Reabilitação cardíaca em Portugal: a intervenção que falta!

A Organização Mundial de Saúde definiu Reabilitação Cardíaca (RC), em 1964, como “… o conjunto de actividades necessárias para fornecer ao doente com cardiopatia uma condição física, mental e social tão elevadas quanto possível, que lhe permita retomar o seu lugar na vida da comunidade, pelos seus próprios meios e de uma forma tão normal quanto possível”. Os Programas de Reabilitação Cardíaca (PRC) foram lançados para promover uma recuperação física rápida após enfarte agudo do miocárdio (síndrome coronário agudo - SCA, na nomenclatura actual), orientada para reintegração social rápida e plena, nomeadamente para a retoma da actividade profissional, após SCA ou cirurgia cardíaca (coronária, valvular ou transplante). Para além dos doentes que sofreram SCA complicado ou após cirurgia cardíaca, a obtenção de uma boa capacidade física tem uma importância significativa nos trabalhadores cuja actividade exige esforço físico violento, como os agrícolas ou da construção civil, assim como nos doentes idosos e nas mulheres. Actualmente, para além da promoção da capacidade funcional, os PRC assumiram-se como programas de prevenção secundária, implementando também a adopção de um estilo de vida saudável, a observância da terapêutica farmacológica e a educação dos doentes e dos seus familiares, de forma a auxiliá-los a viver com a doença. Por este motivo, passaram a ter grande interesse e indicação, mesmo para doentes que não apresentam limitações físicas como os submetidos a angioplastia coronária e os que sofrem de angina de peito. Na última década acumulou-se evidência científica de benefício dos PRC em relação a novos grupos de doentes, como os que apresentam insuficiência cardíaca, sendo ou não portadores de pacemaker de ressincronização ou de cardioversor desfibrilhador. O estilo de vida e as medidas de prevenção secundária preconizados pelos PRC compreendem actividade física regular, nutrição saudável, controlo do stress e dos factores de risco clássicos, em particular o tabagismo e a obesidade que deverão ser objecto de programas especiais. O exercício físico adaptado, de intensidade moderada e ajustado ao gosto e à patologia dos participantes, é talvez o componente mais importante do programa pelas suas propriedades anti-ateroscleróticas, anti-trombóticas, anti-isquémicas, antiarrítmicas e benefícios psicológicos. Está indicado não só como antagonista dos efeitos nefastos do sedentarismo, mas também como promotor das outras mudanças de comportamento que se devem manter por tempo indeterminado. Duas meta-análises, publicadas no final dos anos 80 do século passado, que incluíram estudos com cerca de 9.000 doentes tratados segundo as recomendações da época, demonstraram sobrevivência 25% superior à dos doentes do grupo controlo. Apesar dos grandes avanços verificados nas últimas décadas no tratamento farmacológico da doença coronária e nas técnicas de revascularização, em particular na angioplastia, que poderiam ter reduzido a probabilidade dos programas de reabilitação demonstrarem benefícios, duas meta-análises recentes, publicadas em 2004 e 2005, voltaram a demonstrar redução da mortalidade superior ou igual a 25 % no grupo de RC relativamente ao grupo controlo. A redução de mortalidade e de hospitalizações condicionadas pela RC dos doentes com insuficiência cardíaca está demonstrada na meta-análise europeia ExTrAMATCH e no estudo americano HF-ACTION, recentemente publicado. Também há alguma evidência de que os PRC diminuem os custos para o Sistema de Saúde pela redução do número de eventos verificados no período de seguimento.

Digital radiography detectors - A technical overview: Part 2

Digital X-ray detector technologies provide several advantages when compared with screen-film (SF) systems: better diagnostic quality of the radiographic image, increased dose efficiency, better dynamic range and possible reduction of radiation exposure to the patient. The transition from traditional SF systems to digital technology-based systems highlights the importance of the discussion around technical factors such as image acquisition, themanagement of patient dose and diagnostic image quality. Radiographers should be aware of these aspects concerning their clinical practice regarding the advantages and limitations of digital detectors. Newdigital technologies require an up-to-date of scientific knowledge concerning their use in projection radiography. This is the second of a two-part review article focused on a technical overview of digital radiography detectors. This article provides a discussion about the issues related to the image acquisition requirements and advantages of digital technologies, the management of patient dose and the diagnostic image quality.

Communication: The criticality of self-assembled rigid rods on triangular lattices

The criticality of self-assembled rigid rods on triangular lattices is investigated using Monte Carlo simulation. We find a continuous transition between an ordered phase, where the rods are oriented along one of the three (equivalent) lattice directions, and a disordered one. We conclude that equilibrium polydispersity of the rod lengths does not affect the critical behavior, as we found that the criticality is the same as that of monodisperse rodson the same lattice, in contrast with the results of recently published work on similar models. (C) 2011 American Institute of Physics. [doi:10.1063/1.3556665]

Phase diagrams of binary mixtures of patchy colloids with distinct numbers and types of patches: Theempty fluid regime

We investigate the effect of distinct bonding energies on the onset of criticality of low functionality fluid mixtures. We focus on mixtures ofparticles with two and three patches as this includes the mixture where "empty" fluids were originally reported. In addition to the number of patches, thespecies differ in the type of patches or bonding sites. For simplicity, we consider that the patches on each species are identical: one species has threepatches of type A and the other has two patches of type B. We have found a rich phase behavior with closed miscibility gaps, liquid-liquid demixing, and negative azeotropes. Liquid-liquid demixing was found to pre-empt the "empty" fluid regime, of these mixtures, when the AB bonds are weaker than the AA or BB bonds. By contrast, mixtures in this class exhibit "empty" fluid behavior when the AB bonds are stronger than at least one of the other two. Mixtureswith bonding energies epsilon(BB) = epsilon(AB) and epsilon(AA) < epsilon(BB), were found to exhibit an unusual negative azeotrope. (C) 2011 American Institute of Physics. [doi:10.1063/1.3561396]

Exposição ocupacional a mercúrio: associação com a atividade da paraoxonase humana e vitaminas A e E

Mestrado em Segurança e Higiene no Trabalho

Generalizing repeating patterns: a study with children aged four

This paper presents part of a study that aimed to understand how the emergence of algebraic thinking takes place in a group of four-year-old children, as well as its relationship to the exploration of children‘s literature. To further deepen and guide this study the following research questions were formulated: (1) How can children's literature help preschoolers identify patterns?; (2) What strategies and thinking processes do children use to create, analyze and generalize repeating and growing patterns?; (3) What strategies do children use to identify the unit of repeat of a pattern? and (4) What factors influence the identification of patterns? The paper focuses only on the strategies and thinking processes that children use to create, analyze and generalize repeating patterns. The present study was developed with a group of 14 preschoolers in a private school in Lisbon, and it was carried out with all children. In order to develop the research, a qualitative research methodology under the interpretive paradigm was chosen, emphasizing meanings and processes. The researcher took the dual role of teacher-researcher, conducting the study with her own group and in her own natural environment. Participant observation and document analysis (audio and video recordings, photos and children productions) were used as data collection methods. Data collection took place from October 2013 to April 2014. The results of the study indicate that children master the concept of repeating patterns, and they are able to identify the unit of repeat, create and analyze various repeating patterns, evolving from simpler to more complex forms.

Dynamic behaviour of soft core sandwich beam structures using kriging-based layerwise models

Sandwich structures with soft cores are widely used in applications where a high bending stiffness is required without compromising the global weight of the structure, as well as in situations where good thermal and damping properties are important parameters to observe. As equivalent single layer approaches are not the more adequate to describe realistically the kinematics and the stresses distributions as well as the dynamic behaviour of this type of sandwiches, where shear deformations and the extensibility of the core can be very significant, layerwise models may provide better solutions. Additionally and in connection with this multilayer approach, the selection of different shear deformation theories according to the nature of the material that constitutes the core and the outer skins can predict more accurately the sandwich behaviour. In the present work the authors consider the use of different shear deformation theories to formulate different layerwise models, implemented through kriging-based finite elements. The viscoelastic material behaviour, associated to the sandwich core, is modelled using the complex approach and the dynamic problem is solved in the frequency domain. The outer elastic layers considered in this work may also be made from different nanocomposites. The performance of the models developed is illustrated through a set of test cases. (C) 2015 Elsevier Ltd. All rights reserved.