79 resultados para Rural et urbain


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Les résultats des études PISA – aussi bien en ce qui concerne celle de 2000 comme celle de 2003 - n’ont guêre été satisfaisants pour de nombreux pays de l’OCDE (ce n’est pas le cas pour la Belgique!). Par exemple Portugal, s’il présente des résultats comparables à la moyenne des pays européens ou même supérieurs pour la région de Lisbonne et la vallée du Tage, présente des résultats inférieurs pour l’ensemble du territoire. La Suisse est, curieusement, un autre pays qui se situe en deçà des expectatives. Selon le rapport 2003 (Ramalho, 2004 :50), les études comparatives en littéracie (lecture) et en numéracie n’ont pas démontré de différence significative par rapport aux résultats de 2000. Nous avons pris connaissance d’une étude suisse qui avait pris pour point de départ des résultats également défavorables, pour ce pays, au même rapport PISA : cette recherche analyse l’insertion socio-économique des familles comme également l’influence des transmissions familiales sur les parcours scolaires des élèves.

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Doutoramento em Conservação e Restauro, especialidade Teoria, História e Técnicas

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Espaces et sociétés, N.79, modes de vie et société portugaise, pág. 93-106

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The synthetic study of the uppermost Cretaceous of the Beira Litoral (fauna, floral confirms its upper Campanian-Maastrichtian age. It shows the presence of a tropical to subtropical climate in an area constituted by a low coastal plain only occasionally linked to the sea, saturared with fresh water and possessing accordingly, a predominantely freshwater fauna (Viso, Aveiro); this plain changed towards the interior into a drier more forested zone with a more abundant terrestrial fauna which includes mammals (Taveiro). A thorough study of the chelonian Rosasia, abundant on the coastal plain, was made possible thanks to the discovery of a skull: it demonstrates that the genus belongs to the family Bothremydidae, revalided here. The composition of this family is presented, its phylogenetic and paleobiogeographic relation with the other pleurodires are analyzed, and its diagnosis established. The family is constituted of three groups; Rosasia belongs to one of rhese, the Bothremys group.

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Cabatuquila conglomerate ferricrete (Malanje Province, located North Central Angola) corresponds to a thick (1O-15m) and hardcornice at the top of "Baixa de Cassanje" escarpment. "Baixa de Cassanje" is a large graben part of South Congo basin. Cabatuquila conglomerate ferricrete seems to correspond to a Plio-Pleistocene morphology which has already disappeared. Laterization dynamics and ferricrete formation processes took place on the Tertiary surface, before being tilted to the Congo Basin. Materials submitted to these processes are mainly alluvial deposits from a pre-Cuanza drainage system. This drainage system flowed to the North before being captured to the Atlantic, as a consequence of the movement which deformed the Tertiary surface during the Pleistocene. The erosion dynamics, which created the Cassanje depression, has occurred after the late Tertiary surface deformation. That dynamics might be related to the Cuango drainage system, which was reorganized after that deformation.

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The study of new abundant coral crops and a systematic revision of the historie collections allow us to extend significantly the data about the Upper Oligocene and Miocene Scleractinia of the French atlantic basins. The SW and W-NW France faunas have been considered, and complete lists of the different defined taxa are presented. The general lines of the evolution of this group are specified, and linked to the paleoclimatic and paleobiogeographic changes.

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The Quaternary fluvial formations of the Doukkala plain are, until now, slightly studied. Our study has allowed to precise that the fluvial terraces of the oued "the Ourn Rbia oued", are clearly distinguished from the secondary oueds terraces by the dynamic deposit of the alluvial materials. Moreover, the mammal fossils recolted from some of these terraces allow to review the ages attributed by Gigout (1951).

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The Domerian sections from the Lusitanian Basin of São Pedro de Muel, Rabaçal and Tomar have provided us with more than 1100 Ostracods belonging from 18 genus and about 48 species. The faunal diversity and density of the associations decrease in space (from Tomar to Rabaçal and São Pedro de Muel) and time, with favourable environments for the proliferation of Ostracods at the lower part of the sections (Stokesi subzone) and more hostile at the upper part (Ragazzonii subzone). The Monestieri and Nitescens horizons and the Subnodosus subzone are characterized by a typical assemblage of Ostracods. The palaeoecological Ostracod indexes reveal the fluctuations of the oxygenation, temperature, depth and hydrodynamism of the water, on the different sections and on the whole platform. They display a diachronous cooling in the Lower Domerian series. In the upper part of the Middle and in the Upper Domerian, the deeper, less oxygenated and cooler waters prevent the development of the Ostracod faunas.

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Several Lower and Middle Miocene localities in the Lower Tagus basin near Lisbon yielded Latidae fragmentary remnants. No really decisive character has been recognized that would allow us to state these remnants could surely be ascribed to the genus Lates Cuv. & Val., although we regard this as nearly certain. There are some differences between the Miocene latidae under study and the type species Lates niloticus L. this suggests us to report the concerned remnants to a Lates (?) sp. that could belong to a new, hitherto undescribed species. The occurrence of Lates in fluviatile or lagoonal beds in the Lower Tagus basin Miocene series is not at all surprising under a paleoeciological view point. Even less if account is taken of the presence in the same levels of Siluriforms remnants belonging to Bagridae and Ariidae, two families that are well represented in Africa. Bagrid spines have been found at Quinta das Pedreiras in association with Lates (?) sp. remnants. The Lates (?) sp. discovery in the Lower and Middle Miocene from the Lower Tagus basin results in extending to the West this genus' biogeographic distribution. It is indeed the first discovery of this genus on Europe's Atlantic coasts. No matter which was the geographic origin of these fishes, they had to migrate several hundreds of kilometers through marine waters before entering the Tagus' estuary. The association of Lates (?) sp. remnants with Siluriform ones that have an extant, broad repartition in Africa south of the Sahara points out to an African origin. These thermophyll fishes imigration along the Atlantic coasts from lberian Peninsula probably has been possible owing to a warm climatic event that allowed them to migrate ca. 5 degrees (in latitude) northwards in Burdigalian times.

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A distal part of tibiotarsus from Charneca do Lumiar (Langhian, MN5) is identified as Palaeoperdix media, formerly known as Miophasianus medius. This species is thus known on a large area of the Palearctic province, from Portugal to Poland, and from the beginning of the Middle Miocene (MN 5) to the beginning of the Upper Miocene (MN9). An indeterminate, Gruid from Quinta das Pedreiras (Lower Langhian, MN4) and a few marine birds' remnants from Penedo Norte (Burdigalian) have been recognized.

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The geological sections studied at the São Gião sector (Cantanhede region) have allowed the establishment of a clear succession of ammonite associations during the Middle and Upper Toarcian (“Margas calcárias de São Gião” and “Calcários margosos de Póvoa da Lomba” Formations). The fossil collections were gathered over the last 40 years and, in spite of the apparent facies monotony, come from a thick and fossiliferous marly-limestone unit. The ammonite succession allows the establishment and/or verification of a certain number of biostratigraphical elements, of which are worthy of mention: – the tethyan character of the fauna from the Gradata to the Meneghinii Zones; this differentiation starts with the occurrence of Collina, Crassiceras and Furloceras of the Gradata Zone; – the succession of Osperleioceras, with the connection between the “caussenardes”(O. reynesi, O. authelini) forms and those from Algeria (O. nadorense, O. matteii), which is placed at the beginning of the Aalensis Zone; – the succession of Hammatoceratinae: H. roubanense (Gradata Z.), H. bonarellii (Bonarellii Z.), H. speciosum (Speciosum Sub-zone), followed by Crestaites meneghinii (Reynesi Sub-zone and Meneghinii Z.); Pseudaptetoceras appear next (Aalensis Zone). The dynamic evolution of the sector is characterized by the persistence of marly sedimentation during the Meneghinii Zone, in probable relation to the paleostructural play of the Arunca-Montemor meridian axis.

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From an early age Henri Tintant was conforted with the problematic relationships between Science and Faith. After a traditional religious education, he took responsabilities within groups of teenagers and adults through scouting and the J. E. C. (an organisation of catholic students). In 1940 he was at Montpellier distributing unauthorised leaflets defending religious faith. But more significant is his intellectual contribution. He was an active and inspiring member of several workshops and in one in particumar initiated by the Catholic University of Lyon entitled : "From Naturalist to Theologians" where he would start a very fruitful and compelling intellectual collaboration with Father Gustave Martelet a jesuit theologian and a strong supporter of a permanent dialog with the scientists. Throughout the years they will gradually come to the conclusion of a necessary synergy between the scientific and the theologic approach when dealing with the mystery of religious faith . Even in the last months of his life, Henri Tintant was writing to his friendon the subject, with the same profound religious faith that brought him the serenity and the open mindness he has showed throughout his teaching and scientific career. His legacy will remain in two of his last thoughts: "Almost 50 years of scientific research have brought me a lot of pleausures and satisfactions but no answer to the essential questions. In my personal case, science and researching have not driven me away from my religious faith, on the contrary the helped me in my awareness of its utmost necessity". "Faithful to my religious belief, I am convinced that with the death, the inevitable human destiny, not everything disapears completely but another form of live, unimaginable for our limited minds, emerges, bearing in itself the perfect realization of all our hopes and desires".

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Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Terminologia

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Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Ordenamento do Território e Planeamento Ambiental

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RESUMO: A tese de doutoramento visa demonstrar duas proposições: a comorbilidade de 4 situações de doença prevalentes, hipertensão arterial (HTA), diabetes (DM), doença cardíaca isquémica (DCI) e asma é um assunto importante em Medicina Geral e Familiar e o seu estudo tem diversas implicações na forma como os cuidados de saúde são prestados, na sua organização e no ensino-aprendizagem da disciplina. O documento encontra-se dividido em 4 partes: 1) justificação do interesse do tema e finalidades da dissertação; 2) revisão sistemática de literatura publicada entre 1992 e 2002; 3) apresentação de dois trabalhos de investigação, descritivos e exploratórios que se debruçam sobre a mesma população de estudo, o primeiro intitulado “Comorbilidade de quatro doenças crónicas e sua relação com factores sócio demográficos” e o segundo, “Diferenças entre doentes, por médico e por sub-região, na comorbilidade de 4 doenças crónicas”; 4) conclusões e implicações dos resultados dos estudos na gestão da prática clínica, nos serviços, no ensino da disciplina da MGF e no desenvolvimento posterior de uma linha de investigação nesta área. O primeiro estudo tem como objectivos: descrever a prevalência da comorbilidade entre as 4 doenças-índice; verificar se existe relação entre o tempo da primeira doença e o tempo decorrido até ao aparecimento da 2ª e da 3ª doença, nas 4 doenças; determinar a comorbilidade associada às 4 doenças; identificar eventuais agrupamentos de doenças e verificar se existe relação entre comorbilidade e factores sociais e demográficos. O segundo estudo pretende verificar se existem diferenças na comorbilidade a nível local, por médico, e por Sub-Região de Saúde. O trabalho empírico é descritivo e exploratório. A população é constituída pelos doentes, com pelo menos uma das 4 doenças crónicas índice, das listas de utentes de 12 Médicos de Família a trabalharem em Centros de Saúde urbanos, suburbanos e rurais dos distritos de Lisboa e Beja. Os dados foram colhidos durante um ano através dos registos médicos. As variáveis sócio demográficas estudadas são: sexo, idade, etnia/raça, escolaridade, situação profissional, estado civil, tipo de família, funcionalidade familiar, condições de habitação. A comorbilidade é definida pela presença de duas ou mais doenças e estudada pelo número de doenças coexistentes. O tempo de duração da doença é definido como o número de anos decorridos entre o ano de diagnóstico e 2003. Os problemas de saúde crónicos são classificados pela ICPC2. Nas comparações efectuadas aplicaram-se os testes de Mann-Whitney e de Friedman, de homogeneidade e de análise de resíduos. A Análise Classificatória Hierárquica foi utilizada para determinar o agrupamento de doenças e a Análise de Regressão Categórica e Análise de Correspondências na relação entre as características sócio demográficas e a comorbilidade. Identificaram-se 3998 doentes. A idade média é de 64,3 anos (DP=15,70). Há uma correlação positiva significativa (r =0,350 r=0) entre “anos com a primeira doença”e “idade dos doentes” em todos os indivíduos (homens r=0,129 mulheres r=0,231). A comorbilidade entre as quatro doenças crónicas índice está presente em 1/3 da população. As associações mais prevalentes são HTA+DM (14,3%) e HTA+DCI (6,25%). Existe correlação positiva, expressiva, entre a duração da primeira doença, quando esta é a HTA ou a DM, e o intervalo de tempo até ao aparecimento da 2ª e da 3ª doenças. Identificaram-se 18 655 problemas crónicos de saúde que se traduziram em 244 códigos da ICPC2. O número médio de problemas foi de 5,94 (DP=3,04). A idade, a actividade profissional, a funcionalidade familiar e a escolaridade foram as variáveis que mais contribuíram para diferenciar os indivíduos quanto à comorbilidade. Foram encontradas diferenças significativas entre médicos(c2=1165,368 r=0) e entre os agrupamentos de doentes por Sub-Região de Saúde (c2= 157,108 r=0) no respeitante à comorbilidade. Na partição por Lisboa o número médio de problemas é de 6,45 e em Beja de 5,35. Deste trabalho ressaltam várias consequências para os profissionais, para os serviços, para o ensino e para a procura de mais saber nesta área. Os médicos, numa gestão eficiente de cuidados são chamados a desempenhar um papel de gestores da complexidade e de coordenadores assim como a trabalhar num modelo organizativo apoiado numa colaboração em equipa. Por sua vez os serviços de saúde têm que desenvolver medidas de avaliação de cuidados que integrem a comorbilidade como medida de risco. O contexto social da cronicidade e da comorbilidade deverá ser incluído como área de ensino. A concluir analisa-se o impacto do estudo nos colaboradores e o possível desenvolvimento da investigação nesta área.----------------------------------------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.--------RÉSUMÉ:Cette thèse de doctorat prétend démontrer deux postulats : le premier, que la comorbidité de quatre maladies fréquentes, hypertension artérielle (HTA), diabète (DM), maladie cardiaque ischémique (DCI) et asthme, est un thème important en Médecine Générale et Familiale et que son étude 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'intérêt du sujet et objectifs de la dissertation ; 2) étude systématique de publications éditées entre 1992 et 2002 ; 3) présentation de deux travaux de recherche, descriptifs et exploratoires, un premier intitulée « Comorbidité de quatre maladies chroniques et leur relation avec des facteurs sociodémographiques » et un deuxième « Différences entre malades, selon le médecin et la sous région, dans la comorbilité de quatre maladies chroniques» ; 4) conclusions et conséquences des résultats des études dans la gestion de la pratique clinique, dans les services, dans l'enseignement de la discipline de MGF et dans le développement postérieur de la recherche dans ce domaine. Les objectifs de la première étude sont les suivants : décrire la prévalence de la comorbidité entre les quatre maladies chroniques, vérifier s'il existe une relation entre temps de durée de la première maladie et l'espace de temps jusqu'à le diagnostic de la 2ème ou 3ème maladie; déterminer la comorbidité entre les 4 maladies ; identifier d'éventuelles groupements de maladies et vérifier s'il existe une relation entre comorbidité et facteurs sociodémographiques. La deuxième étude prétend vérifier s'il existe des différences de comorbidité entre médecins et par groupement régional. Le travail empirique est descriptif et exploratoire. La population est composée des malades ayant au moins une des quatre maladies chroniques parmi les listes de malades de douze Médecins de Famille qui travaillent dans des Centres de Santé urbains, suburbains et ruraux (Districts de Lisbonne et Beja). Les données ont été extraites pendant l'année 2003 des registres des médecins. Les variables sociodémographiques étudiées sont : le sexe, l'âge, l'ethnie/race, la scolarité, la situation professionnelle, l'état civil, le type de famille, sa fonctionnalité, les conditions de logement. La comorbidité est définie lorsqu'il existe deux ou plusieurs maladies et est étudiée d'après le nombre de maladies coexistantes. La durée de la maladie est établie en comptant le nombre d'années écoulées entre le diagnostique et 2003. Les problèmes de santé chroniques sont classés par l'ICPC 2. Pour les comparaisons les tests de Mann-Whitney et Friedman, de homogénéité et analyse de résidues ont été appliqués. L'Analyse de Classification Hiérarchique a été utilisée pour procéder au regroupement des maladies et l'Analyse de Régression Catégorique et l'Analyse de Correspondances pour étudier la relation entre les caractéristiques sociodémographiques et la comorbilité. Les principaux résultats sont les suivants : les 3998 malades identifiés ont 64,3 ans d'âge moyen (DP=15,70). Il existe une corrélation positive significative (r =0,350 r=0) entre « les années avec la première maladie » et « l'âge des malades », chez tous les individus (hommes r=0,129 femmes r=0,231). La comorbidité entre les quatre maladies chroniques est une réalité chez 1/3 des patients. Les associations les plus fréquentes sont HTA+DM (14%) et HTA+DCI (6,25%). Il existe une corrélation positive significative entre la durée de la première maladie, HTA ou DM, et l'écart jusqu'à l'apparition de la deuxième et de la troisième maladie. Chez les malades, 18.655 problèmes chroniques de santé ont été identifiés et traduits en 244 codes de l'ICPC2. La moyenne des problèmes a été de 5,94 (DP=3,04). L'âge, l'activité professionnelle, la fonctionnalité familiale et la scolarité sont les variables qui ont le plus contribué à différencier les individus face à la comorbilité. Des différences notoires ont été trouvées entre médecins (c2=1165,368 r=0) et entre les groupements régionaux (c2=157,108 r=0) en ce qui concerne la comorbidité. Dans le groupe de patients de Lisbonne, le chiffre moyen de problèmes est de 6,45 et à Beja il est de 5,35. Cette étude met en évidence plusieurs conséquences pour les professionnels, les services, l'enseignement et l'élargissement du savoir dans ce domaine. Les médecins, soucieux de gérer efficacement les soins sont appelés à jouer un rôle de gestionnaires de la complexité et de coordinateurs, de même qu'à travailler dans un modèle d'organisation soutenus par un travail d'équipe. D'autre part, les services de santé doivent eux aussi développer des mesures d'évaluation des soins qui intègrent la comorbidité comme mesure de risque. Le contexte social de la chronicité et de la comorbidité devra être inclus comme domaines à étudier. La fin de cette thèse décrit l'impact de cette étude sur les collaborateurs et le développement futur de la recherche dans ce domaine.