O sítio da Ponte da Azambuja 2 (Portel, Évora) e a emergência dos recintos de fossos no SW peninsular nos finais do 4º milénio A.N.E.

Tese de doutoramento, Arqueologia, Faculdade de Ciências Humanas e Sociais, Universidade do Algarve, 2015O estudo da Pré-história recente no atual território português assistiu, a partir dos finais da década de 1990, a uma “verdadeira revolução empírica” (Valera, 2008: 112) na qual se encontra a temática dos recintos de fossos, cujo boom na sua identificação, associada às problemáticas subjacentes, a isolaram como unidade de estudo específica datada de entre finais do 4.º e todo o 3.º milénio a.n.e. “Quais os motivos que levaram as sociedades dos finais do 4.º milénio a.n.e. a construírem recintos de fossos no SW Peninsular?” foi a questão de partida que alicerçou a presente dissertação. A construção de uma resposta coerente ao problema colocado passou pela implementação de um questionário prévio e análise de dados empíricos obtidos no sítio da Ponte da Azambuja 2 (Portel, Évora). Após a revisão da literatura, esta dissertação centrou-se neste sítio arqueológico, efetuando-se: a caracterização das condições de implantação; a descrição da intervenção arqueológica e a leitura interpretativa da estratigrafia e das estruturas identificadas; a análise da cultura material, adotando um perspetiva que visa não só o enquadramento tipológico dos artefactos mas também a tecnologia da sua execução; a discussão dos processos de formação do registo arqueológico e das inferências sociais daí resultantes; a reconstrução paleoambiental e consequentes estratégias de subsistência, providenciando o cenário da ação destes grupos. A partir da comparação com outros dez recintos coevos conclui-se que o surgimento deste novo paradigma de apropriação do espaço estará relacionado com fenómenos de agregação social, impulsionados por um aumento demográfico (deduzido pelo megalitismo funerário), que consequentemente necessita de modos de produção mais eficazes e eficientes. As condições paleoclimáticas associadas aos movimentos populacionais em curso desde os períodos antecedentes, originaram um novo modelo de organização territorial, regulador de uma sociedade mais complexa do que é tradicionalmente assumido

The differential role of central and bridge symptoms in deactivating psychopathological networks

The network model of psychopathology suggests that central and bridge symptoms represent promising treatment targets because they may accelerate the deactivation of the network of interactions between the symptoms of mental disorders. However, the evidence confirming this hypothesis is scarce. This study re-analyzed a convenience sample of 51 cross-sectional psychopathological networks published in previous studies addressing diverse mental disorders or clinically relevant problems. In order to address the hypothesis that central and bridge symptoms are valuable treatment targets, this study simulated five distinct attack conditions on the psychopathological networks by deactivating symptoms based on two characteristics of central symptoms (degree and strength), two characteristics of bridge symptoms (overlap and bridgeness), and at random. The differential impact of the characteristics of these symptoms was assessed in terms of the magnitude and the extent of the attack required to achieve a maximum impact on the number of components, average path length, and connectivity. Only moderate evidence was obtained to sustain the hypothesis that central and bridge symptoms constitute preferential treatment targets. The results suggest that the degree, strength, and bridgeness attack conditions are more effective than the random attack condition only in increasing the number of components of the psychopathological networks. The degree attack condition seemed to perform better than the strength, bridgeness, and overlap attack conditions. Overlapping symptoms evidenced limited impact on the psychopathological networks. The need to address the basic mechanisms underlying the structure and dynamics of psychopathological networks through the expansion of the current methodological framework and its consolidation in more robust theories is stressed.info:eu-repo/semantics/publishedVersio

Case series of 103 children with SARS-CoV-2 infection in Portugal

Copyright © Ordem dos Médicos 2020Introduction: The North Lisbon University Hospital Center was activated for referral of SARS-CoV-2 infected patients on the 11th March 2020. The aim of this study is to describe the experience at the Department of Pediatrics in the approach and the clinical outcomes of infected children. Material and methods: A descriptive observational study was performed. Children and adolescents (0 to 18 years) with SARS-CoV-2 infection, diagnosed in the emergency room or admitted to the Department of Pediatrics between March 11th and June 18th, were included. Hospital records and Trace COVID-19 platform were reviewed and patient caregivers were interviewed to assess follow up. Results: Among 103 diagnosed children, 83% had a known previous contact with an infected patient, 43% presented fever and 42% presented respiratory symptoms. Ten percent had risk factors and 21% were aged under one year old. Ten percent were hospitalised, one needing intensive care, with paediatric inflammatory multisystem syndrome. Blood tests were performed in 9% and chest radiograph in 7%. No children required ventilation, antiviral therapy or underwent thoracic computed tomography scan. Eight percent of children returned to the emergency room and one child was hospitalised. The clinical outcome is known in 101 patients and is favourable in all. Discussion: Most children had an epidemiological link and little clinical repercussion, even during the first year of life. The expected mild severity in children justified the use of established clinical criteria and recommendations for similar conditions, regarding tests and hospitalizations. No antiviral treatments were given due to lack of evidence of its benefits. Conclusion: This strategy contributed to a low consumption of hospital resources and proved safe in this series.info:eu-repo/semantics/publishedVersio

Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

This work was funded by 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”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.publishersversionpublishe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Attitudes of police recruits towards offenders: the Impact of the police training on attitudinal change

The traditional prevailing perspectives on attitudes assume that attitudes, once formed, are relatively stable over time. However, research has revealed that attitudes may be influenced by different factors that may change them. The present pre-posttest study aims to understand if the police recruits’ attitudes towards offenders change after police training and analyse the impact of sociodemographic and personality variables on recruits’ attitudes towards offenders. The Attitude Scale towards Offenders (ATO) and the NEO-FFI Personality Inventory were used in a sample of 74 recruits of a Portuguese Police Force at the beginning and the end of the police training program. Results revealed that, at the end of the training, recruits hold more negative attitudes towards offenders. Those who had previous professional experience in the army hold more positive attitudes, but only at the beginning of the training. Only attitudes towards offenders at the beginning of the police training program predict recruits’ attitudes towards offenders at the end of the training. These results emphasize the importance of initial and continuous training of recruits and police officers.info:eu-repo/semantics/publishedVersio

Análise da fundamentação das decisões dos juízes: a relevância dos relatórios sociais

A partir da análise da importância dada aos relatórios sociais para determinação da sanção elaborados pela Direcção-Geral de Reinserção Social, o objectivo deste trabalho consiste em analisar como os juízes fundamentam a motivação das decisões de sentença. Através de uma metodologia qualitativa baseada na análise de conteúdo de sentenças no âmbito criminal, pudemos identificar três tipos de argumentos usados pelos juízes para motivar as suas decisões: argumentos relativos ao crime, argumentos relativos ao arguido e argumentos do próprio juiz. Using the analysis of the importance given to social reports for sentence determination made by Direcção-Geral de Reinserção Social, the aim of this paper consists in studying how judges justify judicial decisions. Using a qualitative methodology based on content analysis of criminal sentences we identified three categories of arguments used by judges to support their sentence decisions: crime explanations, offender explanations and explanations based on the own judge experiences

Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence : Mixed Methods Study

Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring >= 4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). Conclusions: The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app

Comparison of different histological indexes in the assessment of UC activity and their accuracy regarding endoscopic outcomes and faecal calprotectin levels

Objective Histological remission is being increasingly acknowledged as a therapeutic endpoint in patients with UC. The work hereafter described aimed to evaluate the concordance between three histological classification systems-Geboes Score (GS), Nancy Index (NI) and RobartsHistopathologyIndex (RHI), as well as to evaluate their association with the endoscopic outcomes and the faecal calprotectin (FC) levels. Design Biopsy samples from 377 patients with UC were blindly evaluated using GS, NI and RHI. The results were compared with the patients' Mayo Endoscopic Score and FC levels. Result GS, NI and RHI have a good concordance concerning the distinction between patients in histological remission or activity. RHI was particularly close to NI, with 100% of all patients classified as being in remission with NI being identified as such with RHI and 100% of all patients classified as having activity with RHI being identified as such with NI. These scores could also predict the Mayo Endoscopic Score and the FC levels, with their sensitivity and specificity levels depending on the chosen cut-offs. Moreover, higher FC levels were statistically associated with the presence of neutrophils in the epithelium, as well as with ulceration or erosion of the intestinal mucosa. Conclusions GS, NI and RHI histopathological scoring systems are comparable in what concerns patients' stratification into histological remission/activity. Additionally, FC levels are increased when neutrophils are present in the epithelium and the intestinal mucosa has erosions or ulcers. The presence of neutrophils in the epithelium is, indeed, the main marker of histological activity.Portuguese IBD Group (GEDII-Grupo de Estudo da Doenca Inflamatoria Intestinal)info:eu-repo/semantics/publishedVersio