Efetividade da intervenção conservadora e de um programa de exercício físico no solo na osteoartrose do joelho

RESUMO: Objectivo: O estudo do efeito da fisioterapia e do exercício em diversos indicadores relacionados com a osteoartrose do joelho tem evidenciado efeitos benéficos em utentes com esta condição. Nesta sequência, pretendeu-se avaliar a efetividade da intervenção conservadora em conjunto com um programa de exercícios ao nível da dor, rigidez, amplitude articular, função física e qualidade de vida em utentes com osteoatrose do joelho a curto prazo, quando comparado com a intervenção recomendada. A prática clínica atual em Portugal, sob prescrição, desenvolve-se de acordo com o padrão que se pretende investigar. Metodologia: Trata-se de um estudo quasi-experimental controlado e sem aleatorização. Os utentes da Clínica FPM (n=20; 35,0% homens, 65,0% mulheres) sujeitos à intervenção conservadora (calor húmido, ultra-som e massagem) em conjunto com um programa de exercício no solo, durante um período de 4 semanas com frequência diária, integram o grupo experimental e os utentes inscritos no programa de exercício a solo do “Viver Activo” no Leirisport (n=21; 23,8% homens, 76,2% mulheres), num período de 8 semanas com frequência bi-semanal são considerados como grupo de controlo. Os instrumentos de medida aplicados foram o Knee Outcome Osteoarthritis Score (KOOS) para os outcomes dor, rigidez, função física e qualidade de vida e a goniometria para a amplitude articular. Resultados: Em ambos os grupos foram observados aumentos significativos em todos os outcomes avaliados pelo KOOS (dor, rigidez, função física e qualidade de vida) e pela goniometria (amplitude articular) num período de 4 e 8 semanas. Quando comparada a evolução do grupo experimental com a do grupo controlo, verifica-se que as diferenças significativas ocorrem na flexão (p <0,05) (maior evolução para o grupo experimental), e na dor (p <0,05) (maior evolução para o grupo controlo). Nos outcomes rigidez, função física e qualidade de vida foi ainda possível identificar resultados positivos que sugerem possíveis benefícios da intervenção em grupo para os sujeitos a ela submetidos. Discussão e Conclusão: Estes resultados sugerem que a intervenção clínica individualizada é mais efectiva do que a intervenção em grupo no aumento da amplitude articular do joelho em utentes com osteoartrose a curto prazo. No entanto, para os outcomes dor, rigidez, função física e qualidade de vida, a intervenção em grupo parece ser clinicamente e estatisticamente melhor. A relevância deste estudo afirma-se ao demonstrar que utentes com osteoartrose do joelho que integrem um programa de exercício em grupo beneficiam de melhorias importantes. Ao adicionar sessões de fisioterapia para realização de intervenção conservadora individualizada e exercícios supervisionados agrega um maior alívio sintomático.-------- ABSTRACT: Study of physical therapy and exercise into several indicators associated to knee osteoarthritis has shown positive effects in subjects within this condition. According to the study it has been evaluated the effectiveness of a conservative intervention along with a exercise program directed to pain, stiffness, range of motion, physical function and quality of life of patients with knee osteoarthritis in a short term when compared with the recommended intervention. Under prescription the current clinical practice in Portugal is developed according to the pattern to investigate. Methodology: This is a quasi-experimental controlled study without randomization. The subjects of FPM Clinic (n= 20, 35.0% men, 65.0% women) were submitted to the conservative intervention (hot pack, ultrasound and massage) with a land exercise program during a 4 week-period (all-weekly) were assigned in the experimental group. Patients signed in the land exercise program of "Active Living" in Leirisport (n = 21, 23.8% men, 76.2% women) a 8 week-period (bi-weekly) were assigned as control group. Outcomes were measured by the Knee Outcome Osteoarthritis Score (KOOS) for pain, stiffness, physical function and quality of life. Goniometry was used for range of motion. Results: Both treatment groups obtained successful outcomes measured by significant reductions in KOOS scores and improvement in goniometry in a 4 and 8-week period. When compared the evolution of the experimental group with the control group it appears that significant differences occur in the range of motion (p <0.05) (further progress in the experimental group), and pain (p <0.05) (further evolution for the control group). In outcomes stiffness, physical function and quality of life was possible to identify positive results that suggest potential benefits of intervention for the submitted subjects. Discussion and Conclusion: These results suggest that individualized clinical intervention is more effective than group intervention in range of motion improving in patients with knee osteoarthritis in a 4-week period. However outcomes for pain, stiffness, physical function and quality of life appear to be clinically and statistically better for the group intervention. The significance of this study is essencial because it demonstrates that patients with knee osteoarthritis who incorporate an exercise program in group reveal improvements. When adding physical therapy sessions with individual conservative intervention and supervised exercises the result is an improvement of symptomatic relief.

Efectividade de um programa de exercício aquático na osteoartrose do joelho

RESUMO: A osteoartrose do joelho é uma condição clínica cuja prevalência tem aumentado nos últimos anos na população idosa. Trata-se de uma condição que pode ser bastante incapacitante para o idoso, gerando um forte impacto social e económico. O exercício aquático tem sido identificado como um factor de promoção da melhoria do quadro clínico nesta população, mas a sua efectividade não está, ainda, determinada. Objectivo: investigar a efectividade, a curto e médio prazo, de um programa de exercício aquático, realizado em grupo, com a duração de 8 semanas, na amplitude articular, dor e rigidez do joelho, e na função física e qualidade de vida, em idosos com osteoartrose do joelho. Metodologia: Recorreu-se a um estudo quase-experimental, double-blind, controlado, sem aleatorização, cuja amostra, constituída por 43 sujeitos, foi selecionada por conveniência. Os sujeitos do grupo experimental (n=22) foram submetidos ao programa de exercício aquático e os do grupo de controlo (n=21) foram submetidos ao programa de exercício no solo. Ambos os programas foram definidos de acordo com as recomendações internacionais para a prática de exercício físico em idosos com osteoartrose (Arthritis Foundation, 2009a, 2009b). Todo o grupo foi avaliado no início do programa, no final do mesmo (8 semanas) e após 6 semanas de follow-up, nos seguintes indicadores: amplitude articular do joelho (através do goniómetro), dor, rigidez, função e qualidade de vida (através do KOOS). Resultados: A amostra deste estudo foi constituída por sujeitos maioritariamente do género feminino (76,7%), com uma média de 72,7 anos (DP=5,49). O programa de exercício aquático implementado demonstrou um aumento da amplitude articular passiva de flexão (p<0,0001) e extensão (p=0,016) do joelho, uma diminuição da dor e da rigidez articular (p<0,0001), um aumento da função nas AVD’s (p<0,0001) e no desporto/lazer (p=0,031), e ainda, um aumento da qualidade de vida (p<0,0001). Contudo, apenas os níveis de amplitude articular passiva de extensão do joelho (p=0,083) e de função no desporto/lazer (p=0,244) se mantiveram ao longo das seis semanas de follow-up. Conclusões: Apesar de algumas limitações, considera-se que este estudo é de grande importância para a comunidade científica e para os fisioterapeutas preocupados com a crescente prevalência da osteoartrose e dos custos associados. O exercício aquático parece ser uma estratégia importante na melhoria do estado de saúde dos idosos com osteoartrose do joelho.----------------- ABSTRACT: The osteoarthritis of the knee is a clinical condition that has been increasing among the elderly population over the past few years. It’s a condition that can be fairly disabling to the elderly individual, and which generates a strong social and economic impact. Aquatic exercise has been named as a promotional factor in the improvement of the clinical picture in this population, but its effectiveness is yet to be determined. Objective: To investigate the effectiveness, in a short and medium term, of an aquatic exercise program undertaken by a group over eight weeks, in the joint amplitude, pain and stiffness of the knee, and in the physical function and quality of life in elderly people who suffer from knee osteoarthritis. Methodology: was used a double-blind, quasi-experimental study with no randomization and its 43 subjects were selected as a matter of convenience. The subjects of the experimental group (n=22) were subjected to an aquatic exercise program and those of the control group (n=21) were subjected to a land-based exercise program. Both programs have followed international recommendations on the practice of physical exercise in elderly people who suffer from osteoarthritis (Arthritis Foundation, 2009a, 2009b). The entire group was evaluated in the beginning and at the end of the program (8 weeks later), and after a 6 week follow-up, in these parameters: knee range of motion (through a goniometer), pain, stiffness, function and quality of life (through KOOS). Results: This sample was predominantly female (76,7%) with a mean age of 72,7 years (SD=5,49). Aquatic exercise resulted in increase of passive joint flexion (p<0,0001) and knee extension (p=0,016), in the decline of pain and stiffness (p<0,0001), in the increase of function in the ADLs (p<0,0001). However, only the knee extension amplitude (p=0,083) and the function in sports/leisure (p=0,244) were kept through the six-week follow-up. Conclusions: Despite some limitations, this study is of great importance to the community and to the physiotherapists concerned with the growing prevalence of osteoarthritis and the associated costs. Aquatic exercise appears to be an important strategy in the improvement of the health condition of patients who suffer from knee osteoarthritis.

EDP InovCity: Electricity feedback with smart meters through tv

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Long-term behaviour of railway transitions under dynamic loading application to soft soil sites

Dissertação para obtenção do Grau de Doutor em Engenharia Civil

Design of future distribution grids

Dissertação para obtenção do Grau de Mestre em Engenharia Electrotécnica e de Computadores

Functional and structural studies of two enzymes: membrane bound kinase and Z-DNA/Z-RNA-binding protein

Dissertação para obtenção do Grau de Doutor em Sistemas de Bioengenharia

Vodafone - Kabel Deutschland Merger

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Finance from the NOVA – School of Business and Economics

Wound Healing: a genetic approach in Drosophila

The wound healing response is an essential mechanism to maintain the integrity of epithelia and protect all organisms from the surrounding milieu. In the “purse-string” mechanism of wound closure, an injured epithelial sheet cinches its hole closed via an intercellular contractile actomyosin cable.(...)

Contratos de prestação de serviços de comunicações electrónicas

The object of this dissertation is the analysis of the legal framework applicable to contracts for provision of electronic communications services, while trying to offer solutions to some of the issues regarding this matter. The main focus of this study will be the rules concerning service’s suspension, which have been recently amended. The technological development and the establishment of these services as information transmitters and work tools were noteworthy for its growing importance at the present time. These services include cable television, telephone (landline and mobile) and internet and they are regulated by Law nr 23/96, July 26th, along with other essential public services. Said law sets a group of principles and duties, such as good faith (article 3), continuity and quality of the service (article 7) and the duty to rightfully inform the user (article 4), in order to protect the users. For the analysis of legal framework applicable to these particular contracts it is also fundamental to mention Law nr 5/2004, February 10th, known as Electronic Communications Law. The provisions regarding the service’s suspension are currently prescribed in articles 52.º and 52.º-A of the law. Given the amendments introduced by Law nr 10/2013, January 28th, consumers are subjected to a regulation different from the one applicable to the other users, established in the new article 52.º-A. From our analysis, we have concluded that the main change from past provisions has to do with the automatic termination of the contract as consequence of the consumer’s failure to pay the price or to conclude a written payment arrangement after service’s suspension.

The Environmental History of Cetaceans in Portugal: Ten Centuries of Whale and Dolphin Records

The history between cetaceans and humans is documented throughout time not only in reports, descriptions, and tales but also in legal documents, laws and regulations, and tithes. This wealth of information comes from the easy spotting and identification of individuals due to their large size, surface breathing, and conspicuous above water behaviour. This work is based on historical sources and accounts accounting for cetacean presence for the period between the 12th and 17th centuries, as well as scientific articles, newspapers, illustrations, maps, non-published scientific reports, and other grey literature from the 18th century onwards. Information on whale use in Portugal's mainland has been found since as early as the 12th century and has continued to be created throughout time. No certainty can be given for medieval and earlier events, but both scavenging of stranded whales or use of captured ones may have happened. There is an increasing number of accounts of sighted, stranded, used, or captured cetaceans throughout centuries which is clearly associated with a growing effort towards the study of these animals. Scientific Latin species denominations only started to be registered from the 18th century onwards, as a consequence of the evolution of natural sciences in Portugal and increasing interest from zoologists. After the 19th century, a larger number of observations were recorded, and from the 20th century to the present day, regular scientific records have been collected. Research on the environmental history of cetaceans in Portugal shows a several-centuries-old exploitation of whales and dolphins, as resources mainly for human consumption, followed in later centuries by descriptions of natural history documenting strandings and at sea encounters. Most cetaceans species currently thought to be present in Portuguese mainland waters were at some point historically recorded.

Study of Helium II heat transport phenomena in superconducting rutherford type cables

This thesis is a study of how heat is transported in non-steady-state conditions from a superconducting Rutherford cable to a bath of superfluid helium (He II). The same type of superconducting cable is used in the dipole magnets of the Large Hadron Collider (LHC). The dipole magnets of the LHC are immersed in a bath of He II at 1.9 K. At this temperature helium has an extremely high thermal conductivity. During operation, heat needs to be efficiently extracted from the dipole magnets to keep their superconducting state. The thermal stability of the magnets is crucial for the operation of the LHC, therefore it is necessary to understand how heat is transported from the superconducting cables to the He II bath. In He II the heat transfer can be described by the Landau regime or by the Gorter-Mellink regime, depending on the heat flux. In this thesis both measurements and numerical simulation have been performed to study the heat transfer in the two regimes. A temperature increase of 8 2 mK of the superconducting cables was successfully measured experimentally. A new numerical model that covers the two heat transfer regimes has been developed. The numerical model has been validated by comparison with existing experimental data. A comparison is made between the measurements and the numerical results obtained with the developed model.

EDP inovcity: Electricity feedback with smart meters through TV

In this work project I propose an innovative service – Electricity Feedback with Smart Meters through TV – to be considered as an additional test in the residential electricity use feedback trials currently being conducted in EDP’s InovCity project. My proposal is based on relevant past and current research studies, both Portuguese and international, which explain and support the proposed operationalization and characteristics of this new service. Furthermore, a careful analysis about the segmentation framing, the best market entry strategy and the consequences of adopting a joint venture with cable TV operators, is also provided. Finally, I present a SWOT analysis and highlight critical issues affecting the effectiveness of feedback which require further research.

Damage propagation in composite Materials meso-mechanical models

Composite materials have a complex behavior, which is difficult to predict under different types of loads. In the course of this dissertation a methodology was developed to predict failure and damage propagation of composite material specimens. This methodology uses finite element numerical models created with Ansys and Matlab softwares. The methodology is able to perform an incremental-iterative analysis, which increases, gradually, the load applied to the specimen. Several structural failure phenomena are considered, such as fiber and/or matrix failure, delamination or shear plasticity. Failure criteria based on element stresses were implemented and a procedure to reduce the stiffness of the failed elements was prepared. The material used in this dissertation consist of a spread tow carbon fabric with a 0°/90° arrangement and the main numerical model analyzed is a 26-plies specimen under compression loads. Numerical results were compared with the results of specimens tested experimentally, whose mechanical properties are unknown, knowing only the geometry of the specimen. The material properties of the numerical model were adjusted in the course of this dissertation, in order to find the lowest difference between the numerical and experimental results with an error lower than 5% (it was performed the numerical model identification based on the experimental results).

Contratos de prestação de serviços de comunicações electrónicas

The object of this dissertation is the analysis of the legal framework applicable to contracts for provision of electronic communications services, while trying to offer solutions to some of the issues regarding this matter. The main focus of this study will be the rules concerning service’s suspension, which have been recently amended. The technological development and the establishment of these services as information transmitters and work tools were noteworthy for its growing importance at the present time. These services include cable television, telephone (landline and mobile) and internet and they are regulated by Law nr 23/96, July 26th, along with other essential public services. Said law sets a group of principles and duties, such as good faith (article 3), continuity and quality of the service (article 7) and the duty to rightfully inform the user (article 4), in order to protect the users. For the analysis of legal framework applicable to these particular contracts it is also fundamental to mention Law nr 5/2004, February 10th, known as Electronic Communications Law. The provisions regarding the service’s suspension are currently prescribed in articles 52.º and 52.º-A of the law. Given the amendments introduced by Law nr 10/2013, January 28th, consumers are subjected to a regulation different from the one applicable to the other users, established in the new article 52.º-A. From our analysis, we have concluded that the main change from past provisions has to do with the automatic termination of the contract as consequence of the consumer’s failure to pay the price or to conclude a written payment arrangement after service’s suspension.

PT Multimedia

The purpose of the present case – and accompanying Teaching Notes – is to better understand the spin-off of PT Multimédia, by Portugal Telecom, after receiving a Public Takeover Offer from Sonaecom, in 2006. The Government and the Competition Authority had never looked in a serious way at PT’s dominant position and the lack of room for competition in the TMT sector – PT was the owner of both the cable and copper networks, having access to privileged information from its competitors with control over the wholesale and retail businesses. In 2006, the company received a takeover offer from Sonaecom, the TMT subsidiary from the Portuguese conglomerate Sonae. The offer was voted and rejected by a majority of PT shareholders, but the whole process triggered several recommendations from the regulatory bodies. As a result, PT divested its cable business with the spin-off of PT Multimédia, giving birth to a new competitor and a totally different landscape in the telecommunications sector in Portugal.