A comparative study of alternative approaches for common factors identification

Preliminary version

Prevalência de lesões músculo-esqueléticas ligadas ao trabalho (LMELT) em higienistas orais: contributo para a saúde e segurança no local de trabalho

Mestrado em Intervenção Sócio-Organizacional na Saúde - Área de especialização: Qualidade e Tecnologias da Saúde.

Housework, paid work and psychiatric symptoms

OBJECTIVE: To evaluate the hypothesis that work burden, the simultaneous engagement in paid work and unpaid family housework, is a potential risk factor for psychiatric symptoms among women. METHODS: A cross-sectional study was carried out with 460 women randomly selected from a poor area of the city of Salvador, Brazil. Women between 18 to 70 years old, who reported having a paid occupation or were involved in unpaid domestic activities for their families, were eligible. Work burden-related variables were defined as: a) double work shift, i.e., simultaneous engagement in a paid job plus unpaid housework; and b) daily working time. Psychiatric symptoms were collected through a validated questionnaire, the QMPA. RESULTS: Positive, statistically significant associations between high (>7 symptoms) QMPA scores and either double work shift (prevalence ratio -- PR=2.04, 95% confidence interval -- CI: 1.16, 2.29) or more than 10 hours of daily work time (PR=2.29, 95% CI: 1.96, 3.43) were found after adjustment for age, marital status and number of pre-school children. CONCLUSIONS: Major correlates of high QMPA scores are work burden variables. Being married or having pre-school children are also associated with high QMPA scores only when associated with work burden.

Tratamento radiocirúrgico de metástases cerebrais: a relação da histologia, localização cerebral e sintomas

Objetivo – Caracterizar clínica e estatisticamente os doentes com metástases cerebrais submetidos a radiocirurgia. Metodologia – Análise retrospetiva dos doentes com metástases cerebrais submetidos a radiocirurgia com Linac no Hospital do Meixoeiro, sendo a informação analisada no SPSS, versão 18. Resultados – Avaliaram‑se 116 doentes com metástases cerebrais. As localizações primárias de pulmão (54,30%) e mama (21,60%) predominaram. Destacaram‑se como sintomas mais frequentes: cefaleias, fraqueza motora, hemiparesia, paresia e tonturas. Confirma‑se a existência de correlação entre os sintomas decorrentes da presença de metástase e a sua localização cerebral, evidenciando a sua importância no diagnóstico precoce das metástases. O lobo frontal foi a localização cerebral predominante. Discussão e Considerações Finais – Verifica‑se que tendencialmente não existe correlação entre a localização primária e a localização cerebral da metástase. O número de metástases tratadas não sugere ter influência no tempo de sobrevida após o seu diagnóstico. A realização de cirurgia e/ou administração de radioterapia holocraniana previamente à radiocirurgia não apresentou prolongamento de sobrevida em comparação com os doentes não submetidos a tratamento prévio. ABSTRACT: Objective – To characterize clinically and statistically patients with brain metastases who underwent radiosurgery. Methodology – Retrospective analysis of patients with brain metastases that underwent linear accelerator‑based radiosurgery in Hospital do Meixoeiro, and the information analyzed in SPSS version 18. Results – Were evaluated 116 patients with brain metastases. Primary tumors of lung (54.30%) and breast (21.60%) were predominant. Symptoms that stood out as common: headache, motor deficit, hemiparesis, paresis and dizziness. It was confirmed the existence of a correlation between the symptoms arising from the presence of metastasis and its brain location, showing its importance in early diagnosis of metastases. The frontal lobe and the parietal lobe represented the most affected locations by brain metastases. Discussion of results and Concluding Remarks – It verified that tends to be no correlation between the primary location of the tumor and the location of brain metastasis. The number of treated metastases didn’t suggest influence on survival after their diagnosis. The realization of surgery and/or administration of whole‑brain irradiation therapy prior to radiosurgery, showed no prolongation of survival compared with patients that were not submitted to previous treatment.

All the world in a boat: portuguese folklore, common sense and ideology

This essay sees “through” an object produced by Portuguese folklore: the moliceiro boat of Ria de Aveiro, whose most original characteristic is the group of four different panels painted on each boat. These unique panels have echoed national mythologies and have undergone influence from institutional channels of instruction and propaganda for much of the twentieth century. We will analyse how this boat expresses the inventory of a community’s identity, imagination, and practices.

O impacto do uso da tala nocturna na funcionalidade do indivíduo com síndrome do túnel carpiano

A síndrome do túnel carpiano (STC) é considerada a neuropatia compressiva mais comum na população. É causada pela compressão directa sobre o nervo mediano no interior do túnel carpiano, que origina parestesias, dor na mão e disfunção muscular. Como consequência destes sintomas, os indivíduos vêem comprometida a sua funcionalidade ao nível das ocupações e, por consequência, alterado o seu desempenho ocupacional. Este trabalho tem como objectivo principal verificar de que forma a utilização da tala nocturna influencia a funcionalidade do indivíduo com STC. Concomitantemente pretende-se definir em que medida alterações das forças de preensão palmar e de pinças se relaciona com o uso da tala. Por último, identificar quais as variáveis sócio - demográficas e as que caracterizam a patologia que estão relacionadas com o problema em estudo e aos valores obtidos com as escalas do Boston Carpal Tunnel Questionnaire (BQTC), nos indivíduos dos grupos controlo e experimental. A amostra é constituída por 22 indivíduos no grupo controlo e 24 no grupo experimental, com diagnóstico de STC ligeiro e moderado. Foram aplicados o BCTQ, o dinamómetro e o pinch meter de Jamar. Os resultados deste estudo mostram uma diminuição significativa da sintomatologia da STC, após a aplicação da tala, nos momentos de reavaliação e follow up, (p=0,000 e p=0,004), assim como um aumento significativo da funcionalidade nos dois momentos (p=0,000 e p=0,004). Deste estudo conclui-se que a utilização da tala nocturna beneficia os indivíduos com STC ligeiro e moderado.

Avaliação da postura corporal em estudantes do ensino superior

A Era moderna trouxe ao Homem meios que facilitam muitas das suas tarefas diárias, diminuindo a actividade física e condicionando a postura corporal. Actualmente a população jovem, e sobretudo os estudantes, encontra-se exposta a uma grande quantidade de riscos de alterações posturais. Todavia, a postura assumida por parte desta classe não tem sido muito investigada. Sendo assim, este estudo tem como objectivo geral a avaliação bi-dimensional da postura corporal, na posição de pé e de sentado, de estudantes do 1º ano do Curso de Terapia Ocupacional, do Instituto Politécnico de Leiria. Os objectivos específicos centram-se na verificação das relações entre as alterações posturais desse grupo de estudantes e os sintomas de lesões músculo-esqueléticas nos últimos 12 meses, os factores sócio-demográficos e os factores considerados de risco de alterações posturais em estudantes. Para tal, utilizaram-se o Software para Avaliação Postural e a Versão adaptada do Questionário Nórdico Músculoesquelético. Constataram-se elevadas percentagens de posturas inadequadas. Na posição de pé todos os indivíduos apresentam alterações posturais num ou mais segmentos analisados, sendo que a flexão do tronco é a mais frequente. Já na posição sentada a alteração postural mais frequente é a inclinação da cabeça para o lado direito. Verificou-se ainda que algumas das alterações posturais apresentam uma relação positiva e significativa com os sintomas de lesões músculo-esqueléticas, com alguns factores de risco e sócio-demográficos. A partir dos resultados obtidos, torna-se evidente a necessidade de estabelecer programas de consciencialização para esta problemática, assim como programas de prevenção de desvios posturais.

Prevalência e análise de factores de risco de problemas neuro-músculo-esqueléticos em músicos

Introdução: A prevalência de problemas neuro-músculo-esqueléticos nos músicos é elevada, pois estão sujeitos a grande exigência física e psicológica. Objectivos: Analisar a prevalência de factores de risco em marimbistas e caracterizar a postura da coluna vertebral na situação de tocar. Métodos: A recolha das situações de risco foi realizada através de um questionário e a postura da coluna, numa amostra de 10 marimbistas, analisada pelo SAPO. Resultados: As posturas entre as situações sem tocar e a tocar um excerto difícil são significativamente diferentes. Conclusão: Os marimbistas têm uma grande prevalência de sintomas sendo necessários programas de educação e promoção de saúde.

Effects of fungal contamination on respiratory symptoms of poultry workers

Exposure to certain fungi (molds) can cause human illness by 3 specific mechanisms: generation of a harmful immune response, direct infection by the organism or/and toxic-irritant effects from mold byproducts. Moulds are considered central elements in daily exposure of poultry workers and can be the cause of an increased risk of occupational respiratory diseases, like allergic and non-allergic rhinitis and asthma.

Effects of fungal contamination on respiratory symptoms of poultry workers

Moulds are considered central elements in daily exposure of poultry workers and can be the cause of an increased risk of occupational respiratory diseases, like allergic and non-allergic rhinitis and asthma. The objective is to evaluate the exposure to different species of moulds in poultries and relate them with respiratory symptoms in poultry workers. Seven Portuguese poultries were analyzed in order to assess air fungal contamination, as well as to evaluate the existence of clinical symptoms associated with asthma and other allergy diseases by European Community Respiratory Health Survey questionnaire.

Climacteric symptoms and quality of life: validity of women's health questionnaire

OBJECTIVE: To evaluate the reliability and validity of the Portuguese version of the Women's Health Questionnaire. METHODS: In order to evaluate the Women's Health Questionnaire (WHQ), an analytical cross-sectional study was carried out at the women's menopause outpatient clinic of a university hospital in São Paulo, Brazil. There were studied 87 women in perimenopause or menopause, defined as experiencing at least one year's absence of menstrual flow. The following variables were collected: demographic data, clinical variables (Kupperman index and correlate numeric scale) and quality of life indexes (SF-36 and utility). RESULTS: The WHQ proved to be a questionnaire easily translated into Portuguese and well-adjusted to Brazilian women. The internal consistency of the overall WHQ was excellent (Cronbach alpha =0.83; 95% CI: 0.71-0.91). Test-retest reliability was also excellent (intraclass correlation coefficient [ICC]=0.92; 95% IC: 0.86-0.96) and had good absolute agreement (0.84; 95% CI: 0.71-0.92). A satisfactory clinical validity was observed. The construct validity was corroborated by clear associations with others scales. A good index of responsiveness after the intervention was reached. CONCLUSIONS: The Portuguese version of the WHQ is of easy and fast administration and understanding. Its measuring properties were related, allowing its use in the evaluation of Brazilian climacteric women's quality of life for various purposes.

A influência do modelo pedagógico em variáveis psicológicas de estudantes do 1º ano da ESTSP-IPP

Introdução – A adaptação ao ensino superior reveste-se de experiências académicas que podem constituir fonte de stress para os estudantes. A implementação de novos modelos pedagógicos, no âmbito do processo de Bolonha, introduz novas variáveis cujo impacto, designadamente em termos de saúde, importa conhecer. Este estudo tem como objetivo analisar as associações entre modelo pedagógico (Problem Based Learning – PBL vs. modelos próximos do tradicional) e variáveis psicológicas (coping, desregulação emocional, sintomas psicossomáticos, perceção de stress e afeto). Metodologia – O estudo tem um design transversal. Foram usados os seguintes questionários online: Brief-COPE, Escala de Dificuldades de Regulação Emocional, Questionário de Manifestações Físicas de Mal-Estar, Escala de Stress Percebido e Escala de Afeto Positivo e Negativo. A amostra é constituída por 183 estudantes do primeiro ano (84% do género feminino) de cursos da Escola Superior de Tecnologia da Saúde do Porto – Instituto Politécnico do Porto (ESTSP-IPP). Resultados – Foram encontradas correlações significativas entre as variáveis demográficas e psicológicas. Considerando diferentes modelos pedagógicos, foram encontradas diferenças significativas nas variáveis psicológicas. Os principais preditores de stress na amostra foram: ser mulher, frequentar uma licenciatura no modelo PBL, ter maiores índices de desregulação emocional, apresentar mais sintomas psicossomáticos, menos afeto positivo e mais afeto negativo. Conclusão – As diferenças encontradas entre modelos pedagógicos são discutidas, possibilitando a reflexão sobre as implicações práticas e sugestões para futuras investigações.

Perfil ecocardiográfico do doente com estenose aórtica degenerativa

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular - Área de especialização: Ultrassonografia Cardiovascular.

Pesticides and respiratory symptoms among farmers

OBJECTIVE: Despite the intensive use of pesticides in agriculture there are few studies assessing the risk of respiratory conditions from this exposure. The study aimed at quantifying the prevalence of respiratory symptoms among farmers and evaluating its relationship with occupational use of pesticides and the prevalence of respiratory symptoms. METHODS: A cross-sectional study was conducted among 1,379 farmers from two municipalities of Southern Brazil in 1996. Frequency and type of chemical exposure and pesticide poisoning were recorded for both sexes. All subjects aged 15 years or older with at least 15 weekly hours of agricultural activity were interviewed. An adapted questionnaire developed by the American Thoracic Society was used for the assessment of respiratory symptoms. Multivariate logistic regression analysis was carried out. RESULTS: More than half (55%) of interviewees were male. The prevalence of asthma symptoms was 12% and chronic respiratory disease symptoms was 22%. Higher odds ratios for both asthma (OR=1.51; 95% CI: 1.07-2.14) and chronic respiratory disease (OR=1.34; 95% CI 1.00-1.81) symptoms were found in women. Logistic regression analysis identified associations between many forms of exposure to pesticides and increased respiratory symptoms. Occurrence of pesticide poisoning was associated with higher prevalence of asthma symptoms (OR=1.54; 95% CI: 1.04-2.58) and chronic respiratory disease symptoms (OR=1.57; 95% CI: 1.08-2.28). CONCLUSIONS: In spite of causality limitations, the study results provide evidence that farming exposure to pesticides is associated with higher prevalence of respiratory symptoms, especially when the exposure is above two days per month.

Influence of environmental temperature and humidity on the acute ventilatory response to exercise in asthmatic adolescents

Asthma is a chronic inflammatory disorder of the respiratory airways affecting people of all ages, and constitutes a serious public health problem worldwide (6). Such a chronic inflammation is invariably associated with injury and repair of the bronchial epithelium known as remodelling (11). Inflammation, remodelling, and altered neural control of the airways are responsible for both recurrent exacerbations of asthma and increasingly permanent airflow obstruction (11, 29, 34). Excessive airway narrowing is caused by altered smooth muscle behaviour, in close interaction with swelling of the airway walls, parenchyma retractile forces, and enhanced intraluminal secretions (29, 38). All these functional and structural changes are associated with the characteristic symptoms of asthma – cough, chest tightness, and wheezing –and have a significant impact on patients’ daily lives, on their families and also on society (1, 24, 29). Recent epidemiological studies show an increase in the prevalence of asthma, mainly in industrial countries (12, 25, 37). The reasons for this increase may depend on host factors (e.g., genetic disposition) or on environmental factors like air pollution or contact with allergens (6, 22, 29). Physical exercise is probably the most common trigger for brief episodes of symptoms, and is assumed to induce airflow limitations in most asthmatic children and young adults (16, 24, 29, 33). Exercise-induced asthma (EIA) is defined as an intermittent narrowing of the airways, generally associated with respiratory symptoms (chest tightness, cough, wheezing and dyspnoea), occurring after 3 to 10 minutes of vigorous exercise with a maximal severity during 5 to 15 minutes after the end of the exercise (9, 14, 16, 24, 33). The definitive diagnosis of EIA is confirmed by the measurement of pre- and post-exercise expiratory flows documenting either a 15% fall in the forced expiratory volume in 1 second (FEV1), or a ≥15 to 20% fall in peak expiratory flow (PEF) (9, 24, 29). Some types of physical exercise have been associated with the occurrence of bronchial symptoms and asthma (5, 15, 17). For instance, demanding activities such as basketball or soccer could cause more severe attacks than less vigorous ones such as baseball or jogging (33). The mechanisms of exercise-induced airflow limitations seem to be related to changes in the respiratory mucosa induced by hyperventilation (9, 29). The heat loss from the airways during exercise, and possibly its post-exercise rewarming may contribute to the exercise-induced bronchoconstriction (EIB) (27). Additionally, the concomitant dehydration from the respiratory mucosa during exercise leads to an increased interstitial osmolarity, which may also contribute to bronchoconstriction (4, 36). So, the risk of EIB in asthmatically predisposed subjects seems to be higher with greater ventilation rates and the cooler and drier the inspired air is (23). The incidence of EIA in physically demanding coldweather sports like competitive figure skating and ice hockey has been found to occur in up to 30 to 35% of the participants (32). In contrast, swimming is often recommended to asthmatic individuals, because it improves the functionality of respiratory muscles and, moreover, it seems to have a concomitant beneficial effect on the prevalence of asthma exacerbations (14, 26), supporting the idea that the risk of EIB would be smaller in warm and humid environments. This topic, however, remains controversial since the chlorified water of swimming pools has been suspected as a potential trigger factor for some asthmatic patients (7, 8, 20, 21). In fact, the higher asthma incidence observed in industrialised countries has recently been linked to the exposition to chloride (7, 8, 30). Although clinical and epidemiological data suggest an influence of humidity and temperature of the inspired air on the bronchial response of asthmatic subjects during exercise, some of those studies did not accurately control the intensity of the exercise (2, 13), raising speculation of whether the experienced exercise overload was comparable for all subjects. Additionally, most of the studies did not include a control group (2, 10, 19, 39), which may lead to doubts about whether asthma per se has conditioned the observed results. Moreover, since the main targeted age group of these studies has been adults (10, 19, 39), any extrapolation to childhood/adolescence might be questionable regarding the different lung maturation. Considering the higher incidence of asthma in youngsters (30) and the fact that only the works of Amirav and coworkers (2, 3) have focused on this age group, a scarcity of scientific data can be identified. Additionally, since the main environmental trigger factors, i.e., temperature and humidity, were tested separately (10, 28, 39) it would be useful to analyse these two variables simultaneously because of their synergic effect on water and heat loss by the airways (31, 33). It also appears important to estimate the airway responsiveness to exercise within moderate environmental ranges of temperature and humidity, trying to avoid extreme temperatures and humidity conditions used by others (2, 3). So, the aim of this study was to analyse the influence of moderate changes in air temperature and humidity simultaneously on the acute ventilatory response to exercise in asthmatic children. To overcome the above referred to methodological limitations, we used a 15 minute progressive exercise trial on a cycle ergometer at 3 different workload intensities, and we collected data related to heart rate, respiratory quotient, minute ventilation and oxygen uptake in order to ensure that physiological exercise repercussions were the same in both environments. The tests were done in a “normal” climatic environment (in a gymnasium) and in a hot and humid environment (swimming pool); for the latter, direct chloride exposition was avoided.