Seasonality of cardiovascular risk factors: an analysis including over 230 000 participants in 15 countries

Objective: To assess the seasonality of cardiovascular risk factors (CVRF) in a large set of population-based studies.

Methods: Cross-sectional data from 24 population-based studies from 15 countries, with a total sample size of 237 979 subjects. CVRFs included Body Mass Index (BMI) and waist circumference; systolic (SBP) and diastolic (DBP) blood pressure; total, high (HDL) and low (LDL) density lipoprotein cholesterol; triglycerides and glucose levels. Within each study, all data were adjusted for age, gender and current smoking. For blood pressure, lipids and glucose levels, further adjustments on BMI and drug treatment were performed.

Results: In the Northern and Southern Hemispheres, CVRFs levels tended to be higher in winter and lower in summer months. These patterns were observed for most studies. In the Northern Hemisphere, the estimated seasonal variations were 0.26 kg/m2 for BMI, 0.6 cm for waist circumference, 2.9 mm Hg for SBP, 1.4 mm Hg for DBP, 0.02 mmol/L for triglycerides, 0.10 mmol/L for total cholesterol, 0.01 mmol/L for HDL cholesterol, 0.11 mmol/L for LDL cholesterol, and 0.07 mmol/L for glycaemia. Similar results were obtained when the analysis was restricted to studies collecting fasting blood samples. Similar seasonal variations were found for most CVRFs in the Southern Hemisphere, with the exception of waist circumference, HDL, and LDL cholesterol.

Conclusions: CVRFs show a seasonal pattern characterised by higher levels in winter, and lower levels in summer. This pattern could contribute to the seasonality of CV mortality.

Optical coherence tomography (OCT) for detection of macular oedema in patients with diabetic retinopathy

Background

Diabetic macular oedema (DMO) is a thickening of the central retina, or the macula, and is associated with long-term visual loss in people with diabetic retinopathy (DR). Clinically significant macular oedema (CSMO) is the most severe form of DMO. Almost 30 years ago, the Early Treatment Diabetic Retinopathy Study (ETDRS) found that CSMO, diagnosed by means of stereoscopic fundus photography, leads to moderate visual loss in one of four people within three years. It also showed that grid or focal laser photocoagulation to the macula halves this risk. Recently, intravitreal injection of antiangiogenic drugs has also been used to try to improve vision in people with macular oedema due to DR.Optical coherence tomography (OCT) is based on optical reflectivity and is able to image retinal thickness and structure producing cross-sectional and three-dimensional images of the central retina. It is widely used because it provides objective and quantitative assessment of macular oedema, unlike the subjectivity of fundus biomicroscopic assessment which is routinely used by ophthalmologists instead of photography. Optical coherence tomography is also used for quantitative follow-up of the effects of treatment of CSMO.

Objectives

To determine the diagnostic accuracy of OCT for detecting DMO and CSMO, defined according to ETDRS in 1985, in patients referred to ophthalmologists after DR is detected. In the update of this review we also aimed to assess whether OCT might be considered the new reference standard for detecting DMO.

Search methods

We searched the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment Database (HTA) and the NHS Economic Evaluation Database (NHSEED) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1950 to June 2013), Web of Science Conference Proceedings Citation Index - Science (CPCI-S) (January 1990 to June 2013), BIOSIS Previews (January 1969 to June 2013), MEDION and the Aggressive Research Intelligence Facility database (ARIF). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 25 June 2013. We checked bibliographies of relevant studies for additional references.

Selection Criteria

We selected studies that assessed the diagnostic accuracy of any OCT model for detecting DMO or CSMO in patients with DR who were referred to eye clinics. Diabetic macular oedema and CSMO were diagnosed by means of fundus biomicroscopy by ophthalmologists or stereophotography by ophthalmologists or other trained personnel.

Data collection and analysis

Three authors independently extracted data on study characteristics and measures of accuracy. We assessed data using random-effects hierarchical sROC meta-analysis models.

Main results

We included 10 studies (830 participants, 1387 eyes), published between 1998 and 2012. Prevalence of CSMO was 19% to 65% (median 50%) in nine studies with CSMO as the target condition. Study quality was often unclear or at high risk of bias for QUADAS 2 items, specifically regarding study population selection and the exclusion of participants with poor quality images. Applicablity was unclear in all studies since professionals referring patients and results of prior testing were not reported. There was a specific 'unit of analysis' issue because both eyes of the majority of participants were included in the analyses as if they were independent.In nine studies providing data on CSMO (759 participants, 1303 eyes), pooled sensitivity was 0.78 (95% confidence interval (CI) 0.72 to 0.83) and specificity was 0.86 (95% CI 0.76 to 0.93). The median central retinal thickness cut-off we selected for data extraction was 250 µm (range 230 µm to 300 µm). Central CSMO was the target condition in all but two studies and thus our results cannot be applied to non-central CSMO.Data from three studies reporting accuracy for detection of DMO (180 participants, 343 eyes) were not pooled. Sensitivities and specificities were about 0.80 in two studies and were both 1.00 in the third study.Since this review was conceived, the role of OCT has changed and has become a key ingredient of decision-making at all levels of ophthalmic care in this field. Moreover, disagreements between OCT and fundus examination are informative, especially false positives which are referred to as subclinical DMO and are at higher risk of developing clinical CSMO.

Authors' conclusions

Using retinal thickness thresholds lower than 300 µm and ophthalmologist's fundus assessment as reference standard, central retinal thickness measured with OCT was not sufficiently accurate to diagnose the central type of CSMO in patients with DR referred to retina clinics. However, at least OCT false positives are generally cases of subclinical DMO that cannot be detected clinically but still suffer from increased risk of disease progression. Therefore, the increasing availability of OCT devices, together with their precision and the ability to inform on retinal layer structure, now make OCT widely recognised as the new reference standard for assessment of DMO, even in some screening settings. Thus, this review will not be updated further.

A censura sem limites : as práticas de censura no cinema e seus ecos na contemporaneidade demográfica luso-brasileira (1930-1950)

Tese de doutoramento, Educação (História da Educação), Universidade de Lisboa, Instituto de Educação, 2015

Choosing to be Jews: a Sociological Reflection on American Jews Since 1950, pt. 1

The second half of the twentieth century has been a time when American Jews have experienced a minimum of prejudice and almost all domains of life have been accessible to them, but it has also been a time of assimilation, of swelling rates of inter-marriage, and of large numbers ignoring their Jewishness completely. Jews have no trouble building synagogues, but they have all sorts of trouble filling them. The quality of Jewish education is perhaps higher than ever before, and the output of Jewish scholarship is overwhelming in its scope and quality, but most American Jews receive a minimum of religious education and can neither read nor comprehend the great corpus of Jewish literature in its Hebrew (or Aramaic) original. This is a time in America when there is no shame in being a Jew, and yet fewer American Jews seem to know what being a Jew means. This book is part of a stocktaking that has been occurring among Jews as the century in which their residence in America was firmly established comes to an end. Grounded in empirical detail, it provides a concise yet analytic evaluation of the meaning of the many studies and surveys of the last four and a half decades. All those who want to know what it means and has meant to be an American Jew will find this volume of interest.

Choosing to be Jews: a Sociological Reflection on American Jews Since 1950, pt. 2

The second half of the twentieth century has been a time when American Jews have experienced a minimum of prejudice and almost all domains of life have been accessible to them, but it has also been a time of assimilation, of swelling rates of inter-marriage, and of large numbers ignoring their Jewishness completely. Jews have no trouble building synagogues, but they have all sorts of trouble filling them. The quality of Jewish education is perhaps higher than ever before, and the output of Jewish scholarship is overwhelming in its scope and quality, but most American Jews receive a minimum of religious education and can neither read nor comprehend the great corpus of Jewish literature in its Hebrew (or Aramaic) original. This is a time in America when there is no shame in being a Jew, and yet fewer American Jews seem to know what being a Jew means. This book is part of a stocktaking that has been occurring among Jews as the century in which their residence in America was firmly established comes to an end. Grounded in empirical detail, it provides a concise yet analytic evaluation of the meaning of the many studies and surveys of the last four and a half decades. All those who want to know what it means and has meant to be an American Jew will find this volume of interest.

Choosing to be Jews: a Sociological Reflection on American Jews Since 1950, pt. 3

The second half of the twentieth century has been a time when American Jews have experienced a minimum of prejudice and almost all domains of life have been accessible to them, but it has also been a time of assimilation, of swelling rates of inter-marriage, and of large numbers ignoring their Jewishness completely. Jews have no trouble building synagogues, but they have all sorts of trouble filling them. The quality of Jewish education is perhaps higher than ever before, and the output of Jewish scholarship is overwhelming in its scope and quality, but most American Jews receive a minimum of religious education and can neither read nor comprehend the great corpus of Jewish literature in its Hebrew (or Aramaic) original. This is a time in America when there is no shame in being a Jew, and yet fewer American Jews seem to know what being a Jew means. This book is part of a stocktaking that has been occurring among Jews as the century in which their residence in America was firmly established comes to an end. Grounded in empirical detail, it provides a concise yet analytic evaluation of the meaning of the many studies and surveys of the last four and a half decades. All those who want to know what it means and has meant to be an American Jew will find this volume of interest.

History of Electrex 1950-1993

Electrex developed from a small exhibition at the start of the 1950s into the top electrotechnical exhibition of products and related services in the UK by the 1990s. Its emergence reflected a complex relationship with the key trade association, BEAMA (the British Electrical and Allied Manufacturers' Association). This history places this development in a wider context marked by the disappearance of the British Industries Fair in the 1950s, the entry to Europe and the establishment of the National Exhibition Centre in Birmingham. In the process it is also a rare case study of the under-explored business histories of exhibitions, as well as casting light on the changing post-war fortunes of the British electrical industries.

Regards croisés francophones et portugais : les images des Portugais dans la littérature romanesque contemporaine (1950-2000)

Tese de doutoramento em Línguas e Literaturas Românicas, Literatura Românica Comparada

Relações sinuosas: Portugal e o mundo árabe, 1950-1973

Nas três últimas décadas do colonialismo português, as políticas destinadas às populações muçulmanas da Guiné e de Moçambique passaram da hostilidade mais ou menos aberta para uma estratégia de sedução, com vista a promover um “Islão português” e a usar certos sectores muçulmanos no combate aos movimentos nacionalistas. Esta transição teve também uma componente transnacional, na medida em que se quis alargar a intervenção portuguesa a um espaço estratégico designado como “mundo islâmico”. O presente artigo procura analisar essa intervenção, debruçando-se sobre o pensamento geopolítico que a informou e as suas aplicações diplomáticas, em particular no relacionamento com os países árabes.

Modelos e materiais de ensino da matemática moderna em Portugal (1950-1965)

Este artigo tem por base um estudo enquadrado no uso de materiais/modelos de ensino da Matemática na década de 60, aquando da implementação do Movimento Matemática Moderna, em Portugal. Para atingir este objectivo definimos três questões: 1) Já havia interesse no uso destes novos métodos de ensino, e consequentemente no uso de materiais diversos que levassem a uma melhor aprendizagem por parte dos alunos, antes da década de 60? 2) De que modo os professores aplicaram e usaram estes métodos/materiais na sua prática docente? E que formação tiveram? 3) Quais os métodos e materiais que os professores utilizavam nas suas aulas? O foco central deste trabalho parte da análise de dois artigos escritos na revista Labor, o primeiro em 1952 e o segundo em 1960, pelo professor António Augusto Lopes1 sobre o uso de materiais no 1º ciclo e o Laboratório de Matemática. Toda a pesquisa deste trabalho focou-se na interpretação de material fornecido pelo professor Lopes (manuscritos, relatórios, livros e fotografias, documentos do Ministério da Educação Nacional), bem como por reflexões e comentários do próprio, registadas na forma de entrevista,2 sobre o que foi o Movimento Matemática Moderna ao nível da prática docente, com recurso a novas metodologias e materiais de ensino. O período que irá ser analisado em termos cronológicos será de 1957 a 1965, isto porque é um período experimental e de mudança. A reunião de 57 da CIEAEM em Madrid é o marco histórico que irá despoletar o interesse da Comissão e de Augusto Lopes para a aplicação dos novos materiais\modelos. Apesar de só em 1965 serem criadas as primeiras turmas piloto para aplicação das metodologias e dos novos materiais\modelos preconizadas pelo MMM.