Tudo o que vem �� rede �� peixe? A credibilidade da informa����o na web

O objetivo deste estudo �� conhecer uma vertente espec��fica do perfil informacional dos alunos que cresceram na era digital, ditos nativos digitais, na utiliza����o que fazem da Internet. Assim, pretende-se aferir os crit��rios que aplicam na avalia����o das fontes de informa����o dispon��veis na web na vertente da credibilidade. A an��lise dos dados obtidos, resultantes da aplica����o de 195 question��rios a alunos do 8�� ao 12��, �� enquadrada e sustentada por revis��o da literatura acerca do conceito de credibilidade da informa����o.

El multiculturalismo en la Uni��n Europea organizaci��n y acceso a la informaci��n: el ejemplo de los centros de documentaci��n europea

Este texto parte de la caracterizaci��n del concepto de multiculturalismo en general y espec��ficamente en el contexto de la UE. A continuaci��n, intentamos demostrar el car��cter multicultural de una red de informaci��n, la red de los CDE, presente en todo el territ��rio de la EU, a partir de los resultados de encuestas distribu��das a los responsables, a sus utilizadores y en base a los datos recogidos durante visitas a algunos de ellos. Efectivamente, se verifica la exist��ncia de diferencias substanciales Finlandia, Irlanda, Hungr��a y Portugal en lo que respecta a la localizaci��n de los CDE, las tipolog��as de utilizadores, al uso de lenguages sistem��ticos y alfab��ticos para la organizaci��n de la informaci��n. Estas diferencias son menos marcadas pero tambi��n existen en lo que respecta a las ��reas tem��ticas mas buscadas y los aspectos que los utilizadores de los CDE consideran que facilitan su acceso a la informaci��n. Por lo que se refiere a las formas de b��squeda en el cat��logo y a los aspectos que se apuntan como obst��culos en el acceso a la informaci��n parece haber m��s coincidencia entre los diferentes pa��ses.

Safety climate and its relationship with furniture companies��� safety performance and workers��� risk acceptance

This study aims to analyse the relationship between safety climate and the level of risk acceptance, as well as its relationship with workplace safety performance. The sample includes 14 companies and 403 workers. The safety climate assessment was performed by the application of a Safety Climate in Wood Industries questionnaire and safety performance was assessed with a checklist. Judgements about risk acceptance were measured through questionnaires together with four other variables: trust, risk perception, benefit perception and emotion. Safety climate was found to be correlated with workgroup safety performance, and it also plays an important role in workers��� risk acceptance levels. Risk acceptance tends to be lower when safety climate scores of workgroups are high, and subsequently, their safety performance is better. These findings seem to be relevant, as they provide Occupational, Safety and Health practitioners with a better understanding of workers��� risk acceptance levels and of the differences among workgroups.

A influ��ncia do modelo pedag��gico em vari��veis psicol��gicas de estudantes do 1�� ano da ESTSP-IPP

Introdu����o ��� A adapta����o ao ensino superior reveste-se de experi��ncias acad��micas que podem constituir fonte de stress para os estudantes. A implementa����o de novos modelos pedag��gicos, no ��mbito do processo de Bolonha, introduz novas vari��veis cujo impacto, designadamente em termos de sa��de, importa conhecer. Este estudo tem como objetivo analisar as associa����es entre modelo pedag��gico (Problem Based Learning ��� PBL vs. modelos pr��ximos do tradicional) e vari��veis psicol��gicas (coping, desregula����o emocional, sintomas psicossom��ticos, perce����o de stress e afeto). Metodologia ��� O estudo tem um design transversal. Foram usados os seguintes question��rios online: Brief-COPE, Escala de Dificuldades de Regula����o Emocional, Question��rio de Manifesta����es F��sicas de Mal-Estar, Escala de Stress Percebido e Escala de Afeto Positivo e Negativo. A amostra �� constitu��da por 183 estudantes do primeiro ano (84% do g��nero feminino) de cursos da Escola Superior de Tecnologia da Sa��de do Porto ��� Instituto Polit��cnico do Porto (ESTSP-IPP). Resultados ��� Foram encontradas correla����es significativas entre as vari��veis demogr��ficas e psicol��gicas. Considerando diferentes modelos pedag��gicos, foram encontradas diferen��as significativas nas vari��veis psicol��gicas. Os principais preditores de stress na amostra foram: ser mulher, frequentar uma licenciatura no modelo PBL, ter maiores ��ndices de desregula����o emocional, apresentar mais sintomas psicossom��ticos, menos afeto positivo e mais afeto negativo. Conclus��o ��� As diferen��as encontradas entre modelos pedag��gicos s��o discutidas, possibilitando a reflex��o sobre as implica����es pr��ticas e sugest��es para futuras investiga����es.

Cultural Intelligence Scale: Validation in a Multicultural Setting of Erasmus Mundus Students and Alumni

Purpose: This work aims at further developing and testing the psychometric properties of the Cultural Intelligence Scale (Ang & Van Dyne, 2006) in an Erasmus Mundus Students and Alumni Population, including reliability. Design Methodology: The study included 626 participants from 109 different countries that emcompasses 6 continents. Exploratory and Confirmatory Factor Analysis procedures were carried out in order to test the scale in a multicultural scale of Erasmus Mundus Students. Reliability was assessed using Cronbach Alpha. Results: The scale presents excellent psychometric properties with alpha values that range from .84 to .90. Exploratory and Confirmatory Factor Analyses demonstrated that the original model of the scale presents an exceptionally good fit. Limitations: The present study was conducted using a convenience sample and online questionnaires that limit its conclusions when we consider the globality of the Erasmus Mundus Students. Research/Practical Implications: This study presents evidence that Ang and Van Dyne���s scale is an adequate measure instrument to assess intercultural intelligence in a multicultural setting of students and alumni. Originality/Value: Multicultural samples and studies are becoming more and more present and relevant; the study of intercultural competences and habilities is becoming increasingly important, and in this task, solid psychometric instruments are of paramount importance. This study presents evidence that Ang and Van Dyne���s (2006) scale is a fairly recent and parsimonious instrument with excellent psychometric properties properties.

Cultural Intelligence (CQ) in Erasmus Mundus Students and Alumni: an exploratory study on the levels and antecedents of CQ

Erasmus Mundus Masters (EMM) are programs with a strong component of interculturality. Our study aimed at understanding the level of cultural intelligence (CQ) of EMM students and alumni, as well as some of the characteristics associated with higher levels of CQ. The study included 626 EMM students and alumni from 109 different countries that encompasses 6 continents. Ang and Van Dyne���s (2006) cultural intelligence scale was used; closed and open ended questions were used to describe the sample���s sociodemographic characteristics and experiences regarding interculturality. After validating and assessing the scale���s psychometric properties, relations between different variables were explored using Pearson���s correlation, ANOVA, t Tests, and GLM procedures. We then analysed the open ended responses to gain further insight on our results. Differences among respondents are mainly equated with international experience rather than nationality or training. Respondents��� open ended replies provided us with a deeper insight on why training seems to be so ineffective in developing CQ. This is a transversal study that uses self-reporting measures; also, questionnaires were conducted in English, which was not the mother tongue of most of the respondents. This work is consistent with the CQ literature, however we argue that training mentioned by respondents systematically fails to meet some of literature���s foremost conditions for effective CQ trainings and provide clues for the implementation of more successful initiatives. With an exceptionally diverse sample, this study contributes towards the understanding of mechanisms of developing CQ among EMM and international Students. Results can be useful for selection processes, training/development of CQ and reducing dropout/turnover.

Factors that Influence Adherence to Exercise among Patients Attending a Cardiac Rehabilitation Program

Objective: The aim of this study was to compare the factors of adherence to physical activity in subjects attending a cardiac rehabilitation program, and subjects who have withdrawal this same program using the Transtheoretical Model of behavior change. Methods: We conducted an observational, cross sectional type study, with a sample of 33 individuals (15 currently participating in the Cardiac Rehabilitation Program and 18 who no more attended the same program), with the questionnaires being personally delivered or sent by mail. For data analysis, we used the computer program SPSS�� version 16.0. The significance level was set at 0.05. Results: There were no significant differences in the states of Change, Self-efficacy, Decisional Balance and Change Processes in both groups. We obtained a high Spearman correlation between States of Change and Self-efficacy (r2 = 0.778) and the Pros (r2 = 0.764) and Againsts (r2 = -0.744) in Decisional Balance. However, there were no significant evidence to affirm that States of Change and experiential processes of change (p = 0.465) andbehavioral (p = 0.300) had a correlation. A relationship was found, in terms of proportions between physical activity incorporated or not in a Cardiac Rehabilitation Program and age (p = 0.003), occupation (p = 0.010) and the entity paying the costs of program (p = 0.027). Conclusion: It was concluded that perceived self-efficacy and Pros and Againsts of the Decisional Balance are related to adherence to physical activity. Results also point out that age, profession and the entity paying the costs of the program influences the dropout of Cardiac Rehabilitation Programs.

Human toxocariasis: a seroepidemiological survey in the municipality of Campinas (SP), Brazil

The occurrence of human Toxocara infection was evaluated in three neighborhoods of the periphery of the Campinas municipality (Jardim Santa M��nica, Jardim S��o Marcos and Jardim Campineiro) in 1999. Forty residences and 138 residents were randomly selected by drawing lots and were submitted to a seroepidemiological survey, which included blood collection for the immunoenzymatic detection (ELISA) of anti-Toxocara antibodies and a blood count, and the application of a semi-structured questionnaire for the evaluation of epidemiological data. Significant levels of anti-Toxocara antibodies were detected in 23.9% of the 1999 samples. No significant difference in the frequency of infection according to age was observed. Environmental contamination with Toxocara eggs was observed in 12.3 and 14.0% of 57 soil samples collected in the same region in December 1998 and July 1999, respectively. Univariate analysis and multiple logistic regression of the data obtained from the questionnaires and of the results of the serological tests, suggest a significant influence of socioeconomic variables on the frequency of human infection with Toxocara under the conditions prevalent in the study area.

O lugar da Hispanoam��rica no processo de ensinoaprendizagem de Espanhol como L��ngua Estrangeira no Ensino Secund��rio Portugu��s

Tendo em conta um enfoque comunicativo experiencial (Fern��ndez- Corbacho, 2014) e uma pedagogia cr��tica emancipat��ria (Jim��nez Raya, Lamb & Vieira, 2007), enriquecida por enfoques multissensoriais (Arslan, 2009), �� nossa inten����o, com este projeto, contribuir para a implementa����o de pr��ticas que espelhem as variedades lingu��sticas e culturais da Hispanoam��rica (Liceras, 1995; Beave, 2000) na aula de espanhol como l��ngua estrangeira no ensino secund��rio portugu��s. Neste estudo, atrav��s duma perspetiva metodol��gica de ��ndole qualitativa, pretendemos, como ponto de partida, analisar: a) as representa����es de alunos portugueses sobre o lugar da Hispanoam��rica no processo de ensino-aprendizagem de espanhol como l��ngua estrangeira (Altmann & Vences, 2004; P��rez, 2003), atrav��s de inqu��ritos por question��rio; e, ainda, b) as abordagens das variedades lingu��sticas e culturais do espanhol, que surgem nos manuais utilizados no ensino secund��rio portugu��s. Por outro lado, atrav��s de um estudo de caso (Benson, Chik, Gao, Huang & Wang, 2009), procur��mos evidenciar uma mostra de poss��veis boas pr��ticas did��tico-pedag��gicas e materiais, com vista a um trabalho sistem��tico e pr��ativo com as variedades lingu��sticas e culturais do espanhol, baseado numa (hiper)pedagogia cr��tica e encarando a l��ngua enquanto objeto manipul��vel e potenciador de cidad��os verdadeiramente conscientes do mundo. Para tal, cri��mos materiais f��sicos e digitais, que foram posteriormente implementados com alunos do 11�� ano de escolaridade, no n��vel de inicia����o de espanhol, num agrupamento de escolas da regi��o de Aveiro. Os resultados mostram que pr��ticas e materiais desta natureza poder��o favorecer aprendizagens comunicativas experienciais, quanto �� cria����o de futuros cidad��os cr��ticos e ativos, fomentando o desenvolvimento das suas compet��ncias comunicativa plurilingue e pluricultural e duma consci��ncia cultural cr��tica (Byram, Gribkova & Starkey, 2002) dos alunos, no contexto de ensino-aprendizagem do ensino secund��rio.

Students��� perceptions about assessment using an e-learning platform

ISCAP���s Information Systems Department is composed of about twenty teachers who have, for several years, been using an e-learning environment (Moodle) combined with traditional assessment. A new e-assessment strategy was implemented recently in order to evaluate a practical topic, the use of spreadsheets to solve management problems. This topic is common to several courses of different undergraduate degree programs. Being e-assessment an outstanding task regarding theoretical topics, it becomes even more challenging when the topics under evaluation are practical. In order to understand the implications of this new type of assessment from the viewpoint of the students, questionnaires and interviews were undertaken. In this paper the analysis of the questionnaires are presented and discussed.

Factores individuais que condicionam a Sa��de : um estudo caso-controlo

RESUMO - O presente projecto enquadra-se no paradigma salutog��nico e visa apurar alguns dos factores que determinam que algumas pessoas se apresentem mais saud��veis que a popula����o em geral. Foi seleccionado um estudo, quantitativo, anal��tico tipo caso-controlo (1 caso para 3 controlos), em que os casos s��o constitu��dos por indiv��duos integrando a Fun����o P��blica que se encontram acima do percentil 95 de assiduidade ao trabalho nos ��ltimos dois anos e com uma auto-percep����o de Sa��de classificada como muito boa, os controlos s��o indiv��duos que n��o obedecem �� defini����o de caso. Os indiv��duos ser��o emparelhados por idade, g��nero, estado civil, carreira, categoria profissional e unidade funcional que integram. A assiduidade ser�� calculada com recurso aos certificados de incapacidade tempor��ria entregues nos respectivos servi��os. Os factores a estudar s��o os mais citados na literatura como factores salutog��nicos ou factores de protec����o, s��o eles: - Sentido de Coer��ncia de Antonowsky - Locus de controlo - Auto conceito -Auto Efic��cia - Aptid��o f��sica nas tr��s vertentes cl��ssicas: Capacidade aer��bia, Composi����o corporal, Aptid��o muscular. Todos estes factores ser��o estudados com recurso a question��rios auto preenchidos devidamente testados e validados para o portugu��s de Portugal sendo a aptid��o f��sica apurada com recurso �� bateria de testes "Fitness Gram" adoptada para Portugal pelo Instituto do Desporto de Portugal e pelo Minist��rio da Educa����o. Os resultados ser��o apurados com recurso ao software de an��lise epidemiol��gica EPIDAT. 3.1. ---------------- ABSTRACT - The present project follows the salutog��nic 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.

Protec����o radiol��gica do doente em tomografia computorizada

RESUMO - A preocupa����o com os conhecimentos, atitudes, cren��as e pr��ticas, no que concerne �� utiliza����o de radia����es ionizantes para fins de diagn��stico, e a sensibiliza����o de todos os agentes envolvidos, m��dicos, t��cnicos, f��sicos, utentes e respons��veis pela Sa��de Publica, relativamente aos n��veis de radia����o emitida nos exames de Tomografia Computorizada (TC), assume particular import��ncia no dom��nio da Sa��de P��blica, na medida em que �� necess��rio influenciar o desenvolvimento de pr��ticas que promovam, auditem e garantam a presta����o do controlo da qualidade radiol��gica e dosim��trica nos servi��os de Radiologia a n��vel Nacional. Para tal, e no ��mbito da publica����o de estudos j�� realizados ao n��vel da Uni��o Europeia, ���Orienta����es Europeias dos Crit��rios de Qualidade para a Tomografia Computorizada (1999) ���, �� proposto estabelecer orienta����es na realiza����o de estudos que permitam, numa primeira fase, estabelecer a compara����o com os resultados obtidos pelos mecanismos de Controlo da Qualidade (CQ), analisar e proceder aos ajustes (se necess��rio) e, numa segunda fase, implementar uma moldura sistem��tica de avalia����o peri��dica dos n��veis de dose de radia����o por exame TC e que permita a monitoriza����o dos dados. Nesse sentido, prop��e-se a realiza����o de um Estudo Nacional que envolva a rede hospitalar p��blica, privada e universit��ria, partindo da metodologia utilizada em estudos pr��vios noutros pa��ses da Europa, como seja, selec����o do equipamento de TC existente na Institui����o Hospitalar, onde ser��o reunidas informa����es atrav��s do preenchimento de question��rios relativos ao equipamento a utilizar. Ser��o recolhidos dados relativos ao utente, ao equipamento e par��metros de aquisi����o de imagem, que permitam identificar os n��veis de refer��ncia de diagn��stico (NRD) em TC, na realidade Portuguesa. Foi efectuado um estudo piloto numa institui����o EPE e os valores obtidos n��o s��o significativos, nem podem assumir valor preditivo dado o reduzido tamanho da amostra. Apesar disso, sugerem a exist��ncia de par��metros que podem ser alterados e com isso podem fazer variar a dose de radia����o utilizada. ENSP/UNL Maria de F��tima Vaz de Carvalho 5 Espera-se obter com este estudo, como foi referido, a base do estabelecimento dos NRD em TC em Portugal. ----------------- ABSTRACT - The purpose of this study, in an empirical point of view, emerges from concern with the knowledge, attitudes, beliefs and practices regarding the use of ionizing radiation for diagnostic purposes and awareness of all actors involved, medical physical, technical, and responsible public health for the development of practices that promote, audited and ensure the provision of radiological quality control and dosing in radiology service at national level. In view of the complexity and characteristics involved in relation to ionizing radiation, all assume their part in protecting the physical integrity of each user and a global perspective, to ensure the safeguarding of public health, while global and globalizing factor. To this end, and in the context of the publication of studies already carried out at European Union level, "European guidelines for quality criteria for computed tomography", it is proposed to establish guidelines in conducting studies to initially establish the comparison with the results obtained by QC and make adjustments if necessary, and subsequently implement a systematic periodic assessment frame that allows monitoring of data. Accordingly, it is proposed to conduct a national study involving the public network, private and University hospitals, that extends from the methodology used in previous studies in other countries of Europe, as is, selection of equipment of existing CT in Hospital Institution, where information will be gathered by filling out questionnaires concerning the equipment to be used. Data will be collected for the wearer, equipment and parameters of image acquisition, identifying diagnostic reference levels (NRD) in CT in Portuguese fact. A pilot study was carried out in an institution EPE and the values obtained are not significant, nor can they take predictive value given the small sample size. Despite this, suggest the existence of parameters that can be changed and this can vary the dose of radiation used It is hoped to get with this study, as mentioned, the basis of the establishment of NRD in CT in Portugal.

Impacto do Exerc��cio F��sico Combinado na Percep����o do Estado de Sa��de da Pessoa com Doen��a Pulmonar Obstrutiva Cr��nica

AIM: The aim of the study was to evaluate the effectiveness of a 10-week combined training programme (aerobic and strength exercise) compared to an aerobic training programme, and respiratory physiotherapy on COPD patients' health. METHODS: Fifty subjects with moderate to severe COPD were randomly assigned to two groups. Combined group (CG, n=25) who underwent combined training, and aerobic group (AG, n=25) who underwent aerobic training. These were compared with fifty COPD subjects who underwent respiratory physiotherapy, breathing control and bronchial clearance techniques (RP group, n = 50). We evaluated health state through two questionnaires, St. George's Respiratory Questionnaire (SGRQ) and SF-36, at the beginning and at the end of the programme. RESULTS: The CG group showed differences (p<0.0001) in modification rates in state of health compared to the AG and RP groups in the activity (64 �� 9%, 19 �� 7%, 1 �� 15%) , impact (35 �� 5%, 20 �� 18%, 1 �� 14%) and total (41 �� 9%, 26 �� 17%, 1 �� 15%) domains assessed by the SGRQ, and the physical function (109 �� 74%, 22 �� 12%, 0.1 �� 18%), physical role (52 �� 36%, 11 �� 15%, 1.3 �� 21%) and vitality (83 �� 39%, 14 �� 38%) domains assessed by SF-36. CONCLUSION: These results suggest that combined training in subjects with COPD appears to be a more effective method, with better clinical changes, and improvements in health state perception.

Prevalence of Asthma in a Portuguese Countryside Town:Repercussions on Absenteeism and Self-Concept

Background: Childhood asthma represents an increasing health problem and is the leading cause of hospital admission and absenteeism in children with chronic disease. It also compromises quality of life, eventually contributing to disturbances in self-concept. Self-concept is a recent and global perspective of ���the self��� and relates to skills, self-image and self-esteem. Little information is available on this topic and there are no data from Portuguese countryside towns. Objective: The aim of this study was to determine the prevalence of asthma among all school children in the 5th and 6th grades in a Portuguese countryside town and to establish its possible correlation with absenteeism and self-concept. Methods: In April 2002, two questionnaires were administered in the presence of the researcher to a group of 950 children attending different schools. The children completed the internationally renowned questionnaires: ISAAC and the Self-Concept Scale by Susan Harter. Results: Our sample (n = 818) had a mean age of 11 years (10-15 years) and a male-to-female ratio of 1/1. The cumulative prevalence of asthma was11.9% and that of active asthma was 8.8 %; 63.9% of asthmatics were male and 36.1 % were female. The mean age of asthmatics was 11.34 years and 74 % had active symptoms. Comparison of this group of 97 asthmatic children with the remaining children revealed a statistically significant correlation between the presence of asthma and school absenteeism (global: p = 0.04; gymnastics: 0.05). Regarding the Self-Concept Scale a statistically significant association was found between the presence of asthma and school achievement (p = 0.027), physical appearance (p = 0.015), behavior (p < 0.000) and self-esteem (p < 0.000). No statistically significant correlations were found in social acceptance (p = 0.289) or athletic competence (p = 0.085). Asthmatic boys had higher self-concept scores than girls, except in the domain of behavior. Conclusions: Twelve percent of the population studied was asthmatic. In asthmatic children, absenteeism was higher and self-concept was lower for almost all domains, except social acceptance and athletic achievement, probably due to overprotection.

Aborto recorrente das causas na mulher ��s consequ��ncias para o casal

RESUMO: O aborto recorrente (AR) �� um evento extremamente traum��tico com grande impacto na vida dos casais. Apesar de avan��os significativos verificados na investiga����o m��dica, cerca de 50% dos casos continua sem uma causa identificada. Alguns aspectos como a caracteriza����o inadequada das doentes e das perdas gestacionais, assim como diferentes metodologias utilizadas no seu estudo, t��m influenciado a preval��ncia de alguns dos factores causais e dificultado a compreens��o do AR. Da mesma forma, pouco se sabe sobre as diferen��as de g��nero na viv��ncia psicol��gica do aborto recorrente e das suas eventuais repercuss��es para o relacionamento do casal, centrando-se os poucos estudos existentes preferencialmente na mulher. Por esta raz��o, o objectivo desta tese foi a caracteriza����o dos factores m��dicos associados ao AR e das consequ��ncias psicol��gicas desta entidade, contribuindo para promover estrat��gias cl��nicas baseadas na evid��ncia espec��fica. Na primeira parte desta tese (cap��tulos 1 e 2), ap��s uma breve introdu����o geral e atrav��s de uma revis��o da literatura, efectua-se uma reflex��o sobre o tema, abordando a epidemiologia do aborto recorrente, os factores m��dicos e os aspectos psicol��gicos associados. Nos cap��tulos 3 e 4 descrevemos tr��s estudos efectuados em mulheres portuguesas com aborto recorrente. O primeiro estudo teve por objectivo caracterizar os factores m��dicos e determinar o padr��o da perda recorrente de gravidez, numa coorte de mulheres submetidas a um protocolo de diagn��stico definido. As participantes foram agrupadas de acordo com a paridade (AR prim��rio ou secund��rio) e a idade gestacional das perdas (embrion��rias ou fetais). As anomalias da cavidade uterina, a SAAF e as transloca����es equilibradas parentais foram os factores mais prevalentes. 15,6% das participantes eram obesas. Em 55,5% dos casos n��o foi identificado nenhum factor. A hist��ria obst��trica materna influenciou significativamente os resultados encontrados: os factores anat��micos e a SAAF foram mais prevalentes em nul��paras e as perdas inexplicadas foram mais frequentes em mulheres com AR secund��rio. Assim, os nossos dados refor��am os resultados de pesquisas anteriores sobre a import��ncia da obesidade, da s��ndrome de anticorpos antifosfol��pidos e das anomalias uterinas estruturais como factores associados ao AR e mostram que os a paridade �� um moderador da import��ncia desses factores. Cap��tulo 6 94 A aus��ncia de resultados consensuais na literatura sobre a etiologia do AR condiciona a pesquisa sistem��tica de alguns factores, envolvendo exames dispendiosos, muitas vezes sem que exista evid��ncia que suporte a sua associa����o com esta entidade. A trombofilia heredit��ria �� uma das condi����es frequentemente investigadas nestas doentes. O nosso segundo estudo pretende contribuir para clarificar o papel de duas muta����es (factor V Leiden e protrombina G20210A) na perda recorrente de gravidez e esclarecer a necessidade do seu rastreio nestas situa����es. Foi efectuada a pesquisa destes polimorfismos em 100 mulheres com AR inexplicado e num grupo de controlo de mult��paras sem hist��ria de perdas de gravidez. Na nossa amostra n��o se verificou uma associa����o entre perdas embrion��rias recorrentes e estas muta����es. Nas mulheres com este tipo de perdas, a preval��ncia do FLV foi inclusive menor do que a verificada nos controlos. Pelo contr��rio, nas participantes com perdas fetais a preval��ncia destes polimorfismos foi muito superior �� verificada nos controlos, sugerindo uma poss��vel associa����o entre estas duas entidades. A pequena dimens��o deste ��ltimo subgrupo de mulheres, n��o nos permitiu contudo tirar conclus��es. Uma investiga����o prospectiva multic��ntrica �� necess��ria antes de recomendar a pesquisa da trombofilia heredit��ria na investiga����o do AR. Procur��mos incluir tamb��m nesta tese uma dimens��o psicol��gica e contribuir assim para o conhecimento dos processos relacionais originados pelo AR. No terceiro estudo foram investigadas as diferen��as de g��nero na viv��ncia do AR e o seu impacto no relacionamento e sexualidade do casal. Participaram neste estudo 30 casais sem filhos, com pelo menos 3 abortos espont��neos consecutivos. Cada membro do casal respondeu a um conjunto de question��rios (Impact of Events Scale, Perinatal Grief Scale, Partnership Questionnaire e Intimate Relationship Scale). Os resultados mostram que as mulheres sofrem mais intensamente do que os homens com o AR, relacionando-se a intensidade do seu sofrimento com a qualidade do relacionamento conjugal. A sexualidade do casal �� tamb��m afectada pelo stress e pelo sofrimento associados ao AR. Uma avalia����o e acompanhamento deste tipo de problemas s��o imprescind��veis para ajudar estes casais a manterem a qualidade afectiva e sexual da sua rela����o. Finalmente, no cap��tulo 5 sumari��mos as conclus��es de toda a contribui����o pessoal para a investiga����o sobre os factores associados e repercuss��es para o casal da perda recorrente de gravidez.-------------------ABSTRACT: Recurrent miscarriage (RM), a rare condition, has been described as a traumatic event for couples. Parental chromosomal anomalies, maternal thrombophilic disorders and structural uterine anomalies have been directly associated with RM. However, despite significant advances in medical research, the vast majority of cases remain unexplained. Aspects as the ethnic diversity of the population with different expression of genes, the inappropriate characterization of patients and of pregnancy losses, as well as different methodologies used in their study, have influenced the prevalence of etiological factors and have hampered the understanding of this problem. Similarly, little is known about gender differences in psychological experience of RM and its implications for the relationship of the couple. The first objective of this thesis is the characterization of the medical factors and of the psychological consequences related with RM, in the Portuguese population, helping to promote specific evidence-based clinical strategies. In the first part of this thesis, and after a brief general introduction (Chapter 1), a critical review of literature on the definition, the epidemiology and the dimensions involved, with a special emphasis on associated medical and psychological aspects of recurrent miscarriage, is presented (Chapter 2). In Chapters 3 and 4 we describe three studies carried out in Portuguese couples with RM. The first study aimed to investigate the etiological factors and the pattern of pregnancy loss in a cohort of women with RM. Subjects were divided in groups according to their parity (primary or secondary RM) and time of pregnancy loss (embryonic or fetal). Parental chromosome anomalies, uterine anomalies and antiphospholipid syndrome were the most prevalent medical factors. 15.6% of the women were obese. In the majority of cases (55.5%) no identifiable cause was detected. Parity influenced significantly our results. There was a higher prevalence of anatomic factors and antiphospholipid syndrome in primary RM. On the other hand, unexplained losses were more frequent in secondary RM. Except for the parental chromosomal abnormalities; the frequency of risk factors was similar among women with fetal or embryonic losses. Our data emphasizes the results of previous research on the importance of obesity, antiphospholipid syndrome and structural uterine abnormalities as known risk factors for RM, and shows that parity is an important moderator of the weight of those risk factors. Our second study aims to clarify the role of two mutations (factor V Leiden and prothrombin G20210A) and elucidate the need for their screening in Portuguese women with RM. FVL and PT G20210A analysis was carried out in 100 women with three or more consecutive miscarriages and a control group of 100 parous controls with no history of pregnancy losses. Secondary analysis was made regarding gestational age at miscarriage (embryonic and fetal loss). Overall the prevalence of FVL and PT G20210A was similar in RM women compared with controls. In the RM embryonic subgroup of women, FVL prevalence was inclusively lower than that of controls. Conversely in women with fetal losses both polymorphisms were much more frequent, although statistical significance was not reached due to the small size of this subgroup of patients. These data indicate that inherited maternal thrombophilia is not associated with RM prior to 10 weeks of gestation. Therefore, its screening is not indicated as an initial approach in Portuguese women with RM and a negative personal history of thromboembolic.96 Our second study aims to clarify the role of two mutations (factor V Leiden and prothrombin G20210A) and elucidate the need for their screening in Portuguese women with RM. FVL and PT G20210A analysis was carried out in 100 women with three or more consecutive miscarriages and a control group of 100 parous controls with no history of pregnancy losses. Secondary analysis was made regarding gestational age at miscarriage (embryonic and fetal loss). Overall the prevalence of FVL and PT G20210A was similar in RM women compared with controls. In the RM embryonic subgroup of women, FVL prevalence was inclusively lower than that of controls. Conversely in women with fetal losses both polymorphisms were much more frequent, although statistical significance was not reached due to the small size of this subgroup of patients. These data indicate that inherited maternal thrombophilia is not associated with RM prior to 10 weeks of gestation. Therefore, its screening is not indicated as an initial approach in Portuguese women with RM and a negative personal history of thromboembolic. In our third study, we investigate gender differences in RM experience and its impact on the couple's relationship and sexuality. Each member of 30 couples with RM answered a set of questionnaires, including the Impact of Events Scale (Horowitz et al., 1979), the Perinatal Grief Scale (Toedter et al., 1988), the Partnership Questionnaire (Hahlweg, 1979) and the Intimate Relationship Scale (Hetherington e Soeken, 1990). Results showed that men do grieve, but less intensely than women. Although the quality of the couple���s relationship seemed not to be adversely affected by RM, both partners described sexual changes after those events. Grief was related to the quality of communication in the couple for women, and to the quality of sex life for men. An understanding of such issues is critical in helping these couples to maintain sexual and affective quality of their relationship. Finally, in Chapter 5, conclusions and clinical implications of all personal contribution to the investigation on associated factors and relational consequences of recurrent miscarriage are presented.