População residente de um hospital psiquiátrico: que saúde visual?

Introdução - Numa tentativa pioneira em Portugal de avaliar o estado da visão dos pacientes residentes de um Hospital Psiquiátrico, foi nosso objectivo identificar alterações visuais existentes nesta população, passíveis de comprometer o funcionamento do sistema visual e com repercussões negativas nas actividades da vida diária; caracterizar e corrigir ametropias; relacionar as patologias encontradas com a medicação e seleccionar! encaminhar os utentes para consulta de oftalmologia. Métodos - Foram examinados 254 pacientes residentes num Hospital Psiquiátrico de Lisboa, com idade compreendida entre os 25 e os 92 anos de idade, com diagnóstico no âmbito da saúde mental, capacidade de deslocação e alguma autonomia. Na recolha de dados foi utilizado o protocolo de observação do rastreio visual, tendo sido avaliados os seguintes parâmetros: Acuidade visual, Estudo refractivo; Função sensório-motora; Visão cromática; Segmento anterior; Tensão ocular. O rastreio foi composto por duas fases: uma primeira fase para identificação das alterações visuais, com 254 residentes e uma segunda fase, com 100 residentes, para correcção das ametropias diagnosticadas e prescrição óptica. Os resultados foram sujeitos a uma análise estatística descritiva e inferencial através do programa SPSS. Resultados - A maioria dos pacientes era do sexo masculino (64,2%), internados principalmente por esquizofrenia (47,24%) e medicados com antipsicóticos (82,8%) mas tomando também anti-parkinsónicos (62,3%) e ansiolíticos (52,4%). Apenas 20,87% da amostra tinha feito anteriormente um exame visual. Além de 33,86% de cataratas, em que 27,4% representam residentes entre os 20 e os 50 anos, encontraram-se acuidades visuais baixas. Para longe, 51% dos indivíduos apresentavam acuidade visual no intervalo entre contar dedos e os 6/10. No que concerne à acuidade visual para perto, os resultados obtidos demonstram que a maioria da população apresenta também baixa acuidade visual, entre os 1/10 e os 3/10, tanto para olho direito (25,59%), como para o olho esquerdo (26,38%). É de referir que esta baixa acuidade visual atinge um total de 27 indivíduos no intervalo dos 40 aos 59 anos. Foi ainda identificado um número expressivo de exoforias para perto (38,58%) e 7,15% de neuropatias glaucomatosas. Do estudo refractivo (2. Fase do rastreio visual), resultou a prescrição de 75 óculos, o que levou a uma melhoria significativa da acuidade visual, principalmente para perto: 50% da amostra que apresentava acuidade visual, no intervalo de percepção luminosa aos 6/10, passou a 3%, após correcção refractiva. No decurso do rastreio 5 residentes foram encaminhadas para o serviço de urgência por neuropatia glaucomatosa e melanoma da coróide. Apenas 5,5% teve alta e os restantes foram encaminhados para consulta de oftalmologia (34% com prioridade). Conclusões - Este rastreio permitiu além da correcção das ametropias diagnosticadas, encaminhar, os residentes com alterações visuais, para tratamento, possibilitando assim, que esta população use a sua visão da melhor maneira e potencializando um aumento da qualidade de vida destes pacientes.

Statistical classification of road pavements using near field vehicle rolling noise measurements

Low noise surfaces have been increasingly considered as a viable and cost-effective alternative to acoustical barriers. However, road planners and administrators frequently lack information on the correlation between the type of road surface and the resulting noise emission profile. To address this problem, a method to identify and classify different types of road pavements was developed, whereby near field road noise is analyzed using statistical learning methods. The vehicle rolling sound signal near the tires and close to the road surface was acquired by two microphones in a special arrangement which implements the Close-Proximity method. A set of features, characterizing the properties of the road pavement, was extracted from the corresponding sound profiles. A feature selection method was used to automatically select those that are most relevant in predicting the type of pavement, while reducing the computational cost. A set of different types of road pavement segments were tested and the performance of the classifier was evaluated. Results of pavement classification performed during a road journey are presented on a map, together with geographical data. This procedure leads to a considerable improvement in the quality of road pavement noise data, thereby increasing the accuracy of road traffic noise prediction models.

Sistemas distribuídos: serviços Grid Computing

A necessidade de poder computacional é crescente nas diversas áreas de actuação humana, tanto na indústria, como em ambientes académicos. Grid Computing permite a ligação de recursos computacionais dispersos de maneira a permitir a sua utilização mais eficaz, fornecendo aos utilizadores um acesso simplificado ao poder computacional de diversos sistemas. Os primeiros projectos de Grid Computing implicavam a ligação de máquinas paralelas ou aglomerados de alto desempenho e alto custo, disponíveis apenas em algumas instituições. Contrastando com o elevado custo dos super-computadores, os computadores pessoais e a Internet sofreram uma evolução significativa nos últimos anos. O uso de computadores dispersos em uma WAN pode representar um ambiente muito interessante para processamento de alto desempenho. Os sistemas em Grid fornecem a possibilidade de se utilizar um conjunto de computadores pessoais de modo a fornecer uma computação que utiliza recursos que de outra maneira estariam omissos. Este trabalho consiste no estudo de Grid Computing a nível de conceito e de arquitectura e numa análise ao seu estado actual hoje em dia. Como complemento foi desenvolvido um componente que permite o desenvolvimento de serviços para Grids (Grid Services) mais eficaz do que o modelo de suporte a serviços actualmente utilizado. Este componente é disponibilizado sob a forma um plug-in para a plataforma Eclipse IDE.

Environmental life cycle assessment of concrete made with fine recycled concrete aggregates

The majority of worldwide structures use concrete as its main material. This happens because concrete is economically feasible, due to its undemanding production technology and case Of use. However, it is widely recognized that concrete production has a strong environmental impact in the planet. Natural aggregates use is one of the most important problems of concrete production nowadays, since they are obtained from limited, and in some countries scarce, resources. In Portugal, although there are enough stone quarries to cover coarse aggregates needs for several more years, Supplies of fine aggregates are becoming scarcer, especially in the northern part of the country. On the other hand, as concrete structures' life cycle comes to an end, an urgent need emerges to establish technically and economically viable solutions for demolition debris, other than for use as road base and quarry fill. This paper presents a partial life cycle assessment (LCA) of concrete made with fine recycled concrete aggregates performed with EcoConcrete tool. EcoConcrete is a tailor-made, interactive, learning and communications tool promoted by the Joint Project Group (JPG) on the LCA of concrete, to qualify and quantify the overall environment impact of concrete products. It consists of an interactive Excel-spreadsheet in which several environmental inputs (material quantities, distances from origin to production Site, production processes) and outputs (material, energy, emissions to air, water, soil or waste) are collected in a life cycle inventory, and are then processed to determine the environmental impact (assessment) of the analysed concrete, in terms of ozone layer depletion, smog or "greenhouse" effect.

Variáveis psicológicas e percepção do estado de saúde em indivíduos submetidos a ressincronização cardíaca

A insuficiência cardíaca afecta cerca de 261 mil pessoas em Portugal constituindo um problema de saúde pública. Pretendemos avaliar aspectos associados à recuperação do estado de saúde nesta síndrome, em particular a esperança, o afecto e a felicidade. Recorremos a um estudo longitudinal com 128 indivíduos sintomáticos com má fracção de ejecção do ventrículo esquerdo. Utilizámos um questionário para caracterizar os aspectos sóciodemográficos, clínicos e funcionais, o Kansas City Cardiomiopathy Questionnaire (KCCQ) para avaliar a qualidade de vida, a Subjective Hapiness Scale (SHS) para a felicidade, a HOPE Scale (HOPE) para a esperança e a Positive And Negative Afect Schedule (PANAS) para o afecto. Os questionários de caracterização sócio-demográfica, clínica e funcional, KCCQ e o SHS foram aplicados em três momentos: no internamento, prévio à instituição de terapêutica médica na sua totalidade e ao terceiro e sexto mês após a intervenção médica, na consulta externa. A maioria dos participantes eram homens em classe III da classificação da New York Heart Association com etiologia isquémica. No internamento e antes da terapêutica médica, observámos que a esperança, a felicidade e o afecto se relacionaram com a qualidade de vida, a felicidade e o afecto positivo com a esperança. No período avaliado foram submetidos a: terapia de ressincronização cardíaca (n=52), cardioversor-desfibrilhador implantável (n=44), cirurgia valvular com revascularização do miocárdio (n=14), optimização terapêutica farmacológica (n=10), transplante cardíaco (n=8). Foram significativos os resultados da qualidade de vida, da classificação da New York Heart Association, do exercício físico, da fracção de ejecção do ventrículo esquerdo e das arritmias cardíacas (estrasístoles e taquicardias ventriculares). A felicidade foi preditora da qualidade de vida e da funcionalidade. O afecto negativo foi preditor da satisfação com a insuficiência cardíaca. Concluímos da importância das variáveis positivas a par dos procedimentos médicos no tratamento das pessoas com insuficiência cardíaca. ABSTRACT - Heart failure affects about 261 000 people in Portugal constituting a public health problem. We intend to evaluate aspects of the health recovery in this syndrome, in particular hope, affection and happiness. We used a longitudinal study with 128 symptomatic patients with poor ejection fraction of left ventricle. We used a questionnaire to characterize the socio-demographic, clinical and functional aspects, the Kansas City Cardiomiopathy Questionnaire (KCCQ) to assess the quality of life, the Subjective Happiness Scale (SHS) for happiness, the HOPE Scale (HOPE) for hope and the Positive And Negative Affect Schedule (PANAS) for affection. The questionnaires of sociodemographic, clinical and functional KCCQ and SHS were applied on three occasions: on admission, prior to the execution of medical therapy in its totality and in the third and sixth months after medical intervention in the outpatient. Most of the participants were men in Class III New York Heart Association classification with ischemic etiology. At admission and before medical therapy, we observed that the hope, happiness and affection were related to the quality of life, happiness and positive affect with hope. Over the studied period were submitted to: cardiac resynchronization therapy (n=52), implantable cardioverter-defibrillator (n=44), valvular surgery with coronary artery bypass graft surgery (n=14), optimizing drug therapy (n=10), heart transplant (n=8). The significant results were the quality of life, the New York Heart Association classification, the exercise, the ejection fraction and left ventricular cardiac arrhythmias (ventricular tachycardia and estrasistoles). Happiness was a predictor of quality of life and functionality. The negative affect was a predictor of satisfaction with heart failure. We concluded that the positive variables and the medical procedures were important in treating people with heart failure.

Relation of happiness, hope and affection with quality of life in patients with heart failure

Introduction: Meeting the actual role of positive psychology, begins to be recognized the relation of positive variables with health. Objective: To know the relation of happiness, hope and affection with quality of life in individuals with heart failure. Population and Methodology: 128 individuals with heart failure, 98 men and 30 women, 61.9±12,1 years of age, 6,6±3,9 years in school and 74,2% retired because of this disease. 56,3% were in Class III of New York Heart Association, with poor left ventricular ejection fraction (25,3±6,2%). The clinical history was of 9,4±8,5 years for this heart disease and had at least one hospitalization due to heart failure with 51,6% having ischemic heart disease.

Happiness, hope and affection as predictors of quality of life and functionality of individuals with heart failure at 3 month follow up

Introduction: Meeting the actual role of positive psychology, begins to be recognized the contribution of positive variables in health outcomes. Objective: To know the contribution of happiness, hope and affection individually and as a whole in the quality of life and functionality of individuals with heart failure. Population and Methodology: 128 individuals with heart failure, 98 men and 30 women, 61.9±12,1 years of age, 6,6±3,9 years of school and 74,2% retired because of this disease. 56,3% were in Class III of New York Heart Association, with poor left ventricular ejection fraction (25,3±6,2%). The clinical history was of 9,4±8,5 years for this heart disease and had at least one hospitalization due to heart failure with 51,6% having ischemic heart disease.

Assessment of exposure to airborne ultrafine particles in the urban environment of Lisbon, Portugal

The aim of this study was the assessment of exposure to ultrafine in the urban environment of Lisbon, Portugal, due to automobile traffic, and consisted of the determination of deposited alveolar surface area in an avenue leading to the town center during late spring. This study revealed differentiated patterns for weekdays and weekends, which could be related with the fluxes of automobile traffic. During a typical week, ultrafine particles alveolar deposited surface area varied between 35.0 and 89.2 μm2/cm3, which is comparable with levels reported for other towns such in Germany and the United States. These measurements were also complemented by measuring the electrical mobility diameter (varying from 18.3 to 128.3 nm) and number of particles that showed higher values than those previously reported for Madrid and Brisbane. Also, electron microscopy showed that the collected particles were composed of carbonaceous agglomerates, typical of particles emitted by the exhaustion of diesel vehicles. Implications: The approach of this study considers the measurement of surface deposited alveolar area of particles in the outdoor urban environment of Lisbon, Portugal. This type of measurements has not been done so far. Only particulate matter with aerodynamic diameters <2.5 (PM2.5) and >10 (PM10) μm have been measured in outdoor environments and the levels found cannot be found responsible for all the observed health effects. Therefore, the exposure to nano- and ultrafine particles has not been assessed systematically, and several authors consider this as a real knowledge gap and claim for data such as these that will allow for deriving better and more comprehensive epidemiologic studies. Nanoparticle surface area monitor (NSAM) equipments are recent ones and their use has been limited to indoor atmospheres. However, as this study shows, NSAM is a very powerful tool for outdoor environments also. As most lung diseases are, in fact, related to deposition of the alveolar region of the lung, the metric used in this study is the ideal one.

Happiness, hope, and affection as predictors of quality of life and functionality of individuals with heart failure at three-month follow-up

The scientific evidence supporting the management of the chronically ill in a positive psychological perspective in opposition to traditional pathological approach is scarce. This study examines issues associated with recovery of health status in heart failure, in particular hope, affection, and happiness. We use a longitudinal study of 128 symptomatic patients who after medical intervention reported improved quality of life and function at 3-month follow-up. We evaluated the contribution of happiness, hope and affection, individually and as a whole, in the quality of life and functionality of individuals with heart failure. Happiness (Subjective Happiness Scale), Hope (HOPE Scale), and affection (PANAS (positive and negative affect schedule)) were determined before medical intervention. Individually, we found that happiness is correlated with the quality of life and functionality, hope to self-efficacy dimension of the quality of life scale, positive affect to functionality and negative affect with symptoms dimension, quality of life dimension, and overall sum of the quality of life scale. Overall, we found that happiness has a unique contribution to the quality of life, except in self-efficacy dimension where hope takes this contribution and positive affect has a unique contribution to the functionality in this short-term follow-up. The results highlight the importance of positive variables to health outcomes for people with heart failure and should be considered in intervention programs for this syndrome.

A importância das otoemissões acústicas num programa de conservação de audição em trabalhadores expostos ao ruído

Mestrado em Segurança e Higiene no Trabalho

Optimising protocol of acquisition and post-processing procedures in the assessment of coronary artery disease by computed tomography

Coronary artery disease (CAD) is currently one of the most prevalent diseases in the world population and calcium deposits in coronary arteries are one direct risk factor. These can be assessed by the calcium score (CS) application, available via a computed tomography (CT) scan, which gives an accurate indication of the development of the disease. However, the ionising radiation applied to patients is high. This study aimed to optimise the protocol acquisition in order to reduce the radiation dose and explain the flow of procedures to quantify CAD. The main differences in the clinical results, when automated or semiautomated post-processing is used, will be shown, and the epidemiology, imaging, risk factors and prognosis of the disease described. The software steps and the values that allow the risk of developingCADto be predicted will be presented. A64-row multidetector CT scan with dual source and two phantoms (pig hearts) were used to demonstrate the advantages and disadvantages of the Agatston method. The tube energy was balanced. Two measurements were obtained in each of the three experimental protocols (64, 128, 256 mAs). Considerable changes appeared between the values of CS relating to the protocol variation. The predefined standard protocol provided the lowest dose of radiation (0.43 mGy). This study found that the variation in the radiation dose between protocols, taking into consideration the dose control systems attached to the CT equipment and image quality, was not sufficient to justify changing the default protocol provided by the manufacturer.

A comparison of Sinogram Affirmed Iterative Reconstruction and filtered back projection on image quality and dose reduction in paediatric head CT: a phantom study

Background: Computed tomography (CT) is one of the most used modalities for diagnostics in paediatric populations, which is a concern as it also delivers a high patient dose. Research has focused on developing computer algorithms that provide better image quality at lower dose. The iterative reconstruction algorithm Sinogram-Affirmed Iterative Reconstruction (SAFIRE) was introduced as a new technique that reduces noise to increase image quality. Purpose: The aim of this study is to compare SAFIRE with the current gold standard, Filtered Back Projection (FBP), and assess whether SAFIRE alone permits a reduction in dose while maintaining image quality in paediatric head CT. Methods: Images were collected using a paediatric head phantom using a SIEMENS SOMATOM PERSPECTIVE 128 modulated acquisition. 54 images were reconstructed using FBP and 5 different strengths of SAFIRE. Objective measures of image quality were determined by measuring SNR and CNR. Visual measures of image quality were determined by 17 observers with different radiographic experiences. Images were randomized and displayed using 2AFC; observers scored the images answering 5 questions using a Likert scale. Results: At different dose levels, SAFIRE significantly increased SNR (up to 54%) in the acquired images compared to FBP at 80kVp (5.2-8.4), 110kVp (8.2-12.3), 130kVp (8.8-13.1). Visual image quality was higher with increasing SAFIRE strength. The highest image quality was scored with SAFIRE level 3 and higher. Conclusion: The SAFIRE algorithm is suitable for image noise reduction in paediatric head CT. Our data demonstrates that SAFIRE enhances SNR while reducing noise with a possible reduction of dose of 68%.

Assessment of exposure to airborne ultrafine particles in the urban environment of Lisbon, Porugal

The aim of this study was the assessment of exposure to ultrafine in the urban environment of Lisbon, Portugal, due to automobile traffic, and consisted of the determination of deposited alveolar surface area in an avenue leading to the town center during late spring. This study revealed differentiated patterns for weekdays and weekends, which could be related with the fluxes of automobile traffic. During a typical week, ultrafine particles alveolar deposited surface area varied between 35.0 and 89.2 mu m(2)/cm(3), which is comparable with levels reported for other towns such in Germany and the United States. These measurements were also complemented by measuring the electrical mobility diameter (varying from 18.3 to 128.3 nm) and number of particles that showed higher values than those previously reported for Madrid and Brisbane. Also, electron microscopy showed that the collected particles were composed of carbonaceous agglomerates, typical of particles emitted by the exhaustion of diesel vehicles. Implications: The approach of this study considers the measurement of surface deposited alveolar area of particles in the outdoor urban environment of Lisbon, Portugal. This type of measurements has not been done so far. Only particulate matter with aerodynamic diameters <2.5 (PM2.5) and >10 (PM10) mu m have been measured in outdoor environments and the levels found cannot be found responsible for all the observed health effects. Therefore, the exposure to nano- and ultrafine particles has not been assessed systematically, and several authors consider this as a real knowledge gap and claim for data such as these that will allow for deriving better and more comprehensive epidemiologic studies. Nanoparticle surface area monitor (NSAM) equipments are recent ones and their use has been limited to indoor atmospheres. However, as this study shows, NSAM is a very powerful tool for outdoor environments also. As most lung diseases are, in fact, related to deposition of the alveolar region of the lung, the metric used in this study is the ideal one.