Intervenção da fisioterapia após ligamentoplastia do LCA

RESUMO: Objectivo: Este estudo teve por objectivo descrever a prática clínica e os resultados da intervenção da fisioterapia, às 6, 12 e 24 semanas, em indivíduos após ligamentoplastia do LCA. Introdução: O sucesso da ligamentoplastia do LCA está directamente relacionado com a reabilitação após a realização da mesma, permitindo ao utente o retorno a um estilo de vida activo. Apesar de se saber que um programa de reabilitação estruturado e baseado na evidência tem um papel fulcral nos resultados após cirurgia, e de existir consenso sobre a efectividade destes programas após a cirurgia, o mesmo não se pode afirmar acerca de quais os melhores componentes que devem fazer parte desse programa. Tendo em conta a heterogeneidade encontrada na literatura, no que diz respeito à nomenclatura utilizada, às diferenças de duração dos protocolos e às variações significativas nas recomendações dos cuidados de reabilitação, torna-se primordial a realização duma caracterização da prática clínica da fisioterapia em indivíduos submetidos a ligamentoplastia em Portugal, e consequentemente, descrever quais os resultados obtidos ao nível da incapacidade funcional, intensidade de dor e percepção global de melhoria. Metodologia: Realizou-se um estudo de série de casos, com uma amostra de conveniência, do tipo não probabilístico, constituída por 14 utentes referidos para 4 clínicas de fisioterapia e para 3 hospitais, e que cumpriam os critérios de inclusão e exclusão estabelecidos. Os utentes foram avaliados em 4 momentos pré-definidos: na 1ª sessão de fisioterapia e às 6, 12 e 24 semanas após cirurgia. Os resultados obtidos após intervenção da fisioterapia foram descritos ao nível da incapacidade funcional, da intensidade da dor e da percepção global de melhoria. Paralelamente realizou-se uma caracterização da prática clínica relativamente às modalidades utilizadas, número de sessões de tratamento e duração do episódio de cuidados. Resultados: Observou-se uma tendência de melhoria ao longo das 24 semanas em todas as dimensões da Knee injury and Osteoarthritis Outcome Score (KOOS) e na Escala Numérica da Dor (END), assim como na percepção de melhoria pelo utente, medida através da Patient Global Impression of Change Scale (PGIC). Às 6 semanas, as melhorias nas variáveis de resultados foram superiores às encontradas às 12 e 24 semanas, ao nível da incapacidade funcional (à excepção das dimensões KOOS – actividades desportivas e de lazer e KOOS - qualidade de vida) e dor. Relativamente à intervenção da fisioterapia observou-se uma grande heterogeneidade nas modalidades e procedimentos utilizados. Em média realizaram-se 58,14 (±14,15) sessões, sendo que 71 foi o número de sessões mais utilizado. Conclusão: Os resultados deste estudo sugerem que apesar da heterogeneidade da prática clínica, a intervenção da fisioterapia proporciona melhorias ao nível da capacidade funcional e da dor, em indivíduos submetidos a ligamentoplastia do LCA e que essas melhorias são percepcionadas pelos participantes como clinicamente importantes. ---------ABSTRACT: Objective: The aim of this study was to describe the clinical practice and the results of physical therapy intervention, at 6, 12 and 24 weeks, in subjects after ACL reconstruction. Introduction: The success of ACL reconstruction is directly related with the rehabilitation after the surgery, allowing the patient to an active lifestyle return. Despite knowing that a rehabilitation program based on evidence and well designed has a key role in the results after surgery, the same cannot be said about what the best components that should make part of this program. Taking into account the heterogeneity found in the literature, whether at the level of the nomenclature used, whether at level of the differences in duration of the protocols, as well as the existence of recommendations of rehabilitative care that present significant variations at the international level, it becomes paramount to achieving a characterization of the clinical practice of physical therapy in subjects after ACL reconstruction in Portugal, and consequently describe the results obtained regarding to functional disability and pain intensity. Methodology: A case series design with a convenience sample of 14 patients referred to 7 different outpatients physical therapy settings, that fulfilled the pre- established inclusion and exclusion criteria. Patients were evaluated in four pre-defined moments: in the first session of physiotherapy and at 6, 12 and 24 weeks after surgery. The results obtained after physiotherapy intervention were described at the level of functional disability, pain and global perception of change. Subsequently, it was proceeded the characterization the practice of physical therapy regarding to the modalities used, the number of treatment sessions and duration of the episode of care. Results: It was found that there was a trend of improvement, clinically important, over the 24 weeks in all dimensions of Knee injury and Osteoarthritis Outcome Score (KOOS) and in the Numerical Pain Rating Scale (NPRS). At 6 weeks, improvements were superior to those found at 12 and 24 weeks, at the level of functional disability (with the exception of the KOOS-sports and recreation function and KOOS-knee related quality of life dimensions) and pain. As regards the intervention of physical therapy found that the heterogeneity encountered both at the level of clinical practice as evidence,are difficult to compare. On average 58,14 (±14,15) sessions were held, with 71 was the most commonly used sessions numbers. Conclusion: The results of this study suggest that in spite of the heterogeneity of clinical practice, physical therapy intervention provides improvements in terms of functional disability and pain in subjects after ACL reconstruction.

Intervenção da fisioterapia em indíviduos com osteoartrose do joelho: características da prática clínica, resultados obtidos e fatores de prognóstico para os resultados de sucesso

RESUMO:Introdução: O conhecimento acerca da prática da Fisioterapia, bem como a influência das características dos indivíduos com Osteoartrose do joelho (OA) no prognóstico dos resultados alcançados com a Fisioterapia, tem sido alvo de estudo em vários países. No entanto em Portugal, estudos desta natureza são escassos ou inexistentes. Objetivo: Este trabalho teve dois principais objetivos: Por um lado pretendeu caracterizar a prática da Fisioterapia e determinar os seus resultados em indivíduos com OA do joelho ao nível da intensidade da dor, incapacidade funcional e perceção global de melhoria; Por outro, identificar fatores preditivos para os resultados de sucesso após a intervenção da Fisioterapia. Metodologia: Trata-se de um estudo de coorte prospetivo com 77 participantes que foram avaliados antes e após a intervenção (8 semanas), com um follow-up de 3 meses. Procedeu-se à caracterização da prática da Fisioterapia quanto às modalidades utilizadas, número de sessões de tratamento e duração do episódio de cuidados. Os resultados obtidos foram medidos após intervenção (8 semanas) e num follow-up (3 meses), através da Escala Numérica da Dor (END), da versão Portuguesa do Questionário Knee Injury and Osteoarthritis Outcome Score (KOOS-PT), e da versão Portuguesa da Patient Global Impression of Change Scale (PGIC-PT). As características sociodemográficas e clínicas foram incluídas como potenciais fatores de prognóstico com base no critério de pontuação ≥5 na PGIC-PT e a análise dos dados foi realizada através do método de regressão logística multivariado no sentido de identificar as associações entre as variáveis na baseline e as variáveis de resultado (p<0.05). Resultados: Os resultados obtidos revelaram que existe uma grande diversidade de modalidades e procedimentos terapêuticos realizados pelos fisioterapeutas no tratamento da OA do joelho (em média 4 modalidades por utente), sendo os exercícios, a eletroterapia e a terapia manual, as intervenções mais frequentemente realizadas. Os resultados da intervenção revelaram uma redução significativa da intensidade da dor e da incapacidade funcional (medida pelas diferentes dimensões da KOOS-PT) às 8 semanas e aos 3 meses (p=0,001). A probabilidade de obter bons resultados na percepção de melhoria para realizar actividades da vida diária, está significativamente associada com a pontuação na dimensão KOOS AVD (OR=1,106, 95% IC 1,056-1,159) e com a intensidade da dor, (OR=0,543, 95% IC 0,300-0,983), na baseline. A probabilidade de obter bons resultados na percepção de melhoria relativa à dor, está significativamente associada com a pontuação na dimensão KOOS DOR (OR=1,116, 95% IC 1,030-1,209), e dimensão KOOS ADL (OR=1,123, 95% IC 1,014-1,243), na baseline. Conclusões: Os resultados do presente estudo revelam que a intervenção em Fisioterapia em casos de OA do joelho, apesar de utilizar uma grande diversidade de modalidades terapêuticas, proporciona uma redução significativa dos níveis de dor e incapacidade funcional em utentes com OA do joelho. Os resultados do presente estudo sugerem ainda que o sucesso da intervenção pode ser predito a partir de variáveis clinicas na baseline.------------ABSTRACT:Introduction: The knowledge about the practice of physical therapy, as well as the influence of the characteristics of subjects with knee osteoarthritis (OA) in the prognosis of the results achieved with physiotherapy, have been studied in several countries. However in Portugal, such studies are scarce or nonexistent. Objective: This study had two main aims: on one hand sought to characterize the practice of physical therapy and determine their outcomes in subjects with OA of the knee joint at the level of pain intensity, functional disability and global perception of improvement; Secondly, to identify predictive factors for successful outcomes after the intervention of physiotherapy. Methods: This was a prospective cohort study with 77 participants who were evaluated before and after the intervention (8 weeks), with a follow-up of 3 months. Proceeded to characterize the practice of physical therapy as modalities used, number of treatment sessions and duration of the period of care. The results were measured after intervention (8 weeks) and a follow-up (3 months) by a Numerical Rating Scale (NRS), the Portuguese version of the Knee Injury and Osteoarthritis Questionnaire Outcome Score (KOOS-PT) and the Patient Global Impression of Change Scale- Portuguese Version (PGIC-PT). The sociodemographic and clinical characteristics were included as potential prognostic factors based on scoring criteria≥5 na PGIC-PT and data analysis was performed using the method of multivariate logistic regression to identify associations between variables at baseline and outcome variables (p<0.05). Results: The results revealed that there is a great diversity of modalities and therapeutic procedures performed by physiotherapists in the treatment of knee OA (average 4 per user modes), with exercises, electrotherapy and manual therapy interventions most frequently performed. The results of intervention showed a significant reduction in the severity of pain and functional disability (measured by the different dimensions of the KOOS-PT) at 8 weeks and at 3 months (p = 0.001). The probability of getting good results in the perception of improvement to perform activities of daily living, is significantly associated with scores on the dimension KOOS ADL (OR=1,106, 95% CI 1,056-1,159) and the intensity of pain (OR = 0.543, 95% CI 0.300 to 0.983) at baseline. The probability of getting good results in the perception of improvement of the pain is significantly associated with scores on the KOOS PAIN (OR = 1.116, 95% CI 1.030 to 1.209) and KOOS ADL (OR = 1.123, 95% CI 1.014 to 1.243) at the baseline. Conclusions: The results of this study show that Physiotherapy treatment in cases of knee OA, provide a significant reduction of pain and disability among users with knee OA, despite the wide variety of therapeutic modalities. The results of this study also suggest that the success of the intervention can be predicted from clinical variables at baseline.

Motivation drivers of millenniums for engaging in crowdsourcing ventures

Double Degree

Why and how projects in organizations differ? The example of Portuguese profit and non-profit organizations

This research has as a goal to give an overview of what Project Management is in Portugal. The purpose is not to focus on a small picture, but to understand the broad concept and perception of Project Management in Portugal in two very important sectors: Profit- and Non-Profit Sector. Both Profit- and Non-Profit project managers have been interviewed, giving an insight of how different projects are in both sectors and why. This paper will be especially helpful comparing the Project Management maturity of Portugal to other countries regarding these two different point of views.

The effect of energy and traffic light labeling on parents purchasing decisions of cereals for their children

Objective: Nutritional labeling systems are considered a tool to fight obesity since they aim to contribute for more informed food choices as well as assist consumers to make healthier nutrition options and in this manner, contribute to a decrease in the obesity rate. This study intends to analyze the effect of different types of labeling systems on parents’ purchasing decisions for their children on a specific product: breakfast cereals. More precisely, how labels affect parents’ perception of healthiness regarding cereals and if the nutritional information has an effect on intended purchases for their children. Participants and methods: We conducted a study with 135 Portuguese parents of children aged 4 to12 years. Parents answered a questionnaire with one of three hypothetical cereals menus. Menus only differed in their nutritional labeling technique: no labels (control group), reference intake labels or traffic light labels. In addition, we conducted 20 face-to-face interviews to a different group of parents in order to perform a recall task. Findings: This paper provides no evidence to suggest that energy labeling or traffic light labeling systems alone were successful in helping parents making healthy purchases of cereals for their children. Therefore, there is the need to promote supplementary policies to encourage the consumption of healthier food and help fight obesity.

The names of things: terminology and the practice of art history

This paper aims to explore the ways in which standard art history terminology shapes the practice of art history by conditioning the interpretation of specific works of art and, in certain cases, the definition of a research subject (especially where questions of genre and periodization are concerned). Taking as a case study a painting by Georges de La Tour, the Peasant Couple Eating, I will argue that terms such as realism, realistic, naturalistic etc. used for its description and/or interpretation, far from constituting objective stylistic characterizations, shape our perception of the work in question. Bringing the question of social class to the center of the discourse on realism, I propose to show how the social divide between the painter and his subject matter (in this case, the peasants) is internalized in the painting’s style and meaning, and how it is fundamental for the understanding of its intentionality and function.

Development and modulation of magnetic responsive supported ionic liquid membranes

The work presented in this thesis aims at developing a new separation process based on the application of supported magnetic ionic liquid membranes, SMILMs, using magnetic ionic liquids, MILs. MILs have attracted growing interest due to their ability to change their physicochemical characteristics when exposed to variable magnetic field conditions. The magnetic responsive behavior of MILs is thus expected to contribute for the development of more efficient separation processes, such as supported liquid membranes, where MILs may be used as a selective carrier. Driven by the MILs behavior, these membranes are expected to switch reversibly their permeability and selectivity by in situ and non-invasive adjustment of the conditions (e.g. intensity, direction vector and uniformity) of an external applied magnetic field. The development of these magnetic responsive membrane processes were anticipated by studies, performed along the first stage of this PhD work, aiming at getting a deep knowledge on the influence of magnetic field on MILs properties. The influence of the magnetic field on the molecular dynamics and structural rearrangement of MILs ionic network was assessed through a 1H-NMR technique. Through the 1H-NMR relaxometry analysis it was possible to estimate the self-diffusion profiles of two different model MILs, [Aliquat][FeCl4] and [P66614][FeCl4]. A comparative analysis was established between the behavior of magnetic and non-magnetic ionic liquids, MILs and ILs, to facilitate the perception of the magnetic field impact on MILs properties. In contrast to ILs, MILs show a specific relaxation mechanism, characterized by the magnetic dependence of their self-diffusion coefficients. MILs self-diffusion coefficients increased in the presence of magnetic field whereas ILs self-diffusion was not affected. In order to understand the reasons underlying the magnetic dependence of MILs self-diffusion, studies were performed to investigate the influence of the magnetic field on MILs’ viscosity. It was observed that the MIL´s viscosity decreases with the increase of the magnetic field, explaining the increase of MILs self-diffusion according to the modified Stokes- Einstein equation. Different gas and liquid transport studies were therefore performed aiming to determine the influence of the magnetic behavior of MILs on solute transport through SMILMs. Gas permeation studies were performed using pure CO2 andN2 gas streams and air, using a series of phosphonium cation based MILs, containing different paramagnetic anions. Transport studies were conducted in the presence and absence of magnetic field at a maximum intensity of 1.5T. The results revealed that gas permeability increased in the presence of the magnetic field, however, without affecting the membrane selectivity. The increase of gas permeability through SMILMs was related to the decrease of the MILs viscosity under magnetic field conditions.(...)

Life cycle analysis of zero waste management for Jonggol green city

A Zero waste management is believed to be one of methods to gain sustainability in urban areas. Take advantages of resources as enough as the needs and process it until the last part to be wasted is a contribution to take care the environment for the next generation. Reduce, reuse, and recycle are three simplesactivities which are until nowadays consideredas the back bone of zero waste. Jonggolgreen city is a new urban area in Indonesia with a 100 ha of surface area zoned as education tourism area. It is an independent area with pure natural resources of water, air, and land to be managed and protected. It is planned as green city through zero waste management since2013. In this preliminary period, a monitoring tool is being prepared by applying a Life Cycle Analysis (LCA) for urban areas [1]. This paper will present an explanatory assessment ofthe zero waste management for Jonggolgreen city. The existing situation will be examined through LCA and afterwards,the new program and the proposed green design to gain the next level of zero waste will be discussed. The purpose is to track the persistence of the commitment and the perception of the necessary innovationsin order to achieve the ideal behavior level of LCA.

Adoção e difusão de aplicações das tecnologias da informação: iniciativas lançadas no âmbito de processos de implantação de aplicações em organizações – estudo de práticas profissionais e proposta de ferramenta de suporte

Tese de Doutoramento Tecnologias e Sistemas de Informação

Sensory intensity assessment of olive oils using an electronic tongue

Olive oils may be commercialized as intense, medium or light, according to the intensity perception of fruitiness, bitterness and pungency attributes, assessed by a sensory panel. In this work, the capability of an electronic tongue to correctly classify olive oils according to the sensory intensity perception levels was evaluated. Cross-sensitivity and non-specific lipid polymeric membranes were used as sensors. The sensor device was firstly tested using quinine monohydrochloride standard solutions. Mean sensitivities of 14±2 to 25±6 mV/decade, depending on the type of plasticizer used in the lipid membranes, were obtained showing the device capability for evaluating bitterness. Then, linear discriminant models based on sub-sets of sensors, selected by a meta-heuristic simulated annealing algorithm, were established enabling to correctly classify 91% of olive oils according to their intensity sensory grade (leave-one-out cross-validation procedure). This capability was further evaluated using a repeated K-fold cross-validation procedure, showing that the electronic tongue allowed an average correct classification of 80% of the olive oils used for internal-validation. So, the electronic tongue can be seen as a taste sensor, allowing differentiating olive oils with different sensory intensities, and could be used as a preliminary, complementary and practical tool for panelists during olive oil sensory analysis.

The music of language: an ERP investigation of the effects of musical training on emotional prosody processing

Recent studies have demonstrated the positive effects of musical training on the perception of vocally expressed emotion. This study investigated the effects of musical training on event-related potential (ERP) correlates of emotional prosody processing. Fourteen musicians and fourteen control subjects listened to 228 sentences with neutral semantic content, differing in prosody (one third with neutral, one third with happy and one third with angry intonation), with intelligible semantic content (semantic content condition--SCC) and unintelligible semantic content (pure prosody condition--PPC). Reduced P50 amplitude was found in musicians. A difference between SCC and PPC conditions was found in P50 and N100 amplitude in non-musicians only, and in P200 amplitude in musicians only. Furthermore, musicians were more accurate in recognizing angry prosody in PPC sentences. These findings suggest that auditory expertise characterizing extensive musical training may impact different stages of vocal emotional processing.

O processo de adoção e implementação do Orçamento Participativo: os casos de Braga e Guimarães

Dissertação de mestrado em Administração Pública (área de especialização em Gestão Pública)

Three-dimensional technology facilitates surgical performance of novice laparoscopy surgeons: a quantitative assessment on a porcine kidney model

Objective To determine whether the use of 3-dimensional (3D) imaging translates into a better surgical performance of naïve urologic laparoscopic surgeons during pyeloplasty (PY) and partial nephrectomy (PN) procedures. Materials and Methods Eighteen surgeons without any previous laparoscopic experience were randomly assigned to perform PY and PN in a porcine model using initially 2-dimensional (2D) and 3D laparoscopy. A surgical performance score was rated by an "expert" tutor through a modified 5-item global rating scale contemplating operative field view, bimanual dexterity, efficiency, tissue handling, and autonomy. Overall surgical time, complications, subjective perception of participating surgeons, and inconveniences related to the 3D vision were recorded. Results No difference in terms if operative time was found between 2D or 3D laparoscopy for both the PY (P =.51) and the PN (P =.28) procedures. A better rate in terms of surgical performance score was noted by the tutors when the study participants were using 3D vs 2D, for both PY (3.6 [0.8] vs 3.0 [0.4]; P =.034) and PN (3.6 [0.51] vs 3.15 [0.63]; P =.001). No complications occurred in any of the procedures. Most (77.2%) of the participating na??ve laparoscopic surgeons had the perception that 3D laparoscopy was overall easier than 2D. Headache (18.1%), nausea (18.1%), and visual disturbance (18.1%) were the most common issues reported by the surgeons during 3D procedures. Conclusion Despite the absence of translation in a shorter operative time, the use of 3D technology seems to facilitate the surgical performance of naive surgeons during laparoscopic kidney procedures on a porcine model.

Factors associated with the donation and non-donation of embryos for research: a systematic review

Background: Systematic knowledge on the factors that influence the decisions of IVF users regarding embryo donation for research is a core need for patient-centred policies and ethics in clinical practice. However, no systematic review has been provided on the motivations of patients who must decide embryo disposition. This paper fills this gap, presenting a systematic review of quantitative and qualitative studies, which synthesizes the current body of knowledge on the factors and reasons associated with IVF patients’ decisions to donate or not to donate embryos for research. Methods: A systematic search of studies indexed in PubMed, ISIWoK and PsycINFO, published before November 2013, was conducted. Only empirical, peer-reviewed, full-length, original studies reporting data on factors and reasons associated with the decision concerning donation or non-donation of embryos for research were included. Eligibility and data extraction were performed by two independent researchers and disagreements were resolved by discussion or a third reviewer, if required. The main quantitative findings were extracted and synthesized and qualitative data were assessed by thematic content analysis. Results: A total of 39 studies met the inclusion criteria and were included in the review. More than half of the studies (n ¼ 21) used a quantitative methodology, and the remaining were qualitative (n ¼ 15) or mixed-methods (n ¼ 3) studies. The studies were derived mainly from European countries (n ¼ 18) and the USA(n ¼ 11). The proportion of IVF users who donated embryos for research varied from 7% in a study in France to 73% in a Swiss study. Those who donate embryos for research reported feelings of reciprocity towards science and medicine, positive views of research and high levels of trust in the medical system. They described their decision as better than the destruction of embryos and as an opportunity to help others or to improve health and IVF treatments. The perception of risks, the lack of information concerning research projects and the medical system and the conceptualization of embryos in terms of personhood were the most relevant motives for not donating embryos for research. Results relating to the influence of sociodemographic characteristics and reproductive and gynaecological history were mostly inconclusive. Conclusions: Three iterative and dynamic dimensions of the IVF patients’ decision to donate or not to donate embryos for research emerged from this review: the hierarquization of the possible options regarding embryo disposition, according to the moral, social and instrumental status attributed to embryos; patients’ understanding of expectations and risks of the research on human embryos; and patients’ experiences of information exchange and levels of trust in the medical-scientific institutions.

Predictive factors of complications after coronary stent implantation

OBJECTIVE: To analyze the predictive factors of complications after implantation of coronary stents in a consecutive cohort study. METHODS: Clinical and angiographic characteristics related to the procedure were analyzed, and the incidence of major cardiovascular complications (myocardial infarction, urgent surgery, new angioplasty, death) in the in-hospital phase were recorded. Data were stored in an Access database and analyzed by using the SPSS 6.0 statistical program and a stepwise backwards multiple logistic regression model. RESULTS: One thousand eighteen (mean age of 61±11 years, 29% females) patients underwent 1,070 stent implantations. The rate of angiographic success was 96.8%, the rate of clinical success was 91%, and the incidence of major cardiovascular complications was 7.9%. The variables independently associated with major cardiovascular complications, with their respective odds ratio (OR) were: rescue stent, OR = 5.1 (2.7-9.6); filamentary stent, OR = 4.5 (2.2-9.1); first-generation tubular stent, OR = 2.4 (1.2-4.6); multiple stents, OR = 3 (1.6-5.6); complexity of the lesion, OR = 2.4 (1.1-5.1); thrombus, OR = 2 (1.1-3.5). CONCLUSION: The results stress the importance of angiographic variables and techniques in the risk of complications and draw attention to the influence of the stent's design on the result of the procedure.