TIME, to move forward? Comment on “a universal outcome measure for headache treatments, care-delivery systems and economic analysis”

The paper from Steiner et al. suggests that an outcome measure expressed in time units may be an adequate method to assess the impact of headache disorders, regardless of diagnosis or health care setting, proving useful for cost-benefit analysis and health policy definition. Using time lost to each attack – weighted by disability – may prove to be a reliable measure to establish the effectiveness of acute treatment, but if considering also the attack frequency it could evaluate the effects of preventive strategies. A measure such as the Headache Gauge, which translates the proportion of time lost to headache -related disability, has proven to be applicable also in routine clinical practice as well, and can be tested in clinical trials and populational analysis. There are practical limitations, such as disability assessment and the need for prospective data collection to avoid recall bias but it seems consensual that impairment related to primary headache disorders is primarily driven by the TIME stolen from the perfect health status.info:eu-repo/semantics/publishedVersio

Cognitive functions during migraine attacks

Tese de doutoramento, Medicina (Neurologia), Universidade de Lisboa, Faculdade de Medicina, 2015Background: Attack-related cognitive symptoms in migraine are frequent yet scarcely characterized and undervalued as contributors of disability. Conflicting evidence arose about an increased risk of cognitive decline in older migraine patients. Objectives: (1) to study the occurrence of cognitive symptoms in migraine attacks; (2) to evaluate objective evidence of cognitive dysfunction in migraine attacks and its neuronal correlates and (3) to study the effect of persisting migraine in cognitive function or cognitive decline in older adults. Methods: Occurrence of attack-related cognitive symptoms was detailed by systematic literature review and a cross-sectional clinical-based systematic survey; their relevance to disability was studied prospectively using headache diaries. An instrument (Mig-SCog) was developed, validated and tested to identify and quantify attack-related subjective cognitive symptoms. Cognitive function during attacks was evaluated by a systematic literature review and a clinical-based prospective two-period randomized cross-over study using an extensive neuropsychological battery. A briefer battery was tested in repeated applications in interictal patients and controls. Brain perfusion during attacks was studied with arterial spin labeling magnetic resonance imaging (ASL-MRI) and cortical response to a working memory task with blood-oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI). A prospective controlled cross-sectional population-based study of neuropsychological performance of older adults with persisting migraine and non-migraine headache was followed by a 5 years re-evaluation of the same sample, to screen for cognitive decline. Results: Cognitive symptoms were the most frequent non-migraine defining symptoms reported in the prodromic(37%) and headache(38%) phases of migraine attacks in a systematic review of 28 series, with a total sample of 8392 patients. Cognitive symptoms are also present in the postdromic or resolution phase, although fatigue (71%) is reported more often. Of 165 patients prospectively surveyed, 87% reported an average of 2.5 attack-related symptoms, over two-thirds executive (attention, processing efficiency and speed). Cognitive symptoms were ranked prospectively by 34 migraine patients recording 229 attacks, being second only to pain in terms of intensity and attack-related disability. An instrument to quantify migraine attack-related symptoms was constructed from a set of 43 candidate items, using factor analysis. The reduced 9 item Mig-SCog is fast to apply covering executive functions and language, having good internal consistency (Cronbachs’ alpha 0.82) and reliability (Cohen’s kappa 0.55) and high correlation with external validity measures such as the 43-candidate item list (rho=0.69) and the Cognitive Failures Questionnaires(rho=0.61). The Mig-SCog presents negligible recall bias (no difference in scores obtained during an attack or while headache free) and Migraine patients score it higher for migraine higher for migraine (7.9±4.6) than for non-headache pain (2.3±2.9, p<0.0006) or pain free (1.6±2.4, p<0.0006). Comparing Mig-SCog scores in migraine and tension-type headache patients, those were higher for migraine in all scale items (p<0.0001) except those related to naming (8 and 9). The AUC of Mig-SCog score for the diagnosis of Migraine was 0.835 (95% CI of 0.763-0.906, p< 0.0001) reinforcing specificity for migraine. Ten studies of neuropsychological evaluation during migraine attacks are available in the literature, only half had data allowing comparison of cognitive performance within and outside attacks (encompassing 163 migraine patients). All these were able to demonstrate some type of impairment (most often executive) although some bias could not be excluded from their study design. In our sample of 24 patients which completed an extensive neuropsychological evaluation in these two conditions (attack and headache-free) controlling for the majority of relevant bias (in particular the practice effect), performance was worse during the attack in the majority of cognitive tests, in particular in word reading speed (p=0.013), verbal learning (p=0.01), short term verbal recall with (p=0.01) and without (p=0.013) semantic cueing and delayed recall with (p=0.003) and without (p=0.05) semantic cues. Another sample of 24 interictal migraine patients and 24 matched controls performed equally in a shorter battery focused on executive functions that was applied twice with a short interval (average 45 days) to test the practice effect of repeated evaluations that was demonstrated in all tests, being significant in Stroop Interference test (p=0.002, multiplicity corrected); a meaningful score change was determined for each raw test scores. We were unable to find any relevant brain perfusion nor brain activation differences evoked by a working memory task during a spontaneous migraine without aura attack of an average intensity of 6.8 on a 0-10 VAS scale and an average duration of 16 hours in a sample of 13 women, compared to being headache-free. Persistent migraine or headache after the age of 50 related to worse performance in some neuropsychological tests (attention and processing speed in migraine patients, n=61; sematic memory and memory retrieval in non-migraine headache, n=50) in a population sample of 478 individuals tested extensively. After 5 years, 275 (57.5%) of the same sample were screened for cognitive decline, that occurred in 14.9% of the sample. Neither migraine nor non-migraine headache influenced the odds of decline. Discussion: Attack-related cognitive symptoms are very frequent, mostly executive and contribute to disability, supporting that they should be addressed as endpoint in clinical trials of acute migraine treatments and included in disability assessments. An efficient way to assess attack-related subjective cognitive symptoms in clinical practice or research is now available – the Mig-SCog. Although migraine-related reversible cognitive dysfunction was demonstrated during attacks, no advances on potential brain mechanisms underlying these findings were made. Interest is focused to obtain more functional data, with studies of evoked activation paradigms, functional connectivity and combined imaging and neurophysiological studies. Although persisting headache in older adults seems to influence executive performance, these changes are most likely adaptive and do not seem to influence the process of brain degeneration and associated cognitive decline

Deep learning model for doors detection a contribution for context awareness recognition of patients with Parkinson’s disease

Freezing of gait (FoG) is one of the most disabling motor symptoms in Parkinson’s disease, which is described as a symptom where walking is interrupted by a brief, episodic absence, or marked reduction, of forward progression despite the intention to continue walking. Although FoG causes are multifaceted, they often occur in response of environment triggers, as turnings and passing through narrow spaces such as a doorway. This symptom appears to be overcome using external sensory cues. The recognition of such environments has consequently become a pertinent issue for PD-affected community. This study aimed to implement a real-time DL-based door detection model to be integrated into a wearable biofeedback device for delivering on-demand proprioceptive cues. It was used transfer-learning concepts to train a MobileNet-SSD in TF environment. The model was then integrated in a RPi being converted to a faster and lighter computing power model using TensorFlow Lite settings. Model performance showed a considerable precision of 97,2%, recall of 78,9% and a good F1-score of 0,869. In real-time testing with the wearable device, DL-model showed to be temporally efficient (~2.87 fps) to detect with accuracy doors over real-life scenarios. Future work will include the integration of sensory cues with the developed model in the wearable biofeedback device aiming to validate the final solution with end-users

Sistemas de bases de dados orientados por colunas

Dissertação de mestrado em Engenharia de InformáticaNos últimos tempos os sistemas de bases de dados orientados por colunas têm atraído muita atenção, quer por parte de investigadores e modeladores de base de dados, quer por profissionais da área, com particular interesse em aspectos relacionados com arquiteturas, desempenho dos sistemas e sua escalabilidade ou em aplicações de suporte à decisão, nomeadamente em Data Warehousing e Business Inteligence. Ao contrário dos sistema de bases de dados mais tradicionais (“orientados à linha”), neste tipo de sistemas cada coluna de uma tabela de uma base de dados é armazenada separadamente. Deste modo, em vez de se armazenar uma linha seguida de outra, todos os valores de um atributo pertencente à mesma coluna são continuamente comprimidos e armazenados num pacote um pouco mais denso. A aplicação deste tipo de sistemas de bases de dados permite, principalmente, minimizar o tempo das queries típicas de um ambiente data warehousing, que através de sistemas de bases de dados mais convencionais seriam difíceis de minimizar. Neste trabalho, além da abordagem genérica ao tema, desenvolveram-se trabalhos especificamente orientados para a sua aplicação a um caso de estudo real. As técnicas abordadas seguiram de perto a metodologia apresentada por Kimball et al. (2008), tendo-se dado particular enfâse ao modelo de representação dos dados. Após o estudo necessário ter sido realizado, este trabalho focou-se a análise da influência e utilidade dos sistemas de bases de dados orientados por colunas num sistema de data warehousing. Tendo em consideração dois sistemas de bases de dados distintos, um relacional e outro não relacional, aplicou-se um conjunto de queries típicas de um ambiente de data warehousing sobre o mesmo conjunto de dados, apontando as diferenças em nível de tempo. Desta forma, a importância dada à sua estrutura base, funcionalidades, linguagens de descrição, manipulação e controlo, sistemas de gestão, entre outros, acabaria por facilitar o processo de conversão da base de dados em questão, do seu povoamento e a própria exploração das queries no Sistema de Data Warehousing implementado.Recently systems-oriented database columns have drawn the attention from researchers, database modelers and professionals interested in subjects such as architectures, systems performance and its scalability or decision support applications, including Data Warehousing and Business Intelligence. In this type of systems each table’s column of a database is stored separately, unlike the traditional system databases (“line oriented”). Thus instead of storing one line after another, all the values of an attribute belonging to the same column are continuously compressed and stored in a slightly more dense package. The application of this type of database systems enables to reduce the time of queries normally used in a data warehousing environment. This would be unlikely to achieve in conventional database systems. In this project besides the generic approach to the subject applied their approach to a real case study. The techniques used in this project follow Kimball’s methodology [Kimball et al., 2008], putting the stress in the data’s model representation. After a first study has been conducted, this work focused the analysis of the influence and usefulness of database systems oriented for columns in a data warehousing system. Considering two different database systems, i.e. a relational and non-relational system, a set of queries typical of a data warehousing environment was applied on the same data set highlighting the time differences. Thus, the importance given to its basic structure, features, description languages, manipulation and control, management systems, among others, would eventually facilitate the process of converting the database and its settlement and exploration of queries in the implemented data warehousing system

Immune Thrombocytopenia Associated with Mycoplasma pneumoniae Infection

Immune thrombocytopenia (ITP) related to Mycoplasma pneumoniae infection is a rare condition and usually associated with a severe clinical course. We here report a case of a young man with a clinical diagnosis of severe ITP secondary to M. pneumoniae infection. The clinical features, therapy and outcome are presented

Qualidade de vida e sintomatologia emocional e comportamental em adolescentes com doença das células falciformes

Dissertação de mestrado, Psicologia (Área de Especialização em Psicologia Clínica e da Saúde - Psicologia da Saúde e da Doença), Universidade de Lisboa, Faculdade de Psicologia, 2021Enquadramento: estudos têm verificado que as manifestações e características da Doença das Células Falciformes (DCF) têm impacto nos domínios da Qualidade de Vida Relativa à Saúde (QVRS) dos adolescentes e que os coloca em risco para perturbações psicossociais. Esses resultados foram reforçados na revisão sistemática de literatura apresentada neste estudo, que seguiu as recomendações da Preferred Reporting Item for Systematic Reviews and Meta-Analysis (PRISMA) e incluiu 29 artigos na análise. Objetivo: identificar os níveis da QVRS e os indicadores de problemas emocionais e comportamentais em adolescentes com DCF. Método: a amostra integrou 22 participantes, 11 adolescentes com DCF com idades entre 13 e 17 anos e 11 pais/cuidadores, que preencheram o Pediatric Quality of Life Sickle Cell Disease Module (PedsQL-SCD), o KIDSCREEN-10 e o Pediatric Symptom Checklist-17 (PSC-17). Foi realizada uma análise descritiva e correlacional. Resultados: os adolescentes da amostra apresentam QVRS baixa, com resultados piores nas subescalas relativas ao impacto e controlo da dor, tanto no relato dos adolescentes como dos pais/cuidadores. No KIDSCREEN-10, verificou-se uma QVRS moderada, em ambos os relatos. No relato dos adolescentes verificaram-se associações significativas entre perturbações emocionais e de comportamento e dificuldades na comunicação com os cuidadores formais sobre a doença; e entre o risco para problemas de internalização e as subescalas relativas a emoções negativas direcionadas à DCF e dificuldades de compreensão por outras pessoas do diagnóstico. No relato dos pais/cuidadores, foram identificadas associações negativas entre o risco de perturbações emocionais e de comportamento e a subescala Emoções e a perceção de que a QVRS dos adolescentes é afetada por dificuldades de compreensão da sua doença por outros. Conclusões: este estudo reforça os resultados de estudos similares sobre a prevalência de risco de perturbações psicossociais e emoções negativas em relação à doença, avaliadas pelos adolescentes e pelos seus pais/cuidadores, e colocando em evidência a relação entre a QVRS e as características da DCF, especificamente, o impacto da dor e o seu controlo.Background: studies have found that the manifestations and characteristics of Sickle Cell Disease (SCD) have an impact on domains of adolescents’ health-related quality of life (HRQoL), and that it puts them at risk for psychosocial disorders. These results were reinforced in the systematic review presented in this study, which followed the recommendations of the Preferred Reporting Item for Systematic Reviews and Meta-Analysis and included 29 articles. Objective: identify HRQoL levels and signs of emotional and behavioral problems in adolescents with SCD. Method: the sample consisted of 22 participants, 11 adolescents with SCD, ages 13 to 17 years, and 11 parents/caregivers, who completed the Pediatric Quality of Life Sickle Cell Disease Module (PedsQL-SCD), the KIDSCREEN- 10 and the Pediatric Symptom Checklist-17 (PSC-17). Descriptive and correlational analysis were performed. Results: the adolescents in this sample have a low HRQoL and, as shown in the self and parent proxy reports, the subscales related to pain impact and control have the worst results. KIDSCREEN-10 showed a moderate HRQL in both reports. In the adolescents' self-report, significant associations were found between emotional and behavioral problems, and difficulties in communicating with medical staff about the disease; as well as between risk for internalizing problems and the subscales related to negative emotions directed towards SCD and difficulty when others don’t understand what is like having SCD. In parent-proxy negative associations were identified between the risk of emotional and behavioral disturbances and negative emotions like anger, as well as the perception that the adolescents' HRQoL is affected when other people don’t understand what is like having SCD. Conclusions: this study reinforces the results of similar studies about the prevalence of risk for psychosocial problems and negative emotions related to the disease, assessed by adolescents and parents/caregivers and highlights the relation between HRQoL and SCD’s characteristics, especially the impact and control of pain

Relatório de estágio para obtenção do grau de mestre em Educação Pré-Escolar e Ensino do 1º Ciclo do Ensino Básico

A concretização do presente relatório tem como finalidade a obtenção de grau de mestre em Educação Pré-Escolar e Ensino do 1.º Ciclo do Ensino Básico. Todo o relatório explana as experiências vividas ao longo dos estágios pedagógicos desenvolvidos, primeiro na valência 1.º Ciclo, na Escola Básica do 1.º Ciclo com Pré-escolar do Tanque, Santo António numa turma de 2.º ano e o segundo, no Pré-Escolar, na Escola Básica do 1.º Ciclo com Pré-escolar de São Filipe. Toda a praxis teve como fundamento desenvolver experiências ao nível pessoal e profissionais inerentes à profissão docente. A parte teórica do trabalho enaltece a importância do papel do docente enquanto agente reflexivo e investigativo como parte integrante da construção da identidade do mesmo. São igualmente engrandecidos pressupostos teóricos que assumiram um papel preponderante na construção de todas as aprendizagens realizadas. A prática pedagógica visou responder a questões colocadas inicialmente, apelando à metodologia de investigação-ação, centrada em princípios orientadores de aprendizagem cooperativa e trabalho de projeto. Considerando que a praxis centra-se nos alunos e crianças, tornou-se imprescindível recorrer à caraterização de contextos das instituições educativas e respetivos alunos e crianças

Clínica de animais de companhia

O presente relatório foi realizado no âmbito da unidade curricular de Estágio Curricular, integrante do plano de estudos do Mestrado Integrado de Medicina Veterinária da Universidade de Évora. O estágio foi efetuado na clínica Vetfunchal – Centro Médico Veterinário, durante cinco meses. Encontra-se dividido em dois capítulos. O primeiro engloba o relatório da casuística acompanhada pelo estagiário e, o segundo, é constituído por uma monografia acerca das obstruções urinárias em animais de companhia, incluindo ainda a apresentação de um caso clínico. A obstrução urinária é mais frequente em felídeos machos, devido à sua conformação anatómica. É considerada uma emergência em veterinária, sendo essencial proceder rapidamente à estabilização do animal e tratamento da causa subjacente. É recomendado, primeiramente, realizar sempre tratamento médico, todavia, por vezes, é necessário recorrer a intervenção cirúrgica para resolução definitiva; Abstract: Small animal practice The present report was elaborated following the curricular externship, part of the Integrated Master in Veterinary Medicine of the University of Évora. The internship was performed at the Vetfunchal – Centro Médico Veterinário, with a total length of five months. This report is divided in two chapters: the first one covers the casuistry accompanied during the externship and the second includes a monography about urinary obstructions in small animals, including the presentation of a case report. Urinary obstruction is more common in male cats, due to their anatomic conformation. This represents a veterinary emergency, implying a quick stabilization and treatment of the cause. In such cases, medical treatment is the recommended procedure, however, some cases need surgery for definitive resolution

Estudo de Mercado sobre a Aceitação de um Novo Sabonete de Vinho do Porto

O vinho do Porto é um dos principais produtos Portugueses exportados sendo consumido atualmente em quase todo o mundo. Este facto deve-se à sua elevada qualidade e às suas características próprias que fazem dele um vinho inconfundível e histórico e sem dúvida uma referência mundial na área da enologia. Este trabalho teve como intuito o desenvolvimento de um produto, neste caso, um sabonete a partir do vinho do Porto. Para a sua produção utilizou-se como base glicerina sólida, creme hidratante sem odor, com o objetivo de conferir propriedades hidratantes, e essência de sândalo, que vai conferir ao sabonete um odor agradável e duradouro na pele. Através da análise sensorial foram comparadas duas amostras com a mesma composição básica, diferindo apenas porque uma delas continha vinho do Porto e a outra não, confirmou-se que os consumidores têm uma preferência pelo sabonete elaborado a partir do vinho do Porto