Prevenção do tabagismo: um caminho na prestação de cuidados de saúde

Esta tese é constituída por dois estudos. O estudo de prevenção primária é experimental, ensaio clínico randomizado, cujo programa de intervenção “Para- Par sem Tabaco” é baseado na metodologia da formação pelos pares, com o objectivo de avaliar a sua eficácia. A amostra é constituída por 310 estudantes que frequentam o 7º e 8º Anos das Escolas Básicas e Secundárias de Oliveira de Azeméis por amostragem aleatória em conglomerados (turmas). 153 estudantes constituíram o grupo de controlo e 157 o grupo experimental. A observação foi feita antes, no final e passado um ano da intervenção. Foram construídas e validadas três escalas, que apresentaram bons argumentos de fidelidade e validade. Dos resultados ressaltam os benefícios na redução do consumo de cigarros por semana, a perspectiva futura menos associada ao consumo de tabaco; uma evolução na concordância sobre o alto risco face à auto-estima, comportamentos e tabaco; e alguma consistência nas suas percepções sobre o tabaco e as motivações dos fumadores. Verificou-se uma maior eficácia no sexo masculino. Nos dois grupos, com o aumento da idade, aumentou a idade de experimentação tabágica, o número de cigarros consumidos semanalmente e o número de amigos fumadores. No grupo experimental, constata-se que os adolescentes filhos de pais fumadores consomem mais cigarros por semana e têm mais amigos fumadores. O estudo de prevenção secundária e terciária do tabagismo foi efectuado com o objectivo de avaliar a eficácia e identificar os factores que interferem nas consultas de cessação tabágica. Tratando-se de um estudo descritivocorrelacional retrospectivo e de coorte. A amostra (probabilística aleatória – K=4) foi constituída por 395 elementos inscritos na consulta de cessação tabágica de 12 Centros de Saúde do Distrito de Aveiro entre 2004 a 2009 (pesquisa de arquivo). A avaliação foi feita em três momentos: na última consulta, aos três e seis meses de seguimento. Conclui-se que os elementos com mais habilitações académicas, que consomem menos cigarros e com menor grau de dependência tabágica, são os que apresentam maior sucesso na cessação tabágica aos três meses de seguimento. Os sujeitos que referem, na primeira consulta, conseguir reduzir menos cigarros e os que apresentam maior motivação, na primeira consulta, são os que apresentam mais sucesso na cessação tabágica na última consulta e aos três meses de seguimento. Os elementos com mais idade, sem apoio familiar, que apresentam um maior tempo sem fumar, em tentativas anteriores e os que mais utilizaram as consultas, foram os que conseguiram mais sucesso na cessação tabágica aos três e seis meses de seguimento. Os elementos que não fizeram tratamento específico não têm sucesso. Os elementos da amostra obtiveram ganho ponderal com redução nos valores da pressão arterial sistólica e diastólica. Destes estudos foram retiradas algumas linhas orientadoras para a prestação de cuidados de saúde nesta complexa área de intervenção.

Ecological assessment of the red deer population in the Lousã Mountain

Durante o último século, as populações de cervídeos têm aumentado substancialmente um pouco por toda a Europa. O veado Cervus elaphus não foi exceção, apresentando atualmente uma ampla distribuição geográfica. Após a quase extinção de todas as populações selvagens desta espécie em Portugal, o número de efetivos de veado e a área de distribuição da espécie têm aumentado significativamente nas últimas décadas. Esta proliferação deveu-se fundamentalmente aos processos de reintrodução implementados em algumas zonas do país, como foi o caso da Serra da Lousã. Dez anos após a reintrodução, a expansão geográfica e demográfica é já uma realidade e a espécie assume um papel relevante tanto do ponto de vista cinegético como turístico. Com o aumento das populações de ungulados, surge a necessidade de aumentar o conhecimento existente sobre estas espécies, particularmente ao nível das estimativas populacionais, do uso e seleção de habitat, do comportamento e da fisiologia das populações. Neste sentido, um dos objetivos foi comparar quatro métodos de contagem de excrementos em termos de estimativa populacional, aplicabilidade e eficiência. Face aos resultados obtidos, o método de transectos lineares com distance sampling revelou-se o mais eficiente, providenciando uma boa precisão num menor tempo. Relativamente ao uso e seleção do habitat, recorrendo a transectos de contagem de excrementos e a observações diretas, verificou-se que o veado seleciona positivamente habitats que lhe proporcionam simultaneamente alimento e refúgio, como é o caso das áreas de ecótono. A preferência por áreas de ecótono evidencia um comportamento adaptativo de maximização de energia, no qual os animais optam por procurar refúgio na proximidade das áreas de alimentação de forma a minimizarem os dispêndios energéticos. Em termos de dinâmica populacional, verificou-se uma relação entre a densidade de veado e o tamanho dos seus grupos, bem como o efeito nos mesmos do coberto vegetal. Contudo, dado o seu alto dimorfismo sexual em termos de tamanho corporal, as preferências de habitat podem também ser em parte responsáveis pela segregação sexual fora da época de reprodução. Face aos resultados obtidos através do método de observação direta de animais, a segregação sexual surge como consequência da interação entre fatores sociais e de habitat, que resultam de diferentes estratégias reprodutivas por parte de ambos os sexos. As diferentes estratégias reprodutivas são também notórias em termos de condição física e imunológica, com os machos a aumentarem a sua condição durante as épocas de primavera e verão de forma a melhorarem a sua performance durante o cio, e as fêmeas a viverem grande parte do ano no limiar da condição física devido ao seu investimento na sobrevivência da sua descendência. Globalmente, o veado apresenta uma boa adaptação à Serra da Lousã e representa um importante recurso natural para esta região. Contudo, para que a proliferação desta população selvagem continue, é necessária a implementação de medidas de gestão adequadas a este ecossistema mediterrâneo.

A Democratic Opening? The AKP and the Kurdish Left

Since its foundation, militant democratic arguments have underpinned an enforced secularism in Turkey. The 2002 election of the AKP, described as a “moderate Islamist party”, has challenged Turkey’s secular identity. In the more than twelve years since the AKP has been in power, Turkey’s political landscape has experienced significant changes, with periods of extensive democratic reforms punctuated by regression in certain areas, notably freedom of expression and the right to protest. State repressive measures coupled with Recep Tayyip Erdoğan’s reluctance to exit the political stage have been the focus of much commentary and analysis. This article argues, however, that under AKP rule the Kurdish issue – critical to ensuring the normalization of politics and democratization in Turkey – has been brought in from the political cold and assesses the creation and role of the HDP (Halkların Demokratik Partisi), a Kurdish political party that is endeavoring to situate itself in the mainstream of Turkey’s political landscape. We posit that the HDP can be viewed as the offspring of this “democratic opening,” a project that was meant to ensure a radical transformation of the Kurdish issue in Turkey. Through analysing the historical trajectory of both AKP and HDP and the militant democratic arguments that led to their predecessors’ exclusion from the public sphere, this article engages with the key question of the extent to which the AKP’s treatment of the Kurdish issue has provided a vehicle for broader democratisation and facilitated a reconsideration of the Kurdish question in Turkey.

Contribuição parental do linguado do Senegal, Solea senegalensis (KAUP 1858), em aquacultura

Dissertação mest., Biologia Marinha, Universidade do Algarve, 2008

Um estudo exploratório sobre a relação existente entre as representações sócio-profissionais e as escolhas educativas dos filhos

Dissertação de Mestrado, Observação e Análise da Relação Educativa, Faculdade de Ciências Humanas e Sociais, Universidade do Algarve, 2006

Estudo da variabilidade genética de marcadores moleculares ligados ao gene da MGP e sua aplicação para paternidades em Sparus aurata

Dissertação de Mestrado, Biologia Marinha, Especialização em Biotecnologia Marinha, Faculdade de Ciências do Mar e do Ambiente, Universidade do Algarve, 2008

Caracterização do comportamento reprodutivo do cavalo-marinho de focinho comprido (Hippocampus guttulatus, Cuvier 1928)

Dissertação de Mestrado, Biologia Marinha, Especialização em Pescas e Aquacultura, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2009

A proteomic study of the effects of nutrient restriction in utero on postnatal metabolism

It is widely recognized that protein restriction in utero may cause metabolic and endocrine adaptations, which may be of benefit to the neonate on a short-term basis but may cause adverse long-term conditions such as obesity, Type 2 diabetes, metabolic syndrome, hypertension and cardiovascular diseases. Adequate foetal and early post natal nutrient and energy supply is therefore essential for adult animal health, performance and life span. In this project it was investigated the progressive adaptations of the hepatic proteome in male mink offspring exposed to either a low protein (FL) or an adequate protein (FA) diet in utero fed either on a low protein (LP) or on an adequate (AP) diet from weaning until sexual maturity. Specifically, the aim was to determine the metabolic adaptations at selected phases of the animal’s first annual cycle and establish the metabolic priorities occurring during those phases. The three different morphological stages studied during the first year of development included, end of bone growth at 4 months of age, maximal fat accretion at 6 months of age and sexual maturity at 12 months of age. A reference proteome of mink liver coming from these different animal groups were generated using 2D electrophoresis coupled to MALDI-TOF analysis and the way in which dietary treatment affect their proteome was established. Approximately 330 proteins were detected in the mink liver proteome. A total of 27 comparisons were carried out between all different animal groups which resulted in 20 differentially expressed proteins. An extensive survey was conducted towards the characterization of these proteins including their subcellular localization, the biological processes in which they are involved and their molecular functions. This characterization allowed the identification of proteins in various processes including the glycolysis and fatty acid metabolism. The detailed analysis of the different dietary treatment animal groups was indicative of differences in metabolism and also to changes associated with development in mink.

Biochemical indices and life traits of loggerhead turtles (Caretta caretta) from Cape Verde Islands

The loggerhead turtle (Caretta caretta) is an endangered marine reptile for whom assessing population health requires knowledge of demographic parameters such as individual growth rate. In Cape Verde, as within several populations, adult female loggerhead sea turtles show a size-related behavioral and trophic dichotomy. While smaller females are associated with oceanic habitats, larger females tend to feed in neritic habitats, which is reflected in their physiological condition and in their offspring. The ratio of RNA/DNA provides a measure of cellular protein synthesis capacity, which varies depending on changes in environmental conditions such as temperature and food availability. The purpose of this study was to evaluate the combined use of morphometric data and biochemical indices as predictors of the physiological condition of the females of distinct sizes and hatchlings during their nesting season and how temperature may influence the physiological condition on the offspring. Here we employed biochemical indices based on nucleic acid derived indices (standardized RNA/DNA ratio-sRD, RNA concentration and DNA concentration) in skin tissue as a potential predictor of recent growth rate in nesting females and hatchling loggerhead turtles. Our major findings were that the physiological condition of all nesting females (sRD) decreased during the nesting season, but that females associated with neritic habitats had a higher physiological condition than females associated with oceanic habitats. In addition, the amount of time required for a hatchling to right itself was negatively correlated with its physiological condition (sRD) and shaded nests produced hatchlings with lower sRD. Overall, our results showed that nucleic acid concentrations and ratios of RNA to DNA are an important tool as potential biomarkers of recent growth in marine turtles. Hence, as biochemical indices of instantaneous growth are likely temperature-, size- and age-dependent, the utility and validation of these indices on marine turtles stocks deserves further study.

Timing and mode of delivery in twins : the ongoing controversy

Tese de doutoramento, Medicina (Ginecologia e Obstetrícia), Universidade de Lisboa, Faculdade de Medicina, 2014

Regulatory interactions between the metabolic sensors SIRT1 and AMPK in modulating PPARα linked functions, in obesity-dependent type 2 diabetes mellitus

Tese de doutoramento, Ciências Biomédicas (Ciências Funcionais), Universidade de Lisboa, Faculdade de Medicina, 2014

Spatial justice: law and the geography of withdrawal

While spatial justice could be the most radical offspring of law’s recent spatial turn, it remains instead a geographically informed version of social justice. The majority of the existing literature on the subject has made some politically facile assumptions about space, justice and law, thereby subsuming the potentially radical into the banal. In this article, I suggest that the concept of spatial justice is the most promising platform on which to redefine, not only the connection between law and geography, but more importantly, the conceptual foundations of both law and space. More concretely, the article attempts two things: first, a radical understanding of legal spatiality. Space is not just another parameter for law, a background against which law takes place, or a process that the law needs to take into consideration. Space is intertwined with normative production in ways that law often fails to acknowledge, and part of this article is a re-articulation of the connection. Second, to suggest a conception of spatial justice that derives from a spatial law. Such a conception cannot rely on given concepts of distributive or social justice. Instead, the concept of spatial justice put forth here is informed by post-structural, feminist, post-ecological and other radical understandings of emplacement and justice, as well as arguably the most spatial of philosophical discourses, that of Deleuze–Guattari and the prescribed possibilities of space as manifold.

Comparing impact and cost-effectiveness of primary prevention strategies for lipid-lowering.

BACKGROUND: Lipid-lowering therapy is costly but effective at reducing coronary heart disease (CHD) risk. OBJECTIVE: To assess the cost-effectiveness and public health impact of Adult Treatment Panel III (ATP III) guidelines and compare with a range of risk- and age-based alternative strategies. DESIGN: The CHD Policy Model, a Markov-type cost-effectiveness model. DATA SOURCES: National surveys (1999 to 2004), vital statistics (2000), the Framingham Heart Study (1948 to 2000), other published data, and a direct survey of statin costs (2008). TARGET POPULATION: U.S. population age 35 to 85 years. Time Horizon: 2010 to 2040. PERSPECTIVE: Health care system. INTERVENTION: Lowering of low-density lipoprotein cholesterol with HMG-CoA reductase inhibitors (statins). OUTCOME MEASURE: Incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: Full adherence to ATP III primary prevention guidelines would require starting (9.7 million) or intensifying (1.4 million) statin therapy for 11.1 million adults and would prevent 20,000 myocardial infarctions and 10,000 CHD deaths per year at an annual net cost of $3.6 billion ($42,000/QALY) if low-intensity statins cost $2.11 per pill. The ATP III guidelines would be preferred over alternative strategies if society is willing to pay $50,000/QALY and statins cost $1.54 to $2.21 per pill. At higher statin costs, ATP III is not cost-effective; at lower costs, more liberal statin-prescribing strategies would be preferred; and at costs less than $0.10 per pill, treating all persons with low-density lipoprotein cholesterol levels greater than 3.4 mmol/L (>130 mg/dL) would yield net cost savings. RESULTS OF SENSITIVITY ANALYSIS: Results are sensitive to the assumptions that LDL cholesterol becomes less important as a risk factor with increasing age and that little disutility results from taking a pill every day. LIMITATION: Randomized trial evidence for statin effectiveness is not available for all subgroups. CONCLUSION: The ATP III guidelines are relatively cost-effective and would have a large public health impact if implemented fully in the United States. Alternate strategies may be preferred, however, depending on the cost of statins and how much society is willing to pay for better health outcomes. FUNDING: Flight Attendants' Medical Research Institute and the Swanson Family Fund. The Framingham Heart Study and Framingham Offspring Study are conducted and supported by the National Heart, Lung, and Blood Institute.

Food availability affects the maternal transfer of androgens and antibodies into eggs of a colonial seabird.

Mothers can improve the quality of their offspring by increasing the level of certain components in their eggs. To examine whether or not mothers increase deposition of such components in eggs as a function of food availability, we food-supplemented black-legged kittiwake females (Rissa tridactyla) before and during egg laying and compared deposition of androgens and antibodies into eggs of first and experimentally induced replacement clutches. Food-supplemented females transferred lower amounts of androgens and antibodies into eggs of induced replacement clutches than did non-food-supplemented mothers, whereas first clutches presented no differences between treatments. Our results suggest that when females are in lower condition, they transfer more androgens and antibodies into eggs to facilitate chick development despite potential long-term costs for juveniles. Females in prime condition may avoid these potential long-term costs because they can provide their chicks with more and higher quality resources.

Congenital heart disease in pregnancies complicated by maternal diabetes mellitus. An international clinical collaboration, literature review, and meta-analysis.

PURPOSE: Investigation of the incidence and distribution of congenital structural cardiac malformations among the offspring of mothers with diabetes type 1 and of the influence of periconceptional glycemic control. METHODS: Multicenter retrospective clinical study, literature review, and meta-analysis. The incidence and pattern of congenital heart disease in the own study population and in the literature on the offspring of type 1 diabetic mothers were compared with the incidence and spectrum of the various cardiovascular defects in the offspring of nondiabetic mothers as registered by EUROCAT Northern Netherlands. Medical records were, in addition, reviewed for HbA(1c) during the 1st trimester. RESULTS: The distribution of congenital heart anomalies in the own diabetic study population was in accordance with the distribution encountered in the literature. This distribution differed considerably from that in the nondiabetic population. Approximately half the cardiovascular defects were conotruncal anomalies. The authors' study demonstrated a remarkable increase in the likelihood of visceral heterotaxia and variants of single ventricle among these patients. As expected, elevated HbA(1c) values during the 1st trimester were associated with offspring fetal cardiovascular defects. CONCLUSION: This study shows an increased likelihood of specific heart anomalies, namely transposition of the great arteries, persistent truncus arteriosus, visceral heterotaxia and single ventricle, among offspring of diabetic mothers. This suggests a profound teratogenic effect at a very early stage in cardiogenesis. The study emphasizes the frequency with which the offspring of diabetes-complicated pregnancies suffer from complex forms of congenital heart disease. Pregnancies with poor 1st-trimester glycemic control are more prone to the presence of fetal heart disease.