86 resultados para Manutenção condicionada
Resumo:
Dissertao apresentada Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para a obteno do grau de Mestre em Engenharia e Gesto Industrial
Resumo:
Resumo Uma estratgia de avaliao e preveno de riscos na exposio a agentes qumicos deve ter sempre em conta que a vigilncia do ambiente de trabalho e a da sade dos trabalhadores so aspectos complementares de uma mesma realidade os riscos resultantes da interaco entre um agente qumico e os trabalhadores a ele expostos. Se Vigilncia Ambiental compete apreciar o risco, pela caracterizao do agente no ambiente de trabalho, a Vigilncia Biolgica pronuncia-se sobre a interaco entre o txico e o organismo, avaliando a resposta agresso qumica e a evoluo das reaces de adaptao ou de desajuste face absoro do txico. Os Indicadores Biolgicos, deste modo, assumem um estatuto de instrumento privilegiado na vigilncia da sade dos trabalhadores expostos, na medida em que medem a quantidade de txico que efectivamente penetrou e foi absorvido, ou o resultado (efeito) determinado por essa mesma dose. O presente estudo procura contribuir para a definio de um quadro metodolgico de utilizao dos Indicadores Biolgicos na avaliao/gesto da exposio profissional ao chumbo, designadamente apreciando a variao da protoporfirina-zinco (PPZ), indicador at ao presente ainda no utilizado em Portugal. O chumbo um metal de ocorrncia natural, cujos nveis nos diversos ecossistemas resultam, principalmente, das actividades antropognicas de natureza domstica e industrial. A sua capacidade poluente assinalvel, representando uma fonte de exposio permanente para o homem, demonstrvel pela sua constante presena no organismo apesar de no desempenhar qualquer tipo de funo fisiolgica. So actualmente inmeras as suas aplicaes, tornando a exposio profissional ao chumbo uma realidade vasta: indstrias de acumuladores elctricos, de vidros, de plsticos e de munies, construo civil, manutenção e reparao automvel e de navios, fabrico de tintas, indstrias electrnicas, fundies e actividades de soldadura so, entre outras, situaes onde uma realidade a ter em conta. A penetrao dos compostos inorgnicos de chumbo no organismo efectua-se principalmente por via respiratria, no sendo, no entanto, desprezvel, a sua penetrao por via digestiva. As partculas absorvidas so transportadas pelo sangue principalmente ligadas aos eritrocitos (95%), distribuem-se pelos tecidos moles e depositam-se essencialmente no tecido sseo, onde representam mais de 90% da carga corporal do total absorvido e tendo a um elevado tempo de semi-vida (mais de 20 anos). No metabolizado no organismo e a sua eliminao efectua-se essencialmente por via renal,sendo igualmente excretado, em menor escala, atravs das fezes, do suor, da saliva, das faneras e do leite materno. O conhecimento cientfico evidencia que concentraes sanguneas de chumbo entre 20 e 50 mg/dL so susceptveis de determinar efeitos adversos no homem, podendo ser afectados o sistema hematopoitico, o sistema nervoso, o sistema cardiovascular, o sistema reprodutor e o sistema imunitrio. Contudo, ainda muito h a clarificar no mbito da toxicidade do chumbo. Os nveis de exposio a que correspondem as alteraes nos diversos rgos e sistemas continuam a ser motivo de alguma controvrsia. As caractersticas carcinognicas e mutagnicas do chumbo so, ainda, um campo de vasta exigncia de investigao. A intoxicao por chumbo e seus sais (Saturnismo) de origem ocupacional reconhecida em Portugal como doena profissional (grupo 1 - Doenas Provocadas por Agentes Qumicos, da Lista das Doenas Profissionais). uma intoxicao do tipo crnico, fruto da absoro contnua de doses relativamente pequenas durante longo perodo, evidenciando-se no seu incio por sinais e sintomas vagos e difusos de grande inespecificidade, que podem incluir, nomeadamente, perda de apetite, sabor metlico na boca, palidez, mal-estar e fadiga, cefaleias, mialgias e artralgias, irritabilidade, tremores finos, obstipao, clicas abdominais, insnias, dficit da memria de curto prazo e da capacidade de concentrao. Um importante conjunto de indicadores biolgicos pode ser utilizado na vigilncia peridica da sade de trabalhadores nestas condies de exposio. Tais indicadores (de dose ou de efeito), encerram diferentes significados e comportam distintas exigncias, competindo ao Mdico do Trabalho, no mbito dos programas de preveno dos efeitos adversos relacionados com a exposio profissional a chumbo, seleccionar a sua utilizao e interpretar a sua informao, de modo a avaliar a interaco do txico com o organismo numa fase de reversibilidade. O presente estudo envolveu 180 trabalhadores dos quais 110 apresentavam plumbmias (Pb-S) iguais ou superiores a 40 mg/dL. Alm da Pb-S, a todos foi doseada a protoporfirina-zinco (PPZ) e efectuado o Hemograma e a cerca de 25% foi determinada a concentrao do cido d-aminolevulnico urinrio (ALA-U). Os doseamentos da PPZ efectuados em amostra de sangue capilar atravs de um hematofluormetro porttil revelaram-se de total fiabilidade, dando significado a uma tcnica de fcil execuo e baixo custo. A avaliao do tipo de colheita urinria para doseamento do ALA-U concluiu pela necessidade de recurso a urinas de 24 horas.Os resultados do estudo evidenciaram uma elevada associao entre a PPZ e a Pb-S, com uma maior magnitude e de incio mais precoce do que o que registado na associao da Pb-S com o ALA-U. Revelaram, ainda, fracos nveis de associao da hemoglobina (e outros parmetros hematolgicos) com a Pb-S. E demonstraram para um cut-off de 100 mg/ dL de PPZ, taxa de falsos negativos e falsos positivos, para plumbmias a partir de 70 mg/dL, inferiores a 20%. Assim, concluiu-se que, nos protocolos de vigilncia de sade de trabalhadores expostos a chumbo, o doseamento da PPZ por hematofluormetro, em sangue de colheita capilar, adequado, fivel e de realizao preferencial em relao ao do ALA-U. Concluiu-se, tambm, que a realizao do hemograma apenas se justifica em situaes individuais que clinicamente o tornem aconselhvel. E que estes protocolos devem incluir a realizao da Pb-S e da PPZ, podendo, em situaes de controlo rigoroso (ambiental, biolgico e clnico), basear-se apenas na determinao da PPZ reservando os outros indicadores para aprofundar a investigao mdica nos casos de taxas elevadas desta ou de situaes limitantes. Rsume Une stratgie dvaluation et de prvention des risques dexposition aux agents chimiques doit toujours tenir en considration que la vigilance du lieu de travail et de la sant des travailleurs sont des aspects complmentaires dune mme ralit les risques rsultant dune interaction entre lagent chimique et les travailleurs exposs. Si cest la Vigilance Ambiantale de juger le risque, par la caractrisation de lagent dans le lieu de travail, la Vigilance Biologique, elle, se prononce sur linteraction entre le toxique et lorganisme, valuant la rponse lagression chimique et lvolution des ractions dadaptation ou de rupture face labsorption du toxique. Les Indicateurs Biologiques assument ainsi un statut dinstrument privilgi de vigilance de la sant des travailleurs exposs, dans la mesure o ils dterminent la quantit de toxique qui a effectivement t pntr et absorb, ou le rsultat (effet) dtermin par cette dose. Cette tude-ci cherche contribuer la dfinition dun cadre mthodologique dutilisation des Indicateurs Biologiques dans lvaluation/ gestion de lexposition professionnelle au plomb inorganique, valuant spcialement le comportement de la protoporphirine-zinc (PPZ), indicateur pas encore utilis au Portugal.Le plomb est un mtal doccurrence naturelle dont les niveaux dans les diffrents cosystmes en rsultent, principalement, des activits anthropogniques de nature domestique et industrielle. Sa capacit polluante peut tre signale, reprsentant une source dexposition permanente pour lhomme, celle-ci dmontrable par sa prsence continue dans lorganisme, mme si elle ny accomplit aucune fonction physiologique. Actuellement ses applications sont innombrables, faisant de lexposition professionnelle au plomb une ralit de grande ampleur : industries daccumulateurs lectriques, de verre, de plastique et de munitions, btiments, manutention et rparation automobile et navale, fabrication dencres, industries lectroniques, fontes et activits de soudure sont, entre autres, des situations relles a en tenir compte. La pntration du plomb inorganique dans lorganisme se fait principalement par voie respiratoire, pouvant se faire galement par voie digestive. Les particules absorbes sont transportes par le sang, surtout lies aux rythrocytes (95%), se repartent travers les tissus mous et se dposent essentiellement dans le tissu osseux, o elles reprsentent plus de 90% de la charge corporelle de ce qui a t absorb et ont un temps de demi-vie lev (plus de 20 ans). Le plomb nest pas mtabolis dans lorganisme et son limination se fait essentiellement par voie rnale, pouvant tout de mme, une moindre chelle, tre excrt dans les fces, de la sueur, de la salive, des ongles, des cheveux et du lait maternel. La connaissance scientifique met en vidence que des concentrations sanguines de plomb entre 20 et 50 mg/dL sont susceptibles de dterminer des effets adverses dans lhomme, pouvant les systmes hmatopotique, nerveux, cardiovasculaire, reproducteur et immunitaire en tre affects. Cependant, il en reste beaucoup claircir dans le domaine de la toxicit du plomb. Les niveaux dexposition auxquels correspondent les modifications des divers organes et systmes, demeurent toujours sujet de quelque controverse. Les caractristiques carcinogniques et mutagniques du plomb restent toujours un champ dinvestigation dune grande exigence. Lintoxication par le plomb et ses sels (Saturnisme) dorigine occupationnelle est reconnue, au Portugal, comme une maladie professionnelle (groupe 1- Maladies Provoques par des Agents Chimiques, de la Liste des Maladies Professionnelles). Cest une intoxication du tipe chronique, due labsorption continue de doses relativement petites pendant une longue priode, mise en vidence travers des signes et des symptmes vagues et diffus sans grande spcificit, lesquels peuvent inclure, particulirement, le manque dapptit, got mtallique dans la bouche, pleur, malaise et fatigue, cphales, myalgies et arthralgies, irritabilit, tremblements fins, constipation, coliques abdominales, insomnies, dficit de la mmoire court terme et de la capacit de concentration.Un ensemble important dindicateurs biologiques peut tre employ dans la vigilance priodique de la sant des travailleurs dans ces conditions dexposition. Ces indicateurs (de dose ou deffet) renferment diffrentes significations et comportent diverses exigences, devant le Mdecin de Travail, dans le domaine des programmes de prvention des effets adverses qui sont en relation avec lexposition professionnelle au plomb, slectionner son utilisation et interprter son information de faon valuer linteraction de llment toxique avec lorganisme un stade de rversibilit. Ltude ci-prsent engloba 180 travailleurs desquels 110 prsentaient des plombmies (Pb-S) gales ou suprieures 40 mg/dL. part la Pb-S, la protoporphyrine-zinc (PPZ) leur a t prise en dosage et un Hmogramme fut effectu et fut dtermin lacide d- aminolvulinique urinaire (ALA-U) sur environ 25% des travailleurs. Le dosage de la PPZ efectu en chantillon de sang capillaire par un fluorimtre portable, sest accomplit dune fiabilit total, donnant du sgnificat une tchnique de facile execution et bas prix. Lvaluation de la prise urinaire par dosage du ALA-U conclut au besoin dun recours aux urines de 24 heures Les rsultats de ltude ont mis en vidence une association leve entre la PPZ et la Pb- S, avec une intensit majeure et de dbut plus prcoce par rapport celui qui fut registr lors de lassociation de la Pb-S avec la ALA-U. Ces rsultats ont galement montr de faibles niveaux dassociation entre lhmoglobine (et autres paramtres hmatologiques) et la Pb-S. Ils ont dmontr aussi, une valeur de cut-off de 100 mg/dL de PPZ, des taux de faux ngatifs et faux positifs, pour des plombmies de 70 mg/dL, infrieurs 20%. On peut donc conclure que dans les protocoles de vigilance de la sant des travailleurs exposs au plomb, le dosage de la PPZ par fluorimetrie dans le sang capillaire est adquat, fiable et de ralisation prfrentielle par rapport celui du ALA-U. On peut galement conclure que la ralisation de lhmogramme ne se justifie que dans les cas individuels o, cliniquement, celui-ci est conseill. De plus, ces protocoles doivent inclure la ralisation de la Pb-S et de la PPZ, pouvant, en cas de contrle rigoureux (ambiantal, biologique et clinique), sappuyer que dans la dtermination de la PPZ rservant les autres indicateurs pour approfondir linvestigation mdicale dans les cas o les taux de celle-ci sont levs ou dans les cas de situations limitantes. Summary Any strategy to evaluate and prevent the risks of chemical agents exposure must always regard the work environment and workers health as complementary aspects of one reality - the resulting risks from the interaction between the chemical agent and the exposed workers. It is the responsibility of Environmental Monitoring to evaluate the risks of exposure by the characterization of the chemical agent in the work environment. Biological Monitoring, on the other hand, pronounces itself over the toxin and body interaction, evaluating human response to the chemical aggression and the body adaptations to the toxic absorption. Biological Exposure Indices (BEI) assume, therefore, a privileged status among exposed workers' health monitoring instruments, as they measure the actual penetrated and absorbed toxic quantity and the effect it produces. This research study aims to contribute to the definition of a methodological strategy on the utilization of BEIs in evaluating inorganic lead's occupational exposure, more specifically appreciating the zinc protoporphyrin (ZPP) variation, an index that has never been taken under consideration in Portugal until now. Lead is a natural metal whose ecosystems levels are mainly due to domestic and industrial anthropogenic activities. Its pollutant capacity is notable, representing a permanent exposure risk shown by its constant presence in the human body, although it has no physiologic function. Nowadays, lead's applications are countless, turning its professional exposure a huge reality: storage batteries industries, glass industries, plasterers and munitions industries, building construction, ships and motor car maintenance and repairing, ink manufacture, electronics industries, foundries and other soldering activities are, among so many other, realities to attend to. Respiration is the main cause of human body's inorganic lead absorption, although digestive pathway must not to be ignored. The absorbed particles are transported by blood, essentially bounded to erythrocytes (95%). It is distributed by soft tissues and settled mainly on bone tissues, where it represents approximately 90% of the total body charge and has a high half-life time (more than 20 years). It is not metabolized by the organism, its elimination being effectuated by renal activity and, in smaller scale, through lees, sweat, saliva, nails, hair and maternal milk.Scientific knowledge shows that concentrations of lead in blood between 20 e 50 mg/dL are susceptible to determine adverse effects in man and able to affect the hematopoietic system, the nervous system, the cardiovascular system, the reproductive system and the immunological system. Nevertheless, there's still much to be learned and clarified about lead's toxicity. The correlation between exposure levels and human's systems and organs alteration levels continues to be a centre of controversies. Still, lead's carcinogenic and mutagenic characteristics continue to be a high demanding research field. Intoxication by lead and its compounds (saturnism), from occupational origin, is recognized in Portugal as an occupational disease, included in Group 1 - Chemical Agents Caused Diseases, on the Occupational Diseases List. It is a chronic intoxication caused by a continuous absorption of small doses, throughout a long period of time. Its signs and symptoms are diffuse and imprecise, of great unspecificity, such as loss of appetite, metallic flavor in the mouth, paleness, ailment and fatigue, headaches, myalgia and arthralgia, irritability, thin tremors, constipation, abdominal pain, insomnias, short memory loses and inability to concentrate. A considered number of BEIs can be used in Periodic Health Monitoring of workers in such exposure conditions. Such BEI (dose indices or effect indices) provide different meanings and imply different procedures, being Occupational Doctors responsibility, in the context of lead related adverse effects preventive programmes, to select and interpret its information, in order to evaluate the interaction between toxic and organism in a reversible phase of the toxic action. The present research study involved 180 workers, 110 of which presented blood lead levels (PbB) above or equal to 40 mg/dL. Besides PbB, all workers has been evaluated for zinc protoporphyrin levels (PPZ) and submitted to a haemogram. About 25% of the workers were selected for d-aminolevulinic urinary acid (ALA-U) determination. The evaluation of PPZ, by a portable hematofluorometer using capillary blood samples, turned out to be an easy procedure with low costs and total warrantability. As in regard for ALA- U procedure, it was concluded the necessity of 24 hours urine samples. This research results underlined a strong connection between ZPP and PbB, which was found to to be stringer and to begin earlier than it was registered for PbB and ALA-U association. The same study also revealed a low association level between PbB and hemoglobin or other hematological indices. It was also verified less than 20% of false negatives and false positives cases when admitted a ZPP 100 mg/dL cut off value for PbB 70 mg/dL. As in result it was concluded that in Health Monit
Resumo:
RESUMO O Problema. A natureza, diversidade e perigosidade dos resduos hospitalares (RH) exige procedimentos especficos na sua gesto. A sua produo depende do nmero de unidades de prestao de cuidados de sade (upcs), tipo de cuidados prestados, nmero de doentes observados, prticas dos profissionais e dos rgos de gesto das upcs, inovao tecnolgica, entre outros. A gesto integrada de RH tem evoludo qualitativamente nos ltimos anos. Existe uma carncia de informao sobre os quantitativos de RH produzidos nas upcs e na prestao de cuidados domicilirios, em Portugal. Por outro lado, os Servios de Sade Pblica, abrangendo o poder de Autoridade de Sade, intervm na gesto do risco para a sade e o ambiente associado produo de RH, necessitando de indicadores para a sua monitorizao. O quadro legal de um pas nesta matria estabelece a estratgia de gesto destes resduos, a qual condicionada pela classificao e definio de RH por si adoptadas. Objectivos e Metodologias. O presente estudo pretende: quantificar a produo de RH resultantes da prestao de cuidados de sade, em seres humanos e animais nas upcs, do sistema pblico e privado, desenvolvendo um estudo longitudinal, onde se quantifica esta produo nos Hospitais, Centros de Sade, Clnicas Mdicas e Dentrias, Lares para Idosos, Postos Mdicos de Empresas, Centros de Hemodilise e Clnicas Veterinrias do Concelho da Amadora, e se compara esta produo em dois anos consecutivos; analisar as consequncias do exerccio do poder de Autoridade de Sade na gesto integrada de RH pelas upcs; quantificar a produo mdia de RH, por acto prestado, nos cuidados domicilirios e, com um estudo analtico transversal, relacionar essa produo mdia com as caractersticas dos doentes e dos tratamentos efectuados; proceder anlise comparativa das definies e classificaes de RH em pases da Unio Europeia, atravs de um estudo de reviso da legislao nesta matria em quatro pases, incluindo Portugal. Resultados e Concluses. Obtm-se a produo mdia de RH, por Grupos I+II, III e IV: nos Hospitais, por cama.dia, considerando a taxa de ocupao; por consulta, nos Centros de Sade, Clnicas Mdicas e Dentrias e Postos Mdicos de Empresas; por cama.ano, nos Lares para Idosos, considerando a sua taxa de ocupao; e por ano, nas Clnicas de Hemodilise e Veterinrias. Verifica-se que a actuao da Autoridade de Sade, produz nas upcs uma diferena estatisticamente significativa no aumento das contratualizaes destas com os operadores de tratamento de RH. Quantifica-se o peso mdio de resduos dos Grupos III e IV produzido por acto prestado nos tratamentos domicilirios e relaciona-se esta varivel dependente com as caractersticas dos doentes e dos tratamentos efectuados. Comparam-se os distintos critrios utilizados na elaborao das definies e classificaes destes resduos inscritas na legislao da Alemanha, Reino Unido, Espanha e Portugal. Recomendaes. Apresentam-se linhas de investigao futura e prope-se uma reflexo sobre eventuais alteraes de aspectos especficos no quadro legal portugus e nos planos de gesto integrada de RH, em Portugal. ABSTRACT The problem: The nature, diversity and hazardousness of hospital wastes (HW) requires specific procedures in its management. Its production depends on the number and patterns of healthcare services, number of patients, professional and administration practices and technologic innovations, among others. Integrated management of HW has been developping, in the scope of quality, for the past few years. There is a lack of information about the amount of HW produced in healthcare units and in the domiciliary visits, in Portugal. On the other hand, the Public Health Services, embracing the Health Authoritys power, play a very important role in managing the risk of HW production to public and environmental health. They need to use some indicators in its monitorization. In a country, rules and regulations define hospital waste management policies, which are confined by the addopted classification and definition of HW. Goals and Methods: This research study aims to quantify the production of HW as a result of healthcare services in human beings and animals, public service and private one. Through a longitudinal study, this production is quantified in Hospitals, Health Centers, Medical and Dental Clinics, Residential Centers for old people, Companies Medical Centers and Veterinary and Haemodyalisis Clinics in Amadoras Council, comparing this production in two consecutive years. This study also focus the consequences of the Health Authoritys role in the healthcare services integrated management of HW. The middle production of HW in the domiciliary treatments is also quantified and, with a transversal analytic study, its association with patients and treatments characteristics is enhanced. Finally, the definitions and classifications in the European Union Countries are compared through a study that revises this matters legislation in four countries, including Portugal. Results and Conclusions: We get the middle production of Groups I+II, III and IV: HW: in Hospitals, by bed.day, bearing the occupation rate; by consultation, in Health Centers, Medical and Dental Clinics and Companies Medical Centers; by bed.year in Residential Centers for old people, considering their occupation rate; by year, in Veterinary and Haemodyalisis Clinics. We verify that the Health Authoritys role produces a significative statistical difference in the rise of the contracts between healthcare services and HW operators. We quantify the Groups III and IVs wastes middle weight, produced by each medical treatment in domiciliary visits and relate this dependent variable with patients and treatments characteristics. We compare the different criteria used in the making of definitions and classifications of these wastes registered in German, United Kingdom, Spain and Portugals laws. Recommendations: Lines of further investigation are explaned. We also tender a reflexion about potential changes in rules, in regulations and in the integrated plans for managing hospital wastes in Portugal. RSUM Le Problme. La gestion des dchets d'activits hospitalires (DAH) et de soins de sant (DSS) exige des procdures spcifiques en raison de leur nature, diversit et dangerosit. Leur production dpend, parmi dautres, du nombre dunits de soins de sant (USS), du type de soins administrs, du nombre de malades observs, des pratiques des professionnels et des organes de gestion des USS, de linnovation technologique. La gestion intgre des DAH et des DSS subit une volution qualitative dans les dernires annes. Il existe un dficit dinformation sur les quantitatifs de DAH et de DSS provenant des USS et de la prestation de soins domiciliaires, au Portugal. Dautre part les Services de Sant Publique, y compris le pouvoir de lAutorit de Sant, qui interviennent dans la gestion du risque pour la sant et pour lenvironnement associ la production de DAH et de DSS, ont besoin dindicateurs pour leur surveillance. Dans cette matire le cadre lgal tablit la stratgie de gestion de ces dchets, laquelle est conditionne par la classification et par la dfinition des DAH et des DSS adoptes par le pays. Objectifs et Mthodologie. Cet tude prtend: quantifier la production de DAH et de DSS provenant de la prestation de soins de sant, en tres humains et animaux dans les USS du systme public et priv. travers un tude longitudinal, on quantifie cette production dans les Hpitaux, Centres de Sant, Cliniques Mdicales et Dentaires, Maisons de Repos pour personnes ges, Cabinets Mdicaux d Entreprises, Centres dHmodialyse et Cliniques Vtrinaires du municipe d Amadora, en comparant cette production en deux ans conscutifs; analyser les consquences de lexercice du pouvoir de lAutorit de Sant dans la gestion intgre des DAH et des DSS par les USS; quantifier la production moyenne de DAH et de DSS dans la prestation de soins domiciliaires et, avec un tude analytique transversal, rapporter cette production moyenne avec les caractristiques des malades et des soins administrs; procder l analyse comparative des dfinitions et classifications des DAH et des DSS dans des pays de lUnion Europenne, travers un tude de rvision de la lgislation relative cette matire dans quatre pays, Portugal y compris. Rsultats et Conclusions. On obtient la production moyenne de DAH et des DSS, par Classes I+II, III et IV: dans les hpitaux, par lit.jour, en considrant le taux doccupation; par consultation, dans les Centres de Sant, Cliniques Mdicales et Dentaires et Cabinets Mdicaux d Entreprises par lit.an dans les Maisons de Repos pour personnes ges en considrant le taux doccupation; et par an, dans les Cliniques dHmodialyse et Vtrinaires. On constate que lactuation de lAutorit de Sant produit dans les USS une diffrence statistiquement significative dans laccroissement de leurs contractualisations avec les oprateurs de traitement de DAH et de DSS. On quantifie le poids moyen des dchets des Classes III et IV produit par acte de prestation de soins domicile et on rapporte cette variable dpendante avec les caractristiques des malades et des soins administrs. On compare les diffrents critres utiliss dans llaboration des dfinitions et des classifications de ces dchets inscrites dans la lgis
Resumo:
Dissertao apresentada por Elisabete de Jesus Barrelas Lopes Raimundo Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa, para obteno do grau de Mestre em Ordenamento do Territrio e Planeamento Ambiental
Resumo:
Dissertao apresentada na Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para obteno do grau de Mestre em Engenharia Mecnica
Resumo:
Dissertao apresentada na faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para obteno de grau de Mestre em Engenharia Mecnica
Resumo:
Dissertao apresentada na Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para obteno do grau de Mestre em Engenharia Mecnica
Resumo:
Dissertao apresentada como requisito parcial para obteno do grau de Mestre em Cincia e Sistemas de Informao Geogrfica
Resumo:
Trabalho apresentado no mbito do Mestrado em Engenharia Informtica, como requisito parcial para obteno do grau de Mestre em Engenharia Informtica
Resumo:
Dissertao apresentada na Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para obteno do grau de Mestre em Engenharia do Ambiente,perfil de Gesto e Sistemas Ambientais
Resumo:
Dissertao apresentada na Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para obteno do grau de Mestre em Engenharia Sanitria
Resumo:
Resumo: Os profissionais de sade podem estar expostos a vrios factores indutores de stress crnico nomeadamente de natureza profissional destacando-se, entre os seus possveis efeitos, a diminuio da resposta de anticorpos aps administrao de vacinas, entre as quais, a vacina contra a gripe. Uma vez que os trabalhadores da sade esto expostos a factores indutores de stress e, simultaneamente, a agentes biolgicos cujos efeitos podero ser prevenidos pela vacinao, pertinente estudar a influncia do stress na resposta imunitria vacina contra a gripe em enfermeiros. Constituram objectivos deste trabalho: (1) estudar a associao entre a presena de stress crnico em enfermeiros hospitalares e a insuficiente resposta imunitria vacina contra a gripe, avaliada um ms aps a vacinao (T1); (2) estudar a associao entre a presena de stress crnico em enfermeiros hospitalares e a reduo dos ttulos de anticorpos dirigidos s hemaglutininas seis meses aps a vacinao (T6) e (3) identificar algumas caractersticas das unidades de internamento e do trabalho dos participantes que possam estar associadas presena de stress crnico e estudar a sua possvel associao com a resposta imunitria vacina contra a gripe. Realizou-se um estudo caso-controlo incorporado num estudo de coortes e a amostra em estudo foi constituda por 136 enfermeiros saudveis (83,8% sexo feminino; mdia de idades de 33anos) de um hospital universitrio. Realizaram-se entrevistas individuais e aplicaram-se as verses portuguesas dos questionrios The General Health Questionnaire (GHQ12) e Maslach Burnout Inventory Human Services Survey (MBI-HSS) para determinao da presena de stress crnico pelo mtodo da triangulao, no incio do estudo (T0) e realizou-se a recolha de dados relativos caracterizao de elementos de trabalho nas unidades de internamento. Foi administrada a vacina contra a gripe e determinou-se os ttulos de anticorpos dirigidos s hemaglutininas de cada estirpe componentes da vacina contra a gripe utilizada em 2007, antes da vacinao, um ms e seis meses aps a vacinao. No se encontrou associao, ao nvel de significncia de 5%, entre a presena de stress e a insuficiente resposta vacina contra a gripe, avaliada pela taxa de indivduos que apresentaram um aumento, ao fim de um ms, inferior a quatro vezes os ttulos de anticorpos antes da vacinao. No entanto, encontrou-se uma maior proporo de indivduos com stress no grupo de participantes em que ocorreu uma diminuio do ttulo de anticorpos dirigidos hemaglutinina AH1 (ac AH1) em T6, quando comparado com o respectivo grupo controlo. A diferena entre grupos foi estatisticamente significativa, quando se avaliou a presena de stress pelo mtodo da triangulao usando a entrevista (p=0,006), pelo mtodo da triangulao usando o GHQ12 (p=0,045) e ainda usando a combinao dos trs critrios (p=0,001). Aps anlise multivariada, verificou-se que a associao entre a presena de XXVI stress e a reduo dos ac AH1 em T6 manteve significado estatstico (respectivamente, p= 0,010, p= 0,042 e p=0,002) e apresentou odds ratio ajustados, em funo de cada um dos mtodos de avaliao da presena de stress, de 3,643, de 2,733 e de 5,223. A quantidade de trabalho percepcionada como sobrecarga constituiu o factor indutor de stress mais vezes referido (58,8% da amostra e 61,8% dos enfermeiros de unidades de internamento), seguida dos conflitos entre profissionais. O contacto com o sofrimento e a morte de doentes foram identificados em quarto lugar pela amostra, mas em segundo pelos enfermeiros de unidades de internamento. Nesses, verificou-se uma associao positiva entre trabalhar em Servios onde o nmero de doentes falecidos foi muito elevado e a presena de stress, medido pelo mtodo da triangulao usando a entrevista (p=0,039), usando o GHQ12 (p=0,019), usando a escala de exausto emocional do MBI-HSS (p=0,012) e pela combinao dos trs mtodos (p=0,014). Verificou-se tambm uma associao positiva entre a presena de stress, identificada pelo mtodo da triangulao usando a escala de exausto emocional do MBI-HSS, e o trabalho em servios de internamento onde a percentagem de doentes idosos (p=0,025) e a taxa de letalidade (p=0,036) foram elevadas. Contudo, no se encontrou associao entre a exposio muito frequente ao sofrimento e morte de doentes e a reduo do ttulo de ac AH1 em T6. Possivelmente, a exposio a esse factor indutor de stress, apesar de estar relacionada com a presena de stress nos enfermeiros de servios de internamento, no foi suficientemente intenso para, por si s, estar associada reduo do ttulo de ac AH1 em T6. A associao encontrada entre a presena de stress crnico e a reduo do ttulo de anticorpos AH1 em T6 vem apoiar a resposta questo de investigao inicialmente colocada de que o stress poder influenciar negativamente a manutenção dos ttulos de anticorpos, mesmo em indivduos adultos no idosos. Assim, o risco de um enfermeiro com stress apresentar reduo do ttulo de anticorpos dirigidos hemaglutinina da estirpe AH1N1 A/Solomon Islands/3/2006 ao fim dos seis meses do estudo, foi 3,6, 2,7 ou 5,2 vezes superior ao de um enfermeiro sem stress, consoante o critrio de stress ter sido determinado, respectivamente, pelo mtodo da triangulao usando a entrevista, pelo mtodo da triangulao utilizando o GHQ12 ou pela combinao dos trs critrios. Summary: Health workers may be exposed to various factors causing chronic stress namely those related directly to their activity, in particular the decrease in the capacity of the response of antibodies after the administration of the vaccines, amongst others the Influenza vaccine. Since health workers are exposed to factors causing stress and at the same time biological agents, whose effects may be prevented through vaccination, it is important to study the influence of stress in the immunity response to the Influenza vaccine on nurses. The aims of this study are: (1) to examine the relation between chronic stress in hospital nurses and the insufficient immunity response to the Influenza vaccine, assessed at one month after vaccination (T1); (2) to examine the relation between chronic stress in hospital nurses and the decrease of the hemagglutinin titles of antibodies six months after vaccination (T6); (3) to identify some characteristics of internment units and the work of the participants that may be related to the presence of chronic stress and to study its possible relation with the immunity response to the Influenza vaccine. A control-case study, integrated in a coortes study, was carried out and the sample under analysis consisted of 136 healthy nurses (83,8% female; average age 33 years old) from a university hospital. Several individual interviews were conducted and the portuguese versions of General Health Questionnaire (GHQ12) and Maslach Burnout Inventory Human Services Survey (MBI-HSS) was applied in order to determine the presence of chronic stress, using the triangulation method at the beginning of the study (T0). Data concerning the particular features of the internment units was collected. The Influenza vaccine was administered and the titles of hemagglutinin antibodies of each strain composing the Influenza vaccine used in 2007, before vaccination, and a month and six months after vaccination, were determined. There was no statistically relevant (5%) relation between stress and the insufficient immune response to the Influenza vaccine, according to the rate of individuals that showed, after a month, a level of antibodies concentration lower than four times the level prior to the vaccination. Nevertheless, there was a greater number of individuals with stress in the group of participants in which there was a decrease of the hemagglutinin titles of antibodies AH1 (ac AH1) in T6, when compared to the control group under study. The difference between groups was statistically relevant when assessing the presence of stress by triangulation method using the interview (p=0,006), by triangulation method using the GHQ12 (p=0,045) and by the combination of the three criteria (p=0,001). After multivariate analysis, it was verified that the XXVIII relation between the presence of stress and the reduction of the ac AH1 in T6 was statistically relevant (respectively, p= 0,010, p= 0,042 and p=0,002) and the odds ratio were, according to each of the methods used to assess the presence of stress, 3,643, 2,733 and 5,223. Overwork was the most emphasised stress-causing factor (58,8% of the sample and 61,8% of the nurses working in the Internment Units), followed by conflicts arousing among co-workers. Witnessing the suffering and death of patients was ranked as the fourth cause of stress, but the second by the nurses of the internment units. The former revealed a positive connection between working in the services, where there was a high rate of deaths, and the presence of stress, when assessing the presence of stress by triangulation method using the interview (p=0,039), the GHQ12 (p=0,019), the MBI-HSS emotional exhaustion scale (p=0,012) and by the combination of the three criteria (p=0,014).There was also a connection between the presence of stress, identified by the method of triangulation using the MBI-HSS emotional exhaustion scale, and working in the internment units, where the percentage of elderly people (p=0,025) and the mortality rate (p=0,036) were high. However, there was no connection between frequent exposure to suffering and death in patients and the reduction of ac AH1 titles, in T6. Although one can establish a connection between stress in nurses working in the internment units and the aforementioned stress-causing factor, the exposure to that factor was not, per se, intense enough to reduce the ac AH1 title in T6. The relation found between the presence of chronic stress and the reduction of AH1 antibodies titles in T6, corroborates the hypothesis that stress can negatively influence the title of antibodies, even in non-elderly adults. Thus, and according to the criteria used to define stress, by the triangulation method using the interview, by the triangulation method using the GHQ12 or the combination of the three criteria respectively, the risk of a nurse suffering from stress showing a reduction in the title of hemagglutinin antibodies for the strain AH1N1 A/Solomon Islands/3/2006 six-month after Influenza vaccine was 3,6, 2,7 or 5,2 times greater than on a nurse suffering from no stress at all. Rsum: Les professionnels de la sant peuvent tre exposs diffrents facteurs inducteurs de stress chronique de nature professionnelle. On remarque, parmi les effets possibles, une baisse de la rponse des anticorps aprs ladministration de vaccins, comme en particulier, le vaccin de la grippe. Lorsque les professionnels de la sant ont t exposs des facteurs inducteurs de stress, et de manire simultane, des agents biologiques dont les effets pourront tre prvenus par la vaccination, il est pertinent dtudier linfluence du stress dans la rponse immunitaire au vaccin de la grippe chez les infirmiers. Ils ont constitu des objectifs dtudes et de discussion : (1) tudier lassociation entre la prsence de stress chronique chez les infirmiers, en milieu hospitalier, et la insuffisant rponse immunitaire au vaccin de la grippe, vrifie un mois aprs la vaccination (T1); (2) tudier lassociation entre la prsence de stress chronique chez les infirmiers, en milieu hospitalier, et la rduction de la teneur des anticorps dirig la hmaglutinina six mois aprs la vaccination (T6) (3) identifier certaines caractristiques des units dinternement, et tudier les aspects du travail des participants, qui puissent tre associe la prsence de stress chronique et tudier sa possible association avec la rponse immunitaire au vaccin de la grippe. Une tude cas-contrle incorpore dans une tude de groupe a t ralise et un chantillon, pour tude, a t constitu par 136 infirmiers sains (83,8% de sexe fminin, ge moyen 33 ans) travaillant dans un hpital universitaire. Des entretiens individuels ont t raliss et les versions portugaises des questionnaires de General Health Questionnaire (GHQ12) et Maslach Burnout Inventory- Human Service Survey (MBI-HSS) ont t utiliss pour dterminer la prsence de stress chronique grce la mthode de triangulation, au dbut de ltude (T0) et un relev de donnes relatives la caractrisation dlments de travail dans les units dinternement a t fait. Le vaccin de la grippe a t administr et les teneurs en anticorps dirigs aux hmaglutininas de chaque composant du vaccin de la grippe pour 2007 ont t dtermins, avant la vaccination et un mois et six mois aprs. On na pas trouv dassociation, un niveau significatif de au moins 5%, entre la prsence de stress et la insuffisant rponse au vaccin de la grippe, value par le taux dindividus qui ont prsent une augmentation, la fin du mois, infrieur quatre fois la teneur des anticorps par rapport avant la vaccination. Cependant , on a trouv une plus grande proportion dindividus victimes de stress dans le groupe des participants o il y a eu une baisse de la teneur des anticorps dirig la hmaglutinina AH1 (ac AH1) en T6, aprs comparaison avec le respectif groupe de contrle. La diffrence entre les groupes a t statistiquement significative lorsquon a vrifi la prsence de stress grce la mthode de triangulation, en utilisant lentretien (p=0,006), par la mthode de triangulation en utilisant le GHQ12 (p=0,045) et en utilisant aussi la combinaison des trois critres (p=0,001). Aprs une analyse XXX multivarie, on a vrifi que lassociation entre la prsence de stress et la rduction des ac AH1 en T6 a conserv un signifi statistique (respectivement, p=0,010, p=0,042 et p=0,002) et a prsent des odds ratio ajusts, en fonction de chacune des mthodes de vrification de la prsence de stress de 3,643, de 2,733 et de 5,223. La quantit de travail perue comme une surcharge constitue le facteur inducteur de stress le plus souvent cit (58,8% de lchantillon et 61,8% des infirmiers des units dinternement), suivi par les conflits entre professionnels. Le contact avec la souffrance et la mort des patients a t plac en quatrime position par lchantillon, mais en deuxime position par les infirmiers des units dinternement. Dans ces cas, on a vrifi une association vidente entre le fait de travailler dans des services o le nombre de patients dcds a t trs lev et la prsence de stress, identifie par la mthode de triangulation, en utilisant lentretien (p=0,039), le GHQ12 (p=0,019), lchelle de fatigue motionnelle du MBI-HSS (p=0,012) et en utilisant aussi la combinaison des trois critres (p=0,014). On a aussi vrifi une association positive entre la prsence de stress, identifie par la mthode de triangulation, en utilisant lchelle de fatigue motionnelle du MBI-HSS et le travail dans des services dinternement o le pourcentage de malade gs (p=0,025) et le taux de mortalit ont t levs (p=0,036). Malgr tout, on na pas trouv dassociation entre lexposition trs frquente la souffrance et la mort des patients et la rduction de la teneur de ac AH1 en T6. Probablement lexposition ce facteur inducteur de stress, bien quelle soit lie la prsence de stress chez les infirmiers des services dinternement, na pas t suffisamment intense pour, en elle-mme, tre associe la rduction de la teneur ac AH1 enT6. Lassociation trouve entre la prsence de stress chronique et la rduction de la teneur des anticorps AH1 en T6 vient renforcer lhypothse que le stress pourra influencer ngativement la manutention des teneurs en anticorps mme chez les individus adultes jeunes. Donc le risque quun infirmier stress prsente une rduction de la teneur en anticorps dirigs la hmaglutinina de le composant AH1N1-A/Solomon Island/3/2006 la fin des six mois dtudes a t 3,6, 2,7 ou 5,2 fois suprieure celui dun infirmier sans stress, aprs avoir dtermin le critre de stress, respectivement par la mthode de triangulation utilisant lentretien, par la mthode de triangulation utilisant le GHQ12 ou par la combinaison des trois critres.
Resumo:
Dissertao apresentada na Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para a obteno do grau de Mestre em Engenharia do Ambiente, perfil Gesto e Sistemas Ambientais
Resumo:
Dissertao para Obteno do Grau de Mestre em Engenharia Civil Estruturas e Geotecnia pela Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa
Resumo:
Dissertao apresentada na Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para oBanho Termostatizadoeno do grau de Mestre em Engenharia Fsica
