A medicina tradicional chinesa em Portugal:estudo de atitudes, hábitos e comportamentos dos não utilizadores

Dissertação, Mestrado, Marketing, Instituto Politécnico de Santarém, Escola Superior de Gestão e Tecnologia, 2014

Bursaphelenchus xylophilus : opportunities in comparative genomics and molecular host–parasite interactions

Most Bursaphelenchus species are fungal feeding nematodes that colonize dead or dying trees. However, Bursaphelenchus xylophilus , the pine wood nematode, is also a pathogen of trees and is the causal agent of pine wilt disease. B. xylophilus is native to North America and here it causes little damage to trees. Where it is introduced to new regions it causes huge damage. The most severely affected areas are found in the Far East but more recently B. xylophilus has been introduced into Portugal and the potential for damage here is also high. As incidence and severity of pine wilt disease are linked to temperature we suggest that climate change is likely to exacerbate the problems caused by B. xylophilus and, in addition, will extend (northwards in Europe) the range in which pine wilt disease can occur. Here we review what is currently known about the interactions of B. xylophilus with its hosts, including recent developments in our understanding of the molecular biology of pathogenicity in the nematode. We also examine the potential developments that could be made by more widespread use of genomics tools to understand interactions between B. xylophilus , bacterial pathogens that have been implicated in disease and host trees.

Review of the genus Bursaphelenchus Fuchs, 1937 (Nematoda, Aphelenchida) with some conclusions on the host-parasite and vector-parasite evolution.

INTRODUCTION AND GOALS: Genus Bursaphelenchus includes several pests of the world importance for the rural economy, the most dangerous are the Bursaphelenchus xylophilus (the pinewood nematode caused decline of the pine trees in south Asia and in one spot area in Europe, Portugal, Peninsula de Setubal) and the Bursaphelenchus cocophilus, causing the decline of coco-palm plantations in Carribean and Latin American regions. The peculiarity of the host-parasite association of the genus that the nematode life cycle includes three trophic components: plant (mostly a tree), insect vector and a fungus. Goals of the presentation is to list all species of the world fauna and all efficient diagnostic characters, then create the identification tool and analyze the similarity of species and possible ways and causes of the host-parasite evolution of the group. RESULTS: Complete list of species with synonymy and a catalogue of all efficient diagnostic characters with their states, selected from papers of the most experienced taxonomists of the genus, are given for the genus Bursaphelenchus. List of known records of Bursaphelenchus species with names of natural vectors and plants and their families is given (for world pests the most important groups of trees and insects are listed). The tabular, traditional and computer-aided keys are presented. Dendrograms of species relationships (UPGMA, standard distance: mean character difference) based on all efficient taxonomic characters and separately on the spicule characters only, are given. Discussion whether the species groups are natural or purely diagnostic ones is based on the relationships dendrograms and the vector and associated plant ranges of Bursaphelenchus species; the xylophilus species group (B. xylophilus, B. abruptus, B. baujardi, B. conicaudatus, B. eroshenkii, B. fraudulentus, B. kolymensis, B. luxuriosae; B. mucronatus), the hunti group (B. hunti, B. seani, B. kevini and B. fungivorus) are probably the natural ones. CONCLUSIONS: The parasitic nematode association includes three trophic components: plant, insect vector and fungus. The initial insect-plant complex Scolytidae-Pinaceae is changeable and only in rare occasions the change of the preferred vector to Cerambycidae (the xylophilus group), Hymenoptera (the hunti group) led to formation of the natural species-groups. From the analysis it is clear that although the vector range is changeable it is comparatively more important for the evolution of the genus Bursaphelenchus than associations with plants at the family level. Data on the fungi species (3rd component in natural Bursaphelenchus associations) are insufficient for the detailed comparative analysis.

Pine wilt disease: a worldwide threat to forest ecosystems

The pinewood nematode (PWN), Bursaphelenchus xylophilus, the causal agent of pine wilt disease (PWD), is a serious pest and pathogen of forest tree species, in particular among the genus Pinus. It was first reported from Japan in the beginning of the XXth century, where it became the major ecological catastrophe of pine forests, with losses reaching over 2 million m3/ year in the 1980s. It has since then spread to other Asian countries such as China, Taiwan and Korea, causing serious losses and economic damage. In 1999, the PWN was first detected in the European Union (EU), in Portugal, and immmediately prompted several government (national and EU) actions to assess the extent of the nematode’s presence, and to contain B. xylophilus and its insect vector (Monochamus galloprovincialis) to an area with a 30km radius in the Setúbal Peninsula, 20 km south of Lisbon. International wood trade, with its political as well as economic ramifications, has been seriously jeopardized. The origin of the population of PWN found in Portugal remains elusive. Several hypotheses may be considered regarding pathway analysis, basically from two general origins: North America or the Far East (Japan or China). World trade of wood products such as timber, wooden crates, palettes, etc… play an important role in the potential dissemination of the pinewood nematode. In fact, human activities involving the movement of wood products may be considered the single most important factor in spreading of the PWN. Despite the dedicated and concerted actions of government agencies, this disease continues to spread. Very recently (2006), in Portugal, forestry and phytosanitary authorities (DGRF and DGPC) have announced a new strategy for the control and ultimately the erradication of the nematode, under the coordination of the national program for the control of the pinewood nematode (PROLUNP). Research regarding the bioecology of the nematode and insect as well as new detection methods, e.g., involving real-time PCR, has progressed since 1999. International agreements (GATT, WTO) and sharing of scientific information is of paramount importance to effectively control the nematode and its vector, and thus protect our forest ecosystems and forest economy.

Progress in the use of scanning electron microscopy (SEM) applied to the taxonomy of the genus Bursaphelenchus (Nematoda: Parasitaphelenchidae)

The scanning electron microscope (SEM) has been a major tool in detailed morphological observations of plant parasitic nematodes during the last 30 years, efficiently complementing light microscopical (LM) studies. Nematodes are extremely difficult to observe and characterize due to their small size (aprox. 1 mm long) and paucity of morphological characters, so detailed surface observations of several organs and nematode regions are of the highest value. Among plant parasitic nematodes, one of the most devastating species is the “pinewood nematode” (PWN), Bursaphelenchus xylophilus, which has been a major problem for forest species, and in particular pines, in Asia (Japan, China, Korea) and has been recently detected in the European Union (Portugal). B. xylophilus belongs to a closely related, morphologically similar group of species, within the genus Bursaphelenchus, and designated by the “xylophilus group”. SEM has become a crucial tool in observing several genital characters of males and females, such as male genital papillae, male copulatory spicules, female vulval flap and female genital papillae.s In this presentation, we will show how SEM has been utilized to observe and characterize the shape of the vulval flap, the presence/ absence of papillae near the flap, and confirm the presence and the arrangement of the male genital papillae. LM is also used in this work to show its value as a complementary tool to SEM, in both genital characteristics and other, general, characters of the genus Bursaphelenchus, such as the male bursa and cephalic region.

Base de dados e chaves electrónicas (ekeys): ferramentas úteis no diagnóstico e identificação de nemátodes fitoparasitas

Com o desenvolvimento das tecnologias de computação, o acesso à informação digital nos diversos domínios científicos tem revolucionado e facilitado a obtenção e utilização rápida de dados biológicos. Nos últimos anos, várias bases de dados (catálogos electrónicos) têm sido desenvolvidas, servindo de portal à biodiversidade existente em diversas áreas do globo (ex. Fauna Europaea, Tree of Life). Este tipo de informação permite a manutenção e a catalogação da biodiversidade existente a nível global; particularmente a biodiversidade de florestas, áreas cultivadas, ecossistemas aquáticos, bem como de espécies exóticas/invasivas encontradas nos diversos ecossistemas. Em 1999, foi detectada pela primeira vez, em Portugal e na Europa, o nemátode da madeira do pinheiro (Bursaphelenchus xylophilus, espécie de quarentena e classificada como A1 pela EPPO), associado ao pinheiro bravo (Pinus pinaster). Na sequência deste trabalho foram desenvolvidas diversas bases de dados, nomeadamente para as espécies do género Bursaphelenchus e outros géneros com espécies de elevado interesse económico (Aphelenchoides, Dolichodorus); bem como para outros grupos de espécies com especial interesse biológico (Laimaphelenchus, Parasitaphelenchus). A reunião deste tipo de informação possibilita a construção de matrizes, e a determinação dos caracteres diagnósticos mais importantes para a identificação das espécies, posteriormente utilizados na elaboração de chaves electrónicas politómicas (com base no sistema PICKEY, Dianov & Lobanov). A utilização e versatilidade deste sistema, nomeadamente para o diagnóstico e a identificação de nemátodes fitoparasitas de elevado interesse económico, é demonstrada como exemplo

Mathilde Bensaude, Portugal´s pioneer Plant Pathologist,

"...the farmers seen to take well to me and not mind my being a woman." (Mathilde Bensaúde , 1920, north Portugal, during de seed potato campaing).

Pine wilt disease: global issues, trade and economic impact

Pine wilt disease (PWD) is perhaps the most serious threat to pine forests worldwide. Since it´s discovery in the early XXth century by Japanese forest researchers, and the relationship with its causative agent, the pinewood nematode (PWN) Bursaphelenchus xylophilus, in the 1970s, PWD has wreaked havoc wherever it appears. Firstly in the Far East (Japan, China and Korea) and now, more recently in 1999, in the EU (Portugal). The forest sector in Portugal plays a major role in the Portuguese economy with a 12% contribution to the industrial gross domestic product, 3.2% of the gross domestic product, 10% of foreign trade and 5% of national employment. Maritime pine (Pinus pinaster) is one of the most important pine productions, and industrial activity, such as the production of wood and resin, as well as coastal protection associated with sand dunes. Also, stone pine (Pinus pinea) plays an important role in the economy with a share derived from the exports of high-quality pineon seed. Thus, the tremendous economical and ecological impact of the introduction of a pest and pathogen such as the PWN, although as far as is known, the only species susceptible to the nematode is maritime pine. Immediately following detection, the research team involved (Univ. Évora, INIAP) informed the national plant quarantine and forest authorities, which relayed the information to Brussels and the appropriate EU authorities. A task force (GANP), followed by a national program (PROLUNP) was established. Since then, national surveys have been taking place, involving MADRP (Ministry of Agriculture), the University of Évora and several private corporations (e.g. UNAC). Forest growers in the area are particularly interested and involved since the area owned by the growers organizations totals 700 000 ha, largely affected by PWD. Detection of the disease has led to serious consequences and restrictions regarding exploration and commercialization of wood. A precautionary phytosanitary strip, 3 km-wide, has been recently (2007) established surrounding the affected area. The Portuguese government, through its national program PROLUNP, has been deeply involved since 1999, and in conjunction with the EU (Permanent Phytosanitary Committee, and FVO) and committed to controlling this nematode and the potential spread to the rest of the country and to the rest of the EU. The global impact of the presence of Bursaphelenchus xylophilus or the threat of its introduction and the resulting pine wilt disease in forested areas in different parts of the world is of increasing concern economically. The concern is exacerbated by the prevailing debate on climate change and the putative impact this could have on the vulnerability of the world’s pine forests to this disease. The scientific and regulatory approach taken in different jurisdictions to the threat of pine wilt disease varies from country to country depending on the perceived vulnerability of their pine forests to the disease and/or to the economic cost due to lost trade in wood products. Much of the research surrounding pine wilt disease has been located in the northern hemisphere, especially in southern Europe and in the warmer, coastal, Asian countries. However, there is an increased focus on this problem also in those countries in the southern hemisphere where plantations of susceptible pine have been established over the years. The forestry sector in Australia and New Zealand are on “high alert” for this disease and are practicing strict quarantine procedures at all ports of entry for wood products. As well, there is heightened awareness, as there is worldwide, for the need to monitor wood packaging materials for all imported goods. In carrying out the necessary monitoring and assessment of products for B. xylophilus and its vectors substantial costs are incurred especially when decisions have to be made rapidly and regardless of whether the outcome is positive or negative. Australia’s response recently to the appearance of some dying pines in a plantation illustrated the high sensitivity of some countries to this disease. Some $200,000 was spent on the assessment in order to save a potential loss of millions of dollars to the disease. This rapid, co-ordinated response to the report was for naught, because once identified it was found not to be B. xylophilus. This illustrates the particular importance of taking the responsibility at all levels of management to secure the site and the need of a rapid, reliable diagnostic method for small nematode samples for use in the field. Australia is particularly concerned about the vulnerability of its 1million hectares of planted forests, 80% of which are Pinus species, to attack from incursions of one or more species of the insect vector. Monochamus alternatus incursions in wood pallets have been reported from Brisbane, Queensland. The climate of this part of Australia is such that the Pinus plantations are particularly vulnerable to the potential outcome of such incursions, and the state of Queensland is developing a risk management strategy and a proactive breeding programme in response to this putative threat. New Zealand has 1.6 million hectares of planted forests and 89% of the commercial forest is Pinus radiata. Although the climate where these forests are located tends to be somewhat cooler than that in Australia the potential for establishment and development of the disease in that country is believed to be high. The passage alone of 200,000 m³/year of wood packaging through New Zealand ports is itself sufficient to require response. The potential incursion of insect vectors of pinewood nematode through the port system is regarded as high and is monitored carefully. The enormous expansion of global trade and the continued use of unprocessed/inadequately-processed wood for packaging purposes is a challenge for all trading nations as such wood packaging material often harbours disease or pest species. The extent of this problem is readily illustrated by the expanding economies and exports of countries in south-east Asia. China. Japan and Korea have significant areas of forestland infested with B. xylophilus. These countries too are among the largest exporting countries of manufactured goods. Despite the attempts of authorities to ensure that only properly treated wood is used in the crating and packaging of goods B. xylophilus and/or its insect vector infested materials is being recorded at ports worldwide. This reminds us, therefore, of the ease with which this nematode pest can gain access to forest lands in new geographic locations through inappropriate use, treatment or monitoring of wood products. It especially highlights the necessity to find an alternative to using low-grade lumber for packaging purposes. Lest we should believe that all wood products are always carriers of B. xylophilus and its vectors, it should be remembered that international trade of all kinds has occurred for thousands of years and that lumber-born pests and diseases do not have worldwide distribution. Other physico-biological factors have a significant role in the occurrence, establishment and sustainability of a disease. The question is often raised as to why the whole of southern Europe doesn’t already have B. xylophilus and pine wilt disease. European countries have traded with countries that are infested with B. xylophilus for hundreds of years. Turkey is an example of a country that appears to be highly vulnerable to pine wilt disease due to its extensive forests in the warm, southern region where the vector, Monochamus galloprovincialis, occurs. However, there is no record of the presence of B. xylophilus occurring there despite the importation of substantial quantities of wood from several countries In many respects, Portugal illustrates both the challenge and the dilemma. In recent times B. xylophilus was discovered there in the warm coastal region. The research, administrative and quarantine authorities responded rapidly and B. xylophilus appears to have been confined to the region in which it was found. The rapid response would seem to have “saved the day” for Portugal. Nevertheless, it raises again the long-standing questions, how long had B. xylophilus been in Portugal before it was found? If Lisbon was the port of entry, which seems very likely, why had B. xylophilus not entered Lisbon many years earlier and established populations and the pine wilt disease? Will the infestation in Portugal be sustainable and will it spread or will it die out within a few years? We still do not have sufficient understanding of the biology of this pest to know the answers to these questions.

Pine Wilt Disease: A Threat to Pine Forests in Turkey?

The pinewood nematode, is the causal agent of pine wilt disease, a serious threat to native pine forest in eastern Asia (Japan, Korea, China and Taiwan) and some parts of North America (USA, Canada and Mexico). In 1999, this nematode was found and identified for the first time in Portugal and in Europe. The detection of this quarantine pest in Portugal has indicated the need to know more about the distribution of Bursaphelenchus spp. in coniferous trees in Europe in order to describe the geographic range of the species and to act quickly in case of the nematode’s unwanted introduction into other European regions. Pine forest has a wide distribution in Turkey that increases the number of susceptible host trees for pinewood nematode. Because of these resaons, some regions of Turkey were surveyed for the presence of the nematode. Three different species of Bursaphelenchus were found. However, B. xylophilus was not detected. The detection of B. mucronatus, very similar to B. xylophilus biologically and morphologically, is very important. The presence of this species indicates that B. xylophilus could spread easly in conifer forests of Turkey. A study was conducted to determine the pathogenicity of B. mucronatus and 80% of seedlings of P. sylvestris were wilted. Biological characteristics of M. galloprovincialis were compared with M. carolinensis, Nort American vector, and some of them were found to be similar.

Pine wilt disease and the pinewood nematode

Pine wilt disease (PWD) is one of the most damaging events affecting conifer forests (in particular Pinus spp.), in the Far East (Japan, China and Korea), North America (USA and Canada) and, more recently, in the European Union (Portugal). In Japan it became catastrophic, damaging native pine species (Pinus thunbergii and P. densiflora), and becoming the main forest problem, forcing some areas to be totally replaced by other tree species. The pine wilt nematode (PWN) Bursaphelenchus xylophilus, endemic, with minor damage, to North America, was introduced in Japan in the early XX century and then spread to Asia (China and Korea) in the 1980s. In 1999 it was detected for the first time in Portugal, where, due to timely detection and immediate government action, it was initially (1999-2008) contained to a small area 30 km SE of Lisbon. In 2008, the PWN spread again to central Portugal, the entire country now being classified as “affected area”. Being an A1 quarantine pest, the EU acted to avoid further PWN spreading and to eradicate it, by actions including financial support for surveyes and eradication, annual inspections and research programs. Experience from control actions in Japan included aerial spraying of insecticides to control the insect vector (the Cerambycid beetle Monochamus alternatus), injection of nematicides to the trunk of infected trees, slashing and burning of large areas out of control, beetle traps, biological control and tree breeding programs. These actions allowed some positive results, but also unsuccessful cases due to the PWN spread and virulence. Other Asian countries also followed similar strategies, but the nematode is still spreading in many regions. In Portugal, despite lower damage than Asia, PWD is still significant with high losses to the forestry industry. New ways of containing PWD include preventing movement of contaminated wood, cutting symptomatic trees and monitoring. Despite a national and EU legislative body, no successful strategy to control and eventually eradicate the nematode and the disease will prevail without sound scientific studies regarding the nematode and vector(s) bioecology and genetics, the ecology and ecophysiology of the pine tree species, P. pinaster and P. pinea , as well as the genomics and proteomics of pathogenicity (resistance/ susceptibility).

Bursaphelenchus pinophilus Brzeski & Baujard, 1997 (Nematoda: Parasitaphelenchinae) associated with nematangia on Pityogenes bidentatus (Herbst, 1783) (Coleoptera: Scolytinae), from the Czech Republic

The occurrence of Bursaphelenchus species in the Czech Republic is poorly known, the first report of the genus being made by Kubátová et al. (2000) who reported the association of B. eremus with the hyphomycetous microfungus, Esteya vermicola, and the bark beetle, Scolytus intricatus, collected from Quercus robur, in central Bohemia. To date, four other species have been reported from the country, namely B. fungivorus (Braasch et al., 2002), B. hofmanni (see Braasch, 2001), B. mucronatus (see Braasch, 2001) and B. vallesianus (Gaar et al., 2006). More recently, a survey for Bursaphelenchus species associated with bark- and wood-boring insects in the Czech Republic identified B. pinophilus Brzeski & Baujard, 1997 from the Moravia region. Although this represents a new country record, it was also associated with nematangia on the hind wings of a new insect vector. A total of 404 bark- and wood-boring insects were collected from declining or symptomatic trees and screened for the presence of Bursaphelenchus. Bark and longhorn beetles were captured manually after debarking parts of the trunk displaying symptoms of insect attacks. Longhorn beetle larvae were also collected together with logs cut from the trunk. Logs were kept at room temperature in the laboratory until insect emergence. Each adult insect was individually dissected in water and examined for nematodes. All nematodes resembling dauer juveniles of Bursaphelenchus were collected and identified by molecular characterisation using a region of ribosomal DNA (rDNA) containing the internal transcribed spacer regions ITS1 and ITS2. ITS-RFLP analyses using five restriction enzymes (AluI, HaeIII, HinfI, MspI, RsaI) were performed to generate the species-specific profile according to Burgermeister et al. (2009). Species identification was also confirmed by morphological data after culture of the dauers on Botrytis cinerea Pers. ex Ft., growing in 5% malt extract agar. During this survey, only species belonging to the Curculionidae, subfamily Scolytinae, revealed the presence of nematodes belonging to Bursaphelenchus. Dauers of this genus were found aggregated under the elytra in nematangia formed at the root of the hind wings (Fig. 1). The dauers were identified from 12 individuals of Pityogenes bidentatus (Herbst, 1783) (Coleoptera: Scolytinae) collected under the bark of Pinus sylvestris trunks. Each insect carried ca 10-100 dauers. The ITS-RFLP patterns of the dauers so obtained confirmed the identification of B. pinophilus associated with this insect species. Bursaphelenchus pinophilus has been found mainly in Europe and has been reported from various countries such as Poland (Brzeski & Baujard, 1997), Germany (Braasch, 2001), and Portugal (Penas et al., 2007). The recent detection of this species associated with dead P. koraiensis in Korea (Han et al., 2009) expands its geographical distribution and potential importance. It has been found associated only with Pinus species, but very little is known about the insect vector. The bark beetle, Hylurgus ligniperda, was initially suggested as the insect vector by Pe-nas et al. (2006), although the nematode associated with this insect was later reclassified as B. sexdentati by morphological and molecular analysis (Penas et al., 2007). According to the literature, P. bidentatus has been cited as a vector of Ektaphelenchus sp. (Kakuliya, 1966) in Georgia, and an unidentified nematode species in Spain (Roberston et al., 2008). Interestingly, B. pinophilus was found in the nematangia formed at the root of the hind wings of P. bidentatus. Although this phenomenon is not so common in other Bursaphelenchus species, B. rufipennis has been found recently in such a structure on the hind wings of the insect Dendroctonus rufipennis (Kanzaki et al., 2008). Although other nematode species (e.g., Ektaphelenchus spp.) are frequently found associated within the same nematangia (see Kanzaki et al., 2008), in this particular case, only dauers of B. pinophilus were identified. The association between B. pinophilus and P. bidentatus represents the first report of this biological association and the association with the Scolytinae strengthens the tight and specific links between this group of Bursaphelenchus species and members of the Scolytinae (Ryss et al., 2005).

Portugal e Brasil – dois países, quantas línguas? Critérios para a Definição de Entidades Linguísticas no Espaço Lusófono

A identificação de critérios para a definição de entidades linguísticas é complexa. No espaço lusófono, tal definição tem associadas consequências em termos linguísticos e sócio-políticos que se procuram caracterizar no presente trabalho, em que se recorre a dados da Aquisição das normas europeia e brasileira do Português para responder a uma questão complexa: quantas línguas existem no espaço da lusofonia? A principal conclusão é a de estamos (ainda) perante uma única entidade linguística a que chamamos "língua", apesar das diferenças que aqui são apontadas e caracterizadas.

A rede de ensino superior em Portugal e o Território: o Caso do Alentejo

Da existência de instituições de ensino superior (IES) nas cidades e nas regiões decorrem efeitos variados que influenciam as dinâmicas sociais e económicas locais. Entre os efeitos mais significativos, e duradoiros, que resultam desta presença, destaca- se a possibilidade de melhorar a qualificação dos recursos humanos. Está demonstrado que territórios com populações mais qualificadas são mais desenvolvidos e, por isso, registam melhores níveis de qualidade de vida. Desta forma, a localização de IES pode ser mais relevante em territórios com níveis de desenvolvimento mais débeis, posicionando-se, nestes casos, como factor de promoção do desenvolvimento. Neste trabalho, que analisa de forma genérica o caso português, e o Alentejo em particular, procuramos avaliar a correlação entre a existência de IES num território e os respectivos níveis de desenvolvimento e qualidade de vida, de modo a consubstanciar o papel das IES enquanto instrumentos de coesão territorial.

THE TEACHING ABOUT THE CARE OF THE ELDERLY IN NURSING TRAINING: THE SITUATION IN PORTUGAL

This paper aims to look at the teaching situation of the nursing undergraduate degree’s courses about eldercare in Portugal. A documentary research on the teaching programs in 39 nursing schools, 26 schools presented syllabus units related to the topic ‘eldercare’ and in eight of these schools the contents of the units were identified. Using textual analysis and from the categories we concluded that the teaching regarding eldercare for the nurse training in Portugal is focused on hospital care; it is directed to the adult/elderly/family; it explores the definitions related to the aging process; it explores community issues, legislation and research. People responsible for the design/monitoring of teaching programs should include teaching regarding eldercare in the nurse training, considering that the elder population is increasing in Portugal.

CAPACITAR O DOENTE PARA A GESTÃO DA DOR

“CAPACITAR O DOENTE PARA A GESTÃO DA DOR” INTRODUÇÃO: Este Programa surge no âmbito do projeto de doutoramento em Enfermagem em que se pretende estudar o efeito de um Programa de Intervenção de Enfermagem na capacidade de gestão da dor por parte do doente oncológico com doença avançada e/ou do cuidador informal em domicilio. JUSTIFICAÇÃO: Um dos sintomas mais frequentes no doente oncológico com doença avançada é a dor. Segundo Palliative Care in European, a dor oncológica, tem uma importância especial porque o cancro é a segunda causa de morte em Portugal e por existir dor moderada a intensa em mais de 90% dos doentes em situação oncológica terminal. O desenvolvimento de um programa estruturado de intervenção de enfermagem que vá de encontro às necessidades do doente oncológico com doença avançada e/ou cuidador, relativamente à gestão da dor, poderá ter um impacto muito significativo no controlo da dor e de outros sintomas. Foi realizada pesquisa relativamente às duas teorias que suportam o estudo, a Teoria de Gestão de Sintomas e a Teoria dos Sintomas Desagradáveis. O Modelo de Gestão de sintomas, foi introduzido em 1994 na Escola de Enfermagem da Universidade de São Francisco na Califórnia, tendo sido revisto em 2001 por (Dodd; JANSON et al.). Foram então, desenvolvidos estudos científicos para a construção de um modelo baseado na evidência científica e também para comparar e contrastar os conceitos dos sintomas, com essa revisão, surge então a Teoria de Gestão de Sintomas. A Teoria de Gestão de Sintomas tem três conceitos essenciais: a experiência de sintomas, as estratégias de gestão de sintomas, e os resultados dos estados dos sintomas. A experiência de sintomas é conceptualizada enquanto algo que influencia e é influenciado tanto pelas estratégias de gestão de sintomas, como pelos resultados dos estados dos sintomas. A Teoria Dos Sintomas Desagradáveis, apresenta três conceitos principais: o (s) sintoma (s), fatores que influenciam e resultados de desempenho. Os sintomas podem ocorrer quer isoladamente, ou em combinação com outros sintomas. Em algumas situações, um sintoma pode preceder ou possivelmente dar origem a outro. Na Teoria Dos Sintomas Desagradáveis, os sintomas são conceptualizados como manifestando múltiplas dimensões e variáveis mensuráveis. Todos os sintomas variam em intensidade ou gravidade, grau de sofrimento associado, duração, e qualidade (Liehr & Smith, 2008). OBJETIVO Implementar um programa de Intervenção de Enfermagem para capacitar o doente na gestão da dor PALAVRAS CHAVES: Programa Educativo; Doente oncológico; dor oncológica MATERIAL A implementação do programa tem a duração prevista para 6 semanas. Compreende duas sessões educativas, três telefonemas e uma sessão de avaliação final. MÉTODOS 1.3 Trabalho de campo/empírico desenvolvido ao longo do semestre Durante dois meses, foi desenvolvido trabalho de campo no Hospital de dia, serviço de Oncologia, onde foi iniciada a investigação, relativamente à identificação de doentes oncológicos em situação de doença avançada. Para a identificação destes doentes assistiu a consultas de oncologia, com diferentes médicos, surgindo uma amostra intencional. O objetivo deste trabalho, foi certificar a existência de doentes oncológicos com doença avançada, prevendo uma média de doentes que se encontram a ser acompanhados naquele serviço. Como resultados e não esgotando a população, foram identificados cinquenta e nove doentes, a maioria do sexo feminino, com uma média de idade nos 65 anos, as neoplasias mais frequentes são a neoplasia do intestino e da mama. Todos os doentes apresentam metastização, sendo a localização mais frequente, o fígado, pulmão e osso. A maioria dos doentes apresenta capacidade de auto - cuidado e disponibilidade para a informação e ensino. A dor física não é referida como sintoma principal, mas como um mal-estar generalizado. O programa foi elaborado, após uma Revisão sistemática de Literatura, com base no programa “ THE PRO-SELF”, nas Orientações Genéricas preconizadas pelo Plano Nacional de Luta Contra a dor e na Intervenção de enfermagem “Controle da Dor” da Nursing Intervention Classification (NIC). RESULTADOS Foi feita uma aplicação em pré-teste do programa num serviço de oncologia, a três doentes oncológicos com doença avançada em domicílio. No início os doentes não apresentavam informação relativamente à gestão da dor, no final demonstraram capacidade para a monitorização da dor e de outros sintomas e para a gestão da terapêutica, realizando os registos num diário de bordo. A proximidade da morte e a alteração do estado de consciência interferem na autonomia e na tomada de decisão. CONCLUSÕES A aplicação deste programa deverá ter início numa fase mais precoce e não só na fase final de doença.