Avaliação do débito máximo da tosse (peak cough flow) na doença pulmonar obstrutiva crónica

Resumo Objectivos: Avaliação da Tosse em doentes com Doença Pulmonar Obstrutiva Crónica (DPOC). Identificar e determinar a relação dos factores preditivos que contribuem para a deterioração da capacidade de tosse nestes indivíduos. Tipo de estudo: Estudo observacional descritivo de natureza transversal. Definição dos casos: Os critérios de diagnóstico da DPOC são o quadro clínico e o Gold standard para diagnóstico da DPOC – a espirometria. População-alvo: Todos os utentes com patologia primária de DPOC diagnosticada que se desloquem ao serviço de função respiratória do Hospital de Viseu, para realizar provas. Método de Amostragem: Foi utilizada uma amostra aleatória constituída por todos os indivíduos, que cumpriram os critérios de inclusão, conscientes e colaborantes, que aceitaram participar neste estudo. Dimensão da amostra: Uma amostra de 55 indivíduos que se deslocaram ao serviço de função respiratória, entre Janeiro e Junho de 2009, para realizar provas de função respiratória. Condução do estudo: Os utentes que aceitaram participar neste estudo foram sujeitos a um questionário de dados clínicos e realizaram 5 testes: índice de massa corporal (IMC), estudo funcional respiratório e gasometria arterial, avaliação da força dos músculos respiratórios (PImax e PEmax) e avaliação do débito máximo da tosse (Peak Cough Flow). Análise estatística: Foram obtidos dados caracterizadores da amostra em estudo, sendo posteriormente correlacionado o valor de débito máximo da tosse (Peak Cough Flow) com os resultados obtidos para as avaliações do IMC, estudo funcional respiratório, PImax e PEmax, gasometria, avaliação da capacidade de Tosse e número de internamentos no último ano por agudização da DPOC. Tendo sido encontrados os valores de correlação entre o Peak Cough Flow e os restantes parâmetros. Resultados: Após análise dos resultados, foram obtidos os valores de Peak Cough Flow para a população com DPOC e verificou-se valores diminuídos em comparação com os valores normais da população, tendo-se verificado maiores valores de PCF em indivíduos do sexo masculino, em comparação aos valores do sexo feminino. Foi analisada a relação entre o PCF e a idade, peso, altura e IMC, não tendo sido encontrada relação, dado que a tosse não apresenta uma variação segundo os valores antropométricos, tal como a relação com os valores espirométricos. Quanto aos parâmetros funcionais respiratórios foram analisadas as relações com o PCF. Verificou-se relações significativas entre o PCF e o FEV1, a FVC, o PEF, apresentando uma relação positiva, onde maiores valores destes parâmetros estão correlacionados com maiores picos de tosse. Quanto a RAW e RV, o PCF apresenta uma relação negativa, onde uma maior resistência da via aérea ou doentes mais hiperinsuflados leva a menores valores de PCF. Por outro lado não foi encontrada relação entre o PCF e a FRC e o TLC. Quanto à força dos músculos respiratórios, verificou-se relação significativa com o PImax e a PEmax em que a fraqueza ao nível dos músculos respiratórios contribuem para um menor valor de PCF. Relativamente aos valores da gasometria arterial, verificou-se relação entre o PCF e a PaO2 de forma positiva, em que doentes hipoxémicos apresentam menores valores de tosse, e a PaCO2, de forma negativa, em que os doentes hipercápnicos apresentam menores valores de PCF tendo sido verificada relação entre o PCF e o pH e sO2. Quanto à relação entre o número de internamentos por agudização da DPOC no último ano e o PCF verificou-se uma relação significativa, onde um menor valor de PCF contribui para uma maior taxa de internamento por agudização da DPOC. Conclusão: Este conjunto de conclusões corrobora a hipótese inicialmente formulada, de que o Peak Cough Flow se encontra diminuído nos indivíduos com Doença Pulmonar Obstrutiva Crónica onde a variação do PCF se encontra directamente relacionada com os parâmetros funcionais respiratórios, com a força dos músculos respiratórios e com os valores de gasometria arterial. ABSTRACT: Aims: Cough evaluation in Chronic Obstructive Pulmonary Disease (COPD) patients. Identify and determine the relation of the predictive factors that contribute to the cough capacity degradation in this type of patients. Type of study: Descriptive observational study of transversal nature. Case definition: The COPD diagnosis criteria are the clinical presentation and the gold standard to the COPD diagnosis- the Spirometry. Target Population: Every patients, with primary pathology of COPD diagnosed, who went to the respiratory function service of Viseu hospital to perform tests. Sampling Method: It was used a random sample constituted by all the, conscious and cooperating individuals, who complied with the inclusion criteria and who accepted to make part of this study. Sample size: A sample of 55 individuals that went to the respiratory function service between January and June 2009 to perform respiratory function tests. Study: The patients who accepted to make part of this study were submitted to a clinical data questionary and performed 5 tests: body mass index (BMI), respiratory functional study, arterial blood gas level, evaluation of respiratory muscles strength (maximal inspiratory pressure (MIP) and maximum expiratory pressure (MEP)), and Peak Cough Flow evaluation. Statistic Analysis: Were obtained characterizing data of the sample in study, and later correlated the value of the Peak Cough Flow with the results from the evaluation of the body mass index (BMI), the respiratory functional study the MIP and MEP, the arterial blood gas level and also with the ability to cough evaluation and the number of hospitalizations in the last year for COPD exacerbations. The values of correlation between the Peak Cough Flow and the other parameters were found. Results: After analyzing the results, were obtained the values of Peak Cough Flow for the population with COPD. There were decreased values compared with the population normal values, having been found higher values of PCF in males compared to female values. It was analyzed the relation between the PCF and the age, weight, height and BMI but no relation was found on account of the fact that the cough does not show a variation according to anthropometric parameters, such as the relation with spirometric values. As for the respiratory functional parameters were analyzed relations with the PCF. There were significant relations between the PCF and FEV1, the FVC, the PEF, presenting a positive relation, where higher values of these parameters are correlated with higher incidence of cough. Concerning the RAW and RV, the PCF has a negative relation, in which a higher airway resistance or in more hyperinflated patients, leads to lower values of PCF. On the other hand no correlation was found between the PCF and the FRC and TLC. Regarding the respiratory muscle strength, there was a significant relation with the MIP and MEP, in which the weakness at the level of respiratory muscles contribute to a lower value of PCF. For values of arterial blood gas level, there was no relation between the PCF and PaO2, in a positive way, in which patients with hypoxemia present lower values of cough, and PaCO2, in a negative way in which hypercapnic patients had lower values of PCF, having being founded a relation between the PCF and the pH and sO2. As for the relation between the number of hospitalizations for COPD exacerbation in the last year and the PCF was found a significant relation, in which a smaller value of PCF contributes to a higher rate of hospitalization for COPD exacerbation. Conclusion: This set of findings supports the hypothesis first formulated that Peak Cough Flow is decreased in individuals with Chronic Obstructive Pulmonary Disease, in which the variation of the PCF is directly related to the respiratory function parameters, the strength of respiratory muscles and the values of arterial blood gases.

Factores individuais que condicionam a Saúde : um estudo caso-controlo

RESUMO - O presente projecto enquadra-se no paradigma salutogénico e visa apurar alguns dos factores que determinam que algumas pessoas se apresentem mais saudáveis que a população em geral. Foi seleccionado um estudo, quantitativo, analítico tipo caso-controlo (1 caso para 3 controlos), em que os casos são constituídos por indivíduos integrando a Função Pública que se encontram acima do percentil 95 de assiduidade ao trabalho nos últimos dois anos e com uma auto-percepção de Saúde classificada como muito boa, os controlos são indivíduos que não obedecem à definição de caso. Os indivíduos serão emparelhados por idade, género, estado civil, carreira, categoria profissional e unidade funcional que integram. A assiduidade será calculada com recurso aos certificados de incapacidade temporária entregues nos respectivos serviços. Os factores a estudar são os mais citados na literatura como factores salutogénicos ou factores de protecção, são eles: - Sentido de Coerência de Antonowsky - Locus de controlo - Auto conceito -Auto Eficácia - Aptidão física nas três vertentes clássicas: Capacidade aeróbia, Composição corporal, Aptidão muscular. Todos estes factores serão estudados com recurso a questionários auto preenchidos devidamente testados e validados para o português de Portugal sendo a aptidão física apurada com recurso á bateria de testes "Fitness Gram" adoptada para Portugal pelo Instituto do Desporto de Portugal e pelo Ministério da Educação. Os resultados serão apurados com recurso ao software de análise epidemiológica EPIDAT. 3.1. ---------------- ABSTRACT - The present project follows the salutogénic paradigm and intends to identify some of the factors that determine why some people are healthier than the general population. It was selected a quantitative, analytic, case-control study type (1 case to 3 controls), in which the cases are constituted by individuals who are integrated in Public Services and find themselves above 95 percentile of assiduity in work in the last two years, and with a self-perception of Health classified as very good, the controls are individuals who don’t obey to the case definition. The individuals will be matched by age, gender, civil state, career, professional category and Functional Unity in the Health services. The assiduity will be calculated with the help of temporary incapacity certificates delivered in the respective services. The currently studying factors are the most cited in literature, like salutogenic factors or protection factors, are those: - Antonowsky’s Sense of Coherence - Locus Control - Self-concept - Self-Efficacy - The three classic strands of Physical Fitness: Aerobic Capacity, Corporal Composition, Muscular Fitness. All these factors will be studied with the resource of properly tested and validated self-filled questionnaires for Portugal Portuguese (language), with the Physical Fitness being determined with the resource of “Fitness Gram” test battery, adopted for Portugal by the Portuguese Sports Institute and the Education Ministry. The results will be determined with the resource of the epidemiologic analysis software EPIDAT. 3.1.

How can clusters help in the product type choice? The case of a specialized retail store

This work project (WP) is a study about a clustering strategy for Sport Zone. The general cluster study’s objective is to create groups such that within each group the individuals are similar to each other, but should be different among groups. The clusters creation is a mix of common sense, trial and error and some statistical supporting techniques. Our particular objective is to support category managers to better define the product type to be displayed in the stores’ shelves by doing store clusters. This research was carried out for Sport Zone, and comprises an objective definition, a literature review, the clustering activity itself, some factor analysis and a discriminant analysis to better frame our work. Together with this quantitative part, a survey addressed to category managers to better understand their key drivers, for choosing the type of product of each store, was carried out. Based in a non-random sample of 65 stores with data referring to 2013, the final result was the choice of 6 store clusters (Figure 1) which were individually characterized as the main outcome of this work. In what relates to our selected variables, all were important for the distinction between clusters, which proves the adequacy of their choice. The interpretation of the results gives category managers a tool to understand which products best fit the clustered stores. Furthermore, as a side finding thanks to the clusterization, a STP (Segmentation, Targeting and Positioning) was initiated, being this WP the first steps of a continuous process.

Rehabilitation of renders of old buildings in Portugal: survey, supporting methodology proposal and case study

The main purpose of the research is to present a proposal for a methodology to support the rehabilitation project of renders of old buildings in Portugal. To achieve the objective it was considered essential to define the main types of participants and aspects to integrate the proposal. The research methodology consists in an inquiry presented to professional participants in rehabilitation, a market study of materials and products available in Portugal, the design of a methodology proposal and its application to a case study. The inquiry sample totals 24 answers from the targeted professionals. A sequence of relevant supporting procedures consists in the proposal, which aims to provide a supporting methodology to decide and project in this context and also to be tested with its application to the building. This proposal was applied to an old building with load-bearing stone masonry walls and air-lime based renders. It was concluded that the assessment of the building and external renderings’ condition, its diagnosis and of the supporting walls, the definition of intervention, the specification of materials to be used and performance requirements to comply, and also plans for conservation and periodic maintenance, are crucial. From the inquiry, compatibility between materials and complementary roles and points of view of different types of participants in rehabilitation must be highlighted. A proposal for a methodology to support the project could provide useful guidance particularly for architects and construction engineers, and improve the understanding of direct participants on site, therefore contributing for the correct implementation of intervention.

“What matters?”: The case of sustainability reporting in Spain and Portugal

This project explores the case of Sustainability Reporting in Spain and Portugal and the recently launched new generation of Global Reporting Initiative Guidelines. The sample of the study is composed of companies included in the “GRI Report list 1999-2015”. In particular 2013 onwards 51 companies that published their G4 Report are taken into consideration. An indirect study is conducted based on the content of the sustainability reports of companies that implemented the Global Report Initiatives (GRI) reporting guidelines in order to identify focus areas of sustainability reporting in Spain and Portugal, analyzing trends and patterns relevant for observation. The project also promotes a discussion of the usability of the G4 guidelines and the adoption of materiality definition.

Rehabilitation of renders of old buildings in Portugal: survey, supporting methodology proposal and case studies

The main purpose of the research is to present a proposal for a methodology to support the rehabilitation project of renders of old buildings. To achieve the objective it was considered essential to define the main types of participants and aspects to integrate the proposal. The research methodology consists in an inquiry presented to several professional participants in rehabilitation, a market study of materials and products available in Portugal, the design of a methodology proposal and its application to a case study. The inquiry sample totals 24 answers from the targeted professionals. A sequence of relevant supporting procedures consists in the proposal, which aims to provide a supporting methodology to decide and project in this context and also to be tested with its application to the building. This proposal was applied to an old building with load-bearing stone masonry walls and air-lime based renders. It was concluded that the assessment of the building and external renderings’ condition, its diagnosis and of the supporting walls, the definition of intervention, the specification of materials to be used and performance requirements to comply, and also plans for conservation and periodic maintenance, are crucial. From the inquiry, compatibility between materials and complementary roles and points of view of different types of participants in rehabilitation must be highlighted. A proposal for a methodology to support the project could provide useful guidance particularly for architects and construction engineers, and improve the understanding of direct participants on site, therefore contributing for the correct implementation of the intervention.

Blended Learning project with Applied Optics. Case study

To show with the case of Applied Optics (AO), the adequacy of blended learning to the teaching/learning process in experimental Science and technology (S&T).

Teamwork and Gendered Work Cultures: The Case of Finland

In this article I focus on women workers’ experiences of transformation from line work to teamworking in Finnish clothing companies in the 1990s and also show what happened after this transformation in the clothing branch. The undertone of it is rather melancholic. Following an initial period of intensive and successful development, clothing work was moved from Finland to countries of cheap labour, such as Estonia, Latvia, Lithuania and Russia, and even China. In this type of network manufacturing, the development of modern information and communication technologies played a central role. My aim is to present the standpoint of women clothing workers in this process. The main body of the empirical data of my study consists of dialogues with clothing workers, union representatives, supervisors and managers. I also make use of my fieldwork notes, memos and research diaries from three companies over a period of five years. Furthermore, in the background lie the action research material from Scandinavian type work conferences and the survey material of an extensive mail inquiry that covered the whole branch in Finland. My own research started in 1991 as a mail inquiry and then continued as a case study in companies from 1992 to 2000, by employing action research and ethnographic methodologies.

The globalisation in the clothing sector and its implications for work organisation: a view from the Portuguese case

The clothing sector in Portugal is still seen, in many aspects as a traditional sector with some average characteristics, such as: low level of qualifications, less flexible labour legislation and stronger unionisation, very low salaries and low capability of investment in innovation and new technology. Is, nevertheless, a very important sector in terms of labour market, with increased weight in the exporting structure. Globalisation and delocalisation are having a strong impact in the organisation of work and in occupational careers in the sector. With the pressure of global competitiveness in what concerns time and prices, very few companies are able to keep a position in the market without changes in organisation of work and workers. And those that can perform good responses to such challenges are achieving a better economical stability. The companies have found different ways to face this reality according to size, capital and position. We could find two main paths: one where companies outsource a part or the entire production to another territory (for example, several manufacturing tasks), close and/or dismissal the workers. Other path, where companies up skilled their capacities investing, for example, in design, workers training, conception and introduction of new or original products. This paper will present some results from the European project WORKS – Work organisation and restructuring in the knowledge society (6th Framework Programme), focusing the Portuguese case studies in several clothing companies in what concern implications of global context for the companies in general and for the workers in particular, in a comparative analysis with some other European countries.

Application of FTA and the perceived impact on employment policies: the case of nanotechnology in the Netherlands, Germany and Portugal

In this paper we will analyse the usage of FTA to support decision-making in employment policy relate to specific occupational groups. The examples can be better understood if one focus on the nanotechnology and its implications on some sectors (clothing, bio-medical engineering, micro-electronics). When this is done will be clear which occupations will engage a restructuring process (engineers, specialised technicians, qualified machine operators, quality controllers) and what policies are being designed to cope with it. This means toward which extend social partners have driven specific policies on these issues (focused in their sectors).

Working in IT projects – Options and Limits of Work Design

Flexible forms of work like project work are gaining importance in industry and services. Looking at the research on project work, the vast majority of present literature is on project management, but increasingly, problems concerning the quality of work and the efficiency of project teams become visible. The question now is how project work can be structured in order to simultaneously provide efficient and flexible work and healthy working conditions ensuring the development of human resources for a long time. Selected results of publicly funded research into project work will be presented based on case studies in 7 software development /IT consulting project teams (N=34). A set of different methods was applied: interviews with management/project managers, group interviews on work constraints, a monthly diary about well-being and critical incidences in the course of the project, and a final evaluation questionnaire on project outcomes focusing on economic and health aspects. Findings reveal that different types of projects exist with varying degree of team members’ autonomy and influence on work structuring. An effect of self-regulation on mental strain could not be found. The results emphasize, that contradicting requirements and insufficient organizational resources with respect to the work requirements lead to an increased work intensity or work obstruction. These contradicting requirements are identified as main drivers for generating stress. Finally, employees with high values on stress for more than 2 months have significantly higher exhaustion rates than those with only one month peaks. Structuring project work and taking into account the dynamics of project work, there is a need for an active role of the project team in contract negotiation or the detailed definition of work – this is not only a question of individual autonomy but of negotiation the range of option for work structuring. Therefore, along with the sequential definition of the (software) product, the working conditions need to be re-defined.

Importance of global co-innovation networks: A TCS case study

Today all kinds of innovations and research work is done by partnerships of competent entities each having some specialized skills. Like the development of the global economy, global innovation partnerships have grown considerably and form the basis of most of the sophisticated innovations today. To further streamline and simplify such cooperation, several innovation networks have been formed, both at local and global levels. This paper discusses the different types of innovations and how cooperation can benefit innovation in terms of pooling of resources and sharing of risks. One example of an open global co-innovation network promoted by Tata Consultancy Services, the TCS COIN is taken as a case. It enables venture capitalists, consultants, research agencies, companies and universities form nodes of the network so that each entity can play a meaningful role in the innovation network. Further, two innovation projects implemented using the COIN are discussed. Innovation Networks like these could form the basis of a unique global innovation network, which is not owned by any company and is used by innovation partners globally to collaborate and conduct research and development.

Component-based software engineering: a quantitative approach

Dissertação apresentada para a obtenção do Grau de Doutor em Informática pela Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia

Future gender relations in global restructuring processes case study evidence from knowledge-intensive, manufacturing and service occupations

Global restructuring processes have not only strong implications for European working and living realities, but also have specific outcomes with regard to gender relations. The following contribution analyses in which way global restructuring shapes current gender relations in order to identify important trends and developments for future gender (in)equalities at the workplace. On the basis of a large qualitative study on global restructuring and impacts on different occupational groups it argues that occupational belonging in line with skill and qualification levels are crucial factors to assess the further development of gender relations at work. Whereas global restructuring in knowledge-based occupations may provide new opportunities for female employees, current restructuring is going to deteriorate female labour participation in service occupations. In contrast, manufacturing occupations can be characterised by persistent gender relations, which do not change in spite of major restructuring processes at the work place. Taking the institutional perspective into account, it seems to be crucial to integrate the occupational perspective in order to apply adequate policy regulations to prevent the reinforcement of gender related working patterns in the near future.

Case study: Estratégia de aplicação de ferramentas de apoio à gestão da performance humana em ambientes Lean

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do Grau de Mestre em Engenharia Industrial