(4) ANAIS - Educa����o e Desenvolvimento

Este �� o quarto volume dos Anais da Unidade de Investiga����o Educa����o e Desenvolvimento (UIED) e nele se apresentam as principais publica����es dos diversos programas e linhas de investiga����o referentes �� actividade do ano de 2003. Uma vis��o do ��ndice d�� alguma medida do ��mbito dos trabalhos desenvolvidos nesta unidade e que abrangem novas tend��ncias do pensamento educativo; pol��ticas educativas; educa����o em ci��ncia; educa����o e mundo do trabalho; educa����o e novas tecnologias; educa����o, desenvolvimento pessoal e sucesso acad��mico e educa����o e enfermagem. Uma informa����o complementar sobre a organiza����o da UIED, bem como dos trabalhos de Teses de Doutoramento e de Mestrado realizados no Departamento de Ci��ncias Sociais Aplicadas da Faculdade de Ci��ncias e Tecnologia da Universidade Nova de Lisboa com o apoio de projectos de investiga����o desenvolvidos na Unidade, �� tamb��m inserida neste volume, tal como ocorreu em volumes anteriores. O Coordenador Cient��fico: Prof. Doutor Jos�� Manuel Matos

Ecophysiology of Ruditapes decussatus

The physiological responses of the clam R. decussatus from the Ria Formosa, southern Portugal, were examined in relation to normoxia, hypoxia (11, 6, 3 and 1.2 kPa) and anoxia; acute elevation of temperature (at 20, 27 and 32 ��C), and its effect on the resistance to air exposure (at 20, 28 and 35 ��C); current velocity (0.6, 3, 8 17, 24 and 36 cm. s-1) and turbidity (10, 100 and 300 mg. l-1 dry weight of particulate matter), and the efficiency of this species in retaining particles of different size (at 10 and 100 mg. l-1); and to copper contamination considering both short-term acute exposure to high levels (0.1-10 mg Cu. l-1) and chronic environmental levels (0.01 mg Cu. l-1). Clearance rates, respiration rates, absorption efficiency and excretion rates were assessed through the physiological energetics in terms of the energy budget and scope for growth (SFG). Stress independent respiration rates (R) and clearance rates (CR) were observed in relation to hypoxia down to 12 kPa and 6 kPa, respectively. Anoxic rates were 3.6 % of normoxic rates. Scope for growth was greatly reduced under extreme hypoxia (14 % of SFG in normoxia). Respiration rate was temperature independent in the range 20-32 ��C but the decline in clearance rate resulted in negative SFG at 32 ��C. Gaping during air exposure and the maintenance of faster aerobic metabolism led to 100 % mortality in 20 hours at 35 ��C, 4 days at 28 ��C and 5 days at 20 ��C. Low current velocities (��� 8 cm. s-1) supported high clearance rates. Shear stresses ��� 0.9 Pa induced sediment movement and disturbed the feeding processes resulting in decreased clearance rates (at 36 cm. s-1, is 10 % of maximum CR). The observed ability of jetting out depleted water at a different level than the one of the inhalant current results is an important adaptation of clams to the slow currents of sheltered environments. Ingestion at high seston concentrations (> 100 mg. l-1) is controled by reducing the amount filtered, lowering CR (to 30 % of CR at low seston loads) and producing pseudofeces. Observed efficient retention of particles (70-100 %) in the range 3 to 8 ��m is beneficial when algal cells are diluted by fine silt particles as it is likely to occur in the clams natural environment. R. decussatus in the short term escaped the exposure to copper by valve closure and therefore acute tests are not applicable to adult clams of this species. At environmental levels chronic exposure to copper did not induce lethal effects during the exposure period (20 days), but scope for growth was reduced to c. 30 %, indicating sustained impairment of physiological functions. The sensitivity of the physiological energetics and the integrated scope for growth measurement in assessing stress effects caused by natural environmental factors was highlighted.

Contributo dos m��sculos respirat��rios para a fisiopatologia da hiperc��pnia na doen��a pulmonar cr��nica estabilizada : parte 4 = The role of the respiratory muscles in the pathophisiology of chronic hypercapnia in clinically stable chronic obstructive pulmonary diseases: part 4

Rev Port Pneumol. VII(2): 251-263, 2001

2,4,6- Ttrichloroanisol:a consumer panel evaluation

���Cork taint��� is a major problem in wine industry and is caused by contamination of wines. This contamination is usually attributed to wine cork stoppers and 2,4,6-trichloroanisole (2,4,6-TCA) is one of the compounds mostly associated to this off-flavour. In this work, a consumer panel performed ���forced choice��� triangular tests in order to measure Odour Detection Thresholds (ODT) and Taste Detection Thresholds (TDT) of 2,4,6-TCA in water, hydro-alcoholic solutions (11.5% and 18% ethanol) and white and red wines. A paired preference test was also performed by the panel in order to measure Odour Rejection Threshold (ORT) in white and red wine spiked with 2,4,6-TCA. Results obtained show that the ODT and the TDT for 2,4,6-TCA in water were 0.2 and 0.3 ng/L, respectively. In hydro-alcoholic solutions with 11.5% and 18% ethanol the ODT were 4 and 10 ng/L respectively. In red wine the ODT and the TDT were 0.9 and 1.7 ng/L and in white wine were 1.5 and 1.0 ng/L respectively. ORT for white was 10.4 ng/L and for red wines 16.0 ng/L. These results suggest that although this group of consumers detected very low concentrations of 2,4,6-TCA in wines, they did not reject the wine at these low concentration values.

Valoriza����o de fosfogesso - contributo para a mineraliza����o do cl��nquer

Disserta����o apresentada na Faculdade de Ci��ncia e Tecnologia da Universidade Nova de Lisboa para obten����o do Grau de Mestre em Engenharia de Materiais

Non-volatile analysis in fruits by laser resonant ionization spectrometry: application to resveratrol (3,5,4 -trihydroxystilbene) in grapes

Applied Physics B Lasers and Optics, vol.71

Estudo da biodegrada����o do ��cido 2,4- diclorofenoxiac��tico, um herbicida selectivo amplamente utilizado na agricultura, por uma estirpe de Pen��cillium

Disserta����o apresentada na Faculdade de Ci��ncias e Tecnologia da Universidade Nova de Lisboa para obten����o do Grau de Mestre em Tecnologia e Seguran��a Alimentar

Contribui����o para o tratamento e gest��o das lamas em excesso das esta����es de tratamento de ��guas residuais - caso de estudo de optimiza����o para a 4 Etar do Conselho de Elvas

Disserta����o apresentada na Faculdade de Ci��ncias e Tecnologia da Universidade Nove de Lisboa para a obten����o do grau de Mestre em Engenharia do Ambiente, perfil Engenharia Sanit��ria

Preval��ncia do consumo de drogas il��citas nas For��as Armadas estudo epidemiol��gico num dos ramos

RESUMO: Desde 1976 que as For��as Armadas desenvolvem ac����es de preven����o do consumo de drogas e ��lcool. Na d��cada de 80 foi criada capacidade laboratorial e deu-se in��cio a um programa de rastreios toxicol��gicos. No quinqu��nio 2001 a 2005, as propor����es de resultados positivos, associando todos os tipos de rastreio, variaram entre 3,7% e 1,5%. De Outubro de 2006 a Julho de 2007 realizou-se um estudo anal��tico transversal, para estimar a preval��ncia do consumo de drogas (canabin��ides, opi��ceos, coca��na e anfetaminas) num dos Ramos das For��as Armadas, com base nos despistes realizados pelo seu laborat��rio. Foi utilizada uma amostra aleat��ria simples de 1039 militares, profissionais (QP) e contratados (RC), no activo e de ambos os sexos. Desde a nomea����o dos militares a rastrear, passando pela cadeia de cust��dia das amostras at�� �� obten����o do resultado foi utilizado apoio inform��tico espec��fico. O processo de pesquisa utilizou duas t��cnicas de triagem por imunoensaio e tecnologia de confirma����o por GC/MS, de acordo com as recomenda����es europeias, permitindo estabelecer uma metodologia standard para organiza����es e empresas. A preval��ncia estimada, de consumidores de droga, foi de 3,8/1.000, para um erro de 0,37%. O n��mero de casos registado (4) n��o permitiu a utiliza����o de testes estat��sticos que conduzissem �� identifica����o de caracter��sticas determinantes da positividade, mas n��o deixou de revelar aspectos inesperados. A observa����o de s��ries de casos e a realiza����o regular de estudos epidemiol��gicos, que ajudem a redefinir grupos alvo e a perceber a dimens��o, as determinantes e as consequ��ncias do consumo de drogas �� sugerida, em conclus��o.--------------------------------------- R��SUM��: Depuis 1976, les Forces Arm��es mettent au point des mesures visant �� pr��venir la consommation de drogues et d'alcool. En 1980, fut cr���� capacit�� laboratoriel et ont ensuite commenc�� un programme de d��pistage toxicologique. Au cours des cinq ann��es allant de 2001 �� 2005, les proportions de consommateurs, impliquant tous les types de d��pistage, allaient de 3,7% �� 1,5 %. D'octobre 2006 �� juillet 2007, une ��tude analytique transversale a ��t�� organis��e pour ��valuer la pr��valence de l���usage de drogues (cannabis, opiac��s, coca��ne et amph��tamines) dans une branche de les Forces Arm��es, bas��e sur les d��pistages faites par un laboratoire militaire, �� l'aide d'un ��chantillon al��atoire de 1039 militaires, professionnels (QP) et sous contract (RC), �� l���actif et des deux sexes. Tout au long du proc��s, de la nomination des donneurs, en passant par la chaine de garde des ��chantillons, jusqu����� obtention du r��sultat, il fut employ�� un appui informatique s��curis��. Le processus de recherche employa deux techniques de tri par imunoessay et la technologie de confirmation GC/MS, selon les recommandations europ��ennes, permettant d'��tablir une m��thodologie standard pour les organisations et les entreprises. La pr��valence estim��e fut de 3,8/1.000 pour une marge d���erreur de 0,37%. Le nombre de cas enregistr��s (4) n'autorise pas l'utilisation de testes statistiques de menant �� l'identification de caract��ristiques d��terminant de la positivit��, mais il permet �� r��v��ler des aspects inattendus. L'observation de s��ries de cas et la tenue r��guli��re d�����tudes ��pid��miologiques, qui contribuent �� red��finir les groupes cibles et de comprendre l'ampleur, les d��terminants et les cons��quences de l'usage de drogues, est sugg��r��, en fin de compte.--------------------------------------- ABSTRACT: Since 1976, the Armed Forces, have been developing measures to prevent the use of drugs and alcohol. In 1980, was created laboratory facility which then started a program of toxicological screenings. In the five years running from 2001 to 2005, the proportions of consumers, involving all types of screening, ranged from 3,7% to 1,5%. From October 2006 to July 2007, a cross-sectional study was held to estimate the prevalence of drug use (cannabinoids, opiates, cocaine and amphetamines) in one branch of the Portuguese Armed Forces, based on laboratory screenings, using a random sample of 1039 military, professional (QP) and enlisted (RC), active-duty and of both sexes. Specific computer support was used all the way, from the appointment, including the chain of custody of samples, to the obtaining of the result. The process of search used two techniques for sorting by immunoassay and confirmation technology GC/MS, according to European recommendations, allowing to establish a standard methodology for organizations and companies. The estimated prevalence of drug users was 3.8/1.000 for a 0.37% error (95% confidence interval). The number of cases registered (4) does not permit use of statistical testing leading to the identification of characteristics weighing in the establishing to extrapolate for the population, but it allows revealing unexpected aspects. The observation of series of cases and the regular holding of epidemiological studies, which help redefine target groups and to understand the extent, the determinants and consequences of drug use, is suggested, in conclusion.

O doente com patologia m��ltipla em medicina geral e familiar: comorbilidade de 4 doen��as cr��nicas

RESUMO: A tese de doutoramento visa demonstrar duas proposi����es: a comorbilidade de 4 situa����es de doen��a prevalentes, hipertens��o arterial (HTA), diabetes (DM), doen��a card��aca isqu��mica (DCI) e asma �� um assunto importante em Medicina Geral e Familiar e o seu estudo tem diversas implica����es na forma como os cuidados de sa��de s��o prestados, na sua organiza����o e no ensino-aprendizagem da disciplina. O documento encontra-se dividido em 4 partes: 1) justifica����o do interesse do tema e finalidades da disserta����o; 2) revis��o sistem��tica de literatura publicada entre 1992 e 2002; 3) apresenta����o de dois trabalhos de investiga����o, descritivos e explorat��rios que se debru��am sobre a mesma popula����o de estudo, o primeiro intitulado ���Comorbilidade de quatro doen��as cr��nicas e sua rela����o com factores s��cio demogr��ficos��� e o segundo, ���Diferen��as entre doentes, por m��dico e por sub-regi��o, na comorbilidade de 4 doen��as cr��nicas���; 4) conclus��es e implica����es dos resultados dos estudos na gest��o da pr��tica cl��nica, nos servi��os, no ensino da disciplina da MGF e no desenvolvimento posterior de uma linha de investiga����o nesta ��rea. O primeiro estudo tem como objectivos: descrever a preval��ncia da comorbilidade entre as 4 doen��as-��ndice; verificar se existe rela����o entre o tempo da primeira doen��a e o tempo decorrido at�� ao aparecimento da 2�� e da 3�� doen��a, nas 4 doen��as; determinar a comorbilidade associada ��s 4 doen��as; identificar eventuais agrupamentos de doen��as e verificar se existe rela����o entre comorbilidade e factores sociais e demogr��ficos. O segundo estudo pretende verificar se existem diferen��as na comorbilidade a n��vel local, por m��dico, e por Sub-Regi��o de Sa��de. O trabalho emp��rico �� descritivo e explorat��rio. A popula����o �� constitu��da pelos doentes, com pelo menos uma das 4 doen��as cr��nicas ��ndice, das listas de utentes de 12 M��dicos de Fam��lia a trabalharem em Centros de Sa��de urbanos, suburbanos e rurais dos distritos de Lisboa e Beja. Os dados foram colhidos durante um ano atrav��s dos registos m��dicos. As vari��veis s��cio demogr��ficas estudadas s��o: sexo, idade, etnia/ra��a, escolaridade, situa����o profissional, estado civil, tipo de fam��lia, funcionalidade familiar, condi����es de habita����o. A comorbilidade �� definida pela presen��a de duas ou mais doen��as e estudada pelo n��mero de doen��as coexistentes. O tempo de dura����o da doen��a �� definido como o n��mero de anos decorridos entre o ano de diagn��stico e 2003. Os problemas de sa��de cr��nicos s��o classificados pela ICPC2. Nas compara����es efectuadas aplicaram-se os testes de Mann-Whitney e de Friedman, de homogeneidade e de an��lise de res��duos. A An��lise Classificat��ria Hier��rquica foi utilizada para determinar o agrupamento de doen��as e a An��lise de Regress��o Categ��rica e An��lise de Correspond��ncias na rela����o entre as caracter��sticas s��cio demogr��ficas e a comorbilidade. Identificaram-se 3998 doentes. A idade m��dia �� de 64,3 anos (DP=15,70). H�� uma correla����o positiva significativa (r =0,350 r=0) entre ���anos com a primeira doen��a���e ���idade dos doentes��� em todos os indiv��duos (homens r=0,129 mulheres r=0,231). A comorbilidade entre as quatro doen��as cr��nicas ��ndice est�� presente em 1/3 da popula����o. As associa����es mais prevalentes s��o HTA+DM (14,3%) e HTA+DCI (6,25%). Existe correla����o positiva, expressiva, entre a dura����o da primeira doen��a, quando esta �� a HTA ou a DM, e o intervalo de tempo at�� ao aparecimento da 2�� e da 3�� doen��as. Identificaram-se 18 655 problemas cr��nicos de sa��de que se traduziram em 244 c��digos da ICPC2. O n��mero m��dio de problemas foi de 5,94 (DP=3,04). A idade, a actividade profissional, a funcionalidade familiar e a escolaridade foram as vari��veis que mais contribu��ram para diferenciar os indiv��duos quanto �� comorbilidade. Foram encontradas diferen��as significativas entre m��dicos(c2=1165,368 r=0) e entre os agrupamentos de doentes por Sub-Regi��o de Sa��de (c2= 157,108 r=0) no respeitante �� comorbilidade. Na parti����o por Lisboa o n��mero m��dio de problemas �� de 6,45 e em Beja de 5,35. Deste trabalho ressaltam v��rias consequ��ncias para os profissionais, para os servi��os, para o ensino e para a procura de mais saber nesta ��rea. Os m��dicos, numa gest��o eficiente de cuidados s��o chamados a desempenhar um papel de gestores da complexidade e de coordenadores assim como a trabalhar num modelo organizativo apoiado numa colabora����o em equipa. Por sua vez os servi��os de sa��de t��m que desenvolver medidas de avalia����o de cuidados que integrem a comorbilidade como medida de risco. O contexto social da cronicidade e da comorbilidade dever�� ser inclu��do como ��rea de ensino. A concluir analisa-se o impacto do estudo nos colaboradores e o poss��vel desenvolvimento da investiga����o nesta ��rea.----------------------------------------ABSTRACT: The PhD Thesis has two propositions, co-morbidity of four chronic conditions (hypertension, asthma, diabetes, cardiac ischaemic disease) is a prevalent and complex issue and its study has several implications in the way care is provided and organised as well as in the learning and teaching of the discipline of General Practice. In the first part of the document arguments of different nature are given in order to sustain the dissertation aims; the second part describes a systematic study of literature review from 1992 to 2002; the third presents two research studies "Comorbidity of four chronic diseases and its relation with socio demographic factors��� and ���Differences between patients among GPs at local and regional level���; implications of study results for practice management, teaching and research are presented in the last part. The prevalence of the four chronic diseases co-morbidity, the relation of the first disease duration with the time of diagnose of the next index condition, the burden of co-morbidity in the four chronic diseases, the clustering of those diseases, the relation between demographic and social characteristics and co-morbidity, are the objectives of the first study. The second intends to verify differences in comorbidity between patients at local and regional level of practice. Research studies were descriptive and exploratory. The population under study were patients enlisted in 12 GPs working in urban and rural health centres, in Lisbon and Beja districts, with at least one of the four mentioned diseases. Data were collected through medical records during one year (2003) and 3998 patients were identified. The social demographic variables were: sex, age, ethnicity/race, education, profession, marriage status, family status, family functionality, home living conditions. Co-morbidity is defined by the presence of two or more diseases, and studied by the number of co-existing diseases. The time duration of the disease is defined by the number of years between the diagnostic year and 2003. The chronic disease problems are classified in accord with ICPC2. The characterization of population is descriptive. The effected comparisons applied the Mann-Whitney, Friedman, homogeneity and analysis of residuals tests. The Classificatory Hierarchy Analysis was utilized to determine the grouping of diseases and the Regression Categorization and Correspondences Analysis was used to study the relation of socio-demographic and co-morbidity. The median age of the population under study is 64,3 (SD= 15,70). There is a significant positive correlation (r =0,350 r=0)between ���years with the first disease��� and ���patient age��� for all individuals (men r=0,129 women r=0,231). Co-morbidity of the four index diseases is present in 1/3 of the studied population. The most prevalent associations for the four diseases are HTA+DM (14,03%) and HTA+IHD (6,25%). Expressive positive correlation between the duration of the first disease and the second and the third index disease interval is found. For the 3988 patients, 18 655 chronic health problems, translated in 244 ICPC2 codes, were identified. The mean number of problems is 5,94 (SD=3,04). Age, professional activity, family functionality and education level are the socio demographic characteristics that most contribute to differentiate individuals concerning the overall co-morbidity. Significant differences in co-morbidity between GP patients at local (c2=1165,368 r=0) and regional level (c2= 157,108 r=0) are found. This study has several consequences for professionals, for services, for the teaching and learning of General Practice and for the pursuit of knowledge in this area. New competences and performances have to be implemented. General Practitioners, assuming a role of co-ordination, have to perform the role of complexity managers in patient's care, working in practices supported by a strong team in collaboration with other specialists. In order to assess provided care, services have to develop tools where co-morbidity is included as a risk measure. The social context of comorbidity and chronicity has to be included in the curricula of General Practice learning and teaching areas. The dissertation ends describing the added value to participant's performance for their participation in the research and an agenda for further research, in this area, based on a community of practice.--------R��SUM��:Cette th��se de doctorat pr��tend d��montrer deux postulats : le premier, que la comorbidit�� de quatre maladies fr��quentes, hypertension art��rielle (HTA), diab��te (DM), maladie cardiaque isch��mique (DCI) et asthme, est un th��me important en M��decine G��n��rale et Familiale et que son ��tude a plusieurs implications au niveau de l'approche pour dispenser les soins, de leur organisation et de l'enseignement/apprentissage de la discipline. Le document comprend quatre parties distinctes : 1) justification de l'int��r��t du sujet et objectifs de la dissertation ; 2) ��tude syst��matique de publications ��dit��es entre 1992 et 2002 ; 3) pr��sentation de deux travaux de recherche, descriptifs et exploratoires, un premier intitul��e �� Comorbidit�� de quatre maladies chroniques et leur relation avec des facteurs sociod��mographiques �� et un deuxi��me �� Diff��rences entre malades, selon le m��decin et la sous r��gion, dans la comorbilit�� de quatre maladies chroniques�� ; 4) conclusions et cons��quences des r��sultats des ��tudes dans la gestion de la pratique clinique, dans les services, dans l'enseignement de la discipline de MGF et dans le d��veloppement post��rieur de la recherche dans ce domaine. Les objectifs de la premi��re ��tude sont les suivants : d��crire la pr��valence de la comorbidit�� entre les quatre maladies chroniques, v��rifier s'il existe une relation entre temps de dur��e de la premi��re maladie et l'espace de temps jusqu'�� le diagnostic de la 2��me ou 3��me maladie; d��terminer la comorbidit�� entre les 4 maladies ; identifier d'��ventuelles groupements de maladies et v��rifier s'il existe une relation entre comorbidit�� et facteurs sociod��mographiques. La deuxi��me ��tude pr��tend v��rifier s'il existe des diff��rences de comorbidit�� entre m��decins et par groupement r��gional. Le travail empirique est descriptif et exploratoire. La population est compos��e des malades ayant au moins une des quatre maladies chroniques parmi les listes de malades de douze M��decins de Famille qui travaillent dans des Centres de Sant�� urbains, suburbains et ruraux (Districts de Lisbonne et Beja). Les donn��es ont ��t�� extraites pendant l'ann��e 2003 des registres des m��decins. Les variables sociod��mographiques ��tudi��es sont : le sexe, l'��ge, l'ethnie/race, la scolarit��, la situation professionnelle, l'��tat civil, le type de famille, sa fonctionnalit��, les conditions de logement. La comorbidit�� est d��finie lorsqu'il existe deux ou plusieurs maladies et est ��tudi��e d'apr��s le nombre de maladies coexistantes. La dur��e de la maladie est ��tablie en comptant le nombre d'ann��es ��coul��es entre le diagnostique et 2003. Les probl��mes de sant�� chroniques sont class��s par l'ICPC 2. Pour les comparaisons les tests de Mann-Whitney et Friedman, de homog��n��it�� et analyse de r��sidues ont ��t�� appliqu��s. L'Analyse de Classification Hi��rarchique a ��t�� utilis��e pour proc��der au regroupement des maladies et l'Analyse de R��gression Cat��gorique et l'Analyse de Correspondances pour ��tudier la relation entre les caract��ristiques sociod��mographiques et la comorbilit��. Les principaux r��sultats sont les suivants : les 3998 malades identifi��s ont 64,3 ans d'��ge moyen (DP=15,70). Il existe une corr��lation positive significative (r =0,350 r=0) entre �� les ann��es avec la premi��re maladie �� et �� l'��ge des malades ��, chez tous les individus (hommes r=0,129 femmes r=0,231). La comorbidit�� entre les quatre maladies chroniques est une r��alit�� chez 1/3 des patients. Les associations les plus fr��quentes sont HTA+DM (14%) et HTA+DCI (6,25%). Il existe une corr��lation positive significative entre la dur��e de la premi��re maladie, HTA ou DM, et l'��cart jusqu'�� l'apparition de la deuxi��me et de la troisi��me maladie. Chez les malades, 18.655 probl��mes chroniques de sant�� ont ��t�� identifi��s et traduits en 244 codes de l'ICPC2. La moyenne des probl��mes a ��t�� de 5,94 (DP=3,04). L'��ge, l'activit�� professionnelle, la fonctionnalit�� familiale et la scolarit�� sont les variables qui ont le plus contribu�� �� diff��rencier les individus face �� la comorbilit��. Des diff��rences notoires ont ��t�� trouv��es entre m��decins (c2=1165,368 r=0) et entre les groupements r��gionaux (c2=157,108 r=0) en ce qui concerne la comorbidit��. Dans le groupe de patients de Lisbonne, le chiffre moyen de probl��mes est de 6,45 et �� Beja il est de 5,35. Cette ��tude met en ��vidence plusieurs cons��quences pour les professionnels, les services, l'enseignement et l'��largissement du savoir dans ce domaine. Les m��decins, soucieux de g��rer efficacement les soins sont appel��s �� jouer un r��le de gestionnaires de la complexit�� et de coordinateurs, de m��me qu'�� travailler dans un mod��le d'organisation soutenus par un travail d'��quipe. D'autre part, les services de sant�� doivent eux aussi d��velopper des mesures d'��valuation des soins qui int��grent la comorbidit�� comme mesure de risque. Le contexte social de la chronicit�� et de la comorbidit�� devra ��tre inclus comme domaines �� ��tudier. La fin de cette th��se d��crit l'impact de cette ��tude sur les collaborateurs et le d��veloppement futur de la recherche dans ce domaine.

Sonatas em trio. Transcri����o e estudo do manuscrito P-VV G pr��tica 118.4

Disserta����o apresentada para cumprimento dos requisitos necess��rios �� obten����o do grau de Mestre em Ci��ncias Musicais (ramo de Musicologia Hist��rica).

Desigualdades socioecon��micas na doen��a cardiovascular em Portugal : estudo baseado no 4�� Inqu��rito Nacional de Sa��de

RESUMO - Em Portugal, as doen��as cardiovasculares (DCV), incluindo o acidente vascular cerebral (AVC) e a doen��a card��aca isqu��mica (DCI), s��o das principais causas de morbi-mortalidade e invalidez. Sabe-se que o n��vel socioecon��mico (NSE) influencia o estado de sa��de, todavia s��o escassas as evid��ncias sobre as desigualdades socioecon��micas na DCV em Portugal. O objectivo deste estudo foi analisar a distribui����o da DCV de acordo com o NSE na popula����o portuguesa. Foi realizado um estudo transversal explorat��rio-descritivo usando a base de dados do 4�� Inqu��rito Nacional de Sa��de, 2005/06. As desigualdades socioecon��micas nas DCV, AVC e DCI, factores de risco [sedentarismo, hipertens��o arterial (HTA), diabetes mellitus (DM), tabagismo, obesidade e sofrimento psicol��gico (Mental Health Inventory ��� 52)] e n��mero de consultas m��dicas, foram analisadas atrav��s dos odds ratio por NSE (rendimento familiar equivalente, escala modificada da OCDE) com intervalo de confian��a de 95% e dos ��ndices e curvas de concentra����o. Dos 21 807 indiv��duos, 53,34% s��o do sexo feminino, a idade m��dia �� de 54��11 e entre 35 e 74 anos. A DCV, a DCI, o AVC, a HTA, a DM e a obesidade est��o associados com NSE mais baixos, o tabagismo est�� associado aos NSE mais elevados, enquanto o sedentarismo, o n��mero de consultas m��dicas e o sofrimento psicol��gico n��o apresentam associa����o significativa com o NSE. Os resultados revelam a associa����o entre os estilos de vida, morbilidade e NSE e demonstram que s��o necess��rias pol��ticas de sa��de mais abrangentes, de acordo com as caracter��sticas individuais, culturais e socioecon��micas e dirigidas �� promo����o da sa��de e preven����o da doen��a. -------------------------------------------- ABSTRACT - Cardiovascular diseases (CVD), including stroke and ischemic heart disease (IHD), are the leading causes of morbidity, mortality and disability in Portugal. It is known that socioeconomic status (SES) influences health status; however there is little evidence about socioeconomic inequalities in CVD in Portugal. The aim of this study was to analyze the distribution of CVD according to SES in the Portuguese population. We conducted a cross-sectional descriptive exploratory study using the database of the 4th National Survey of Health, 2005/06. Socioeconomic inequalities in CVD, stroke, IHD, risk factors [physical inactivity, arterial hypertension (AHT), diabetes mellitus (DM), smoking, obesity and psychological distress (Mental Health Inventory ��� 52)], as well as the number of medical visits, were analyzed by SES (family income using the OECD modified equivalent scale) using odds ratio (confidence interval = 95%), and concentration curves and indices. Of the 21 807 individuals, 53.34% are female, aged between 35 and 74 with mean 54 �� 11 years. CVD, IHD, stroke, AHT, MD and obesity are associated with lower SES, smoking is associated with higher SES, while physical inactivity, number of medical visits and psychological distress showed no significant association with SES. Results suggest an association between lifestyle, morbidity and SES. They also demonstrate the need for comprehensive health strategies, involving health promotion and disease prevention, that incorporate individual, cultural and socioeconomic characteristics.

Bionanoconjugados de Citocromo Tri- h��mico e nanopart��culas de Ouro para biorremedia����o de Cr(VI)

Disserta����o para a obten����o do grau de Mestre em Biotecnologia

Aplica����o de biofilmes de quitosano e de atmosfera modificada na conserva����o de p��ra Rocha de 4�� Gama

Disserta����o para obten����o do Grau de Mestre em Tecnologia e Seguran��a Alimentar na ��rea de especializa����o de Qualidade Alimentar