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A auscultação pulmonar com estetoscópio é uma parte crucial da avaliação do sistema respiratório e no diagnóstico de várias exacerbações e doenças respiratórias. No entanto, pelas suas limitações tão bem conhecidas, tem sido provado que a auscultação pulmonar com um microfone incorporado no smartphone é uma alternativa exequível, quando utilizado por médicos. Tivemos como objetivo avaliar a viabilidade da mesma tecnologia por utilizadores reais. Recrutámos 36 crianças (69% do sexo masculino, média [desvio padrão] de idade foi de 10.1 [3.1] anos; 44% asma, 39% outras doenças respiratórias, 17% sem doenças respiratórias) no serviço de Pediatria num hospital terciário. Primeiramente, os médicos auscultaram com um estetoscópio analógico em 4 locais - traqueia, tórax anterior direito, bases pulmonares direita e esquerda - e documentaram quaisquer sons adventícios detetados. Depois, procedeu-se à auscultação com o smartphone 2 vezes, nos mesmos 4 locais, primeiro pelo médico (n=220) e depois pelo pai (n=264). As gravações (n=484) foram classificadas por 3 anotadores quanto à qualidade e sons adventícios. A maioria das gravações tinha qualidade (80% nos médicos, 72% nos pais). A proporção de sons adventícios (12% e 10%) e acordo com o estetoscópio (81%; k de Cohen=0.193 e 80%; k de Cohen=0.118) foram muito semelhantes nas gravações dos médicos e pais, respetivamente. Os nossos resultados mostraram que a auscultação do smartphone era viável para o utilizador real, mas são necessários mais estudos para melhorar a sua concordância com a auscultação convencional. Stethoscope lung auscultation is a crucial part of the respiratory examination and diagnosis in various respiratory disorders and exacerbations. However, because it has well-known limitations, it has been shown that smartphone built-in microphone auscultation is a feasible alternative to the stethoscope, when applied by a physician. We aimed to assess this technology by real end-users. We recruited 36 children (69% male, mean[standard deviation] age 10.1[3.1]y; 44% asthma, 39% other respiratory diseases, 17% no respiratory diseases) at the Paediatrics department of a tertiary hospital. Firstly, physicians performed conventional auscultation with analog stethoscopes at 4 locations - trachea, right anterior chest, right and left lung bases - documenting any adventitious sounds. Afterwards, smartphone auscultation was recorded twice in those 4 locations, first by the physician (n=220) and later by the parent (n=264). The recordings (n=484) were classified by 3 annotators on quality and adventitious sounds. Most recordings had quality (80%physicians',72%parents'). Proportion of adventitious sounds (12% and 10%) and agreement with the stethoscope (81%; Cohen's K=0.193 and 80%; Cohen's K=0.118) were very similar in the physicians' and parents' recordings, respectively. Our results show that smartphone auscultation was feasible by an end-user, but further investigation is required to improve its agreement with conventional auscultation.

To raise perceived capability (C), opportunity (O) and motivation (M) for physical activity (PA) behaviour (B) among adults, the Portuguese Directorate-General of Health developed a mass media campaign named &ldquo, Follow the Whistle&rdquo, based on behaviour change theory and social marketing principles. Comprehensive formative and process evaluation suggests this media-led campaign used best-practice principles. The campaign adopted a population-wide approach, had clear behavioural goals, and clear multi-strategy implementation. We assessed campaign awareness and initial impact using pre (n = 878, 57% women) and post-campaign (n = 1319, 58% women) independent adult population samples via an online questionnaire, comprising socio-demographic factors, campaign awareness and recall, and psychosocial and behavioural measures linked to the COM-B model. PA was assessed with IPAQ and the Activity Choice Index. The post-campaign recall was typical of levels following national campaigns (24%). Post-campaign measures were higher for key theory-based targets (all p &lt, 0.05), namely self-efficacy, perceived opportunities to be more active and intrinsic motivation. The impact on social norms and self-efficacy was moderated by campaign awareness. Concerning PA, effects were found for vigorous activity (p &lt, 0.01), but not for incidental activity. Overall the campaign impacted key theory-based intermediate outcomes, but did not influence incidental activity, which highlights the need for sustained and repeated campaign efforts.

Issue/problem Implementation of national systems for patients' physical activity (PA) assessment and counselling is a cost-effective strategy recommended in the WHO Global Action Plan for PA 2018-2030. Although Primary Health Care (PHC) professionals are recognized as key agents for PA promotion, challenges remain on how to develop feasible and scalable tools to support them in promoting patients' PA. The Portuguese model could help other countries improve PA assessment and brief counselling in PHC settings. This study aims to describe the tools' development and usage. Description of the problem The Portuguese Directorate-General of Health developed two evidence-based digital tools to support PA promotion by healthcare professionals: a) PA brief assessment tool; and b) brief counselling tool. The assessment tool was incorporated within the electronic medical health record software ?SClínico? in September 2017. It includes three questions: 1) how many days per week the patient performs any kind of PA (work, commuting or leisure-time); 2) how much time per day; and 3) how many hours per day the patient spends in sedentary behaviours. The PA brief counselling tool is available through the electronic medical prescription software ?PEM? since December 2017 and consists of five inter-related self-explanatory guides that can be delivered to patients (printed or by email), according to their motivation and PA levels. They facilitate person-centered and autonomy-supportive PA counselling, targeting specific behaviour change mediators, and using validated techniques. Results From September 2017 to December 2021, 159,179 patients had their PA assessed (2235 per 100,000 users of the National Health Service) and, from these, 16133 received PA brief counselling guides (177 per 100000 residents in Portugal, ≥ 15 years old), with a six-fold and three-fold increases, respectively, between 2018 and 2019 (previous to the COVID-19 pandemic). Future actions will address cost-effectiveness of this policy. Lessons The brief assessment and brief counselling tools were well-accepted and are increasingly being used, with potential for generalized adoption within the Portuguese Health Care System. Main messages Portugal has taken a decisive action to promote PA using PHC as a priority setting. PA tools usage is increasing considerably, highlighting the importance of making available easy-to-use PA promotion tools.

Background Portugal has one of the highest rates of physical inactivity in Europe. To raise the profile of physical activity (PA) among adults, the Portuguese National Physical Activity Promotion Program of the Directorate-General of Health developed and implemented a national mass media campaign in 2019 named ?Follow the Whistle?. The campaign was based on social marketing principles and behavior change theory, namely the COM-B model, and was developed through formative research. We aim to describe the implementation process and short-term impact evaluation data. Methods ‘Follow the Whistle' was launched in June 2019 and continued for 4 weeks (TV, Radio, Online and Cinema, newspapers, outdoors). Pre (n = 878, 57%women) and post (n = 1319, 58%women) independent adult population samples were used to assess campaign impact. Participants were recruited through the mailing list of a Portuguese mutual insurance company, a network from across Portugal. The online questionnaire comprised socio-demographic factors, campaign awareness and recall, and psychosocial and behavioral measures linked to the four targets of the COM-B model, including items to assess perceived capability for physical activity(C), perceived opportunity for practice/ ease of integration of PA in daily living(O), motivation for PA practice(M) and behavior(B) assessed with IPAQ and the Activity Choice Index. Results Pre-and post-campaign samples were broadly demographically similar. Campaign recall increased significantly from 1% to 24% in prompted tagline recall (1/3 at post-campaign correctly recalled specific campaign images). All the targeted COM-B indicators changed in the expected direction, suggesting increases in perceived capability to engage in PA, perceived daily opportunities for being physically active, and in motivation (considering PA as fun, important, and compatible with other important things in life) (all p > 0.05). Results from PA behavior measures revealed increases only for vigorous activities (p > 0.001). Conclusions The GAPPA recommends the creation of active societies starting with best-practice community-wide communications campaigns. Although one focus of the ?Follow-the whistle? (i.e. promotion of active transport and incidental everyday forms of physical activity) was not entirely achieved (i.e. changes only in vigorous activities), the initial campaign objectives of increases in awareness, and influencing intermediate outcomes were achieved. Further campaign waves are planned for future years.

Tools to identify good practices in the design, implementation, and evaluation of physical activity community-based interventions (PACIs) are key to address the physical inactivity pandemic. Existing tools tend to be extensive and with limited applicability to assess small-scale PACIs. This work aimed to report the development and preliminary validity results of a simple, practical, and user-friendly tool to evaluate PACIs in local/municipal contexts. Eighty-six good practice characteristics defined by the World Health Organization (WHO), the Joint Action Framework on Chronic Diseases (CHRODIS), and an umbrella review of good practice characteristics of diet and physical activity interventions were initially extracted and refined in four rounds of revision from an expert panel using a Delphi-type methodology and rated on their relative importance. A pilot application was conducted, and data on the tool usability and applicability were collected through three semi-structured interviews with specialists and coordinators of local/municipal PACIs. For preliminary validation, the refined tool was applied to five community-based programs mostly aimed at an elderly population. The final tool included thirty-four selected characteristics, with a brief explanation and practical examples for each, under three main sections: design, evaluation, and implementation. Each characteristic has a rating (i.e., somewhat important, highly important, mandatory) and a percentage weight. Preliminary validation of this tool pointed to an adequate evaluation of good practice characteristics of municipal PACIs in a reliable, practical, and user-friendly way. Given its adequacy, this tool can support the definition of quality standards for PACIs, encouraging their dissemination and adoption at a regional or national level. Rute Santos is supported by the Portuguese Foundation for Science and Technology (CEECIND/01069/2017 and FCT/UIDB/00617/2020). The authors wish to thank João Moutão, Marta Antunes, João Olivença, Ermelinda Afonso, Carlos Dionísio, César Costa, Ana Lucas, Miguel Arriaga, and Duarte Araújo for their insightful contributions to the refinement of the tool.

&nbsp, Rapid worldwide decreases in physical activity (PA), an increase in sedentary behaviour (SB) and poorer dietary patterns have been reported during COVID-19 confinement periods. However, as national variability has been observed, this study sought to describe PA, SB and eating patterns, and to explore their gender as well as other socio-demographic correlates and how they interrelate in a representative sample of Portuguese adults during the COVID-19 first mandatory social confinement. The survey was applied online and by telephone to 5856 adults (mean age = 45.8 years, 42.6% women). The majority reported high (46.0%) or moderate (20.5%) PA levels. Men, younger participants, those with higher education levels and a favourable perception of their financial situation reported higher PA levels, with the opposite pattern for SB. Physical fitness activities and household chores were more reported by women, with more strength training and running activities reported by men. Regarding eating behaviours, 45.1% reported changes, positive (58%) and negative (42%), with 18.2% reporting increases in consumption of fruit, vegetables, and fish and other seafood consumption, while 10.8% (most with lower educational level and less comfortable with their income) reported an increase in consumption of ready-to-eat meals, soft drinks, savoury snacks, and take-away and delivered meals. Two clusters—a health-enhancing vs. risky pattern—emerged through multiple correspondence analysis characterized by co-occurrence of high vs. low PA levels, positive vs. negative eating changes, awareness or not of the COVID-19 PA and dietary recommendations, perceived financial situation, higher vs. lower educational level and time in social confinement. In conclusion, while in social confinement, both positive and negative PA and eating behaviours and trends were displayed, highlighting the role of key sociodemographic correlates contributing to healthy vs. risky patterns. Results may inform future health interventions and policies to be more targeted to those at risk, and also advocate the promotion of PA and healthy eating in an integrated fashion.&nbsp

INTRODUÇÃO: A Rede CUF em 18 de março, disponibilizou o Hospital CUF Infante Santo (HCIS) como hospital de referência para os doentes com COVID-19 na área da grande Lisboa. O internamento do doente não crítico (IDNC) ficou a cargo de uma equipa médica dedicada (EMD) constituída por médicos do Cluster Tejo, sob coordenação da Medicina Interna. Este estudo reporta as principais características demográficas e clínicas da população internada no IDNC.MATERIAL E MÉTODOS: Estudo retrospetivo analisando os doentes admitidos entre 27 de março e 7 de maio de 2020, no IDNC. Os critérios para diagnóstico de COVID-19 basearam-se na confirmação laboratorial e/ou critérios de diagnóstico imagiológicos. Excluíram-se da análise os doentes inicialmente suspeitos, mas cujo diagnóstico final encontrado foi outro. Clinicamente, o doente não crítico foi definido como tendo um Modified Early Warning Score (MEWS) entre 0-2. Os dados foram coletados do processo clínico eletrónico e da base de dados criada para seguimento destes doentes. Apresentam-se as características demográficas, clínicas, exames complementares, terapêutica e resultados.RESULTADOS: Incluíram-se 44 doentes, média de idades 67 anos, 52,3% homens. Divididos em grupos de acordo com a apresentação, com pneumonia em 75%, os restantes com outra apresentação. Proveniência: domicílio 81,8%, residência sénior 11,4% e outro hospital 8%.Fatores de risco para doença mais grave foram: Idade > 65 anos, 56,8%, hipertensão arterial 59%, doença respiratória crónica 15,9%, obesidade 15,9%, neoplasia ativa 13,6%, diabetes 11,4%, cardiopatia isquémica 11,4%, insuficiência cardíaca 6,8%, imunossupressão 6,8%, com índice de comorbilidades de Charlson média de 3.6. Agravamento clínico significativo com necessidade de escalar cuidados em três doentes (6,8%), em dois (4,5%) com ventilação mecânica invasiva, adicionalmente registado um óbito (2,3%). Demora média de internamento 10 dias, três (6,8%) doentes foram transferidos para outro hospital e 40 (91%) tiveram alta.DISCUSSÃO: A casuística apresentada representa o primeiro grupo de doentes não críticos internados com COVID-19 na Rede CUF da Região de Lisboa. Houve evolução e mortalidade intra-hospitalar abaixo do expectável para as características desta população, nomeadamenteperante a presença de fatores de risco para doença mais grave e elevado índice de comorbilidades. CONCLUSÃO: A interpretação dos resultados obtidos fica condicionada ao pequeno tamanho da amostra e às incertezas ainda existentes nesta nova doença.

Background: This paper aims to discuss how physical activity (PA) brief assessment, brief counseling, and self-monitoring tools were designed and implemented in the Portuguese National Health Service (NHS), and to report on their current use by health professionals and citizens. Methods: Three digital tools to facilitate PA promotion in primary health care (PHC) were developed: 1) a PA brief assessment tool was incorporated in the electronic health record platform &ldquo, SCl&iacute, nico Cuidados de Sa&uacute, de Prim&aacute, rios&ldquo, 2) a brief counseling tool was developed in the software &ldquo, PEM&mdash, Prescri&ccedil, &atilde, o Eletr&oacute, nica M&eacute, dica&rdquo, (electronic medical prescription), and 3) a &ldquo, Physical Activity Card&rdquo, was incorporated in an official NHS smartphone app called &ldquo, MySNS Carteira&rdquo, Results: From September 2017 to June 2019, 119,386 Portuguese patients had their PA assessed in PHC. Between December 2017 and June 2019, a total of 7957 patients received brief intervention for PA by a medical doctor. Regarding the app &ldquo, 93,320 users activated the &ldquo, between February 2018 and December 2018. Conclusions: These tools represent key actions to promote PA among Portuguese citizens using PHC as a priority setting. Further initiatives will follow, including proper assessment of their clinical impact and training programs for health care professionals on PA promotion.

Modal shifting and jumping in thermally buckled plates has been investigated previously using computational models; however, relatively few experimental explorations have been reported. In this study, the modal shifts and jumps in a simple rectangular plate or panel were investigated using digital image correlation to obtain detailed mode shapes. One face of the planar panel, which was 219 × 146 mm, was speckled and viewed with a stereoscopic digital image correlation system using pulsed-laser illumination and with a laser vibrometer at a single point. The other face was heated using a set of 1 kW quartz lamps to produce a non-uniform temperature distribution which progressively increased from room temperature to around 760 K. An infra-red camera recorded the time-varying temperature distribution on the panel while it was excited with an electrodynamic shaker. A waterfall plot, or time-frequency spectrogram, showing natural frequencies as a function of time was generated, which highlighted the shifting response of the panel with temperature. The heating sequence was repeated and the panel excited at the natural frequencies identified in the waterfall plot, which permitted the corresponding mode shapes to be measured. These data showed that mode shifting and jumping was present with asymmetric heating, but not with spatially uniform heating, and was associated with thermally-induced buckling.

A presente tese contempla dois estudos e baseou-se nos dados recolhidos no âmbito do projecto de investigação Impacto do desporto federado, do desporto escolar e da actividade física regular feita após o horário escolar no estilo e qualidade de vida das crianças e dos adolescentes (6 a 11 anos) em função da sua idade óssea, um estudo transversal com duração de 3 anos, financiado pela Fundação para a Ciência e Tecnologia (FCT) (PTDC/DES/113156/2009). O primeiro estudo investigou o papel do comprimento relativo do membro inferior na relação entre a massa livre de gordura e o gasto energético de repouso numa amostra de adolescentes (n = 611, 13.63 ± 1.87 anos). Estimou-se o comprimento relativo do membro inferior através da estatura e altura sentado [CRMI = (estatura - altura sentado)/estatura] e o gasto energético de repouso utilizando a equação de Müller. Identificou-se um efeito moderador do comprimento relativo do membro inferior através de um modelo de regressão linear múltipla (β = - 0.016; SE = 0.005; p = .003). A análise de covariância mostrou que adolescentes com um comprimento relativo do membro inferior superior têm um maior gasto energético de repouso por quilograma de massa livre de gordura [F(2,607) = 6.001; R2 = .114; p = .003]. O segundo estudo focou-se na validação relativa do Nível de Actividade Física (PAL) obtido através do Questionário Biossocial e para Avaliação das Rotinas de Vida Diárias em Crianças e Adolescentes, utilizando o ActiGraph GT3X como método de comparação. Analisou-se, igualmente, o impacto da inclusão das actividades durante os períodos de não utilização na qualidade dos dados da acelerometria. Uma amostra de 127 adolescentes (14.24 ± 1.95 anos) utilizou o ActiGraph durante cinco dias consecutivos (dois de fim-de-semana) e registou a duração e percepção de esforço de actividades realizadas fora dos períodos de utilização do acelerómetro. A mesma amostra preencheu o questionário RAPIL II, que incluía a duração e frequência de um largo conjunto de actividades semanais. A análise Bland-Altman baseada na regressão mostrou que a diferença média entre métodos foi de - 1.050 + 0.689PALmédio (LOA = - 0.71298 + 0.18962PALmédio, - 1.38702 + 1.18838PAL médio) e - 1.031 + 0.654PALmédio (LOA = - 0.33236 - 0.11106PALmédio, - 1.72964 + 1.41906PALmédio), incluindo ou excluindo da análise as actividades nos períodos de não utilização. O RAPIL II é válido em contexto populacional, apresentando uma boa concordância com o ActiGraph GT3X, mas não em contexto de avaliação individual. Deve ser considerada a inclusão das actividades em períodos de não utilização do acelerómetro. Ambos os estudos abrem novos caminhos para futura investigação, quer no respeitante ao papel da proporção corporal na estimação das necessidades energéticas, quer na avaliação epidemiológica do Nível de Actividade Física, através de um método acessível e pouco dispendioso. The present thesis comprises two studies and was based on the data collected under the research project The impact of regular competitive sport, extracurricular school-based sport and out-of-school time physical activities on lifestyle and quality of life of children and adolescents (11 to 16 years old) considering their bone age, a 3-year cross-sectional study sponsored by the Science and Technology Foundation (FCT) (PTDC/DES/113156/2009). The first study investigated the role of relative leg length on resting energy expenditure-to-fat-free mass relationship in a sample of adolescents (n = 611, 13.63 ± 1.87 years). Relative leg length was estimated through height and sitting height [RLL = (height - sitting height)/height], and resting energy expenditure using Müller equation. A moderation effect of relative leg length was identified through a multiple linear regression model (β = - 0.016; SE = 0.005; p = .003). Analysis of covariance showed that adolescents with higher relative leg length have higher resting energy expenditure by kilogram of fat-free mass [F(2,607) = 6.001; R2 = .114; p = .003]. The second study focused on the relative validation of Physical Activity Level (PAL) obtained with the Biosocial and Daily Life Routines Questionnaire for Children and Youth (RAPIL II), using ActiGraph GT3X as comparison method. It was also analyzed the impact of including non-wear time activities on the accelerometry data quality. A sample of 127 adolescents (14.24 ± 1.95 years) used the ActiGraph GT3X during five consecutive days (two weekend days), and recorded the duration and perceived exertion of non-wear time activities. The same sample completed the RAPIL II questionnaire, which included the duration and frequency of a large set of week activities. Bland-Altman regression analysis showed a mean difference between methods of -1.050+0.689MeanPAL (LOA = -0.71298+0.18962MeanPAL, -1.38702+1.18838MeanPAL) and -1.031+0.654MeanPAL (LOA = -0.33236-0.11106MeanPAL, - 1.72964+1.41906MeanPAL) when non-wear time activities were included or excluded from analysis. RAPIL II is valid on a population basis, presenting good agreement with ActiGraph GT3X, but not for individual evaluation purposes. Consideration should be given to the inclusion of non-wear time activities. Both studies open new paths for future research, either regarding the role of body proportion in energy requirements estimation, or the epidemiological assessment of Physical Activity Level through an accessible and low-cost method.

Cytoskeleton defects, including alterations in microtubule stability, in axonal transport as well as in actin dynamics, have been characterized in several unrelated neurodegenerative conditions. These observations suggest that defects of cytoskeleton organization may be a common feature contributing to neurodegeneration. In line with this hypothesis, drugs targeting the cytoskeleton are currently being tested in animal models and in human clinical trials, showing promising effects. Drugs that modulate microtubule stability, inhibitors of posttranslational modifications of cytoskeletal components, specifically compounds affecting the levels of tubulin acetylation, and compounds targeting signaling molecules which regulate cytoskeleton dynamics, constitute the mostly addressed therapeutic interventions aiming at preventing cytoskeleton damage in neurodegenerative disorders. In this review, we will discuss in a critical perspective the current knowledge on cytoskeleton damage pathways as well as therapeutic strategies designed to revert cytoskeleton-related defects mainly focusing on the following neurodegenerative disorders: Alzheimer's Disease, Parkinson's Disease, Huntington's Disease, Amyotrophic Lateral Sclerosis and Charcot-Marie-Tooth Disease.

Mestrado em Marketing A comunicação integrada de marketing (CIM) "ajuda as empresas a encontrarem novas formas de contacto com os consumidores com uma mensagem coerente e a construírem relações de longo prazo com os mesmos" (Clow e Baack, 2012, p. 35). Este projeto visa a elaboração de um plano de CIM para a multinacional LUSH fresh handmade cosmetics, tendo como objetivos principais aumentar a sua notoriedade e visibilidade em Portugal. As áreas de atuação utilizadas para concretizar esses objetivos centram-se sobretudo na comunicação online, comunicação de produto, experience marketing, promoção, comunicação ambiental e responsabilidade social. Parcerias com eco-resorts e restaurantes vegetarianos, ações promocionais em Universidades, um programa de fidelização, sorteios e parcerias online são algumas das táticas aplicadas neste projeto. Integrated Marketing Communications (IMC) "helps company leaders find new ways to contact consumers with a unified message and to engage them in long-term relationships" (Clow e Baack, 2012, p.35). This project includes the preparation of a plan of integrated marketing communications for multinational LUSH fresh handmade cosmetics, having as main goals to increase the brand awareness and visibility in Portugal. The business scope plan used in the plan to achieve these objectives mainly focus online communication, product communication, experience marketing, promotion, environmental communication and social responsibility. Partnerships with eco-resorts and vegetarian restaurants, promotional activities in universities, a loyalty program, online sweepstakes and partnerships are some of the tactics used in this project.