Rastreio do cancro da mama no concelho de Aveiro: do estudo dos fatores determinantes da adesão às propostas educativas emergentes

O cancro da mama feminino pela sua magnitude merece uma especial atenção ao nível das políticas de saúde. Emerge, pois uma visão abrangente que, por um lado, deve atentar para o encargo que esta representa para qualquer sistema de saúde, pelos custos que acarreta, como também, para a qualidade de vida das mulheres portadoras da mesma. Desta forma, a Liga Portuguesa Contra o Cancro (LPCC) tem desenvolvido, em colaboração com as Administrações Regionais de Saúde (ARS), o Programa de Rastreio do Cancro da Mama (PRCM), o qual apresenta, no Concelho de Aveiro, taxas de adesão na ordem dos 50%, ainda distantes dos 70%, objetivo recomendado pelas guidelines da Comissão Europeia. A não adesão tem sido considerada como um dos principais problemas do sistema de saúde, tanto pelas repercussões ao nível de ganhos em saúde, como também na qualidade de vida e na satisfação dos pacientes com os cuidados de saúde, constituindo-se como um fenómeno multifatorial e multidimensional. É neste sentido que o presente trabalho se propõe identificar os fatores, de cariz individual e do meio envolvente, determinantes da adesão ao PRCM, numa amostra de mulheres residentes no Concelho de Aveiro, com idades compreendidas entre os 45 e os 69 anos e, a partir dos resultados emergentes, propor estratégias de educação em saúde. Como procedimentos metodológicos e, numa primeira fase, entre outubro 2009 e maio 2010 foi aplicado um survey, o qual foi complementado com notas de campo dos entrevistadores a uma amostra não aleatória de 805 mulheres, em dois contextos distintos: no centro de saúde às aderentes à mamografia e, no domicílio, às não aderentes. Numa segunda fase, realizamos duas sessões de Focus Group (FG), num total de 12 elementos, um grupo heterogéneo com enfermeiros, médicos e utentes, e um outro grupo homogéneo, apenas com profissionais de saúde. O tratamento dos dados do survey foi efetuado através de procedimentos estatísticos, com utilização do SPSS® versão 17 e realizadas análises bivariadas (qui-quadrado) e multivariadas (discriminação de função e árvore de decisão através do algoritmo Chi-squared Automatic Interaction Detector) com o intuito de determinar as diferenças entre os grupos e predizer as variáveis exógenas. No que diz respeito a indicadores sociodemográficos, os resultados mostram que aderem mais, as mulheres com idades <50 anos e ≥ 56 anos, as que vivem em localidades urbanas, as trabalhadoras não qualificadas e as reformadas. As que aderem menos ao PRCM têm idades compreendidas entre os 50-55 anos, vivem nas zonas periurbanas, são licenciadas, apresentam categoria profissional superior ou estão desempregadas. Em relação às restantes variáveis exógenas, aderem ao PRCM, as mulheres que apresentam um Bom Perfil de Conhecimentos (46.6%), enquanto as não aderentes apresentam um Fraco Perfil de Conhecimentos (50.6%), sendo esta relação estatisticamente significativa (X2= 10.260; p=0.006).Cerca de 59% das mulheres aderentes realiza o seu rastreio de forma concordante com as orientações programáticas presentes no PRCM, comparativamente com 41.1% das mulheres que não o faz, verificando-se uma relação de dependência bastante significativa entre as variáveis Perfil de Comportamentos e adesão(X2= 348.193; p=0.000). Apesar de não existir dependência estatisticamente significativa entre as Motivações e a adesão ao PRCM (X2= 0.199; p=0.656), se analisarmos particularmente, os motivos de adesão, algumas inquiridas demonstram preocupação, tanto na deteção precoce da doença, como na hereditariedade. Por outro lado, os motivos de não adesão, também denotam aspetos de nível pessoal como o desleixo com a saúde, o desconhecimento e o esquecimento da marcação. As mulheres que revelam Boa Acessibilidade aos Cuidados de Saúde Primários e um Bom Atendimento dos Prestadores de Cuidados aderem mais ao PRCM, comparativamente com as inquiridas que relatam Fraca Acessibilidade e Atendimento, não aderindo. A partir dos resultados da análise multivariada podemos inferir que as variáveis exógenas estudadas possuem um poder discriminante significativo, sendo que, o Perfil de Comportamentos é a variável que apresenta maior grau de diferenciação entre os grupos das aderentes e não aderentes. Como variáveis explicativas resultantes da árvore de decisão CHAID, permaneceram, o Perfil de Comportamentos (concordantes e não concordantes com as guidelines), os grupos etários (<50 anos, 50-55anos e ≥56anos) e o Atendimento dos prestadores de cuidados de saúde. As mulheres mais novas (<50 anos) com Perfil de comportamentos «concordantes» com as guidelines são as que aderem mais, comparativamente com os outros grupos etários. Por outro lado, as não aderentes necessitam de um «bom» atendimento dos prestadores de cuidados para se tornarem aderentes ao PRCM. Tanto as notas de campo, como a discussão dos FG foram sujeitas a análise de conteúdo segundo as categorias em estudo obtidas na primeira fase e os relatos mostram a importância de fatores de ordem individual e do meio envolvente. No que se refere a aspetos psicossociais, destaca-se a importância das crenças e como fatores ambientais menos facilitadores para a adesão apontam a falta de transportes, a falta de tempo das pessoas e a oferta de recursos, principalmente se existirem radiologistas privados como alternativa ao PRCM. Tal como na primeira fase do estudo, uma das motivações para a adesão é a recomendação dos profissionais de saúde para o PRCM, bem como a marcação de consultas pela enfermeira, que pode ser uma oportunidade de contacto para a sensibilização. Os hábitos de vigilância de saúde, a perceção positiva acerca dos programas de saúde no geral, o acesso à informação pertinente sobre o PRCM e a operacionalização deste no terreno parecem ser fatores determinantes segundo a opinião dos elementos dos FG. O tipo e a regularidade no atendimento por parte dos profissionais de saúde, a relação entre profissional de saúde/paciente, a personalização das intervenções educativas, a divulgação que estes fazem do PRCM junto das suas pacientes, bem como, a organização do modelos de cuidados de saúde das unidades de saúde e a forma como os profissionais se envolvem e tomam a responsabilização por um programa desta natureza são fatores condicionantes da adesão. Se atendermos aos resultados deste estudo, verificamos um envolvimento de fatores que integram múltiplos níveis de intervenção, sendo um desafio para as equipas de saúde que pretendam intervir no âmbito do programa de rastreio do cancro da mama. Com efeito, os resultados também apontam para a combinação de múltiplas estratégias que são transversais a vários programas de promoção da saúde, assumindo, desta forma, uma perspetiva multidimensional e dinâmica que visa, essencialmente, a construção social da saúde e do bem-estar (i.e. responsabilização do cidadão pela sua própria saúde e o seu empowerment).

Architecture for real-time coordination of multiple autonomous mobile units

Interest on using teams of mobile robots has been growing, due to their potential to cooperate for diverse purposes, such as rescue, de-mining, surveillance or even games such as robotic soccer. These applications require a real-time middleware and wireless communication protocol that can support an efficient and timely fusion of the perception data from different robots as well as the development of coordinated behaviours. Coordinating several autonomous robots towards achieving a common goal is currently a topic of high interest, which can be found in many application domains. Despite these different application domains, the technical problem of building an infrastructure to support the integration of the distributed perception and subsequent coordinated action is similar. This problem becomes tougher with stronger system dynamics, e.g., when the robots move faster or interact with fast objects, leading to tighter real-time constraints. This thesis work addressed computing architectures and wireless communication protocols to support efficient information sharing and coordination strategies taking into account the real-time nature of robot activities. The thesis makes two main claims. Firstly, we claim that despite the use of a wireless communication protocol that includes arbitration mechanisms, the self-organization of the team communications in a dynamic round that also accounts for variable team membership, effectively reduces collisions within the team, independently of its current composition, significantly improving the quality of the communications. We will validate this claim in terms of packet losses and communication latency. We show how such self-organization of the communications can be achieved in an efficient way with the Reconfigurable and Adaptive TDMA protocol. Secondly, we claim that the development of distributed perception, cooperation and coordinated action for teams of mobile robots can be simplified by using a shared memory middleware that replicates in each cooperating robot all necessary remote data, the Real-Time Database (RTDB) middleware. These remote data copies, which are updated in the background by the selforganizing communications protocol, are extended with age information automatically computed by the middleware and are locally accessible through fast primitives. We validate our claim showing a parsimonious use of the communication medium, improved timing information with respect to the shared data and the simplicity of use and effectiveness of the proposed middleware shown in several use cases, reinforced with a reasonable impact in the Middle Size League of RoboCup.

Bottom-up regulation of phytoplankton in the Guadiana estuary

Tese dout., Ciências do Mar (Ecologia Marinha), Faculdade de Ciências e Tecnologia, Univ. do Algarve, 2010

Stories and Statistics: Describing a Mixed Method Study of Effective Classroom Practice

The Effective Classroom Practice project aimed to identify key factors that contribute to effective teaching in primary and secondary phases of schooling in different socioeconomic contexts. This article addresses the ways in which qualitative and quantitative approaches were combined within an integrated design to provide a comprehensive methodology for the research purposes. Strategies for the study are discussed, followed by the challenges of combining complex statistics with individual stories, particularly in relation to the ongoing iteration between these different data sets, and issues of validity and reliability. The findings shed new light on the meanings and measurement of teachers’ effective classroom practice and the complex nature of, and relationships with, professional life phase, teacher identities, and school context.

Position-specific Performance Indicators that Discriminate between Successful and Unsuccessful Teams in Elite Women’s Indoor Field Hockey: Implications for Coaching

The aim of this investigation was to establish median performance profiles for the six playing positions in elite women’s indoor hockey and then identify whether these position-specific profiles could discriminate between qualifying (top four), mid-table and relegated teams in the 2011-12 England Hockey premier league. Successful passing in relegated teams was significantly lower (p<0.008) than in mid-table and qualifying teams in four of the five outfield positions. Furthermore, the right backs of qualifying teams demonstrated significantly fewer (p<0.008) unsuccessful passes (x̃=15.5 ±CLs 15.0 and 10.0 respectively) and interceptions (x̃=4.0 ±CLs 4.0 and 3.0 respectively) than relegated teams (x̃=19.5 ±CLs 21.0 and 17.0; x̃=7.5 ±CLs 8.0 and 6.0 respectively). Finally, the right forwards of relegated teams demonstrated significantly fewer (p<0.008) successful interceptions (x̃=4.0 ±CLs 5.0 and 4.0 respectively) than qualifying teams (x̃=5.0 ±CLs 6.0 and 3.0 respectively) and significantly more (p<0.008) unsuccessful interceptions (x̃=5.5 ±CLs 6.0 and 4.0 respectively) than mid-table teams (x̃=3.0 ±CLs 3.0 and 2.0 respectively). Based on these findings, coaches should adapt tactical strategies and personnel deployment accordingly to enhance the likelihood of preparing a qualifying team. Research should build from these data to examine dribbling, pressing and patterns of play when outletting.

Sociological Knowledge and Transformation at ‘Diversity University’, UK

This chapter is based on a case study of one UK university sociology department and shows how sociology knowledge can transform the lives of ‘non-traditional’ students. The research from which the case is drawn focused on four departments teaching sociology-related subjects in universities positioned differently in UK league tables. It explored the question of the relationship between university reputation, pedagogic quality and curriculum knowledge, challenging taken-for-granted judgements about ‘quality’ and in conceptualising ‘just’ university pedagogy by taking Basil Bernstein’s ideas about how ‘powerful’ knowledge is distributed in society to illuminate pedagogy and curriculum. The project took the view that ‘power’ lies in the acquisition of specific (inter)disciplinary knowledges which allows the formation of disciplinary identities by way of developing the means to think about and act in the world in specific ways. We chose to focus on sociology because (1) university sociology is taken up by all socio-economic classes in the UK and is increasingly taught in courses in which the discipline is applied to practice; (2) it is a discipline that historically pursues social and moral ambition which assists exploration of the contribution of pedagogic quality to individuals and society beyond economic goals; (3) the researchers teach and research sociology or sociology of education - an understanding of the subjects under discussion is essential to make judgements about quality. ‘Diversity’ was one of four case study universities. It ranks low in university league tables; is located in a large, multi-cultural English inner city; and, its students are likely to come from lower socio-economic and/or ethnic minority groups, as well as being the first in their families to attend university. To make a case for transformative teaching at Diversity, the chapter draws on longitudinal interviews with students, interviews with tutors, curriculum documents, recordings of teaching, examples of student work, and a survey. It establishes what we can learn from the case of sociology at Diversity, arguing that equality, quality and transformation for individuals and society are served by a university curriculum which is research led and challenging combined with pedagogical practices which give access to difficult-to-acquire and powerful knowledge.

RFID-based wireless passive sensors utilizing cork materials

This paper presents the design of low-cost, conformal UHF antennas and RFID tags on two types of cork substrates: 1) natural cork and 2) agglomerate cork. Such RFID tags find an application in wine bottle and barrel identification, and in addition, they are suitable for numerous antenna-based sensing applications. This paper includes the high-frequency characterization of the selected cork substrates considering the anisotropic behavior of such materials. In addition, the variation of their permittivity values as a function of the humidity is also verified. As a proof-of-concept demonstration, three conformal RFID tags have been implemented on cork, and their performance has been evaluated using both a commercial Alien ALR8800 reader and an in-house measurement setup. The reading of all tags has been checked, and a satisfactory performance has been verified, with reading ranges spanning from 0.3 to 6 m. In addition, this paper discusses how inkjet printing can be applied to cork surfaces, and an RFID tag printed on cork is used as a humidity sensor. Its performance is tested under different humidity conditions, and a good range in excess of 3 m has been achieved, allied to a good sensitivity obtained with a shift of >5 dB in threshold power of the tag for different humid conditions.

Conceptualização de um evento à luz do brand entertainment e ativação de marcas

Trabalho de projeto apresentado à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Publicidade e Marketing.

Factor V Leiden and Prothrombin G20210A in Portuguese Women with Recurrent Miscarriage: Is it Worthwhile to Investigate?

OBJECTIVE: To compare the prevalence of factor V Leiden (FVL) and prothrombin (PT) G20210A mutations in Portuguese women with unexplained recurrent miscarriage (RM) and a control group of parous women. MATERIALS AND METHODS: FVL and PT G20210A analysis were carried out in 100 women with three or more consecutive miscarriages and 100 controls with no history of pregnancy losses. Secondary analysis was made regarding gestational age at miscarriage (embryonic and fetal losses). RESULTS: Overall, the prevalence of FVL and PT G20210A was similar in women with RM (5 and 3%) compared with controls (5 and 1%) OR 1.36 (CI 95% 0.45-4.08). In RM embryonic subgroup, PT G20210A was observed in 1.3% of women and FVL prevalence (2.6%) was inclusively lesser than that of controls. Both polymorphisms were more prevalent in women with fetal losses than in controls, although statistical significance was not reached due to the small size of the >10 weeks' subgroup. CONCLUSION: These data indicate that neither FVL nor PT G20210A is associated with RM prior to 10 weeks of gestation. Therefore, its screening is not indicated as an initial approach in Portuguese women with embryonic RM and negative personal thromboembolic history.

Global surveillance of cancer survival 1995-2009 : analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75 000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems. FUNDING: Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA).

L'Écho de Paris

1888/06/27 (Numéro 1558).

Reliure de : El Desafio de los reyes de Francia y d'Inglaterra al emperador y rey ñro señor (Carlos V) , con sus respuestas

Numérisation partielle de reliure