Electronic health record portals in Portugal : a perspective from providers and patients

Dissertation presented as the partial requirement for obtaining a Master's degree in Information Management, specialization in Knowledge Management and Business IntelligenceHealthcare systems are becoming more patient centered, as today’s citizens are more active and more informed. In line with this trend, healthcare providers are promoting the use of online applications such as Electronic Health Record (EHR) portals. EHR portals can be defined as web based applications that combine an EHR system and a patient portal, with the potential of helping to achieve benefits for both patients and healthcare providers, which makes the adoption of EHR portals an important field to study and understand. The aim of this study is to characterize the view from providers and patients on EHR portals, having the Portuguese health system as scenario. The methodology was divided into a provider-centered and a patient-centered approach, being characterized as a mixed-methods research as qualitative and quantitative data collection procedures were followed. Results point out that EHR portals are considered by providers as crucial in the establishment of a digital relationship with patients, but efforts still need to be carried out for the users to adhere to these technologies. Also, the portals available in Portugal are heterogeneous in terms of functionalities offered, greatly differing in terms of number of functionalities. Patients view some functionalities of EHR portals more important than others and half of them are users of the portal developed by the public provider. The statistically determinants of adoption of EHR portals were verified. By having the perspective of providers and users, it was possible to provide insights that can be helpful to develop EHR portals that meet patient demands

Estratégias de pares no mercado de capitais: o caso português

Mestrado em GestãoA Estratégia de Negociação de Pares tem sido alvo de vários estudos nas últimas décadas, sendo, contudo, tendencialmente direcionados para mercados com elevada liquidez. Efetivamente regista-se, na literatura, uma lacuna no que se refere a estudos sobre Mercados com baixa liquidez, como é o caso do mercado Português. Considerada uma estratégia de investimento especulativo implica, essencialmente, a escolha de um par de ações que historicamente se movem juntas. O presente estudo teve como objetivo analisar através da aplicação desta estratégia, com base na Abordagem Distância, o desempenho de uma Carteira de ativos comparativamente ao mercado, assim como mostrar que esta estratégia pode ser aplicada em mercados com menor liquidez. A amostra incluiu todos os preços diários para as ações, das 18 empresas cotadas no índice PSI20, no período de 2007 a 2014. O estudo teve, igualmente, em consideração os custos de transação. De modo geral, os resultados encontrados indicaram que a estratégia apresentou um desempenho positivo face ao mercado, mostrando-se, assim, como rentável. Este estudo veio contribuir para que futuros investidores do Índice da Bolsa de Valores Portuguesa (PSI20) possam dispor de mais um instrumento que lhes possibilite mais uma opção de análise na hora de investir.The Pairs Trading Strategy has been the subject of several studies in recent decades, which tend to be directed at markets with high liquidity. In fact, it is noted in the literature a gap with regard to studies on markets with low liquidity, as is the case of the Portuguese market. Considered a speculative investment strategy, this involves essentially the choice of a couple of actions that historically move together. This study aims to analyze through the implementation of this strategy, based on the approach distance, the performance of an asset portfolio compared to the market, as well as show that this strategy can be applied in markets with less liquidity. The sample included all daily prices for the shares of listed companies in xxxx PSI 20 index from 2007 to 2014. The study also took into account the transaction costs. Overall, the results indicated that the strategy had a positive performance against the market, being as well as profitable. This study has contributed to future investors Index of the Portuguese Stock Exchange (PSI 20) as another tool to enable them to a further analysis option when investing

A transição do jardim-de-infância para o 1º ciclo do ensino básico - um salto gigante - intervenção com uma criança com atraso global do desenvolvimento

A entrada para o 1º ciclo do Ensino Básico (1º CEB) é entendida como uma etapa significativa na vida da criança. Independentemente de ela ter frequentado ou não o jardim-de-infância (JI), a transição para o 1º CEB é sempre vista como uma transição importante na vida da criança. Em Portugal a Educação Pré-Escolar (EPE) não é obrigatória, o que implica que, muitas vezes, a transição para o 1º CEB seja ainda mais complexa, dado que a criança nunca teve contato com uma educadora e colegas da sua idade, em contexto educativo. O processo de transição entre o JI e o 1º CEB pode ser eficaz e bem-sucedido se forem estabelecidas ligações que permitam a articulação entre estes dois ciclos educativos. Estas ligações devem ser estabelecidas pelos educadores e docentes do 1º CEB, com base em projetos e práticas decorrentes da gestão curricular. O conceito de “Prontidão escolar” é algo ambíguo e suscetível de várias definições. De um modo geral, este conceito é entendido como um fator determinante para o sucesso escolar da criança. Os professores enfatizam-no tendo em conta os aspetos sociais e a autorregulação da aprendizagem, enquanto os pais dão importância às competências académicas. O trabalho de projeto foi desenvolvido com um grupo de crianças da EPE (com idades compreendidas entre os 4 e os 6 anos), tendo como foco principal uma criança com Atraso Global do Desenvolvimento (AGD). Este projeto pretendeu dar mais ênfase às dimensões sociais, emocionais, pessoais e autorregulatórias da aprendizagem. São estas dimensões que constituem a chave para que o processo de transição seja bem-sucedido. Para tal, procurou-se fundamentar o tema recorrendo a vários autores. Com base nas dimensões mencionadas, foram desenvolvidas um conjunto de atividades, tendo como referencial teórico o programa “Salto de Gigante”. Integra, por último, uma reflexão acerca das atividades concretizadas

An anchored retaining wall in CSM

Cutter soil mixing (CSM) is being recently used in Portugal in several applications. This paper describes a solution in cutter soil mixing reinforced with vertical steel profiles IPE270 for a retaining wall with 66 m long and 13 m high constructed in geological formations of landfill materials, Miocene sandy soils and sandstones, with a phreatic level around 8 m depth. This construction is done nearby commercial buildings. The solution is justified against more classical solutions for anchored retaining walls considering the following aspects: feasibility of CSM in the geological and environment conditions, predict behaviour during and post construction, simplicity of construction process, time of construction, economy and quality assurance. Numerical modelling using a commercial program is carried out, based in geotechnical parameters established at the project level, showing a good agreement of the observed data, in terms of horizontal displacements of the wall and also of the safety levels against bending, shear and compression.Malgré l'utilisation du traitement des sols en profondeur dans les dernières décennies, la technique « cutter soil mixing» (CSM) est récemment utilisé au Portugal dans plusieurs applications. Cet article décrit une solution CSM renforcé avec des profilésverticaux IPE270 pour un mur de soutènement avec 66 m de long et 13 m de haut construit dans des formations géologiques de matériaux de remblayage, des formations du Miocène de sols sablonneux et des grès, avec un niveau de nappe phréatique autour de 8 m de profondeur. Cette construction se fait à proximité de bâtiments commerciaux. La solution est justifiéepar rapport aux solutions plus classiques des murs de soutènement ancrés tenant compte des aspects suivants: faisabilité du CSM dans une vaste gamme des conditions géologiques et de l'environnement, prévoir le comportement durant et après construction, simplicité du processus de construction, le temps de construction, l'économie et l'assurance-qualité. Une modélisation numérique au moyen d’un programme commercial est effectuée avec l’utilisation des paramètres géotechniques établis au niveau du projet, montrant une bonne concordance des données observées, en termes de déplacements horizontaux de la paroi, autant que des niveaux de sécurité contre la flexion, le cisaillement et la compression.The authors wish to thank to “Fundação para a Ciência e a Tecnologia” (FCT) for the financial support under the strategic project PEst-OE/ ECI/UI4047/2011. In addition, the authors would like to thank the contribution of Ângelo Pereira

O estudo da guitarra clássica: a gravação áudio na sala de aula como complemento auxiliar tecnológico

A gravação áudio é utlizada por músicos e estudantes de música como uma ferramenta fundamental para a composição, preparação e estudo de obras musicais. Contudo, poucos métodos de estudo apresentam um modelo de captação sonora (formato Wave) na sala de aula, no ensino da guitarra em conservatórios nos Cursos Artísticos Especializados em Música em Portugal. Esta investigação pretende implementar uma metodologia na aula de guitarra clássica que inclua a gravação áudio direta do repertório tocado pelos alunos na fase de estudo. Esta gravação tem como objetivo a análise, autocrítica e o melhoramento da execução musical, através da audição realizada nas aulas durante a preparação das obras musicaisThe audio recording is used by musicians and music students as an essential tool for music composition, preparation and study of musical pieces. However, few study methods present a model of sound recording (format Wave) in the guitar education classroom at conservatories and music schools of the Specialized Artistic Education in Portugal. This research intends to implement a methodology for class that includes a direct audio recording of the repertoire played by the students in the study phase. This recording aims at the analysis, self-criticism and improvement of the musical performance, through the audition realized in the classes during the preparation of the musical piecesMestrado em Ensino de Músic

Dimensionality of Carbon Nanomaterials Determines the Binding and Dynamics of Amyloidogenic Peptides: Multiscale Theoretical Simulations

Experimental studies have demonstrated that nanoparticles can affect the rate of protein self-assembly, possibly interfering with the development of protein misfolding diseases such as Alzheimer's, Parkinson's and prion disease caused by aggregation and fibril formation of amyloid-prone proteins. We employ classical molecular dynamics simulations and large-scale density functional theory calculations to investigate the effects of nanomaterials on the structure, dynamics and binding of an amyloidogenic peptide apoC-II(60-70). We show that the binding affinity of this peptide to carbonaceous nanomaterials such as C60, nanotubes and graphene decreases with increasing nanoparticle curvature. Strong binding is facilitated by the large contact area available for π-stacking between the aromatic residues of the peptide and the extended surfaces of graphene and the nanotube. The highly curved fullerene surface exhibits reduced efficiency for π-stacking but promotes increased peptide dynamics. We postulate that the increase in conformational dynamics of the amyloid peptide can be unfavorable for the formation of fibril competent structures. In contrast, extended fibril forming peptide conformations are promoted by the nanotube and graphene surfaces which can provide a template for fibril-growth

Computational chemistry for graphene-based energy applications: progress and challenges

YesResearch in graphene-based energy materials is a rapidly growing area. Many graphene-based energy applications involve interfacial processes. To enable advances in the design of these energy materials, such that their operation, economy, efficiency and durability is at least comparable with fossil-fuel based alternatives, connections between the molecular-scale structure and function of these interfaces are needed. While it is experimentally challenging to resolve this interfacial structure, molecular simulation and computational chemistry can help bridge these gaps. In this Review, we summarise recent progress in the application of computational chemistry to graphene-based materials for fuel cells, batteries, photovoltaics and supercapacitors. We also outline both the bright prospects and emerging challenges these techniques face for application to graphene-based energy materials in future.vesk

Estudo das doenças imunoalérgicas na infância : fatores relacionados com os primeiros 1100 dias de vida e estado nutricional atual : Região de Lisboa e Vale do Tejo : COSI Portugal 2018/2019

Tese de mestrado, Epidemiologia, Universidade de Lisboa, Faculdade de Medicina, 2022Introdução: A prevalência de doenças imunoalérgicas (DI) na infância tem aumentado nas últimas décadas comprometendo a qualidade de vida das crianças. A sua origem é multifatorial, relacionando-se não só com causas genéticas, mas também com os estilos de vida da população. Da mesma forma, o excesso de peso infantil tem aumentado a custo da deterioração dos hábitos alimentares e aumento do sedentarismo, influenciado pelo ambiente em que as crianças estão inseridas. O excesso de gordura corporal desencadeia processos de inflamação metabólica que podem influenciar a resposta imunológica e assim ser uma agravante para a ocorrência de alergias. Também os primeiros 1100 dias de vida são um período que influencia a saúde ao longo da vida, pelo que, refletir sobre as causas das DI implica estudar este começo, considerando o papel determinante de fatores como o estado nutricional (EN) materno antes e durante a gravidez, o peso à nascença, e a amamentação, no desenvolvimento do sistema imunitário e manifestação deste grupo de doenças na infância. Este trabalho divide-se em duas partes que resultaram na elaboração de dois artigos distintos que analisam a relação das DI com os seguintes fatores: Excesso de peso na infância e fatores nutricionais relacionados com os primeiros 1100 dias de vida. Objetivo: Verificar se o excesso de peso infantil e os fatores nutricionais dos primeiros 1100 dias de vida, estão associados ao diagnóstico e sintomas reportados de asma, rinite, eczema e alergia alimentar (AA) na infância. Métodos: Este estudo de coorte retrospetivo incluiu crianças de 41 escolas do 1ºCiclo do Ensino (1CEB) da região de Lisboa e Vale do Tejo (LVT) que participaram na 5ª ronda do estudo Childhood Obesity Surveillance Initiative - Portugal. O EN das crianças participantes foi obtido através da base de dados nacional da 5ª ronda COSI, e a informação sobre sintomatologia e diagnóstico de DI, foi obtida através de um questionário validado do International Study of Asthma and Allergies in Childhood (ISAAC) dirigido aos encarregados de educação (EE). Para analisar a relação com o histórico dos fatores nutricionais dos primeiros 1100 dias de vida das crianças, foram incluídas questões adicionais no mesmo questionário. Resultados: Excesso de peso infantil Através do diagnóstico reportado pelos EE, a frequência das doenças foi superior nas crianças com excesso de peso do que nas restantes (Asma 8,5% vs 7,6%; rinite 15,3% vs 14,8%; eczema 23,4% vs 18,8%; AA 8,1% vs 6,7%). Contudo, os resultados não provaram que as diferenças fossem estatisticamente significativas entre os dois grupos (p>0,05). Cerca de 38,7% das crianças com excesso de peso, e 32,8% do grupo sem excesso de peso, tem pelo menos uma destas doenças. Após ajustar para o sexo e fumadores ativos em casa, verificou-se com alguma significância estatística (p=0,07), que as crianças com excesso de peso tendem a ter 1,3 vezes mais chances de ter diagnóstico reportado de pelo menos uma DI face às crianças sem excesso de peso [Odds Ratio Ajustado (ORajust)=1,338; 95% Intervalo de confiança (IC): 0,982-1,823], assim como a ter 1,3 vezes mais chances de apresentar dois sintomas ou mais nos 12 meses anteriores ao estudo (ORajust 1,307; 95% IC: 0,955-1,788). Com diferenças estatisticamente significativas, os resultados indicaram ainda que reportar histórico de pieira (ORajust. 1,585; 95% IC: 1,143-2,199) e de erupção cutânea com comichão associada (ORajust 1,459; 95%IC: 1,026-2,076) tendem a ocorrer mais nas crianças com excesso de peso. Com maior grau de incerteza, destaca-se, no entanto, uma maior tendência na chance de histórico de eczema em crianças com excesso de peso relativamente às que não apresentam excesso de peso (ORajust 1,353; 95%IC: 0,964-1,898).Background: In the last decades, the prevalence of allergic diseases (AD) in childhood has increased, compromising children's quality of life. Its origin is multifactorial, relating not only to genetic causes but also to the population's lifestyles. Likewise, overweight in children has increased mainly due to an increase in poor eating habits and increasingly sedentary lifestyles, influenced by the environment in which children live. Excess body fat triggers metabolic inflammation processes that can influence the immune response and thus be an aggravating factor for allergies occurrence. Also, the first 1100 days of life are a period that influences health throughout life. Reflecting on the causes of AD implies studying this beginning of life, considering the role of determinant factors such as maternal nutritional status (NS) before and during pregnancy, birth weight, and breastfeeding in the development of the immune system and manifestation of this group of diseases in childhood. This work is divided into two parts: The first analyzes the child's overweight factor, and the second analyzes the nutritional factors of the first 1100 days of life. Aim: To verify if childhood overweight and nutritional factors of the first 1100 days of life are associated with the diagnosis and reported symptoms of asthma, rhinitis, eczema, and food allergy (FA) in childhood. Methods: This retrospective cohort study included children from 41 primary schools in the Portuguese region of Lisbon and Tagus Valley, which participated in the 5th round of the Childhood Obesity Surveillance Initiative (COSI) study. The participating children's NS were obtained through the national database of the 5th COSI round, and the information about symptoms and diagnosis of AD was obtained through a validated questionnaire from the International Study of Asthma and Allergies in Childhood (ISAAC) addressed to parents. Additional questions were included in the same questionnaire to analyze AD and the nutritional factors of the first 1100 days of children's history. Results: Childhood overweight: Through the reported diagnosis by the parents, the frequency of diseases was higher in overweight children than in the others (Asthma 8.5% vs 7.6%; rhinitis 15.3% vs 14.8%; eczema 23.4% % vs 18.8%; AA 8.1% vs 6.7%). However, the results did not prove that the differences are statistically significant between the two groups (p>0.05). About 38.7% of overweight children, and 32.8% of the non-overweight group, have at least one of these diseases. After adjusting for sex and active smokers at home, it was found, with some statistical significance (p=0.07), that overweight children are 1.3 times more likely to have a reported diagnosis of at least one ID face. To children without excess weight [Adjusted Odds Ratio (ORadjust)=1.338; 95% Confidence interval (CI): 0.982-1.823], as well as being 1.3 times more likely to have at least two symptoms in the 12 months prior to the study (ORadjust 1.307; 95% CI: 0.955-1.788). With statistically significant differences, the results also indicate that reporting a history of wheezing (ORadjust 1.585; 95% CI: 1.143-2.199) and rash with associated itching (ORadjust 1.459; 95%CI: 1.026-2.076) tends to occur more in overweight children. With a greater degree of uncertainty, however, there is a greater trend in the chance of a history of eczema in overweight children compared to those who are not overweight (ORadjust 1.353; 95%CI: 0.964-1.898). Factors related to the first 1100 days of life: Results with statistical evidence were not observed when the nutritional factors of the first 1100 days of life were analyzed, except for breastfeeding (p=0.036), whose children who were not breastfed are less likely to have a reported asthma diagnosis (OR=0.417; CI 95 % 0.179-0.968). However, estimated ORs indicated trends of greater odds of asthma, either in children of low birth weight (OR=1.099; 95% CI 0.375-3.222) and pre-obesity (OR=1.597, 95% CI 0.887-2.875) mothers when becoming pregnant compared with those who were normal weight. Also, trends of greater odds of asthma were observed in children exclusively breastfed for 3 and 6 months (OR= 1.006; 95%CI 0.641-1.577 & OR=1.156; 95%CI 0.708-1.887) compared to those who breastfed for a shorter period. In the case of rhinitis, there are more chances of diagnosis reported in children whose mothers became pregnant with low birth weight (OR= 1.004; 95%CI: 0.433-2.329) and pre-obesity (OR=1.190; 95%CI: 0.731-1.940), as well as in children who were born with low birth weight (OR=1.153; 95%CI: 0.671-1.980), and in those who were exclusively breastfed for six months (OR=1.105; 95% CI: 0.764-1.597). For eczema, there tends to be a greater chance of diagnosis in children whose mothers were in any of the categories of maternal nutritional deviation in early pregnancy (Low weight: OR=1.395 95%CI: 0.696-2.796); Pre-obesity: OR=1.101; IC95% 0.634-1.579; Obesity: OR=1.856; 95%CI: 0.966-3.567). Also, a higher chance of diagnosis in children who were exclusively breastfed for three and six months (OR=1.977; 95%CI:0.794-1.460 & OR=1.053; 95%CI: 0.751 -1,478). Regarding food allergy, there is a lower trend in the odds of diagnosis in the group of children born with low birth weight (OR=0.874; 95%CI: 0.425-1.798) compared to those born with healthy weight and tending to be less likely in children who were not breastfed (OR= 0.638; 95%CI: 0.303-1.345) compared to those who were breastfed at some point. Discussion: The results indicated stronger scientific evidence and statistical robustness for the association between childhood overweight and allergic symptoms. In this first part of the work, the information provided in the questionnaire is more recent and, therefore easier for parents to remember and report. In addition, data on nutritional status were collected and measured rigorously according to COSI criteria by trained examiners, which gives enormous reliability to the results obtained. When analyzing the factors inherent to the first 1100 days of a child's life, parents are more susceptible to memory bias due to the lag time of about eight years between the events and participation in the study. So, the methodology applied has its limitations in assessing the existence of associations, producing quite controversial results, namely regarding breastfeeding. Conclusion: Excess weight in childhood negatively influences symptoms related to allergic disease and increases the chances of having at least one AD diagnosed in childhood. The need to prevent and control these diseases in childhood contributes to sustaining food education programs to prevent overweight in children. They call for the need to start this work earlier, with pregnancy being a period of opportunity for changes in habits that will influence babies' future health