The burden of chronic low back pain in the adult Portuguese population : an epidemiological population-based study under the scope of Epireumapt

RESUMO: Nos países desenvolvidos a lombalgia é a condição músculo-­‐esquelética mais prevalente. Quando evolui para um quadro crónico é responsável por um encargo económico bastante considerável, não só em relação aos indivíduos, mas também para a sociedade. A lombalgia crónica é por isso uma das principais causas de perda de produtividade e de perda de independência económica, nomeadamente através do absenteísmo (ausência do trabalho), do presenteísmo (perda de produtividade no trabalho, devido à capacidade diminuída provocada pela lombalgia) e da incapacidade para trabalhar (invalidez permanente, total ou parcial). Até à data, em Portugal, a prevalência e carga social da lombalgia crónica eram desconhecidas. Até agora não existiam estudos populacionais de grande dimensão sobre este tema. O objetivo principal desta tese foi determinar a prevalência de lombalgia crónica, e também avaliar a carga social que esta tem na população adulta Portuguesa. O trabalho de investigação foi desenvolvido no âmbito do Estudo Epidemiológico de Doenças Reumáticas em Portugal (EpiReumaPt). Este foi o primeiro estudo de larga escala e de base populacional, que determinou a prevalência de doenças reumáticas e músculo-­‐ esqueléticas na população adulta portuguesa. Foi realizado numa amostra aleatória e representativa, de 10.661 indivíduos do Continente, da Região Autónoma dos Açores e da Região Autónoma da Madeira, entre Setembro de 2011 e Dezembro de 2013. Esta tese foi dividida em duas secções. A primeira secção incluiu o detalhe das questões relativas ao desenvolvimento e gestão do EpiReumaPt, constituindo-­‐se como um guia prático sobre como realizar um estudo de base populacional de larga escala, em Portugal. A metodologia detalhada do EpiReumaPt foi também descrita nesta secção e incluiu os objectivos, o desenho do estudo, as características de recrutamento e a preparação de dados para análise. Nesta secção foram ainda descritos os principais resultados do EpiReumaPt. Estes evidenciaram que a lombalgia foi a condição músculo-­‐esquelética com maior prevalência na população adulta portuguesa.A segunda secção desta tese estimou a prevalência da lombalgia crónica ativa na população adulta Portuguesa, e avaliou a carga social esta condição. A lombalgia ativa foi definida com base na dor auto-­‐relatada no dia da entrevista e que persistia há pelo menos 90 dias (independentemente da causa). A lombalgia foi definida como dor na área definida entre a margem inferior das décimas segundas costelas até às pregas glúteas inferiores, com ou sem dor nos membros inferiores. A carga social foi medida tendo em conta os seguintes parâmetros: qualidade de vida, função, consumo de recursos de saúde, consumo de analgésicos e outros fármacos usados no alívio da dor, sintomas de ansiedade e sintomas de depressão. Os resultados mostraram que o consumo de recursos em saúde e a carga social da lombalgia crónica na população adulta Português é significativa. Também a incapacidade causada pela lombalgia crónica,nos indivíduos com idade ativa, é responsável por elevadas taxas de absenteísmo e má qualidade de vida, aos quais acresce o consequente ónus socioeconómico. Esta tese também concluiu que o consumo de analgésicos e outros medicamentos para alívio da dor, na população adulta portuguesa com lombalgia crónica ativa, é relativamente baixa. A maioria destes indivíduos não tomava nenhum medicamento analgésico, independentemente da intensidade da dor. Mesmo os indivíduos que reportaram dor intensa, apenas 4.0% estavam no primeiro degrau da escada analgésica da Organização Mundial de Saúde; 2.3% usavam opióides fracos e 0.03% usavam opióides fortes para controlar a dor (segundo e terceiro degrau da escada analgésica da Organização Mundial da Saúde). O trabalho de investigação também confirmou que a prevalência de sintomas de ansiedade e depressão entre os indivíduos adultos portugueses com lombalgia crónica ativa é elevada. Nestes indivíduos, registou-­‐se um consumo mais elevado de analgésicos e outros medicamentos para alívio da dor, quando comparados com os indivíduos com lombalgia crónica activa sem esses sintomas psicológicos. Os grupos terapêuticos mais utilizados foram os ansiolíticos, sedativos e hipnóticos, os antidepressivos e os anti-­‐inflamatórios não esteróides. A intensidade média da dor reportada foi também maior entre os indivíduos com lombalgia ativa e sintomas de ansiedade e/ou depressão. Também nestes, foi reportada pior função e pior estado de saúde. Em relação ao consumo de recursos de saúde foram encontradas diferenças significativas entre as duas populações: os indivíduos com lombalgia ativa e sintomas psicológicos concomitantes registaram maior número de consultas de psiquiatria de outras especialidades médicas, assim como precisaram de mais apoio domiciliário nos 12 meses prévios à entrevista do EpiReumaPt. Foram também identificados os fatores associados a sintomas isolados de ansiedade, a sintomas isolados de depressão e a sintomas de ansiedade e depressão. Resumindo,esta tese permitiu concluir que a lombalgia crónica é um problema de saúde comum na população adulta portuguesa, contribuindo para um elevado grau de incapacidade e que consequentemente afeta o desempenho laboral e o bem-­‐estar dos indivíduos. A lombalgia crónica é também responsável por um consumo considerável de recursos de saúde. Acresce ainda que os sintomas de ansiedade e depressão são comuns, entre os indivíduos com lombalgia crónica, contribuindo com uma carga social adicional.---------------------------------- ABSTRACT:Low Back Pain(LBP) is the most prevalent of musculoskeletal condition in developed countries.When it becomes chronic, LBP causesan enormous economic burden on individuals and society -­‐ it is one of the leading causes of loss of productivity and economic independence through absenteeism (time off work), presenteeism (lost productivity because of diminished capacity while at work) and work disability (permanent, partial or complete disablement for work purposes). In Portugal the prevalence and burden of LBP and chronic LBP (CLBP) were poorly defined. Until now no large population-­‐based studies have focused on this. The main aim of this thesis was to determine the prevalence of LBP and CLBP, and also to assess the burden of CLBP in the adult rtuguese population. The research work was developed under the scope of EpiReumaPt (the Portuguese Epidemiologic Study of Rheumatic Diseases). EpiReumaPt was the first national large population-­‐based and prevalence study of rheumatic and musculoskeletal diseases (RMD). It was performed among a randomized and representative sample of 10,661 adult Portuguese subjects recruited in Mainland, Azores and Madeira Islands, from September 2011 to December 2013. The first section of this thesis included detailed issues regarding the development and management of EpiReumaPt, and provided a practical guide on how to set-­‐up a large population-­‐based study in Portugal. The detailed methodology of EpiReumaPt, including its objectives,study design,recruitment features,and data preparation for analyses were also described. The main results from EpiReumaPt study were provided in this section and showed that LBP was the musculoskeletal condition with highest prevalence among Portuguese population. The second section of this thesis estimated the prevalence of active CLBP among adult Portuguese population, and assessed the social burden of this condition. Active CLBP was defined based on self-­‐reported pain on the day of the interview, and for most of the time for at least 90 days (independently from cause). LBP was defined as pain in the back area from the lower margin of the twelfth ribs to he lower gluteal folds, with or without pain referred to the lower limbs. Social burden was measured taking into account the following outcomes: quality of life, function, healthcare resources consumption, analgesic and other pain relief drugs intake, anxiety and depression symptoms. Results showed that the healthcare consumption and social burden of CLBP among adult Portuguese population were enormous, and the disability caused by CLBP among subjects in a working age provides high rates of absenteeism (work loss) and poor quality of life, with a consequent socioeconomic burden. This thesis also concluded that analgesic and other pain relief drugs untake among adult Portuguese population with active CLBP was very low. Most of the subjects with active CLBP did not take any analgesic drug regardless pain severity. Even when subjects self-­‐reported severe pain, only 24.0% were in the 1st step of the analgesic ladder,2.3% used weak analgesic opioids and 0.03% used strong opioids (2nd and 3rd step of WHO analgesic ladder, respectively) to control pain . The research work also confirmed that the prevalence of anxiety and depression symptoms among adult Portuguese subjects with active CLBP was high. Regarding pharmacological therapy, the intake of analgesic and other pain relief drugs was higher among subjects with anxiety and/or depression symptoms, when compared with subjects without these psychological symptoms. Anxiolytics, sedatives and hypnotics, antidepressants and NSAIDs intake had higher usage rates among these subjects. The pain severity mean was also higher among this subjects and function and health status was worse. Regarding healthcare resources consumption,significant differences between the two populations were found. Subjects with ctive CLBP and concomitant psychological symptoms had a higher number of psychiatrist and other physician visits. They also needed more home care in the previous 12 months. Factors associated with isolated symptoms of anxiety, depression,and concomitant anxiety and depression symptoms were also identified. Summarizing, we concluded that CLBP is a common health problem among adult Portuguese population contributing to disability and affecting labor performance, and the well being of subjects. it is also responsible for considerable healthcare resource consumption. Anxiety and depression symptoms are common among subjects with CLBP and provided an additional burden among them

Predicting the impacts of climate change on the distribution and conservation of endemic forest land snails of Madeira Island

Climate change is emerging as one of the major threats to natural communities of the world’s ecosystems; and biodiversity hotspots, such as Madeira Island, might face a challenging future in the conservation of endangered land snails’ species. With this thesis, progresses have been made in order to properly understand the impact of climate on these vulnerable taxa; and species distribution models coupled with GIS and climate change scenarios have become crucial to understand the relations between species distribution and environmental conditions, identifying threats and determining biodiversity vulnerability. With the use of MaxEnt, important changes in the species suitable areas were obtained. Laurel forest species, highly dependent on precipitation and relative humidity, may face major losses on their future suitable areas, leading to the possible extinction of several endangered species, such as Leiostyla heterodon. Despite the complexity of the biological systems, the intrinsic uncertainty of species distribution models and the lack of information about land snails’ functional traits, this analysis contributed to a pioneer study on the impacts of climate change on endemic species of Madeira Island. The future inclusion of predictions of the effect of climate change on species distribution as part of IUCN assessments could contribute to species prioritizing, promoting specific management actions and maximizing conservation investment

Historical Stained Glass Painting Techniques Technology and preservation

The aim of this project is the study of the painting techniques applied on stained glass, namely blue enamels, sanguine red and grisaille. The research and interpretation of several historical treatises dated to between the 12th and the 18th centuries was performed, with a study of the production technology of the selected painting techniques, from the preparation of the pigment to the preparation of the paint. With this in mind, selected raw materials used in the productions of blue enamels were characterized, followed by the reproduction of selected historical recipes of blue enamels, sanguine red and grisaille. Parameters such as firing temperature, grinding and binding agents used to apply the paint on glass were considered. The methodology selected was based on the chemical and morphological characterization of both reproduced powder and paint samples by means of a multi-analytical approach. In addition to the reproduction of the selected painting techniques, corrosion studies of blue enamel powder and paint samples were performed in order to provide new insights on the corrosions mechanisms involved. The results obtained were compared with selected painted stained-glass fragments from Portuguese collections, mainly the ones located in Batalha Monastery, Charola from Convento de Cristo in Tomar and Pena National Palace in Sintra. The present study concluded that the choice of the raw materials to the production of the paint, the binder used to apply the paint, and parameters such as firing temperature and heating rate, had an impact on the outcome, resulting on a better adhesion of the paint layer to the base glass. The use of zaffer as a colouring agent does not allow determination of the outcome of the paint, while adding powdered glass such as smalt gives to the glass painter the opportunity to know the final result before firing. As for sanguine red paint, it is concluded that the final outcome of the paint is strongly influenced by the heating rate. In addition, the use of gum arabic as a binder, or in the pigment itself, provides a better adhesion of the paint layer to the base glass. Regarding the grisaille painting, the main differences between the recipes lay on the composition of the lead-based glass and on the ratios between this and the colouring agents. Furthermore, it was also possible to conclude that there is an evolution of the morphology of the grisailles towards a higher homogeneity of the surface. The corrosion studies performed on blue enamels allowed to conclude that with the lixiviation of the alkaline components of the enamel, cobalt will be influenced by other neighbouring ions, leading to a change of colour. In some cases, Pb2+ ions may also be the responsible for this colour change, with the formation of lead white. The results obtained were in a good agreement with the characterization of the selected case studies, evidencing the importance of the intersection between the written sources and the laboratory work

Macroeconomic determinants of Port and Douro wine exports: An econometric approach

This study analyses recent trends (2006-2018) in Port and Douro wine exports and estimates their macroeconomic determinants. The results of the gravity equation reveal that the purchasing power in importing countries is the most important export determinant of Port and Douro wines. Therefore, in order to increase exports, the strategic decision-makers concerned with the industry should pay special attention to the markets in wealthier countries or with a high potential for economic growth, taking into account issues such as market access, adaptation to the market to wine consumption, and regulation

Facilitated CO2 separation membranes: mixing cyano and amino acid-based ionic liquids

Dissertação para obtenção do Grau de Mestre em Engenharia Química e Bioquímic

Development of a new model for evaluating malaria risk In Chimoio, Mozambique

Dissertation presented as the partial requirement for obtaining a Master's degree in Information Management, specialization in Knowledge Management and Business IntelligenceMalaria is a life-threatening disease that continues to pose serious economic, social and health burdens. Climate plays an important role in the dynamics and distribution of malaria. In particular, temperature and precipitation appear to be critical in perpetuating malaria transmission. In the last decades, there has been an increased interest in the use of weather forecasts for predicting malaria epidemics and setting up early warning systems. In 2017, there have been almost 9 million reported cases of malaria in Mozambique. Malaria is considered one of the deadliest diseases in the country. Previous studies have established that temperature, rainfall and humidity were determinant for malaria transmission and intensity in this region. The purpose of this study is to apply time series analysis and regression modelling to analyse the relationship between malaria incidence and these climatic variables in Chimoio, a municipality located in central Mozambique, and possibly develop a model that can accurately predict the occurrence of malaria outbreaks across this region. With a combination of two (15-week lagged maximum temperature and 3-week lagged precipitation) to three (15-week lagged maximum temperature, 12-week lagged relative humidity and 3-week lagged precipitation) climatic variables, added to the number of malaria cases reported in the previous week, we were able to explain more than 70% of the variability in weekly malaria incidence. These models also quite accurately represent the observed trends of malaria incidence in Chimoio, during the study period. This simple and economical approach, supported by meteorological and epidemiologic data that are readily available, could potentially be applied by local health authorities in order to predict malaria outbreaks. With this information, adequate preventative interventions and resource allocation could be planned and deployed within a more reasonable time frame. Further studies are required in order to determine if this methodology can be successfully applied to other regions of the globe

The adoption of sustainable practices on personal luxury goods : impact on purchase motivations and intention, emotions, and self-identity

With the growth of the luxury industry in recent years, especially the personal goods segment, and with environmental concerns and sustainability increasingly influencing consumers, it is crucial to understand the role of this industry in the spotlight of sustainability. For this reason, this investigation aims to understand what perceptions, feelings, and purchase intentions current and potential consumers will have about these sustainable luxury products. To do this, based on the literature, information was gathered from individuals by (1) developing a questionnaire to assess consumers’ perceptions and attitudes towards different sustainable strategies, and (2) conduction interviews to deepen the knowledge regarding consumer’s emotions regarding sustainable luxury products. This way, it was possible to assess people's perspectives and understanding of the new sustainable production methods that have been implemented. The results of this investigation reveal that, in general, individuals are considerably concerned about the current state of the environment and that despite their positive purchase intentions for this type of sustainable goods, perceptions about them are not unanimous and deserve further look. Thus, this study provides relevant academic and managerial contributions, as it indicates which sustainable strategies are most familiar to individuals, how they judge and evaluate them, and which of them generates higher purchase intentions, granting a deeper knowledge about the potential consumers in this market segment.Com o crescimento da indústria do luxo nos últimos anos, especialmente no segmento de bens pessoais, e com a sustentabilidade e preocupações ambientais a influenciarem cada vez mais os consumidores, torna-se crucial compreender o papel desta indústria num mundo que caminha para um futuro que se pretende cada vez mais sustentável. Por esta razão, esta investigação visa compreender que perceções, sentimentos e intenções de compra terão os consumidores atuais e potenciais sobre estes produtos de luxo sustentáveis. Para tal, com base na literatura, foram recolhidas informações junto de indivíduos por meio de (1) desenvolvimento de um questionário para avaliar as perceções e atitudes dos consumidores em relação a diferentes estratégias sustentáveis e (2) realização de entrevistas para aprofundar as emoções dos mesmos em relação aos produtos de luxo sustentáveis. Desta forma, foi possível avaliar a perspetiva e compreensão das pessoassobre os novos métodos de produção sustentável que têm vindo a ser implementados. Os resultados desta investigação revelam que, de uma forma geral, os indivíduos estão bastante preocupados com o estado atual do ambiente e que apesar das intenções de compra perante este tipo de bens ser positiva, as perceções sobre os mesmos não são unânimes e merecem ser aprofundadas. Assim, este estudo fornece contributos académicos relevantes para a gestão, visto que indica quais estratégias sustentáveis são mais familiares aos indivíduos, como estes as avaliam e quais geram maiores intenções de compra, proporcionando um conhecimento mais profundo sobre os potenciais consumidores deste segmento de mercado

Culturas de Convergência: Avatar de James Cameron

This article is the a theoretical exploration centered on the theme of convergence of cultures, with the backdrop of Avatar, James Cameron. The objective is to clarify the concepts of participatory culture and collective intelligence as practices of transmedia narrative associated with the film. Interests us understand the man's dynamics with technological convergence, given the new possibilities. In the specific case of this study, we can see the dissemination of Avatar in the media: cinema, internet, mobile phone, DVD and Blu-Ray, where there are established protocols between Twentieth Century Fox, Ubisoft and Weta Digital. The analysis in this paper enabled the identification of the power of convergence culture when understood by the fields of cinema, marketing, business, education and any other organization or any other media that need to communicate or promote the active participation of the publicinfo:eu-repo/semantics/publishedVersio

Drivers of wine production in the European Union: a macroeconomic perspective

Over the last decades, the European wine industry has been object of increased international competition, which has implications for the dynamics of wine production. This paper examines the underlying factors of wine production in the European Union (EU) from a macroeconomic perspective. We apply an expanded Cobb-Douglas production function, which includes monetary indicators. A dynamic panel data GMM approach along with pooled OLS and fixed effect model for the period from 1999-2014 are applied to estimate the model. We find a positive impact from labour, capital and wine export and a negative impact from interest rate to wine production; however, no robust and significant impact is observed from wine import as well as from inflation and exchange rates. Our results indicate that EU wine production is influenced by monetary policy, which could be a useful instrument for policy makers promoting wine production in this region.publishedVersio