989 resultados para POSITIVE-PRESSURE VENTILATION
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This contribution presents novel concepts for analysis of pressure–volume curves, which offer information about the time domain dynamics of the respiratory system. The aim is to verify whether a mapping of the respiratory diseases can be obtained, allowing analysis of (dis)similarities between the dynamical pattern in the breathing in children. The groups investigated here are children, diagnosed as healthy, asthmatic, and cystic fibrosis. The pressure–volume curves have been measured by means of the noninvasive forced oscillation technique during breathing at rest. The geometrical fractal dimension is extracted from the pressure–volume curves and a power-law behavior is observed in the data. The power-law model coefficients are identified from the three sets and the results show that significant differences are present between the groups. This conclusion supports the idea that the respiratory system changes with disease in terms of airway geometry, tissue parameters, leading in turn to variations in the fractal dimension of the respiratory tree and its dynamics.
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Resumo Política(s) de saúde no trabalho: um inquérito sociológico às empresas portuguesas A literatura portuguesa sobre políticas, programas e actividades de Segurança, Higiene e Saúde no Trabalho (abreviadamente, SH&ST) é ainda escassa. Com este projecto de investigação pretende-se (i) colmatar essa lacuna, (ii) melhorar o conhecimento dos sistemas de gestão da saúde e segurança no trabalho e (iii) contribuir para a protecção e a promoção da saúde dos trabalhadores. Foi construída uma tipologia com cinco grupos principais de políticas, programas e actividades: A (Higiene & Segurança no Trabalho / Melhoria do ambiente físico de trabalho); B (Avaliação de saúde / Vigilância médica / Prestação de cuidados de saúde); C (Prevenção de comportamentos de risco/ Promoção de estilos de vida saudáveis); D (Intervenções a nível organizacional / Melhoria do ambiente psicossocial de trabalho); E (Actividades e programas sociais e de bem-estar). Havia uma lista de mais de 60 actividades possíveis, correspondendo a um índice de realização de 100%. Foi concebido e desenhado, para ser auto-administrado, um questionário sobre Política de Saúde no Local de Trabalho. Foram efectuados dois mailings, e um follow-up telefónico. O trabalho de campo decorreu entre a primavera de 1997 e o verão de 1998. A amostra (n=259) é considerada representativa das duas mil maiores empresas do país. Uma em cada quatro é uma multinacional. A taxa de sindicalização rondava os 30% da população trabalhadora, mas apenas 16% dos respondentes assinalou a existência de representantes dos trabalhadores eleitos para a SH&ST. A hipótese de investigação principal era a de que as empresas com um sistema integrado de gestão da SH&ST seriam também as empresas com um (i) maior número de políticas, programas e actividades de saúde; (ii) maior índice de saúde; (iii) maior índice de realização; e (iv) maior percentagem dos encargos com a SH&ST no total da massa salarial. As actividades de tipo A e B, tradicionalmente associadas à SH&ST, representavam, só por si, mais de 57% do total. Os resultados, correspondentes às respostas da Secção C do questionário, apontam, para (i) a hipervalorização dos exames de medicina do trabalho; e por outro para (ii) o subaproveitamento de um vasto conjunto de actividades (nomeadamente as de tipo D e E), que são correntemente levadas a cabo pelas empresas e que nunca ou raramente são pensadas em termos de protecção e promoção da saúde dos trabalhadores. As actividades e os programas de tipo C (Prevenção de comportamentos de risco/Promoção de estilos de vida saudáveis), ainda eram as menos frequentes entre nós, a seguir aos Programas sociais e de bem-estar (E). É a existência de sistemas de gestão integrados de SH&ST, e não o tamanho da empresa ou outra característica sociodemográfica ou técnico-organizacional, que permite predizer a frequência de políticas de saúde mais activas e mais inovadores. Os três principais motivos ou razões que levam as empresas portuguesas a investir na protecção e promoção da saúde dos seus trabalhadores eram, por ordem de frequência, (i) o absentismo em geral; (ii) a produtividade, qualidade e/ou competitividade, e (iii) a filosofia de gestão ou cultura organizacional. Quanto aos três principais benefícios que são reportados, surge em primeiro lugar (i) a melhoria da saúde dos trabalhadores, seguida da (ii) melhoria do ambiente do ambiente de trabalho e, por fim, (iii) a melhoria da produtividade, qualidade e/ou competitividade.Quanto aos três principais obstáculos que se põem, em geral, ao desenvolvimento das iniciativas de saúde, eles seriam os seguintes, na percepção dos respondentes: (i) a falta de empenho dos trabalhadores; (ii) a falta de tempo; e (iii) os problemas de articulação/ comunicação a nível interno. Por fim, (i) o empenho das estruturas hierárquicas; (ii) a cultura organizacional propícia; e (iii) o sentido de responsabilidade social surgem, destacadamente, como os três principais factores facilitadores do desenvolvimento da política de saúde no trabalho. Tantos estes factores como os obstáculos são de natureza endógena, susceptíveis portanto de controlo por parte dos gestores. Na sua generalidade, os resultados deste trabalho põem em evidência a fraqueza teóricometodológica de grande parte das iniciativas de saúde, realizadas na década de 1990. Muitas delas seriam medidas avulsas, que se inserem na gestão corrente das nossas empresas, e que dificilmente poderão ser tomadas como expressão de uma política de saúde no local de trabalho, (i) definida e assumida pela gestão de topo, (ii) socialmente concertada, (iii) coerente, (iv) baseada na avaliação de necessidades e expectativas de saúde dos trabalhadores, (v) divulgada, conhecida e partilhada por todos, (vi) contingencial, flexível e integrada, e, por fim, (vii) orientada por custos e resultados. Segundo a Declaração do Luxemburgo (1997), a promoção da saúde engloba o esforço conjunto dos empregadores, dos trabalhadores, do Estado e da sociedade civil para melhorar a segurança, a saúde e o bem-estar no trabalho, objectivo isso que pode ser conseguido através da (i) melhoria da organização e das demais condições de trabalho, da (ii) participação efectiva e concreta dos trabalhadores bem como do seu (iii) desenvolvimento pessoal. Abstract Health at work policies: a sociological inquiry into Portuguese corporations Portuguese literature on workplace health policies, programs and activities is still scarce. With this research project the author intends (i) to improve knowledge on the Occupational Health and Safety (shortly thereafter, OSH) management systems and (ii) contribute to the development of health promotion initiatives at a corporate level. Five categories of workplace health initiatives have been identified: (i) Occupational Hygiene and Safety / Improvement of Physical Working Environment (type A programs); (ii) Health Screening, Medical Surveillance and Other Occupational Health Care Provision (type B programs); (iii) Preventing Risk Behaviours / Promoting Healthy Life Styles (type C programs); (iv) Organisational Change / Improvement of Psycho-Social Working Environment (type D programs); and (v) Industrial and Social Welfare (type E programs). A mail questionnaire was sent to the Chief Executive Officer of the 1500 largest Portuguese companies, operating in the primary and secondary sectors (≥ 100 employees) or tertiary sector (≥ 75 employees). Response rate has reached about 20% (259 respondents, representing about 300 companies). Carried out between Spring 1997 and Summer 1998, the fieldwork has encompassed two direct mailings and one phone follow-up. Sample is considered to be representative of the two thousand largest companies. One in four is a multinational. Union membership rate is about 30%, but only 16% has reported the existence of a workers’ health and safety representative. The most frequent workplace health initiatives were those under the traditional scope of the OSH field (type A and B programs) (57% of total) (e.g., Periodical Medical Examinations; Individual Protective Equipment; Assessment of Working Ability). In SMEs (< 250) it was less likely to find out some time-consuming and expensive activities (e.g., Training on OSH knowledge and skills, Improvement of environmental parameters as ventilation, lighting, heating).There were significant differences in SMEs, when compared with the larger ones (≥ 250) concerning type B programs such as Periodical medical examinations, GP consultation, Nursing care, Other medical and non-medical specialities (e.g., psychiatrist, psychologist, ergonomist, physiotherapist, occupational social worker). With regard to type C programs, there were a greater percentage of programs centred on Substance abuse (tobacco, alcohol, and drug) than on Other health risk behaviours. SMEs representatives reported very few prevention- oriented programs in the field of Drug abuse, Nutrition, Physical activity, Off- job accidents, Blood pressure or Weight control. Frequency of type D programs included Training on Human Resources Management, Training on Organisational Behaviour, Total Quality Management, Job Design/Ergonomics, and Workplace rehabilitation. In general, implementation of this type of programs (Organisational Change / Improvement of Psychosocial Working Environment) is not largely driven by health considerations. Concerning Industrial and Social Welfare (Type E programs), the larger employers are in a better position than SMEs to offer to their employees a large spectrum of health resources and facilities (e.g., Restaurant, Canteen, Resting room, Transport, Infra-structures for physical activity, Surgery, Complementary social protection, Support to recreational and cultural activities, Magazine or newsletter, Intranet). Other workplace health promotion programs like Training on Stress Management, Employee Assistance Programs, or Self-help groups are uncommon in the Portuguese worksites. The existence of integrated OSH management systems, not the company size, is the main variable explaining the implementation of more active and innovative workplace health policies in Portugal. The three main prompting factors reported by employers for health protection and promotion initiatives are: (i) Employee absenteeism; (ii) Productivity, quality and/or competitiveness; and (iii) Corporate culture/management philosophy. On the other hand, (i) Improved staff’s health, (ii) Improved working environment and (iii) Improved productivity, quality and/or competitiveness were the three main benefits reported by companies’ representatives, as a result of successful implementation of workplace health initiatives. (i) Lack of staff commitment; (ii) Lack of time; and (iii) Problems of co-operation and communication within company or establishment (iii) are perceived to be the main barriers companies must cope with. Asked about the main facilitating factors, these companies have pointed out the following ones: (i) Top management commitment; (ii) Corporate culture; and (iii) Sense of social responsibility. This sociological research report shows the methodological weaknesses of workplace health initiatives, carried out by Portuguese companies during the last ‘90s. In many cases, these programs and actions were not part of a corporate health strategy and policy, (i) based on the assessment of workers’ health needs and expectancies, (ii) advocated by the employer or the chief executive officer, (ii) planned and implemented with the staff consultation and participation or (iv) evaluated according to a cost-benefit analysis. In short, corporate health policy and action were still rather based on more traditional OSH approaches and should be reoriented towards Workplace Health Promotion (WHP) approach. According to the Luxembourg Declaration of Workplace Health Promotion in the European Union (1997), WHP is “a combination of: (i) improving the work organisation and environment; (ii) promoting active participation; (iii) encouraging personal development”.Résumée Politique(s) de santé au travail: une enquête sociologique aux entreprises portugaises Au Portugal on ne sait presque rien des politiques de santé au travail, adoptés par les entreprises. Avec ce projet de recherche, on veut (i) améliorer la connaissance sur les systèmes de gestion de la santé et de la sécurité au travail et, au même temps, (ii) contribuer au développement de la promotion de la santé des travailleurs. Une typologie a été usée pour identifier les politiques, programmes et actions de santé au travail: A. Amélioration des conditions de travail / Sécurité au travail; B. Médecine du travail /Santé au travail; C. Prévention des comportements de risque / Promotion de styles de vie sains; D. Interventions organisationnelles / Amélioration des facteurs psychosociaux au travail; E. Gestion de personnel et bien-être social. Un questionnaire postal a été envoyé au représentant maximum des grandes entreprises portugaises, industrielles (≥ 100 employés) ou des services (≥ 75 employés). Le taux de réponse a été environ 20% (259 répondants, concernant trois centaines d’entreprises et d’établissements). La recherche de champ, conduite du printemps 1997 à l’été 1998, a compris deux enquêtes postales et un follow-up téléphonique. L´échantillon est représentatif de la population des deux miles plus grandes entreprises. Un quart sont des multinationales. Le taux de syndicalisation est d’environ 30%. Toutefois, il y a seulement 16% de lieux de travail avec des représentants du personnel pour la santé et sécurité au travail. Les initiatives de santé au travail les plus communes sont celles concernant le domaine plus traditionnel (types A et B) (57% du total): par exemple, les examens de médecine du travail, l’équipement de protection individuelle, les tests d’aptitude au travail. En ce qui concerne les programmes de type C, les plus fréquents sont le contrôle et la prévention des addictions (tabac, alcool, drogue). Les interventions dans le domaine de du système technique et organisationnelle du travail peuvent comprendre les courses de formation en gestion de ressources humaines ou en psychosociologie des organisations, l’ergonomie, le travail posté ou la gestion de la qualité totale. En général, la protection et la promotion de la santé des travailleurs ne sont pas prises en considération dans l’implémentation des initiatives de type D. Il y a des différences quand on compare les grandes entreprises et les moyennes en matière de politique de gestion du personnel e du bien-être (programmes de type E, y compris l’allocation de ressources humaines ou logistiques comme, par exemple, restaurant, journal d’entreprise, transports, installations et équipements sportifs). D’autres activités de promotion de la santé au travail comme la formation en gestion du stress, les programmes d’ assistance aux employés, ou les groupes de soutien et d’auto-aide sont encore très peu fréquents dans les entreprises portugaises. C’est le système intégré de gestion de la santé et de la sécurité au travail, et non pas la taille de l’entreprise, qui aide à prédire l’existence de politiques actives et innovatrices dans ce domaine. Les trois facteurs principaux qui encouragent les actions de santé (prompting factors, en anglais) sont (i) l’absentéisme (y compris la maladie), (ii) les problèmes liés à la productivité, qualité et/ou la compétitivité, et aussi (iii) la culture de l’entreprise/philosophie de gestion. Du coté des bénéfices, on a obtenu surtout l’amélioration (i) de la santé du personnel, (ii) des conditions de travail, et (iii) de la productivité, qualité et/ou compétitivité.Les facteurs qui facilitent les actions de santé au travail sont (i) l’engagement de la direction, (ii) la culture de l’entreprise, et (iii) le sens de responsabilité sociale. Par contre, les obstacles à surmonter, selon les organisations qui ont répondu au questionnaire, seraient surtout (i) le manque d’engagement des travailleurs et de leur représentants, (ii) le temps insuffisant, et (iii) les problèmes de articulation/communication au niveau interne de l’entreprise/établissement. Ce travail de recherche sociologique montre la faiblesse méthodologique des services et activités de santé et sécurité au travail, mis en place par les entreprises portugaises dans les années de 1990, à la suite des accords de concertation sociale de 1991. Dans beaucoup de cas, (i) ces politiques de santé ne font pas partie encore d’un système intégré de gestion, (ii) il n’a pas d’évaluation des besoins et des expectatives des travailleurs, (iii) c’est très bas ou inexistant le niveau de participation du personnel, (iv) on ne fait pas d’analyse coût-bénéfice. On peut conclure que les politiques de santé au travail sont plus proches de la médecine du travail et de la sécurité au travail que de la promotion de la santé des travailleurs. Selon la Déclaration du Luxembourg sur la Promotion de la Santé au Lieu de Travail dans la Communauté Européenne (1997), celle-ci « comprend toutes les mesures des employeurs, des employés et de la société pour améliorer l'état de santé et le bien être des travailleurs » e « ceci peut être obtenu par la concentration des efforts dans les domaines suivants: (i) amélioration de l'organisation du travail et des conditions de travail ; (ii) promotion d'une participation active des collaborateurs ; (iii) renforcement des compétences personnelles ».
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In this paper we develop an appropriate theory of positive definite functions on the complex plane from first principles and show some consequences of positive definiteness for meromorphic functions.
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We study the existence and multiplicity of positive radial solutions of the Dirichlet problem for the Minkowski-curvature equation { -div(del upsilon/root 1-vertical bar del upsilon vertical bar(2)) in B-R, upsilon=0 on partial derivative B-R,B- where B-R is a ball in R-N (N >= 2). According to the behaviour off = f (r, s) near s = 0, we prove the existence of either one, two or three positive solutions. All results are obtained by reduction to an equivalent non-singular one-dimensional problem, to which variational methods can be applied in a standard way.
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Purpose: Pressure ulcers are a high cost, high volume issue for health and medical care providers, having a detrimental effect on patients and relatives. Pressure ulcer prevention is widely covered in the literature, but little has been published regarding the risk to patients in the radiographical setting. This review of the current literature is to identify findings relevant to radiographical context. Methods: Literature searching was performed using Science Direct and Medline databases. The search was limited to articles published in the last ten years to remain current and excluded studies containing participants less than 17 years of age. In total 14 studies were acquired; three were excluded as they were not relevant. The remaining 11 studies were compared and reviewed. Discussion: Eight of the studies used ‘healthy’ participants and three used symptomatic participants. Nine studies explored interface pressure with a range of pressure mat technologies, two studies measured shear (MRI finite element modelling, and a non-invasive instrument), and one looked at blood flow and haemoglobin oxygenation. A range of surfaces were considered from trauma, nursing and surgical backgrounds for their ability to reduce pressure including standard mattresses, high specification mattresses, rigid and soft layer spine boards, various overlays (gel, air filled, foam). Conclusion: The current literature is not appropriate for the radiographic patient and cannot be extrapolated to a radiologic context. Sufficient evidence is presented in this review to support the need for further work specific to radiography in order to minimise the development of PU in at risk patients.
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Introduction: Pressure ulcers are a high cost, high volume issue for health and medical care providers, affecting patients’ recovery and psychological wellbeing. The current research of support surfaces on pressure as a risk factor in the development of pressure ulcers is not relevant to the specialised, controlled environment of the radiological setting. Method: 38 healthy participants aged 19-51 were placed supine on two different imaging surfaces. The XSENSOR pressure mapping system was used to measure the interface pressure. Data was acquired over a time of 20 minutes preceded by 6 minutes settling time to reduce measurement error. Qualitative information regarding participants’ opinion on pain and comfort was recorded using a questionnaire. Data analysis was performed using SPSS 22. Results: Data was collected from 30 participants aged 19 to 51 (mean 25.77, SD 7.72), BMI from 18.7 to 33.6 (mean 24.12, SD 3.29), for two surfaces, following eight participant exclusions due to technical faults. Total average pressure, average pressure for jeopardy areas (head, sacrum & heels) and peak pressure for jeopardy areas were calculated as interface pressure in mmHg. Qualitative data showed that a significant difference in experiences of comfort and pain was found in the jeopardy areas (P<0.05) between the two surfaces. Conclusion: A significant difference is seen in average pressure between the two surfaces. Pain and comfort data also show a significant difference between the surfaces, both findings support the proposal for further investigation into the effects of radiological surfaces as a risk factor for the formation of pressure ulcers.
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Introdução: O CPAP nasal é o tratamento de eleição para os pacientes com Síndrome da Apneia Obstrutiva do Sono (SAOS). Com a máscara nasal podem ocorrer fugas de ar pela boca, que podem por em causa a aderência do paciente ao tratamento devido muitas vezes ao desconforto que provocam, ao aumento do trabalho respiratório e por afectarem a qualidade do sono. Objectivos: Este estudo tem como principal objectivo verificar a eficácia da banda submentoniana e da máscara facial na correcção das fugas pela boca em pacientes com SAOS. Métodos e Participantes: Uma amostra de conveniência de 15 pacientes (8 homens) com SAOS e a fazerem CPAP com máscara nasal, foi recrutada. Foram divididos em dois grupos A e B, onde no grupo A se colocou a banda submentoniana e no grupo B se alterou a interface para máscara facial. Medidas e Resultados: As variáveis avaliadas neste estudo foram as fugas, o IAH, o percentil 95 da pressão de tratamento, a Sa,O2 e os efeitos adversos das duas intervenções. O nível de fugas reduziu no grupo A de 38±11,27 para 24,55±14,30L/min (p=0,002) e no grupo B de 34,34±16,50 para 18,51±16,22L/min (p=0,008). O IAH aumentou no grupo B de 2,60±2,13 para 4,41±3,88 (p=0,016). Relativamente ao percentil 95 da pressão de tratamento aumentou nos dois grupos (Grupo A de 10,15±2,63 para 12,08±2,45cmH2O (p=0,008) e no Grupo B 10,51±1,88 para 12,64±1,29cmH2O (p=0,008)). A Sa,O2 mínima aumentou e o tempo<90% diminui no grupo A com p=0,008, p=0,031, respectivamente. Quanto ao uso auto-reportado verificaram-se poucos efeitos adversos, salientando-se apenas a facilidade de colocação da banda submentoniana, a secura da boca nos dois grupos, a pressão no queixo provocada pela banda e a dor no dorso do nariz provocada pela máscara facial. Conclusão: Ambas as estratégias provaram ser mais eficazes a reduzir a fuga que a máscara nasal. Foram bem toleradas e com poucos efeitos adversos.
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The determination of anti-HBs as a screening test before vaccination has been advisable in order to encounter immune individuals that don't need to receive vaccine protection. A case-report is presented and three other cases are reviewed from the literature. Anti-HBs was positive in these health-care personnels that developped typical acute B hepatitis. Different subtyping involving the d/y determinants were found in the first case, but false-positive anti-HBs even with high titres, determined by RIA, were found in the other cases. Concomitant determination of anti-HBc or absence of screening tests seem to be more reasonable policies until a low-cost and risk-free vaccine is produced.
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Thin Solid Films, vol. 427, nº 1-2
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Buildings account for 40% of total energy consumption in the European Union. The reduction of energy consumption in the buildings sector constitute an important measure needed to reduce the Union's energy dependency and greenhouse gas emissions. The Portuguese legislation incorporate this principles in order to regulate the energy performance of buildings. This energy performance should be accompanied by good conditions for the occupants of the buildings. According to EN 15251 (2007) the four factors that affect the occupant comfort in the buildings are: Indoor Air Quality (IAQ), thermal comfort, acoustics and lighting. Ventilation directly affects all except the lighting, so it is crucial to understand the performance of it. The ventilation efficiency concept therefore earn significance, because it is an attempt to quantify a parameter that can easily distinguish the different options for air diffusion in the spaces. The two indicators most internationally accepted are the Air Change Efficiency (ACE) and the Contaminant Removal Effectiveness (CRE). Nowadays with the developed of the Computational Fluid Dynamics (CFD) the behaviour of ventilation can be more easily predicted. Thirteen strategies of air diffusion were measured in a test chamber through the application of the tracer gas method, with the objective to validate the calculation by the MicroFlo module of the IES-VE software for this two indicators. The main conclusions from this work were: that the values of the numerical simulations are in agreement with experimental measurements; the value of the CRE is more dependent of the position of the contamination source, that the strategy used for the air diffusion; the ACE indicator is more appropriate for quantifying the quality of the air diffusion; the solutions to be adopted, to maximize the ventilation efficiency should be, the schemes that operate with low speeds of supply air and small differences between supply air temperature and the room temperature.
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One important step in the design of air stripping operations for the removal of VOC is the choice of operating conditions, which are based in the phase ratio. This parameter sets on directly the stripping factor and the efficiency of the operation. Its value has an upper limit determined by the flooding regime, which is previewed using empirical correlations, namely the one developed by Eckert. This type of approach is not suitable for the development of algorithms. Using a pilot scale column and a convenient solution, the pressure drop was determined in different operating conditions and the experimental values were compared with the estimations. This particular research will be incorporated in a global model for simulating the dynamics of air stripping using a multi variable distributed parameter system.
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Past studies found three types of infant coping behaviour during Face-to-Face Still-Face paradigm (FFSF): a Positive Other-Directed Coping; a Negative Other-Directed Coping and a Self-Directed Coping. In the present study, we investigated whether those types of coping styles are predicted by: infants’ physiological responses; maternal representations of their infant’s temperament; maternal interactive behaviour in free play; and infant birth and medical status. The sample consisted of 46, healthy, prematurely born infants and their mothers. At one month, infant heart rate was collected in basal. At three months old (corrected age), infant heart-rate was registered during FFSF episodes. Mothers described their infants’ temperament using a validated Portuguese temperament scale, at infants three months of corrected age. As well, maternal interactive behaviour was evaluated during a free play situation using CARE-Index. Our findings indicate that positive coping behaviours were correlated with gestational birth weight, heart rate (HR), gestational age, and maternal sensitivity in free play. Gestational age and maternal sensitivity predicted Positive Other-Direct Coping behaviours. Moreover, Positive Other-Direct coping was negatively correlated with HR during Still-Face Episode. Self-directed behaviours were correlated with HR during Still-Face Episode and Recover Episode and with maternal controlling/intrusive behaviour. However, only maternal behaviour predicted Self-direct coping. Early social responses seem to be affected by infants’ birth status and by maternal interactive behaviour. Therefore, internal and external factors together contribute to infant ability to cope and to re-engage after stressful social events.
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Of 21 human fecal strains of Vibrio parahaemolyticus, isolated on the Northeast Coast of Brazil, eight (38%) were urease positive. Most of these strains, in contrast to the urease-negative ones, did not produce the hemolysin responsible for the Kanagawa phenomenon.
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This study analysed 22 strawberry and soil samples after their collection over the course of 2 years to compare the residue profiles from organic farming with integrated pest management practices in Portugal. For sample preparation, we used the citrate-buffered version of the quick, easy, cheap, effective, rugged, and safe (QuEChERS) method. We applied three different methods for analysis: (1) 27 pesticides were targeted using LC-MS/MS; (2) 143 were targeted using low pressure GC-tandem mass spectrometry (LP-GC-MS/MS); and (3) more than 600 pesticides were screened in a targeted and untargeted approach using comprehensive, two-dimensional gas chromatography time-of-flight mass spectrometry (GC × GC-TOF-MS). Comparison was made of the analyses using the different methods for the shared samples. The results were similar, thereby providing satisfactory confirmation of both similarly positive and negative findings. No pesticides were found in the organic-farmed samples. In samples from integrated pest management practices, nine pesticides were determined and confirmed to be present, ranging from 2 μg kg−1 for fluazifop-pbutyl to 50 μg kg−1 for fenpropathrin. Concentrations of residues in strawberries were less than European maximum residue limits.
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Resumo Objectivos: Avaliação da Tosse em doentes com Doença Pulmonar Obstrutiva Crónica (DPOC). Identificar e determinar a relação dos factores preditivos que contribuem para a deterioração da capacidade de tosse nestes indivíduos. Tipo de estudo: Estudo observacional descritivo de natureza transversal. Definição dos casos: Os critérios de diagnóstico da DPOC são o quadro clínico e o Gold standard para diagnóstico da DPOC – a espirometria. População-alvo: Todos os utentes com patologia primária de DPOC diagnosticada que se desloquem ao serviço de função respiratória do Hospital de Viseu, para realizar provas. Método de Amostragem: Foi utilizada uma amostra aleatória constituída por todos os indivíduos, que cumpriram os critérios de inclusão, conscientes e colaborantes, que aceitaram participar neste estudo. Dimensão da amostra: Uma amostra de 55 indivíduos que se deslocaram ao serviço de função respiratória, entre Janeiro e Junho de 2009, para realizar provas de função respiratória. Condução do estudo: Os utentes que aceitaram participar neste estudo foram sujeitos a um questionário de dados clínicos e realizaram 5 testes: índice de massa corporal (IMC), estudo funcional respiratório e gasometria arterial, avaliação da força dos músculos respiratórios (PImax e PEmax) e avaliação do débito máximo da tosse (Peak Cough Flow). Análise estatística: Foram obtidos dados caracterizadores da amostra em estudo, sendo posteriormente correlacionado o valor de débito máximo da tosse (Peak Cough Flow) com os resultados obtidos para as avaliações do IMC, estudo funcional respiratório, PImax e PEmax, gasometria, avaliação da capacidade de Tosse e número de internamentos no último ano por agudização da DPOC. Tendo sido encontrados os valores de correlação entre o Peak Cough Flow e os restantes parâmetros. Resultados: Após análise dos resultados, foram obtidos os valores de Peak Cough Flow para a população com DPOC e verificou-se valores diminuídos em comparação com os valores normais da população, tendo-se verificado maiores valores de PCF em indivíduos do sexo masculino, em comparação aos valores do sexo feminino. Foi analisada a relação entre o PCF e a idade, peso, altura e IMC, não tendo sido encontrada relação, dado que a tosse não apresenta uma variação segundo os valores antropométricos, tal como a relação com os valores espirométricos. Quanto aos parâmetros funcionais respiratórios foram analisadas as relações com o PCF. Verificou-se relações significativas entre o PCF e o FEV1, a FVC, o PEF, apresentando uma relação positiva, onde maiores valores destes parâmetros estão correlacionados com maiores picos de tosse. Quanto a RAW e RV, o PCF apresenta uma relação negativa, onde uma maior resistência da via aérea ou doentes mais hiperinsuflados leva a menores valores de PCF. Por outro lado não foi encontrada relação entre o PCF e a FRC e o TLC. Quanto à força dos músculos respiratórios, verificou-se relação significativa com o PImax e a PEmax em que a fraqueza ao nível dos músculos respiratórios contribuem para um menor valor de PCF. Relativamente aos valores da gasometria arterial, verificou-se relação entre o PCF e a PaO2 de forma positiva, em que doentes hipoxémicos apresentam menores valores de tosse, e a PaCO2, de forma negativa, em que os doentes hipercápnicos apresentam menores valores de PCF tendo sido verificada relação entre o PCF e o pH e sO2. Quanto à relação entre o número de internamentos por agudização da DPOC no último ano e o PCF verificou-se uma relação significativa, onde um menor valor de PCF contribui para uma maior taxa de internamento por agudização da DPOC. Conclusão: Este conjunto de conclusões corrobora a hipótese inicialmente formulada, de que o Peak Cough Flow se encontra diminuído nos indivíduos com Doença Pulmonar Obstrutiva Crónica onde a variação do PCF se encontra directamente relacionada com os parâmetros funcionais respiratórios, com a força dos músculos respiratórios e com os valores de gasometria arterial. ABSTRACT: Aims: Cough evaluation in Chronic Obstructive Pulmonary Disease (COPD) patients. Identify and determine the relation of the predictive factors that contribute to the cough capacity degradation in this type of patients. Type of study: Descriptive observational study of transversal nature. Case definition: The COPD diagnosis criteria are the clinical presentation and the gold standard to the COPD diagnosis- the Spirometry. Target Population: Every patients, with primary pathology of COPD diagnosed, who went to the respiratory function service of Viseu hospital to perform tests. Sampling Method: It was used a random sample constituted by all the, conscious and cooperating individuals, who complied with the inclusion criteria and who accepted to make part of this study. Sample size: A sample of 55 individuals that went to the respiratory function service between January and June 2009 to perform respiratory function tests. Study: The patients who accepted to make part of this study were submitted to a clinical data questionary and performed 5 tests: body mass index (BMI), respiratory functional study, arterial blood gas level, evaluation of respiratory muscles strength (maximal inspiratory pressure (MIP) and maximum expiratory pressure (MEP)), and Peak Cough Flow evaluation. Statistic Analysis: Were obtained characterizing data of the sample in study, and later correlated the value of the Peak Cough Flow with the results from the evaluation of the body mass index (BMI), the respiratory functional study the MIP and MEP, the arterial blood gas level and also with the ability to cough evaluation and the number of hospitalizations in the last year for COPD exacerbations. The values of correlation between the Peak Cough Flow and the other parameters were found. Results: After analyzing the results, were obtained the values of Peak Cough Flow for the population with COPD. There were decreased values compared with the population normal values, having been found higher values of PCF in males compared to female values. It was analyzed the relation between the PCF and the age, weight, height and BMI but no relation was found on account of the fact that the cough does not show a variation according to anthropometric parameters, such as the relation with spirometric values. As for the respiratory functional parameters were analyzed relations with the PCF. There were significant relations between the PCF and FEV1, the FVC, the PEF, presenting a positive relation, where higher values of these parameters are correlated with higher incidence of cough. Concerning the RAW and RV, the PCF has a negative relation, in which a higher airway resistance or in more hyperinflated patients, leads to lower values of PCF. On the other hand no correlation was found between the PCF and the FRC and TLC. Regarding the respiratory muscle strength, there was a significant relation with the MIP and MEP, in which the weakness at the level of respiratory muscles contribute to a lower value of PCF. For values of arterial blood gas level, there was no relation between the PCF and PaO2, in a positive way, in which patients with hypoxemia present lower values of cough, and PaCO2, in a negative way in which hypercapnic patients had lower values of PCF, having being founded a relation between the PCF and the pH and sO2. As for the relation between the number of hospitalizations for COPD exacerbation in the last year and the PCF was found a significant relation, in which a smaller value of PCF contributes to a higher rate of hospitalization for COPD exacerbation. Conclusion: This set of findings supports the hypothesis first formulated that Peak Cough Flow is decreased in individuals with Chronic Obstructive Pulmonary Disease, in which the variation of the PCF is directly related to the respiratory function parameters, the strength of respiratory muscles and the values of arterial blood gases.