Contribuição para a adaptação cultural do Neck Disability Index e caraterização da prática de fisioterapia em pacientes com dor crónica cervical

RESUMO: Objetivo: Este trabalho teve como objetivo contribuir para o processo de adaptação cultural do Neck Disability Index (NDI), através da análise da sua unidimensionalidade e do estudo da sua fiabilidade (consistência interna e fiabilidade teste-reteste), validade de constructo e poder de resposta. De igual forma pretendeu-se caraterizar a intervenção realizada pela fisioterapia e os resultados obtidos em pacientes com Dor Cervical Crónica (DCC). Introdução: A dor cervical é um problema cada vez mais comum nos países industrializados, constituindo uma das três condições mais frequentemente reportadas por queixas de origem músculo-esquelética. A sua incidência é um fenómeno em crescimento, com custos implicados para a sociedade. Desta forma reconhece-se a importância de um instrumento que monitorize a evolução da incapacidade funcional associada à DCC. O NDI é atualmente o instrumento de avaliação mais recomendado para avaliar a incapacidade funcional associada à dor cervical. Foi traduzido e adaptado à língua portuguesa, mas à data não foi realizada nenhuma avaliação das suas propriedades psicométricas. Por outro lado, apesar de a literatura referir que os serviços de Fisioterapia são extremamente procurados por indivíduos com DCC, em Portugal, a informação sobre a sua prática nesta condição clínica é escassa ou mesmo inexistente. Assim, e sendo a incapacidade nas atividades funcionais uma das variáveis de maior impacto da DCC e ao mesmo tempo um dos resultados principais da intervenção da Fisioterapia, importa por um lado possuir instrumentos capazes de avaliar o nível de incapacidade funcional e a sua mudança, e por outro, aferir qual a intervenção realizada pela Fisioterapia e quais os resultados obtidos. Metodologia: Realizou-se um estudo de coorte prospetivo com uma amostra de conveniência, do tipo não probabilístico, constituída por 88 pacientes com DCC de origem músculo-esquelética e causa não traumática referenciados para 6 serviços de fisioterapia / medicina física e de reabilitação de clínicas e centros de reabilitação, sendo elegíveis todos os pacientes que cumprissem os critérios de inclusão e exclusão estabelecidos. Os pacientes foram avaliados em três momentos pré-definidos: antes do início das sessões de fisioterapia ou na 1ª semana de tratamento; 4 a 7 dias após a 1ª avaliação; e 7 semanas após o início da fisioterapia. Para verificação da unidimensionalidade do NDI, procedeu-se a uma Análise Fatorial Exploratória. As propriedades psicométricas do NDI avaliadas foram a Fiabilidade (consistência interna e fiabilidade teste-reteste), a Validade de Constructo e o Poder de Resposta. Posteriormente procedeu-se à caraterização da prática da fisioterapia quanto às modalidades utilizadas, número de sessões de tratamento e duração do episódio de cuidados. Adicionalmente descreveu-se os resultados obtidos após a intervenção da fisioterapia ao nível da dor e incapacidade. Resultados: os resultados obtidos foram positivos e significativos, com a confirmação da unidimensionalidade do NDI, sendo que em todos os critérios seguidos o fator mínimo retido foi de um. Na avaliação da consistência interna o valor obtido foi acima do mínimo aceitável (α Cronbach = 0,77), enquanto o valor de fiabilidade teste-reteste foi elevado (CCI =0,95). De igual forma, os resultados foram positivos para a validade de constructo, obtendo-se uma associação positiva do NDI com a Escala Numérica da dor (END). O valores de poder de resposta reportaram uma Área Abaixo da Curva de 0,63 (IC 95%=0,51-0,75), com valor de Diferença Mínima Clinicamente importante de 5,5 pontos (sensibilidade = 69,6%; especificidade = 43,6%). Relativamente á intervenção de fisioterapia em casos de DCC verificou-se que as características da prática da fisioterapia reportadas neste relatório são de difícil comparação ou análise dada a escassez ou inexistência de trabalhos publicados sobre este assunto em pacientes com DCC. No entanto, neste estudo, encontraram-se reduções significativas na intensidade da dor e incapacidade funcional após a intervenção de fisioterapia (z= -7,16; p<0,001 e t= 10,412, p<0,05, respetivamente). Conclusão: Os resultados do presente estudo revelam que o NDI-VP possui uma boa Fiabilidade, Validade de Constructo e Poder de Resposta. Revela ainda que a intervenção da fisioterapia em casos de DCC, apesar da escassez de trabalhos publicados, proporciona uma redução significativa dos níveis de dor e incapacidade em pacientes com DCC.--------------- ABSTRACT:Objective: the aim of this study was to contribute for the process of cultural adaption of the Neck Disability Index (NDI), through the analysis of his unidimensionality and the study of his reliability (internal consistency and test-retest reliability), construct validity and responsiveness. At the same time it pretends to characterize the intervention performed by physical therapy and the results in patients with Chronic Neck Pain (CNP). Introduction: neck pain is a common problem in the industrialized countries, since is one of the three most reported conditions by complaints with musculoskeletal origin. His incidence is a growth phenomena that implicate great costs to society. Therefore the importance of an instrument that monitories the evolution of the functional disability associated to CNP is recognized. Nowadays, NDI is the instrument most recommended to evaluate functional disability associated to neck pain. It has been translated and adapted to portuguese but, till now, no evaluation of his psychometric proprieties has been completed. In the other hand, despite literature refers that physical therapy services are extremely searched by patients with neck pain, in Portugal, the information about practice in this clinical condition is very few or inexistent. Therefore, and since disability in the functional activities is one of the variables with most impact of CNP and, at the same time, one of the main results of physical therapy interventions, it’s important to have instruments capable of evaluate the level of functional disability and his change, and also calculate which intervention of physical therapy is most appropriate and his results. Methodology: it was used a prospective cohort study with a convenience sample, non-probabilistic, consisting of 88 patients with CNP of musculoskeletal origin and non-traumatic cause, referred to 6 physical therapy services of clinics and rehabilitation centers, and fulfilled the inclusion and exclusion criteria established. Patients were evaluated in three pre-defined moments: before the beginning of physical therapy or during the first week of treatment; 4 to 7 days after the first evaluation; and 7 weeks after beginning of physical therapy. To verify NDI unidimensionality, we run an Exploratory Factorial Analysis. NDI psychometric proprieties evaluated were reliability (internal consistency and test-retest reliability), construct validity and responsiveness. Subsequently, it was proceeded the characterization the practice of physical therapy regarding to the modalities used, the number of treatment sessions and duration of the episode of care. Additionally it was described the results obtained after the intervention of the physical therapy, the level of pain and the disability. Results: results were positive and significant, with the confirmation of the NDI unidimensionality, since in every followed criteria the minimal retained factor was one. In the evaluation of internal consistency the value was above the minimal accepted (α Cronbach = 0,77), and the test-retest reliability value was high (CCI =0,95). Results were positive to construct validity, with an positive association of the NDI with Numeric Rating Scale (NRS). Responsiveness values reported an Area Under Curve (AUC) of 0,63 (IC 95%=0,51-0,75) with a Minimal Important Detectable Change (MIDC) of 5,5 points (sensitivity = 69,9%; specificity = 43,6%). Regarding physical therapy interventions in CNP, it was verified that the physical therapy characteristics reported are difficult to compare or analyze since there are very few published studies about this topic. However, in this study, significant reductions were founded in pain intensity and functional disability after intervention(z= -7,16; p<0,001 and t= 10,412, p<0,05, respectively).Conclusion: present study results reveals that NDI has an good reliability, construct validity and responsiveness. It also reveals that physical therapy intervention in CNP, beside few studies published, result in a significant reduction of pain and disability levels in patients with CNP.

Microfacies studies of carbonate rocks from Jurassic outcrops in the north of Faro, Southern Portugal

The Middle and Upper Jurassique limestones investigated were sub-divided into nine microfacies (MF) types. The firsts four represent Bathonian sediments with shallow water characteristics typical for carbonate platforms. They are comparable with Wilson's facies zones 6 to 8. Reef and reef debris, near-shore clastic-dominated limestones are not present. These MF-types are reiterated several times without cyclicity. The vertical development of the differentiated facies units indicates a close interfingering. The microfacies data are typical of inter to shallow subtidal environments; both authigenous quartz and low faunal and floral diversity of several layers point to temporary restricted conditions. The occurrence of Dictyoconus cayeuxi LUCAS and Callovian ammonites from the above lying strata argue for a Bathonian age. The MF-types 5-9 (Oxfordian-Kimmeridgian) show completely different sedimentation conditions. Fully marine nearshore recifal limestones alternate with pelagic sediments formed at deeper shelf areas. The pelagic micritic limestones of Oxfordian age are characterized by allodapic intercalations whereas the Oxfordian/Kimmeridgian limestones with tuberolithic fabrics often show intensive silifications. Only initial patch reef growth-stages were reached during the development of the Oxfordian and Kimmeridgian shallow water limestones.

Electrochemical studies on small electron transfer proteins using membrane electrodes

Journal of Electroanalytical Chemistry 541 (2003) 153-162

International Conference on “Foresight Studies on Work in the Knowledge Society“ in Monte de Caparica (FCT-UNL) on 19-20 October 2006

On 19 and 20 October 2006, the Research Centre on Enterprise and Work Organisation (IET) organised the first international conference on “Foresight Studies on Work in the Knowledge Society”. It took place at the auditorium of the new Library of FCT-UNL and had the support of the research project “CodeWork@VO” (financed by FCT-MCTES and co-ordinated by INESC, Porto). The conference related to the European research project “Work Organisation and Restructuring in the Knowledge Society” (WORKS), which is financed by the European Commission. The main objective of the conference was to analyse and discuss research findings on the trends of work structures in the knowledge society, and to debate on new work organisation models and new forms of work supported by ICT.

In-situ X-ray diffraction studies during growth of Ni-Ti shape memory alloy films and their complementary ex-situ characterization

Shape Memory Alloy (SMA) Ni-Ti films have attracted much interest as functional and smart materials due to their unique properties. However, there are still important issues unresolved like formation of film texture and its control as well as substrate effects. Thus, the main challenge is not only the control of the microstructure, including stoichiometry and precipitates, but also the identification and control of the preferential orientation since it is a crucial factor in determining the shape memory behaviour. The aim of this PhD thesis is to study the optimisation of the deposition conditions of films of Ni-Ti in order to obtain the material fully crystallized at the end of the deposition, and to establish a clear relationship between the substrates and texture development. In order to achieve this objective, a two-magnetron sputter deposition chamber has been used allowing to heat and to apply a bias voltage to the substrate. It can be mounted into the six-circle diffractometer of the Rossendorf Beamline (ROBL) at the European Synchrotron Radiation Facility (ESRF), Grenoble, France, enabling an in-situ characterization by X-ray diffraction(XRD) of the films during their growth and annealing. The in-situ studies enable us to identify the different steps of the structural evolution during deposition with a set of parameters as well as to evaluate the effect of changing parameters on the structural characteristics of the deposited film. Besides the in-situ studies, other complementary ex-situ characterization techniques such as XRD at a laboratory source, Rutherford backscattering spectroscopy(RBS), Auger electron spectroscopy (AES), cross-sectional transmission electron microscopy (X-TEM), scanning electron microscopy (SEM), and electrical resistivity (ER) measurements during temperature cycling have been used for a fine structural characterization. In this study, mainly naturally and thermally oxidized Si(100) substrates, TiN buffer layers with different thicknesses (i.e. the TiN topmost layer crystallographic orientation is thickness dependent) and MgO(100) single crystals were used as substrates. The chosen experimental procedure led to a controlled composition and preferential orientation of the films. The type of substrate plays an important role for the texture of the sputtered Ni-Ti films and according to the ER results, the distinct crystallographic orientations of the Ni-Ti films influence their phase transformation characteristics.

Structural and mechanistic studies of iron containing proteins

Dissertação apresentada para obtenção do Grau de Doutor em Bioquímica, ramo de Bioquímica-Física, pela Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia

Periplasmic nitrate reductases: structural and spectroscopic studies

Dissertação apresentada para obtenção do grau de Doutor em Bioquímica, especialidade Bioquímica-Física, pela Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa

Localization studies of the FemXAB protein family in Staphylococcus aureus

Dissertação apresentada para a obtenção do Grau de Mestre em Genética Molecular e Biomedicina, pela Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia

Evaluation of the potential of translocated common cockle for ecological risk assessment studies: bioaccumulation and biomarkers test

Thesis submitted to the Faculdade de Ciências e Tecnologia to obtain the Master’s degree in Environmental Engineering, profile in Ecological Engineering

Wetland Habitat Studies using various Classification Techniques on Multi-Spectral Landsat Imagery: Case study: Tram chim National Park, Dong Thap Vietnam

Dissertation submitted in partial fulfilment of the requirements for the Degree of Master of Science in Geospatial Technologies

Spectroscopic Studies and Characterization of a Novel Electron-Transfer Chain

A novel two-component enzyme system from Escherichia coli involving a flavorubredoxin (FlRd) and its reductase was studied in terms of spectroscopic, redox, and biochemical properties of its constituents. FlRd contains one FMN and one rubredoxin (Rd) center per monomer. To assess the role of the Rd domain, FlRd and a truncated form lacking the Rd domain (FlRd¢Rd), were characterized. FlRd contains 2.9 ( 0.5 iron atoms/subunit, whereas FlRd¢Rd contains 2.1 ( 0.6 iron atoms/subunit. While for FlRd one iron atom corresponds to the Rd center, the other two irons, also present in FlRd¢Rd, are most probably due to a di-iron site. Redox titrations of FlRd using EPR and visible spectroscopies allowed us to determine that the Rd site has a reduction potential of -140 ( 15 mV, whereas the FMN undergoes reduction via a red-semiquinone, at -140 ( 15 mV (Flox/Flsq) and -180 ( 15 mV (Flsq/Flred), at pH 7.6. The Rd site has the lowest potential ever reported for a Rd center, which may be correlated with specific amino acid substitutions close to both cysteine clusters. The gene adjacent to that encoding FlRd was found to code for an FAD-containing protein, (flavo)rubredoxin reductase (FlRd-reductase), which is capable of mediating electron transfer from NADH to DesulfoVibrio gigas Rd as well as to E. coli FlRd. Furthermore, electron donation was found to proceed through the Rd domain of FlRd as the Rd-truncated protein does not react with FlRd-reductase. In vitro, this pathway links NADH oxidation with dioxygen reduction. The possible function of this chain is discussed considering the presence of FlRd homologues in all known genomes of anaerobes and facultative aerobes.

Structure to function studies in UDP-glucose dehydrogenases and nitroreductases

The thesis is divided into two parts corresponding to structural studies on two different proteins. The first part concerns the study of two UDP-glucose dehydrogenases (UGDs) from Sphingomonas elodea ATCC 31461 and Burkholderia cepacia IST 408, both involved in exopolysaccharide production. Their relevance arises because some of these bacterial exopolysaccharides are valuable as established biotechnological products, the former case, whilst others are highly problematic, when used by pathogens in biofilm formation over biological surfaces, as the latter case, namely in the human lungs. The goal of these studies is to increase our knowledge regarding UGDs structural properties, which can potentiate either the design of activity enhancers to respond to the increased demand of useful biofilms, or the design of inhibitors of biofilm production, in order to fight invading pathogens present in several infections. The thesis reports the production and crystallisation of both proteins, the determination of initial phases by single-wavelength anomalous dispersion (SAD) in S. elodea crystals using a seleno-methionine isoform, and phasing of B. cepacia crystals by molecular replacement (MR) using the S. elodea model, as well as the refinement, structural analysis and comparison between the several UGDs structures available during this work.(...)

Learning in higher education: strategies to overcome challenges faced by adult students – lessons drawn from two case studies in Portugal

This paper appears in International Journal of Information and Communication Technology Education edited by Lawrence A. Tomei (Ed.) Copyright 2007, IGI Global, www.igi-global.com. Posted by permission of the publisher. URL:http://www.idea-group.com/journals/details.asp?id=4287.

Spectroscopy studies on conservation issues in modern and contemporary paintings

Dissertation presented to the Faculty of Sciences and Technology of New University of Lisbon in fulfilment of the requirements for the Master’s degree in Conservation and Restoration Specialization in easel painting

Electrical ageing studies of polymeric insulation for power cables (estudo do envelhecimento eléctrico do isolante polimérico de cabos eléctricos

Dissertação apresentada para obtenção do Grau de Doutor em Engenharia Física - Física Aplicada pela Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia