Identidade do jovem rural confrontando com estere��tipo de Jeca Tatu: um estudo qualitativo com os jovens da EFA Rei Alberto I

Disserta����o de mestrado em Ci��ncias da Educa����o, na Faculdade de Ci��ncias e Tecnologia da Universidade Nova de Lisboa e do Dipl��me d' Universit�� Fran��ois Rabelais de Tours

Reciclagem mec��nica de placas de circuitos electr��nicos

Disserta����o apresentada na Faculdade de Ci��ncias e Tecnologia da Universidade Nova de Lisboa para obten����o do grau de Mestre em Engenharia de Materiais

Determina����o dos factores intervenientes na f��rmula de capacidade de carga. Compara����o com o EC7 e com os da literatura existente

Disserta����o apresentada �� Faculdade de Ci��ncias e Tecnologia da Universidade Nova de Lisboa para obten����o do grau de Mestre em Engenharia Geol��gica (Geotecnia)

Anemia de c��lulas falciformes na idade pedi��trica : contribui����o para o estudo das suas principais complica����es e indicadores de progn��stico

RESMO: Introdu����o: A anemia de c��lulas falciformes doen��a heredit��ria, com repercuss��o multi-org��nica, tem grande variabilidade na sua express��o cl��nica. Da�� o interesse do estudo de indicadores de progn��stico. A investiga����o realizada foi precedida de um resumo hist��rico incidindo sobre a compreens��o de aspectos fundamentais da doen��a ao longo dos tempos. Na primeira parte do estudo e ap��s revis��o bibliogr��fica, foram referidos dados da fisiopatologia como base para os estudos que integram a presente disserta����o. Abordou-se o estado da arte relativamente ��s complica����es, aos indicadores de progn��stico e �� terap��utica utilizada. Objectivos: Constitu��ram objectivos deste estudo realizado numa amostra populacional representativa: identificar as les��es a n��vel dos sistemas cardio-respirat��rio e nervoso central, avaliando-se as respectivas repercuss��es; avaliar a presen��a de indicadores de progn��stico entre as vari��veis seleccionadas; estudar a efic��cia e toxicidade da HU nos doentes com as formas graves da ACF. Para a prossecu����o destes objectivos foram delineados para al��m do estudo global tr��s estudos espec��ficos: Estudo 1- repercuss��o no sistema cardio-respirat��rio; Estudo 2- repercuss��o no sistema nervoso central; Estudo 3- terap��utica com hidroxiureia. Doentes e m��todos: Procedeu-se a um estudo prospectivo e multi-institucional durante um per��odo de tr��s anos tendo-se seleccionado para a amostra, e de acordo com crit��rios pr��-definidos, 30 doentes com ACF na fase est��vel da doen��a, com idades compreendidas entre os sete e os 18 anos, todos de origem africana �� excep����o de um caucasiano. O diagn��stico baseou-se em t��cnicas de electroforese e estudo molecular que definiu o genotipo da doen��a e a presen��a da delec����o da ���-talass��mia assim como os haplotipos da amostra populacional. Foram utilizadas diferentes metodologias para avaliar a exist��ncia de les��o pulmonar e cerebral. Atrav��s do estudo estat��stico foram seleccionadas diversas vari��veis como hipot��ticos indicadores de progn��stico. Estudo 1. Para determinar a exist��ncia de les��o a n��vel pulmonar usaram-se duas metodologias diferentes, a avalia����o da fun����o pulmonar com estudo da satura����o da Hb em O2 no sangue arterial e a tomografia computadorizada de alta resolu����o. Estudou-se tamb��m a poss��vel disfun����o card��aca como repercuss��o da les��o pulmonar, atrav��s do ecocardiograma, e os indicadores de progn��stico com significado estat��stico para a les��o encontrada. Estudo 2. O desenho deste estudo foi sobrepon��vel ao anterior, mas com metodologia adequada para o SNC. Procedeu-se ao estudo das les��es cerebrais por meio de exames imagiol��gicos, (RMN-CE e DTC) e de testes psicol��gicos. Correlacionaram-se as tr��s metodologias utilizadas e a import��ncia de cada uma para a decis��o de atitudes terap��uticas preventivas. Estudo 3. Consistiu num estudo aberto prospectivo n��o controlado com nove crian��as e adolescentes com formas graves de ACF, com o objectivo de avaliar a efic��cia da terap��utica com hidroxiureia, durante um per��odo de 24 meses. Todos os doentes completaram no m��nimo 15 meses de terap��utica, com uma dose final m��dia de 19���4 mg/K/dia. Resultados globais: Durante o per��odo anterior �� investiga����o caracterizou-se a amostra populacional estudada quanto ao fenotipo gen��tico, cl��nico e hematol��gico de acordo com os crit��rios utilizados por outros investigadores. Verificou-se: predom��nio do haplotipo Bantu na forma homozig��tica em 53% dos doentes; n��mero total de EVO ���3/ano em 87,5% dos doentes; crises de sequestra����o em 18,75%; dactilites no primeiro ano de vida em 31,2%; quadro de s��psis grave apenas num doente; crises de hiper-hem��lise em 50%; e STA em 59,38% dos doentes. Quanto ao fenotipo hematol��gico evidenciaram-se como factores de risco reticulocitose (13,1x103/���l) e hiperbilirrubin��mia (2,5 mg/dl) e como factores de bom progn��stico a presen��a de delec����o de um gene da ���-talass��mia em 46,9% dos doentes e valor m��dio de Hb 8,1 g/dl. Resultados dos estudos parcelares: Estudo 1. Deste estudo infere-se que a DPR ligeira foi diagnosticada em 70% dos doentes, uma vez que as altera����es da difus��o n��o foram estatisticamente significativas, o estudo dos gases no sangue n��o evidenciaram resultados anormais e a TCAR evidenciou altera����es em 43,3% dos doentes. Apenas num doente se verificou doen��a pulmonar obstrutiva relacionada com maior n��mero da STA.O estudo da disfun����o card��aca encontrada em 86,7% dos doentes n��o reflecte a repercuss��o da DPR a n��vel card��aco, podendo estar associada ��s altera����es fisiopatol��gicas da pr��pria anemia cr��nica. Encontraram-se indicadores de progn��stico hematol��gicos e cl��nicos. Entre os primeiros, valores de Hb ���8,5 g/dl e de HbF ���13% foram considerados indicadores de bom progn��stico para a les��o pulmonar. Em rela����o aos par��metros cl��nicos, as STA n��o foram consideradas indicadoras de progn��stico para a DPR ao contr��rio do que se verificou com o n��mero de EVO. Pela an��lise dos par��metros gen��ticos e socio-econ��micos provou-se a aus��ncia de rela����o estatisticamente significativa com les��o pulmonar. Estudo 2. Pela RMN-CE foram diagnosticados ES em 33,3% com uma localiza����o preferencial na subst��ncia branca profunda em 26,6% dos doentes. Relativamente aos par��metros hematol��gicos seleccionados, o valor m��dio da HbF 8,6% constitu��u um indicador de bom progn��stico para o aparecimento de ES, enquanto o valor m��dio de leuc��citos 12.39x103/��l foi considerado um indicador de mau progn��stico. No estudo do DTC apenas um doente apresentou aumento da velocidade do fluxo cerebral na ACM igual a 196 cm/segundos, associado a vasculopatia grave. Os testes psicol��gicos alterados em 80% dos doentes mostraram ser o m��todo mais sens��vel para detectar altera����es do neurodesenvolvimento, mas sem correla����o com os ES em 10% dos doentes. Real��a-se a baixa percentagem de DTC patol��gicos encontrados neste estudo em rela����o ao n��mero elevado de ES e de testes psicol��gicos alterados, n��o se verificando concord��ncia entre os tr��s exames. Dos indicadores de progn��stico estudados a ���-talass��mia foi considerada um factor de protec����o para o coeficiente de intelig��ncia da escala de Wechsler. Em rela����o a par��metros cl��nicos estudados os doentes com maior n��mero de EVO, tem em m��dia valores inferiores nos testes psicol��gicos. Estudo 3. Neste estudo verificou-se que o valor m��dio da HbF aumentou significativamente de 7,0��4% para 13,7��5,3% (p=0,028) ao fim de 15 meses de terap��utica com hidroxiureia. Clinicamente todos os doentes responderam significativamente com uma redu����o de 80% no n��mero de EVO, 69% no n��mero de internamentos, 76% no n��mero de dias de hospitaliza����o e 67% no n��mero de transfus��es. Deste modo comprovou-se n��o s�� a efic��cia desta terap��utica neste grupo pedi��trico como tamb��m a falta de efeitos secund��rios significativos. Considera-se a necessidade de estudos mais prolongados e em grande s��ries, para com seguran��a se usar a HU antes que a les��o org��nica se estabele��a, portanto logo nos primeiros anos de vida. Conclus��o: Na amostra populacional estudada foram evidenciadas les��es pulmonares e cerebrais na grande maioria dos doentes que condicionaram a sua qualidade de vida. Foram identificados indicadores de progn��stico que poder��o eventualmente ditar medidas terap��uticas precoces com o objectivo de diminuir a morbilidade e a mortalidade neste grupo et��rio. Demonstrou-se que a terap��utica com a HU foi eficaz e bem tolerada----------ABSTRACT: Background: Sickle cell anemia (SCA), a hereditary disease characterized by pain and lifetime multi-organic lesion, is a challenge for all that work with carriers of this disease. The clinical expression variability of SCA is a constant reality and a problem to be solved in the current world of investigation, for which the knowledge of prognostic indicators responsible for the different aspects of clinical evolution diversity wiil be an added value. The study is preceded by a historical summary of the most important factors in the evolution of SCA, which are in themselves, an incentive for future research. In the first part of the study, after an extensive bibliographical revision, physiopathology data is referred to in general and specifically regarding the target organs, that constituted the base for the studies presented in the dissertation. The state of the art for the complications to be studied, the choice of prognostic indicators and the therapeutics application, were approached for the renewed interest in the theme. Aims: In regard to the investigation, the objective was to study the lesions in the most affected organs of a chosen pediatric group, to investigate prognostic indicators for lung and cerebral lesions and to evaluate the protective effect of hydroxyurea in children with severe outcomes. Patients and methods: A prospective and multi-institutional study was carried out during a three-year period, February 1998 to March 2001, with children and adolescents followed up at a Immunohematology Outpatient Clinic of Dona Estef��nia's Hospital, Lisbon. Based in predefined criteria, 30 children with SCA were selected in a stable phase of the disease, aged from seven to 18 years old, all of whom were of African origin with exception of one who was Caucasian. The diagnosis was based on electrophoresis techniques and molecular study that allowed to define the genotype, the presence of deletional alpha-thalassemia as well as haplotypes in the population. Different methodologies were used to evaluate the existence of lung and cerebral lesion. Statistical study of the different variables selected the prognostic indicators. In Study 1, to determine the existence of lung lesion two different methodologies were used: pulmonar function study with arterial blood gases determination; and high resolution computerized tomography. Heart dysfunction as a repercussion of lung lesion was also studied through echocardiography, and prognostic indicators were statistically significant for lesions found. The design of Study 2 was similar to Study 1, but with the appropriate methodology for CNS. After neurological examination, which was normal in all patients (control group), cerebral lesions were studied with imagiologic exams (MRN-CE and TCD) and psychological tests. These three methodologies were correlated and the importance of each one in the decision of the therapeutic profilactic attitudes. Study 3 consisted of a controlled prospective open study in children with severe forms of SCA, with the aim of the evaluating therapeutic effectiveness of hydroxyurea, during a period of 24 months. Results: In the global overall study preceding the Studies 1,2 and 3, there were a prevalence of haplotype Bantu (53%) and other risk factors, namely the number of VOC (87,5%), sequestration crisis (18,75%), dactilytis in first year of life(31,2%), hyperhemolysis crisis (50%) and ATC in more than half of the patients (59,38%). This group of bad prognostic indicators, associated with the population of the lower class according to the Graffar scale, demonstrates the importance of primary health care services, information provided to the children and their relatives, as well as the interest in prophylactic therapeutics, specific screening and prenatal diagnosis. Study 1. It was evident from this study that slight RPD was diagnosed in 70% of the patients, because alterations of the diffusion had no statistical significance and arterial blood gases determinations were normal. Only one patient had restrictive lung disease related with numerous ACS. However ACS was not considered a prognostic indicator for RPD, contrary to the number of EVO. HRTC revealed discreet fibrotic lines that could be related with slight RPD, but the lack of correlation of these two exams (33%) supports the value of lung function tests for precocious diagnosis of RPD. Heart dysfunction was found in 86,7% of patients, does not reflect the repercussion of RPD, but with the physiopathology of chronic anemia. Hematologic and clinical prognostic indicators were found. Good prognostic indicators for the non-evolution of RPD with average Hb values of ��� 8,5 g/dl and average HbF values of ���13%, respectively. The genetic and social-economic factors had no statistical significance; nevertheless, they were more prevalent among Bantu haplotype (53,3%) in patients with RPD. Study 2. RMN-CE detected SI in 33,3% of the patients, with preferential location in deep white substance in 26,6% and in front lobe in 20%. This distribution can be related to structural aspects of the brain and with the high sensibility of this organ to hypoxia. From the hematological parameters selected, average HbF value 8,6% and average leucocyte count 12.39x103/��l were prognostic indicators with different meaning to SI. The increase in the total bilirubin related to hyperhemolysis clinically explains the genesis of SI In the TCD study, only one patient had increased cerebral flow speed >196 cm/sec in CMA, which corresponded to serious vasculopathy in AngioMR. This patient never present previously neurological symptoms and had several hyperhemolysis crisis and VOC as risk factors. Low percentage of pathological TCD in this study, in relation to the high number of SI and altered tests, although without correlation among the three exams, is probably attributed to factors related to the methodology, aspects of cerebral physiopathology or perhaps a sign of good prognostic if the duration of study had not been so short. TCD should be used as a screening method in the age groups with higher risk of AVC and should never be considered separately in prophylactic therapeutics indication. Psychological tests were the most sensitive method to detect neurodevelopment impairment; in 80% of patients the neuropsychologics tests were altered, but without correlation with SI (10%). Since SI can become evident during the first two years of life and develop with time, the first psychological tests should be carried out between 3 and 5 years of age to timely be referred to special education and stimulation programs. Prognostic indicators to psychological tests were also found: alpha-thalassemia was found to be a protection factor of the IQ, just as other hematologic factors (hematocrit, MGCV and erythrocytes count). In relation to clinical parameters, although without statistical significance, patients with larger number of VOC had average lower scores versus the average in tests, except in TP. Results from different studies were conclusive as to the type of lesion found and the importance of prognostic indicators. Study 3. All the patients completed a minimum of 15 months therapeutic treatment with the final average daily dose of 19��4 mg/kg/day. The average value of the fetal hemoglobin increased significantly from 7,0��3,9% to 13,7��5,3% (p=0.028). The HbF average values increased from 6% to 15% after 15 months of therapeutic treatment. Clinically there was a reduction of 80% in the number of VOE , 69% in the number of hospitalization, 76% in the number of days of hospitalization and 67% in the number of transfusions. Once again the effectiveness of this treatment in this pediatric group, as well as the lack of any significant secondary effects, was evident. The study confirms the need for further detailed research in order to safely effect the appropriate treatment prior to the development of organic lesions, which ideally should be in the first year of life. Conclusions: These results allow us to clarify the importance of either pulmonary lesions or either nervous central system impairment among patients, children and adolescents, with sickle cell anemia. These lesions were demonstrated in most of the patients studied compromising their quality of life and the mortality. The treatment with HU is proved to be effective and having low toxicity.

Paralisia cerebral na Regi��o de Lisboa e Vale do Tejo : factores de risco : caracteriza����o multidimensional : inclus��o escolar

RESUMO - A Paralisia Cerebral (PC) deve ser olhada como uma patologia do neurodesenvolvimento: a inf��ncia �� um per��odo de actividade explorat��ria por ess��ncia, a restri����o motora condiciona as v��rias ��reas do desenvolvimento. Contextos, apoios, oportunidades e experi��ncias de vida ser��o determinantes no desenvolvimento de todo o seu potencial. Objectivos/finalidade: Identificar, descrever, comparar e analisar factores de risco associados �� PC, sua caracteriza����o multidimensional e integra����o escolar aos 5 e 10 anos. Procurou���se contribuir para a sua preven����o prim��ria e secund��ria, e obter dados para planeamento e implementa����o dos programas de apoio. M��todos: Adoptou���se a abordagem do Programa Nacional de Vigil��ncia da Paralisia Cerebral (PNVPC) e da Surveillance of Cerebral Palsy in Europe (SCPE). Analisaram���se factores de risco, compet��ncias funcionais, d��fices associados, severidade e integra����o escolar de duas popula����es de Lisboa e Vale do Tejo, (nascimento 1996/1997���2001/2002 e preval��ncia aos 5 e 10 anos). Descreveram���se os dados, efectuaram���se correla����es, aplicaram���se testes de independ��ncia e compararam���se com dados dos nadovivos, dados nacionais e europeus. Analisaram���se os factores que influenciaram a integra����o escolar atrav��s de m��todos de regress��o log��stica. Resultados/Conclus��es/Recomenda����es: 1,65��� e 1,57��� dos nadovivos desenvolveram PC; a preval��ncia aos 5 anos foi de 1,7��� e de 1,48���; 5,9% e 7,9% faleceram antes dos 5 anos. Em 2001/2002 verificou���se aumento de: PC esp��stica bilateral���2/3membros, prematuridade, causa pos���neonatal, n��veis funcionais ligeiros e graves; percentil estaturo���ponderal <3 (5���anos). Diminui����o de: disquin��sia, an��xia e alguns d��fices associados. Destacaram���se as associa����o: prematuridade e PC esp��stica bilateral��� 2/3membros; nascer de termo e an��xia, disquin��sia, prim��paras, d��fices associados e severidade; infec����o pr�����natal e QI<50, epilepsia e severidade; causa pos���neonatal e PC esp��stica bilateral���4membros e m��ltiplos d��fices. Aos 5 anos, as vari��veis explicativas para a n��o inclus��o escolar foram: QI<50 e epilepsia; uma elevada percentagem de crian��as com PC moderada/grave encontrava���se integrada; 75% das que se encontravam desintegradas mantiveram���se nesta situa����o aos 10. Nesta idade, as vari��veis explicativas para a n��o inclus��o escolar foram: QI<50 e motricidade fina; 35,1% encontrava���se fora do ensino regular; 4,5%, embora em idade de escolaridade obrigat��ria, n��o frequentavam qualquer estabelecimento escolar. Informa����o sistematizada, abrangente, objectiva, simples e acess��vel, sobre novos casos de PC, factores de risco, preval��ncia em idades���chave e caracteriza����o multidimensional constitui uma ferramenta cl��nica e epidemiol��gica, que deve sustentar as pol��ticas de sa��de, educacionais e sociais, contribuindo para a perman��ncia destas crian��as no ensino regular, trazendo ��s crian��as e fam��lias o suporte que as encorajem e sustentem nestes processos. ABSTRACT ------- Cerebral Palsy (CP) must be recognized as a neurodevelopmental disorder: childhood is, on its nature, a period for exploring the environment and therefore motor deficit interferes with all developmental areas. The context, support, opportunities and life experiences are determinants for the development of his full potential. Objective/Aim: To identify, describe, compare and analyze CP risk factors the multidimensional characterization and school integration levels at the age of 5 and 10 years. We aim to contribute to CP primary and secondary prevention and provide information for service planning and implementation of support programs. Methods: The approach of National Cerebral Palsy Surveillance Programme (NCPSP) and Surveillance of Cerebral Palsy in Europe (SCPE) were used. For two groups of children from Lisboa e Vale do Tejo region, birth data 1996/1997���2001/2002 and prevalence at 5 and 10 years, were analyzed: CP risk factors, functional ability, associated impairments, severity and school integration settings. Data collected was described, analyzed using correlations, applied tests of independence and compared with new born data, national data and european data. To analyze the factors related to school inclusive settings, logistic regression was appealed. Results/Conclusions/Recommendations: 1,65% and 1,57��� of the new���born alive developed CP. The prevalence at 5 years was 1,7��� and 1,48��� 5,9% and 7,9% died before their 5th birthday. Bilateral spastic CP 2/3limb, preterm birth, cases of post���neonatal origin, mild and sever functional impairment; weight and height percentile <3 at 5 years old Increased in 2001. Decreased dyskinetic CP, anoxia and some additional imparments. Were identified among other the association between prematurity and spastic bilateral CP���2/3 members; born at term and anoxia, dyskinetic CP, first child, associated impairments and severity; prenatal infection and IQ<50, epilepsy and severity; post���neonatal cause and spastic bilateral CP���4 members and associated impairments. At 5���years���old the more explanatory variables for not be in a school inclusive settings were IQ<50 and epilepsy, a high percentage of children with moderate/severe CP was attending regular school, but most children who were out of inclusive settings at 5 years continue on this situations at 10���years���old. At this age the more explanatory variables for not be in a school inclusive settings were: IQ<50 and upper limb function; 35,1% were out of regular school; 4,5%, even in compulsory school age, are out of school. Standardized comprehensive, objective, simple and accessible information about CP new cases, risk factors, prevalence in the key���age and children multidimensional characterization constitutes a clinical and epidemiological tool that should sustain health, educational and social policy. This would support the continuity of these children in regular schools, encouraging g them and their families in these processes.

Estigma e percep����es dos m��dicos de Cl��nica Geral sobre a doen��a mental e o suic��dio

RESUMO: INTRODU����O: A OMS (2001) revela que cerca de 450 milh��es de pessoas sofrem de perturba����es mentais ou comportamentais em todo o mundo, mas apenas uma pequena minoria tem tratamento, ainda que elementar. Transformam-se em v��timas por causa da sua doen��a e convertem-se em alvos de estigma e discrimina����o. O suic��dio �� considerado como um grande problema de sa��de p��blica em todo o mundo, �� uma das principais causas de morte de jovens adultos e situa-se entre as tr��s maiores causas de morte na popula����o entre 15-34 anos (OMS, 2001). As perturba����es mentais aumentam o risco de suic��dio. A depress��o, esquizofrenia, e a utiliza����o de subst��ncias incrementam o risco de suic��dio. Estudos (Sartorius, 2002; Magliano et al., 2012) mostram que os profissionais de sa��de, tal como o p��blico em geral, podem ter atitudes negativas e estigma em rela����o ��s pessoas com perturba����es mentais, podendo agir em conformidade, uma vez feito e conhecido o diagn��stico psiqui��trico. Os cl��nicos gerais s��o os receptores das perturba����es mentais e tentativas de suic��dio nas principais portas de entrada no acesso a cuidados de sa��de. As cren��as, conhecimentos e contacto com a doen��a mental e o suic��dio, podem influenciar a aten����o cl��nica. OBJECTIVOS: Avaliar o estigma e as percep����es dos m��dicos de cl��nica geral em rela����o ��s tentativas de suic��dio, o suic��dio e perturba����es mentais bem como os poss��veis factores associados a estes fen��menos. MATERIAIS E M��TODOS: Estudo do tipo transversal, combinando m��todos quantitativos e qualitativos. A amostra �� constitu��da por 125 sujeitos, m��dicos de cl��nica geral. Utilizaram-se as vers��es adaptadas dos seguintes instrumentos: Question��rio sobre Percep����es e Estigma em Rela����o �� Sa��de Mental e ao Suic��dio (Liz Macmin e SOQ, Domino, 2005) e a Escala de Atitudes sobre a Doen��a Mental (Amanha Hahn, 2002). Para o tratamento estat��stico dos dados usou-se a estat��stica 1) descritiva e 2) An��lise estat��stica das hip��teses formuladas (Qui Quadrado - ���2) a correla����o entre vari��veis (Spearman: ��, rho). Os dados conectados foram limpos de inconsist��ncias com base no pacote inform��tico e estat��stico SPSS vers��o 20. Para a aferi����o da consist��ncia interna foi usado o teste de Alfa de Cronbach. RESULTADOS: Uma boa parte da amostra (46.4%) refere que n��o teve forma����o formal ou informal em sa��de mental e (69.35%) rejeitam a ideia de que ���grupos profissionais como m��dicos, dentistas e psic��logos s��o mais suscept��veis a cometer o suic��dio���. J�� (28.0%) t��m uma perspectiva pessimista quanto a possibilidade de recupera����o total dos sujeitos com perturba����o mental. Sessenta e oito(54.4%) associa sujeitos com perturba����o mental, a comportamentos estranhos e imprevis��veis, 115 (92.0%) a um baixo QI e 35 (26.7%) a poderem ser violentas e e perigosas. Os dados mostram uma associa����o estatisticamente significativa (p���0.001) entre as vari��veis: tempo de servi��o no SNS, recear estar perto de sujeitos com doen��a mental e achar que os sujeitos com doen��a mental s��o mais perigosos que outros. Em termos estat��sticos, existe uma associa����o estatitisticamente significativa entre as duas vari��veis(X2=9,522; p���0.05): percep����o de que ����� vergonhoso ter uma doen��a mental��� e os conhecimentos em rela����o �� doen��a mental. Existe uma correla����o positiva, fraca e estatisticamente significativa entre os conhecimentos dos cl��nicos gerais(beneficiar-se de forma����o em sa��de mental) e a percep����o sobre os factores de risco (������0,187; P���0,039). DISCUSS��O E CONCLUS��ES: A falta de conhecimento sobre as causas e factores de risco para os comportamentos suicid��rios, op����es de interven����o e tratamento, particularmente no ��mbito da doen��a mental, podem limitar a procura de ajuda individual ou dos pr��ximos. Percep����es negativas como o facto de n��o merecerem prioridade nos servi��os, mitos (fr��geis e cobarde, sempre impulsivo, chamadas de aten����o, problemas espirituais) podem constituir-se como um indicador de que os cl��nicos gerais podem sofrer do mesmo sistema de estigma e cren��as, de que sofre o p��blico em geral, podendo agir em conformidade (atitudes de afastamento ereceio). As atitudes s��o influenciadas por factores como a forma����o, cultura e sistema de cren��as. Sujeitos com boa forma����o na ��rea da sa��de mental t��m uma percep����o positiva e optimista sobre os factores de risco e uma atitude positiva em rela����o aos sujeitos com doen��a mental e comportamentos suicid��rios.-------------ABSTRACT: INTRODUCTION: The WHO (2001) reveals that about 450 million people suffer from mental or behavioral disorders worldwide, but only a small minority have access to treatment, though elementary. They become victims because of their disease and they become the targets of stigma and discrimination. Suicide is seen as a major public health problem worldwide, is a leading cause of death for young adults and is included among the three major causes of death in the population aged 15-34 years (WHO, 2001). Mental disorders increase the risk of suicide. Depression, schizophrenia, and the substances misuse increase the risk of suicide. Studies (Sartorius, 2002; Magliano et al, 2012) show that health professionals, such as the general public, may have negative attitudes and stigma towards people with mental disorders, and can act accordingly after psychiatric diagnosis is known. General practitioners are the main entry points of mental disorders and suicide attempts in the health sistem. Beliefs, knowledge and contact with mental illness and suicide, may influence clinical care. OBJECTIVES: To assess stigma and perceptions of general practitioners in relation to suicide attempts, suicide and mental disorders as well as possible factors associated with these phenomena. MATERIAL AND METHODS: This was a descriptive cross-sectional study, combining quantitative and qualitative methods. The sample consisted of 125 subjects, general practitioners. We used adapted versions of the following instruments: Questionnaire of Perceptions and Stigma in Relation to Mental Health and Suicide (Liz Macmin and SOQ, Domino, 2005) and the Scale of Attitudes on Mental Illness (Tomorrow Hahn, 2002). For the statistical treatment of the data we used: 1) descriptive (Data distribution by absolute and relative frequencies for each of the variables under study (including mean and standard deviation measures of central tendency and deviation), 2) statistical analysis of hypotheses using (Chi Square - ���2, a hypothesis test that is intended to find a value of dispersion for two nominal variables, evaluating the association between qualitative variables) and the correlation between variables (Spearman ��, rho), a measure of non-parametric correlation, which evaluates an arbitrary monotonic function can be the description of the relationship between two variables, without making any assumptions about the frequency distribution of the variables). For statistical analysis of the correlations were eliminated subjects who did not respond to questions. The collected data were cleaned for inconsistencies based on computer and statistical package SPSS version 20. To measure the internal consistency was used the Cronbach's alpha test. RESULTS: A significant part of the sample 64 (46.4%) reported no formal or informal training in mental health and 86 (69.35%) reject the idea that "professional groups such as doctors, dentists and psychologists are more likely to commit suicide." On the other hand, 42 (28.0%) have a pessimistic view of the possibility of full recovery of individuals with mental disorder. Sixty-eight ( 54.4 % ) of them associates subjects with mental disorder to strange and unpredictable behavior, 115 ( 92.0 % ), to low IQ, 35 ( 26.7 % ) and even to violent and dangerous behavior, 78 ( 62.4 % ) The data show a statistically significant (p = 0.001) relationship between the following variables: length of service in the NHS, fear of being close to individuals with mental illness and considering individuals with mental illness more dangerous than others. In statistical terms, there is a dependency between the two variables (X2 = 9.522, p> 0.05): the perception that "it is shameful to have a mental illness" and knowledge regarding mental illness. There is a positive and statistically significant weak correlation between knowledge of general practitioners (benefit from mental health training) and the perception of the risk factors (������0,187; P���0,039). DISCUSSION AND CONCLUSIONS: The lack of knowledge about the causes and risk factors for suicidal behavior, intervention and treatment, particularly in the context of mental illness options, may decreaseseeking for help by individual and their relatives. Negative perceptions such as considering that they dont deserve priority in services, myths (weak and cowards, always impulsive, seeking for attentions, spirituals problems) may indicate that general practitioners, may suffer the same stigma and beliefs systems as the general public, and can act accordingly (withdrawal and fear attitudes). Attitudes are influenced by factors such as education, culture and belief system. Subjects with good training in mental health have a positive and optimistic perception of the risk factors and a positiveattitude towards individuals with mental illness and suicidal behaviour.