Propriedades psicométricas da versão portuguesa do Kansas City Cardiomyopathy Questionnaire na miocardiopatia dilatada com insuficiência cardíaca congestiva

Vários estudos demonstraram que os doentes com insuficiência cardíaca congestiva (ICC) têm um compromisso da qualidade de vida relacionada com a saúde (QVRS), tendo esta, nos últimos anos, vindo a tornar-se um endpoint primário quando se analisa o impacto do tratamento de situações crónicas como a ICC. Objectivos: Avaliar as propriedades psicométricas da versão portuguesa de um novo instrumento específico para medir a QVRS na ICC em doentes hospitalizados: o Kansas City Cardiomyopathy Questionnaire (KCCQ). População e Métodos: O KCCQ foi aplicado a uma amostra consecutiva de 193 doentes internados por ICC. Destes, 105 repetiram esta avaliação 3 meses após admissão hospitalar, não havendo eventos ocorridos durante este período de tempo. A idade era 64,4± 12,4 anos (entre 21 e 88), com 72,5% a pertencer ao sexo masculino, sendo a ICC de etiologia isquémica em 42%. Resultados: Esta versão do KCCQ foi sujeita a validação estatística semelhante à americana com a avaliação da fidelidade e validade. A fidelidade foi avaliada pela consistência interna dos domínios e dos somatórios, apresentando valores Alpha de Cronbach idênticos nos vários domínios e somatórios ( =0,50 a =0,94). A validade foi analisada pela convergência, pela sensibilidade às diferenças entre grupos e pela sensibilidade à alteração da condição clínica. Avaliou-se a validade convergente de todos os domínios relacionados com funcionalidade, pela relação verificada entre estes e uma medida de funcionalidade, a classificação da New York Heart Association (NYHA), tendo-se verificado correlações significativas (p<0,01), como medida para avaliar a funcionalidade em doentes com ICC. Efectuou-se uma análise de variância entre o domínio limitação física, os somatórios e as classes da NYHA, tendo-se encontrado diferenças estatisticamente significativas (F=23,4; F=36,4; F=37,4; p=0,0001), na capacidade de descriminação da gravidade da condição clínica. Foi realizada uma segunda avaliação em 105 doentes na consulta do 3º mês após a intervenção clínica, tendo-se observado alterações significativas nas médias dos domínios avaliados entre o internamento e a consulta (diferenças de 14,9 a 30,6 numa escala de 0-100), indicando que os domínios avaliados são sensíveis à mudança da condição clínica. A correlação interdimensões da qualidade de vida que compõe este instrumento é moderada, sugerindo dimensões independentes, apoiando a sua estrutura multifactorial e a adequabilidade desta medida para a sua avaliação. Conclusão: O KCCQ é um instrumento válido, sensível à mudança e específico para medir a QVRS numa população portuguesa com miocardiopatia dilatada e ICC. ABSTRACT - Several studies have shown that patients with congestive heart failure (CHF) have a compromised health-related quality of life (HRQL), and this, in recent years, has become a primary endpoint when considering the impact of treatment of chronic conditions such as CHF. Objectives: To evaluate the psychometric properties of the Portuguese version of a new specific instrument to measure HRQL in patients hospitalized for CHF: the Kansas City Cardiomyopathy Questionnaire (KCCQ). Methods: The KCCQ was applied to a sample of 193 consecutive patients hospitalized for CHF. Of these, 105 repeated the assessment 3 months after admission, with no events during this period. Mean age was 64.4±12.4 years (21-88), and 72.5% were 72.5% male. CHF was of ischemic etiology in 42% of cases. Results: This version of the KCCQ was subjected to statistical validation, with assessment of reliability and validity, similar to the American version. Reliability was assessed by the internal consistency of the domains and summary scores, which showed similar values of Cronbach alpha (0.50-0.94). Validity was assessed by convergence, sensitivity to differences between groups and sensitivity to changes in clinical condition. We evaluated the convergent validity of all domains related to functionality, through the relationship between them and a measure of functionality, the New York Heart Association (NYHA) classification. Significant correlations were found (p<0.01) for this measure of functionality in patients with CHF. Analysis of variance between the physical limitation domain, the summary scores and NYHA class was performed and statistically significant differences were found (F=23.4; F=36.4; F=37.4, p=0.0001) in the ability to discriminate severity of clinical condition. A second evaluation was performed on 105 patients at the 3-month follow-up outpatient appointment, and significant changes were observed in the mean scores of the domains assessed between hospital admission and the clinic appointment (differences from 14.9 to 30.6 on a scale of 0-100), indicating that the domains assessed are sensitive to changes in clinical condition. The correlation between dimensions of quality of life in the KCCQ is moderate, suggesting that the dimensions are independent, supporting the multifactorial nature of HRQL and the suitability of this measure for its evaluation. Conclusion: The KCCQ is a valid instrument, sensitive to change and a specific measure of HRQL in a population with dilated cardiomyopathy and CHF.

Quality of life in dilated cardiomyopathy with refractory chronic heart failure undergoing devices implantation

Heart failure is the final stage of most of cardiac diseases. It is a complex syndrome in which the patients should have the following features: symptoms of heart failure, typically shortness of breath at rest or during exertion, and/or fatigue; signs of fluid retention such as pulmonary congestion or ankle swelling; and objective evidence of an abnormality of the structure or function of the heart at rest. This progressive syndrome as a high incidence and prevalence and poor prognosis: four-year mortality is around 50% with 40% of the patients admitted to hospital dying or readmitted within a year. With ageing, many patients will develop chronic heart failure, which, because of its symptoms, patient’s awareness of their risk of dying, and the effects of therapy, together with frequent hospitalizations, has considerable impact on patient’s health-related quality of life.

Concepções e práticas de um centro de actividades ocupacionais

O presente trabalho tem como principal objectivo tentar conhecer e compreender as concepções educativas de um Centro de Actividades Ocupacionais face ao seu público-alvo em particular, as suas dimensões mais relevantes, os factores que as condicionam e os contextos que as limitam ou facilitam. Procurou-se conhecer as concepções e práticas dos actores educativos que intervêm na formação/educação junto de pessoas portadoras de deficiência mental adultas, clientes de um Centro de Actividades Ocupacionais, geograficamente situado em Lisboa. Para tal, elaborou-se um Estudo de Caso utilizando entrevistas semi estruturadas a sete profissionais do centro como técnica de recolha de dados, sendo estes posteriormente tratados através da análise de conteúdo. Assim, definiram-se como objectivos específicos do estudo: caracterizar as finalidades educativas do Centro de Actividades Ocupacionais; caracterizar as práticas de desenvolvimento para os adultos deficientes mentais; caracterizar o modo de participação dos clientes nas actividades: aspectos facilitadores e constrangimentos; identificar as dificuldades dos funcionários do Centro de Actividades Ocupacionais no atendimento aos clientes; caracterizar as iniciativas da instituição face à actualização profissional dos seus funcionários no sentido de fornecer respostas mais adequadas às necessidades dos clientes e, ainda, caracterizar de acordo com o ponto de vista dos actores educativos, a participação das famílias no processo de desenvolvimento dos clientes. Os resultados do estudo evidenciam que as actividades desenvolvidas no Centro de Actividades Ocupacionais se dividem entre as consideradas como socialmente úteis, como a montagem de material eléctrico, por exemplo, e as estritamente ocupacionais. Embora um dos objectivos do Centro de Actividades Ocupacionais seja a inserção do cliente na comunidade, da análise de dados ressalta que não existem muitas actividades que divulguem para o exterior o trabalho desenvolvido pelos adultos portadores de deficiência mental, promovendo pouca interacção dos indivíduos com a comunidade. As profissionais que participaram no estudo revelam motivação para trabalhar junto dos clientes e preocupação em melhorar o seu desempenho profissional, daí sentirem necessidade em adquirir formação contínua e partilhar experiências com outros profissionais. As famílias dos clientes são consideradas pelas participantes do estudo como sendo participativas no quotidiano do seu familiar, contudo existem factores que condicionam essa participação, como o envelhecimento dos progenitores. Abstract The present work aims to know and understand the educational conceptions of an Occupational Activities Center taking into consideration its target audience, particularly, its most relevant dimensions, the conditioning factors and its respective restrictive or facilitating contexts. The objective was to understand the concepts and daily practices of the educational actors that participate in the training/education of the mentally disabled adults who attend an Occupational Activities Center located in Lisbon. In that light, a Case Study was conducted using as the data collection technique semistructured interviews made to seven employees from the Center. This data was later on processed through content analysis. Thus, the following was defined as the study’s specific goals. To: characterize the educational purposes of the Occupational Activities Center; characterize development practices for the mentally disabled adults; characterize the clients’ participation process in the activities and the respective enabling and restrictive aspects; identify the Occupational Activities Center employees’ problems regarding client assistance; characterize the institution’s initiatives regarding the professional update of its employees in order to provide more adequate answers to its clients’ needs and, finally to identify from the educational actors’ perspective the participative role families’ take on when it comes to the clients’ development processes. The study results determine that the activities developed in the Occupational Activities Center are distinguished between the ones considered socially useful, such as the assembly of electric material, and the strictly occupational activities. Although one of the Occupational Activities Center goals is the insertion of the client within the community itself, the data analysis shows that there aren’t many activities that promote to the outside world the work performed by these mentally disabled adults, not advertising enough the individuals’ interaction with the community. The professional women who participated in the study show determination and motivation in working with the clients and also a concern in improving their professional performances, from this derives their need to attend continuous training and to share experiences with other professionals. The study's participants find the clients’ families involved in the daily routines of their relatives. Nonetheless, there are some factors that condition that involvement, such as the parents’ aging.

Basis invariant conditions for supersymmetry in the two-Higgs-doublet model

The minimal supersymmetric standard model involves a rather restrictive Higgs potential with two Higgs fields. Recently, the full set of classes of symmetries allowed in the most general two-Higgs-doublet model was identified; these classes do not include the supersymmetric limit as a particular class. Thus, a physically meaningful definition of the supersymmetric limit must involve the interaction of the Higgs sector with other sectors of the theory. Here we show how one can construct basis invariant probes of supersymmetry involving both the Higgs sector and the gaugino-Higgsino-Higgs interactions.

Health related quality of life in patients with refractory chronic heart failure undergoing cardiac resynchronization: type of therapeutic response

The benefits of cardiac resynchronization therapy (CRT) in the health-related quality of life (HRQL) are largely demonstrated in selected patients with severe congestive heart failure (CHF). However, the differences between responders and non-responders, with regard to the effect of CRT in the various dimensions that constitute HRQL are still a matter of discussion. Objective: To evaluate the impact of CRT on the HRQL of patients with CHF refractory to optimal pharmacological therapy, within 6 months after CRT. Methods: 43 patients, submitted to successful implantation of CRT, were evaluated in hospital just before intervention and in the outpatient clinic within 6 months after CRT. HRQL was analyzed based on the Kansas City Cardiomyopathy Questionnaire (KCCQ). Patients were classified as super-responders (ejection fraction of left ventricle - LVEF - ≥45% post-CRT), n=15, responders (sustained improvement in functional class and LVEF increased by 15%), n=19, and non-responders (no clinical or LVEF improvement), n=9. Results: In the group of super-responders, CRT was associated with an improvement in HRQL for the various fields and sums assessed (ρ<0.05); in responders, CRT has been associated with an improvement of HRQL in the various fields and sums, except in the self-efficacy dimension (ρ<0.05); in non-responders, CRT was not associated with improvement of HRQL. Conclusion: In a population with severe CHF undergoing CRT, the patients with clinical and echocardiographic positive response, obtained a favorable impact in all dimensions of HRQL, while the group without response to CRT showed no improvement. These data reinforces the importance of HRQL as a multidimensional tool for assessment of benefits in clinical practice.

Impact of flavor-changing neutral current top quark interactions on BR(t -> bW)

We study the effect that flavor-changing neutral current interactions of the top quark will have on the branching ratio of charged decays of the top quark. We have performed an integrated analysis using Tevatron and B-factories data and with just the further assumption that the Cabibbo-Kobayashi-Maskawa matrix is unitary, we can obtain very restrictive bounds on the strong and electroweak flavor-changing neutral current branching ratios Br(t -> qX)< 4.0x10(-4), where X is any vector boson and a sum in q=u, c is implied.

Monitorização da insuficiência cardíaca por parâmetros fisiológicos em portadores de cardioversor-desfibrilhador implantável e/ou sistema de ressincronização cardíaca: HF-PREDICT

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular. Área de especialização: Intervenção Cardiovascular.

Avaliação ecocardiográfica da influência do jejum na resposta a um aumento reversível da pré-carga

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular - Ramo de especialização: Ultrassonografia Cardiovascular

Behaviour and fate of metals in urban wastewater treatment plants: a review

The concerns on metals in urban wastewater treatment plants (WWTPs) are mainly related to its contents in discharges to environment, namely in the final effluent and in the sludge produced. In the near future, more restrictive limits will be imposed to final effluents, due to the recent guidelines of the European Water Framework Directive (EUWFD). Concerning the sludge, at least seven metals (Cd, Cr, Cu, Hg, Ni, Pb and Zn) have been regulated in different countries, four of which were classified by EUWFD as priority substances and two of which were also classified as hazardous substances. Although WWTPs are not designed to remove metals, the study of metals behaviour in these systems is a crucial issue to develop predictive models that can help more effectively the regulation of pre-treatment requirements and contribute to optimize the systems to get more acceptable metal concentrations in its discharges. Relevant data have been published in the literature in recent decades concerning the occurrence/fate/behaviour of metals in WWTPs. However, the information is dispersed and not standardized in terms of parameters for comparing results. This work provides a critical review on this issue through a careful systematization, in tables and graphs, of the results reported in the literature, which allows its comparison and so its analysis, in order to conclude about the state of the art in this field. A summary of the main consensus, divergences and constraints found, as well as some recommendations, is presented as conclusions, aiming to contribute to a more concerted action of future research. © 2015, Islamic Azad University (IAU).