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- ARIA-Italy managing allergic rhinitis and asthma in a changing world: The role of the PharmacistPublication . Paoletti, Giovanni; Giua, Corrado; Marti, Alessandro; Baio, Matteo Alberto; Valli, Nicolò; Ridolo, Erminia; Ventura, Maria Teresa; Passalacqua, Giovanni; Puggioni, Francesca; Lourenço, Olga ; Bousquet, Jean; Canonica, Giogio Walter; Heffler, Enrico; Lombardi, CarloAllergic rhinitis (AR) and asthma are common respiratory disorders that often occur together, affecting quality of life and increasing healthcare expenses of patients. These chronic illnesses are often managed without medical supervision, creating distinct challenges. A lack of resources can limit regular follow-up, which in turn promotes disease mismanagement and an increased reliance on self-medication, including the inappropriate use of corticosteroids and nasal decongestants. Community pharmacies could serve as critical primary healthcare providers, facilitating AR and asthma management by promoting therapy adherence, minimizing drug misuse, and improving symptom monitoring using digital tools. The evolving role of pharmacists as vital healthcare team members is highlighted by their involvement in screening, prevention, and patient education, particularly in underserved communities. Strengthening the partnerships between pharmacists, physicians, and patients may lead to more tailored and effective management strategies. This collaborative approach has demonstrated promise in enhancing disease outcomes and reducing healthcare costs.
- Chronotherapy of Brain Diseases: Assessment of the Circadian Rhythms of Efflux Transporters at the Blood-cerebrospinal Fluid BarrierPublication . Furtado, André Filipe Lino ; Paixão, Telma Alexandra Quintela; Santos, Cecília Reis Alves; Gallardo Alba, Maria EugéniaThe choroid plexus (CP) is an integral part of the blood cerebrospinal-fluid barrier (BCSFB). The CP is formed by a monolayer of cuboidal epithelial cells united by tight junctions. On the apical side, these cells present microvilli and are in contact with the cerebrospinal fluid (CSF). On the basal membrane, these cells are surrounded by a vast network of capillary blood vessels. The CP is responsible for several functions that are vital to the homeostasis of the central nervous system (CNS) where we include the production of the CSF, synthesis of several proteins, CNS protection against foreign elements, CSF detoxification from noxious compounds that result from normal cell metabolism and the transport of multiple molecules across the BCSFB. The CP has an essential role on the transport across the BCSFB of therapeutic molecules targeting the CNS. For that, it expresses multiple membrane transporters that have been described in the literature as essential for the transport of therapeutic compounds across CNS biological barriers. Recently, a functional molecular clock was described in the CP. This means that the biological functions of this structure might have a circadian rhythmicity associated. There's the possibility that this circadian clock influences membrane transporters' expression and activity at the CP which would result in circadian changes of the bioavailability of therapeutic compounds in the CNS depending on the time of administration. As such, the main goal of this doctoral thesis was to analyse the influence of circadian rhythms on the expression of multiple membrane transporters on the CP. Additionally, we used therapeutic compounds, namely methotrexate (MTX) and donepezil (DNPZ) to assess the relation between the CP's membrane transporters circadian expression and their drug transport function across the BCSFB. One of the objectives of this project, as mentioned earlier, was to assess the circadian expression of multiple CP’s membrane transporters. For that, CP primary cell cultures of neonate rats were used. We concluded that rSlc9a1 and rSlc1a5 expression was rhythmic during a 24-hour period while rSlc47a1 did not reveal a circadian pattern. This work also aimed at disclosing the influence of sex on the daily expression oscillations of several ABC and SLC membrane transporters expressed by the CP. For this we used CPs from male, female, ovariectomized and sham-operated female rats. The results showed that the membrane transporter rAbcc1 is expressed in a circadian manner in the CP of male rats, while rAbcg2 presented circadian rhythmic expression in the CP of female rats. Both rAbcc4 and rOat3 were rhythmically expressed in the CP of male and female rats. Next, we used an in vitro model of the CP in order to evaluate the relevance of Abcc4’s circadian expression in the transport of MTX across the BCSFB. We demonstrated that MTX transport across the BCSFB was rhythmic. Besides, we also concluded that Abcc4 circadian expression might influence the MTX circadian transport across the BCSFB. Finally, this project also aimed to describe the impact of circadian rhythms on CP Abcg2 expression and also on the circadian transport profile of DNPZ across the BCSFB. Using CP primary cell cultures of neonate rats, we demonstrated the presence of rAbcg2 circadian expression. Next, using primary cell cultures, an in vitro model of the BCSFB was established and we discovered that DNPZ transport across the BCSFB presents circadian rhythmicity. Furthermore, it was also proposed that besides rABCG2, SLC22A4 could also be involved in the DNPZ circadian transport across the BCSFB. The results obtained in this project demonstrate that membrane transporters present circadian expression in the BCSFB. Moreover, the transport of therapeutic compounds, such as MTX and DNPZ, across the BCSFB is also influenced by the circadian rhythm of CP membrane transporters. In the future, it is essential to further exploit the role of circadian rhythms on the expression of membrane transporters at the CP and its influence on the transport of therapeutic compounds across the BCSFB. This information might prove vital in the treatment of CNS diseases. By timing drug administration with the period when they are more prone to reach the target tissue at the CNS, we are ensuring their maximum target tissue concentration, and a reduction in side effects.
- As Ocupações Pós-Governativas dos Ministros e Secretários de Estado em PortugalPublication . Freire, Diogo Pessoa; Silveira, Pedro Miguel AlegriaHá a perceção de que os ex-governantes saem do governo para carreiras altamente lucrativas no setor privado. Mas será que é uma perceção correta? Será que as ocupações pós-governamentais dos ex-governantes passam por uma carreira no setor privado, com cargos de alta senioridade e que a pasta que detêm no governo influencia futuras ocupações dos mesmos? Esta dissertação pretende responder a estas perguntas, com especial foco nos Governos XIX e XXI Constitucionais Portugueses. Para esta dissertação propomo-nos a mapear as ocupações pós-governamentais dos ex-ministros e secretários de estado desde o primeiro ano após o término do cargo e após três anos, de forma a perceber potenciais padrões. As conclusões demonstram que as ocupações pós-governamentais dos ex-governantes são sobretudo no setor público, geralmente em cargos de média senioridade, e não demonstram uma ligação com as áreas de responsabilidade ministerial previamente exercidas, tornando o caso português, um caso particular, em relação à literatura.
- Development of new Water Landing Infrastructures and ProceduresPublication . Gabriel, Vasco João Capote; Silva, Jorge Miguel dos Reis; Soares, Paulo Alexandre Ramos de FigueiredoThis Master Dissertation arises from an analysis of accidents in Portuguese territory involving water landing and ditching emergencies. The concern regarding this topic was primarily raised by Gabinete de Prevenção e Investigação de Acidentes com Aeronaves e de Acidentes Ferroviários (GPIAAF). Over the past years, Portugal has experienced several accidents of this type, some fatal, which involved or should have involved an in-depth study of the process of water landing and its specificities. It is therefore evident that there is a failure regarding the characteristics of the dedicated water landing infrastructures, as well as an effective risk assessment and flight crew training related to this aspect. This Master Dissertation not only addresses an analysis of historical occurrences, and the lessons retrieved up from them but also the current applicable regulations, to make possible to propose new water landing infrastructures equipped with operational support elements that could assist aircrafts in regular operations as well as emergency situations, if the decision is to ditch the aircraft. For this purpose, two locations are proposed for such infrastructures at two distinct dams, Marateca and Aguieira, being the first near Castelo Branco and the latter on near Viseu. The proposed location of these infrastructures is based on the initial condition that the areas for operation are well defined and marked out, thus avoiding the risk of incursion into them by third parties who are unaware of the delimitation of these restricted areas of operation. It also accounts for the existence of means of rescue, not only for normal operations, but especially in the event of an accident, namely search and rescue means for immediate reaction. It is also proposed to build up the infrastructure on the ‘land side’ with hangars, parking bays and taxiways, which can be used by amphibious or rotary-wing aircraft, while aircraft/crews can move from the maritime to the land environment via docks or access ramps. Moreover, access roads, suitable car parking slots, and restaurants, for example, can have a double-use, for both complementary aerial emergency activities and for tourism purposes, for example. Means for ensuring safety and separation of “airside” to the “landside” are also proposed. This entire study is based on current regulations to ensure the necessary safety and compliance. To ensure that the proposed infrastructure is operation viable, it will be necessary to provide for the most rigorous risk assessments possible, which in terms of crew training will lead to the implementation of new training methods, not only in the theoretical component, but mainly in terms of instruction and flight training, which should be transversal to any Approved training Organisation (ATO). This study is based on the requirements of international and national legislation, which include theoretical and practical training, as well as key points that must be addressed during the training stage. In addition, these points are based on the prerequisites needed to obtain an amphibious aircraft pilot's licence. For this study, and while developing this dissertation, only the crucial flight phases involving the use of the proposed infrastructure have been considered.
- Impacto do E-Commerce na Satisfação do Cliente em Transição de Online para OfflinePublication . Pereira, Daniel Duarte; Pinheiro, Paulo GonçalvesA velocidade de expansão do E-Commerce está a alterar os hábitos de compra dos consumidores e a moldar a forma como as empresas atuam no mercado. Esta realidade é mais evidente e impactante no setor de retalho, onde o E-Commerce possibilitou as empresas ultrapassar as barreiras geográficas para vender e a operar de forma mais eficiente permitindo uma presença online e offline. Esta presença digital criou uma maior exposição das empresas e reconhecimento, facilitando o acesso a informação acerca de um determinado produto ou serviço. O estudo apresenta a análise efetuada sobre o impacto da satisfação persentida pelos consumidores quando transitam de um meio online para offline. Para isso, recorreu-se a uma metodologia qualitativa, sob a forma de entrevistas, de 10 restaurantes pertencentes ao distrito de Castelo Branco, mais concretamente, no concelho da Covilhã. Pretende-se averiguar, dentro do setor da restauração, como o E-Commerce pode influenciar a satisfação do consumidor, potenciar a transição online para offline e qual o diferencial encontrado na satisfação do online comparativamente com o offline. Com os resultados foi possível atestar que E-Commerce tem impacto, positivo ou negativo, na satisfação do consumidor e, incrementa a transição de online para offline, influenciando a satisfação do consumidor. O estudo ajuda a enriquecer o entendimento do E-Commerce com a satisfação do consumidor e, em simultâneo, inside em uma lacuna existente em estudos previamente realizados.
- Hiperandrogenismo e distúrbios menstruais em mulheres atletas: Revisão de literaturaPublication . Sá, Maria Dias; Oliveira, Maria Elisa Cairrão RodriguesIntrodução O papel da testosterona na performance desportiva tem sido cada vez mais estudado, contudo nas atletas do sexo feminino este é controverso. Nos Jogos Olímpicos de 2024 uma atleta argelina protagonizou a questão do hiperandrogenismo e as suas possíveis vantagens competitivas, contudo, o seu efeito na saúde reprodutiva das atletas permanece por analisar. A presente revisão de literatura pretende analisar dados acerca de distúrbios menstruais e hiperandrogenismo em mulheres que praticam exercício físico com grande regularidade, avaliando o impacto deste na sua saúde reprodutiva. Metodologia Procedeu-se a` pesquisa de artigos científicos de 2002 e 2023 na base de dados cienti´fica PubMed® entre os meses de julho e setembro de 2024. Apo´s a aplicac¸a~o dos crite´rios de inclusa~o e exclusa~o, recolheram-se os resultados obtidos de 28 artigos. Resultados Assim, dos 28 artigos considerados, metade estudaram a presença de distúrbios menstruais, sendo o mais comumente reportado o da diminuição da fase lútea. Relativamente a mulheres com distúrbios hormonais e/ou níveis elevados de androgénios, foi reportada uma fraca qualidade nas suas dieta, relacionada com menor balanço calórico/ energético. Efetivamente a energia disponível durante o ciclo menstrual atual foi identificada como um preditor estatístico da presença de um distúrbio de um dado ciclo menstrual, sendo este dado particularmente relevante nos desportos cuja parte estética é mais valorizada, favorecendo distúrbios alimentares. Quanto ao impacto do exercício físico, este foi associado a melhoria a nível hormonal e de comorbilidades no Síndrome dos Ovários Poliquísticos e uma diminuição de excreção de hormonas reprodutivas em mulheres saudáveis. Conclusão A saúde reprodutiva de atletas do sexo feminino permanece um tópico pouco estudado, devendo o seu balanço energético e alimentação ser particularmente monitorizados para prevenir distúrbios menstruais/ ovulatórios nas mesmas.
- Efeitos dos níveis maternos de vitamina D na Pré-eclampsiaPublication . Gonçalves, Marta Luísa Pinto Marques de Sousa; Oliveira, Maria Elisa Cairrão RodriguesIntrodução: A pré-eclampsia (PE), uma doença hipertensiva da gravidez da qual a etiologia ainda não é totalmente compreendida, afeta 8-10% das gestantes no mundo, representando um dos maiores desafios da medicina materno-fetal. A deficiência de vitamina D, prevalente na gestação, tem sido associada a resultados adversos na gravidez, nomeadamente a PE. As evidências sobre o estado e a suplementação de vitamina D na etiologia e prevenção da PE são abordadas neste trabalho. Objetivos: Verificar se existe uma relação entre o défice de vitamina D e a pré-eclampsia bem como se a suplementação com vitamina D na gravidez tem um efeito protetor no desenvolvimento da doença. Materiais e Métodos: A pesquisa bibliográfica foi realizada na plataforma PubMed, Elsevier e Scopus, utilizando as seguintes palavras-chave: "Vitamin D", "Vitamin D Deficiency" e "Pre-Eclampsia". Após a aplicação dos critérios de inclusão e de exclusão, foram incluídos um total de 22 artigos. Resultados: Nos estudos analisados observou-se que baixos níveis de vitamina D aumentam significativamente o risco de PE, enquanto que a suplementação demonstrou efeitos protetores, embora com evidências limitadas. A qualidade metodológica dos estudos, segundo a tabela de evidencia de Furuya-Kanamori et al. 2021, foi maioritariamente baixa, com apenas um estudo de suplementação e dois sobre níveis séricos de vitamina D classificados como de alta qualidade. Conclusão: Embora a deficiência de vitamina D esteja associada a um maior risco de PE, a causalidade permanece inconclusiva. Dados sobre a suplementação são promissores, mas evidências limitadas impedem conclusões definitivas. Ensaios clínicos robustos, com maiores amostras e controlo rigoroso de variáveis, são essenciais para confirmar o papel da vitamina D na prevenção da PE.
- Queda e Risco de Queda em Adultos mais velhos antes e depois de uma Intervenção IntergeracionalPublication . Rocha, Jéssica Mendes; Afonso, Rosa Marina Lopes Brás Martins; Patto, Maria da Assunção Morais e Cunha VazIntrodução e objetivos: As quedas representam um problema de saúde pública significativo sobretudo na população geriátrica, uma vez que, por ano, aproximadamente 28% a 35% dos indivíduos com idade superior ou igual a 65 anos sofrem quedas, sendo importante identificar novas formas de reduzir o seu risco. O projeto Aldeias Educadoras consistiu num programa de envelhecimento ativo e intergeracional realizado em 5 aldeias do concelho do Fundão. Este estudo pretendeu analisar o impacto da implementação deste projeto nas quedas e risco de quedas de adultos mais velhos. Metodologia: Trata-se de um estudo quase-experimental com comparação pré e pós intervenção desenvolvido com 19 participantes do projeto, com idades entre os 67 e 83 anos (74,37 ± 4,56). Os participantes frequentaram sessões comunitárias e escolares, desenvolvendo competências e projetos culturais locais entre idosos, crianças e professores. Foi aplicado um questionário que avaliou o índice de massa corporal (IMC), a prática de atividade física, tal como exercício de resistência, força ou mobilidade, o Times up and go (TUG) e o número de fármacos utilizados diariamente. Resultados: Após a intervenção, a mediana do resultado do TUG dos participantes foi de 11,15 (6,60 – 20,00), que foi menor do que a apresentada no pré-teste (12; 6,24 – 17,38; p=0,021). Não houve diferenças estatisticamente significativas no valor de IMC (Pós 30,7 vs Pré 30; p=0,185) nem na prática de atividade física (Diferença Pós-Pré 5,3%; p=0,500). O número de medicamentos diminuiu após a intervenção (4,78 ± 1,56 vs. 5,56 ± 2,18; p=0,013). Conclusões: Este estudo sugere que a intervenção intergeracional Aldeias Educadoras poderá ter contribuído para melhorar o TUG e, possivelmente, reduzir o número total de fármacos utilizados pelos participantes no estudo. No entanto, o reduzido número de participantes não permite generalizar as conclusões.
- Event-Related Potentials as Biomarkers and Effect Indicators in Transcranial Magnetic Stimulation: A Systematic ReviewPublication . Sobral, Mariana Bouça Nova; Patto, Maria da Assunção Morais e Cunha Vaz; Pinto, Nuno Filipe CardosoIntroduction: Transcranial magnetic stimulation (TMS) assumes a growing role in both clinical practice and fundamental sciences. The electroencephalogram (EEG) enhances TMS applications by providing key temporal resolution, particularly evident in the study of event-related potentials (ERPs). Analysing these time-locked responses to specific stimuli may provide deeper insight into the functional role of brain regions during cognitive processing. Therefore, assessing their effectiveness as biomarkers and indicators of effect is key to advancing research in TMS. Objectives: To determine whether ERPs can serve as biomarkers and effect indicators when using TMS, evaluating the effects of rTMS and TBS on ERPs. Methods: PubMed, SCOPUS, and Web of Science were consulted until February 15th, 2024, using combinations of keywords and/or MeSH terms. The PICO-based framework inclusion criteria were: 1) =18 years old, 2) studies involving healthy or pathological brains, 3) interventions utilising rTMS and ERPs, 4) comparisons between preand post-intervention outcomes, including placebo/sham conditions, and 5) no language restrictions. Primary outcomes included ERP amplitude and latency (such as P300, MMN, N200). Results: Out of the 281 screened articles, 14 met the inclusion criteria. P300 was the most discussed ERP (9 articles), demonstrating significant latency or amplitude changes in 89% of these studies. N200 data was collected in eight studies, seven within P300 research and one independently. Among these, four reported significant changes in latency or amplitude. MMN was addressed in two studies, one reporting significant latency changes. Conclusion: The findings reinforce the potential of ERPs as effect indicators while highlighting the need for further research to validate their utility. Underrepresented ERPs, such as MMN, require deeper investigation, while ongoing P300 research should remain supported.
- Stand-up Paddle Boarding: Muscle activity, kinematics and performance analysis in recreational athletesPublication . Freitas, João Diogo Rodrigues ; Neiva, Henrique Pereira; Conceição , Ana Teresa SilveiraStand-up paddle (SUP) has become increasingly popular due to its accessibility and physical benefits. Despite its growing popularity, there is limited research focusing on the biomechanical factors influencing SUP performance. This doctoral thesis aims to fill this gap by investigating various determinants of SUP performance through four studies. The general objective of this thesis was to analyze kinematic and neuromuscular factors that influence SUP performance in pratical contexts, in recreational-level athletes. The following steps were undertaken: (i) a literature review focused on performance analysis in SUP; (ii) analysis of muscle activation behavior in SUP, focusing on the activation patterns of adjacent and opposite muscles relative to the paddling side; (iii) classify SUP practitioners based on kinematic and neuromuscular activity variables and identify performance differentiators; iv) to examine how different visual focus conditions affect kinematic and neuromuscular responses during SUP. The main findings demonstrated that: (i) SUP athletes have more muscle mass, less body fat, and use more efficient paddling techniques, resulting in better performance; (ii) there seems to be higher muscle activation on the opposite side of the paddle in SUP, suggesting the importance of alternating the paddling side for muscular balance; (iii) faster performers showed a higher stroke frequency and different neuromuscular activation (i.e., higher triceps brachii activity) during the recovery phase of the stroke; (iv) visual focus significantly impacts kinematic and neuromuscular activity during SUP, with the free choice condition resulting in faster speeds, higher stroke frequencies and higher muscle activation during recovery phases of the stroke. These results demonstrate the importance of kinematic and neuromuscular factors in SUP performance. This thesis provides valuable insights for SUP practitioners and coaches to optimize training and performance through a better understanding of these biomechanical and neuromuscular factors.