medidas conservadoras e medicamentosas para a maior parte dos pacientes. O tratamento cirúrgico é uma opção somente para casos específicos. Considerações finais: observa-se que a maioria dos casos de DRGE evoluem para cura espontânea - muitas vezes com auxílio apenas de medidas conservadoras. No entanto, deve-se atentar aos sinais de alarme da doença e, diante da necessidade de intervenção médica, precisa-se conhecer os riscos e benefícios de cada possível conduta.

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.(SFRH/BPD/115169/2016) funded by Fundação para a Ciência e Tecnologia (FCT); ERDF (European Regional Development Fund) through the operations: POCI-01-0145-FEDER-029130 ('mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases—generalisation and evaluation of gamification, peer support and advanced image processing technologies') cofunded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).info:eu-repo/semantics/publishedVersio

Estimativa de potenciais técnicos de energia renovável em Portugal: eólico, solar fotovoltaico, solar concentrado, biomassa e oceanos

Executive Summary: There is a clear need to accelerate the energy transition, including the implementation of renewable electricity production plants, as well as the increase in consumption of other renewable energy carriers in buildings, industry, transport and other sectors. This work provides key information to make this transition possible, that is, the technical renewable energy potentials for Portugal. The aim is thus to contribute to policy support, as well as to decision-making by various Portuguese stakeholders (public and private) in the domains of energy, energy transition and greenhouse gases emissions mitigation. The work presents the technical renewable energy potentials for Portugal to: (i) decentralized solar photovoltaic (PV) plants in artificialized (or built-up) areas; (ii) centralized solar PV plants in non-artificialized (or natural) areas; (iii) concentrated solar power; (iv) onshore wind; (v) offshore wind (floating and fixed); (vi) bioenergy, and (vii) solar thermal. The wave energy primary energy resource potential is also presented (not the technical potential). The technical potential values of renewable energy sources (RES) presented are dynamic values, given the substantial uncertainty associated with their estimation. The study identifies technical RES potentials i.e., the technically viable energy generation achievable from a specific technology, considering the primary energy resource available and the geographic, environmental and land use limitations. RES economic potentials represent the fraction of RES technical potential that is economically viable, but they are not presented in this work. Likewise, this report does not address market potential, that translate the capacity and energy generation that the market effectively manages to implement. The presented RES technical potentials include the total capacity currently installed in the country. The technical potentials are estimated mostly for mainland Portugal, in most cases with a spatial disaggregation of at least NUT2 and sometimes for NUT5 and/or type of building. Despite adopting an approach based on a territorial analysis in which some areas of the country are excluded, this potential does not correspond to the work done in mapping less-sensitive areas towards future definition of RES “Go-To Areas”. The decentralized solar PV potential in artificialized areas is divided into 6 area types: industrial areas; commercial buildings; residential and mixed-use buildings; villas; health, education, cultural, tourist and military buildings, and other land uses (including parking lots and patios, ports, waste and wastewater treatment infrastructure, sports facilities, among others). It is estimated a technical potential of 23.33 GW that could generate up to 36.84 TWh/year. This potential is distributed throughout the entire territory of mainland Portugal but is higher in the North and Center regions. The RES technical potential for centralized solar PV was estimated as a range of values that translate the uncertainty associated with using different levels of concern in excluding certain areas in which solar PV can be deployed (for example to safeguard ecosystems, water resources, agriculture or archaeological heritage). The centralized solar PV potential varies between 168.82 GW and 45.63 GW. The maximum threshold of installed capacity could generate 278.11 TWh/year of electricity. The value is high and reflects on the one hand, the excellence of the solar resource throughout the country, and on the other, the large size of the considered areas. The CSP potential is 62.6 GW with a corresponding electrical production potential of 183.61 TWh/year. It is mainly located in the Alentejo region, although other areas have also been identified in other regions of the country. The wind onshore technical potential is 15.7 GW, that could generate 37.13 TWh/year, taking into account the safeguarding of various areas for the protection of ecosystems and also social acceptability issues. In the case of offshore wind and considering a capacity density of 4 MW/km2 for floating offshore and 5.5 MW/km2 for fixed offshore, a total of 36 GW and 2 GW are obtained, respectively. This capacity could generate up to 126.14 TWh/year (floating offshore) or 6.31 TWh/year (fixed offshore). The solar thermal energy potential focused residential and service buildings (such as nursing homes, barracks, etc., tourism, hospitals, indoor swimming pools and other sports facilities). The potential is of 0.95 GWt and 0.95 TWh/year for service buildings, 7.26 GWt and 5.84 TWh/year for residential buildings. For industry there is a potential of 1.06 GWt, which could generate up to 1.15 TWh/year for applications up to 160 ºC. The total technical potential of solar thermal is 9.25 GWt and 7.93 TWh/year of thermal energy generated, with a substantial weight of residential buildings in the total value. Potential values are disaggregated by NUTS III and type of building. In terms of biomass and bioenergy potential, annual values of forest biomass, agricultural biomass, agro-industrial waste, urban waste and wastewater treatment are estimated, totaling around 58 TWh/year. Regarding the production of biofuels (HVO and FAME) it is estimated that the annual production of domestic used oils and other similar residues is 1.4 TWh/year. The use of oils from food crops such as soybean, sunflower and rapeseed is limited by European (and national) policy guidelines and is 2.1 TWh/year. Regarding wave energy, the resource potential is estimated between 1.4 GW for 80 m bathymetry and 4.8 for 20 m bathymetry. There are substantial uncertainties associated with the presented values, inherent to the methodological approach considered. Nevertheless, these estimates are a valuable starting point to be refined and improved in subsequent updates.N/

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

A list of land plants of Parque Nacional do Caparaó, Brazil, highlights the presence of sampling gaps within this protected area

Brazilian protected areas are essential for plant conservation in the Atlantic Forest domain, one of the 36 global biodiversity hotspots. A major challenge for improving conservation actions is to know the plant richness, protected by these areas. Online databases offer an accessible way to build plant species lists and to provide relevant information about biodiversity. A list of land plants of “Parque Nacional do Caparaó” (PNC) was previously built using online databases and published on the website "Catálogo de Plantas das Unidades de Conservação do Brasil." Here, we provide and discuss additional information about plant species richness, endemism and conservation in the PNC that could not be included in the List. We documented 1,791 species of land plants as occurring in PNC, of which 63 are cited as threatened (CR, EN or VU) by the Brazilian National Red List, seven as data deficient (DD) and five as priorities for conservation. Fifity-one species were possible new ocurrences for ES and MG states

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio