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Introduction: Acute pharyngitis is a common diagnosis in primary care. Although viruses are the most common aetiology, antibiotic therapy is frequently prescribed. The inappropriate antibiotic prescription should be avoided to prevent antibiotic resistance. Many national and international guidelines recommend testing for group A streptococcus (GAS) before antibiotic treatment when clinical presentation suggests GAS infection. Aim: This study aims to describe the feasibility of the implementation of the rapid antigen detection test (RADT) in a primary care setting and its impact on antibiotic prescription. Secondary goals include the evaluation of possible associations between symptoms and RADT results. Methods: From October 2019 to March 2020, patients presenting with acute pharyngitis at USF do Parque were eligible. A questionnaire was applied to divide the individuals into four different groups (clearly viral, probably viral, diagnostic doubt, and probably bacterial), and to assess the previous intention to prescribe antibiotics. We applied 136 questionnaires and performed 133 RADT. Nursing staff classified the specimen collection process and result from interpretation according to its difficulty. The proportion of antibiotics avoided was estimated as the number of times physicians changed their intended antibiotic prescription following a negative RADT result. Results: Among the tests performed, 97.7% were easy to interpret. Without RADT, 45 patients were going to be prescribed an antibiotic. After the test result, 27 antibiotic prescriptions were avoided. Tonsil hypertrophy, palatal petechiae, and fever increased the odds of a positive RADT result. Cough was associated with a negative RADT result. Conclusions: This study showed that RADT is easy to implement and contributed to appropriate antibiotic prescription. Tonsil hypertrophy, palatal petechiae, and fever were significantly associated with a positive RADT result, and cough was associated with a negative RADT result. Primary care centers would benefit from having RADT available when there is a strong suspicion or doubt of bacterial pharyngitis.

A recessão gengival é uma condição frequente encontrada tanto pelo cirurgião-dentista quanto pelo paciente. É definido como o deslocamento apical da margem gengival além da junção cemento-esmalte. Provocando diferentes alterações no periodonto, entre as elas podem ser citadas hipersensibilidade dentinária e sensação de dente alongado. Tendo como objetivo relatar um caso clínico de recessão gengival classe III de Miller em uma paciente do sexo feminino, 45 anos, leucoderma, apresentando sensibilidade dentinária nos dentes anteroinferiores sendo proposto a técnica do enxerto gengival livre subepitelial. Considerado uma opção superior em comparação com a técnica do enxerto gengival livre clássico.

Publisher Copyright: © 2021 The Author(s). Erratum: Correction to: Discontinuation of chronic benzodiazepine use in primary care: a nonrandomized intervention (Family Practice. 2022;39(2):241-248). Family Practice. 2022.39(3):563. (WOS: 000788675100001), (PMID:35485949), (Scopus ID: 85131225556). Background: Chronic benzodiazepine use is a challenge in primary care practice. Protocols to support safe discontinuation are still needed, especially in countries with high utilization rates. Objectives: To evaluate the feasibility, effectiveness, and safety of a benzodiazepine discontinuation protocol in primary care setting. Methods: Nonrandomized, single-arm interventional study, at primary care units. Family physicians (FPs) recruited patients (18-85 years-old) with benzodiazepine dependence and chronic daily use ≥3 months. Patients with daily dosages ≥30 mg diazepam-equivalent, taking zolpidem, with a history of other substance abuse or major psychiatric disease were excluded. After the switch to diazepam, the dosage was gradually tapered according to a standardized protocol. Primary endpoint was the percentage of patients who stopped benzodiazepine at the intervention last visit. Dosage reduction, withdrawal symptoms, patients' and FPs' satisfaction with the protocol were evaluated. Results: From 66 enrolled patients (74% female; 66.7% aged >64 years; median time of benzodiazepine use was 120 months), 2 withdrew due to medical reasons and 3 presented protocol deviations. Overall, 59.4% of participants successfully stopped benzodiazepine (60.7% when excluding protocol deviations). Men had higher probability of success (relative risk = 0.51, P = 0.001). A total of 31 patients reported at least 1 withdrawal symptom, most frequently insomnia and anxiety. Most of participating FP considered the clinical protocol useful and feasible in daily practice. Among patients completing the protocol, 77% were satisfied. For the patients who reduced dosage, 85% kept without benzodiazepines after 12 months. Conclusion: The discontinuation protocol with standardized dosage reduction was feasible at primary care and showed long-term effectiveness. publishersversion publishersversion published

Objective Smoking, unhealthy diet and obesity, sedentary behavior and inability to maintain adequate exercise have significant consequences for several chronic disorders. Blood centers can play a public health role in obesity surveillance and interventions. The purpose study was to evaluate the health status of the blood donors by monitoring the nutritional habits and lifestyle. Methods A descriptive cross-sectional face-to-face questionnaire was developed. It included a 41 item dietary assessment, reporting semi-quantitative food frequency, dietary behavior and questions on self-rated health status. Donors were regular repeat blood donors, eligible to donate. Results Of the 2468 blood donors enrolled between July 2017 and January 2018, 1390 were repeat donors. Only 205 agreed to respond to the questionnaire. Data showed that donors followed mainly a Mediterranean diet and had more awareness to lifestyle, women more than men, in comparison with general population. The prevalence of overweight was found 50.7% in men and 16.9% in women. Conclusions Overweight and obesity are common among regular blood donors and it is more frequent in men than women. The female blood donors seem to be characterized by better knowledge on the relationship between lifestyle and health, and by a better "putting into practice" of the information possessed.

INTRODUCTION: Blood transfusion is a lifesaving procedure for patients affected by hematological diseases or hemorrhage risk. AIM: This retrospective study was aimed to evaluate clinical safety of pediatric transfusions by comparing the frequency of adverse events caused by apheretic blood components vs whole blood. METHODS: From 2011 to 2015, 214 patients (blood malignancy patients, n = 144 and thalassemic patients, n = 70) received 12 531 units of blood components. The adverse acute reactions occurred during patient hospitalization were reported to the Hemovigilance system and assessed by fitting a logistic mixed-effect model. RESULTS: A total of 33 (0.3%) adverse acute events occurred. Odds ratio (OR) of adverse events from apheresis vs whole blood transfusion adjusted by patient classification was not statistically significant (OR [95% CI], 0.75 [0.23-2.47]). CONCLUSION: Our findings showed no significant differences in the prevalence of adverse acute events between blood component collected by apheresis vs whole blood in our study center.

Background Patients with end-stage liver disease (ESLD) have a compromised nutritional status because of the liver crucial role in regulating metabolic homeostasis and energy balance. Data sources A systematic review of literature based on extensive relevant articles published from 2001 to 2017 in English in PubMed database was performed by searching keywords such as liver disease, non-alcoholic liver disease, alcoholic liver disease, malnutrition, epigenetics, gut microbiota, and probiotics. Results Liver transplantation would be one eligible therapy for ESLD patients, even if, the clinical outcome is negatively influenced by malnutrition and/or infections. The malnutrition is a condition of nutrient imbalance with a high incidence in ESLD patients. An accurate evaluation of nutritional status could be fundamental for reducing complications and prolonging the survival of ESLD patients including those undergoing liver transplantation. In addition, the interaction among nutrients, diet and genes via epigenetics has emerged as a potential target to reduce the morbidity and mortality in ESLD patients. The malnutrition induces changes in gut microbiota causing dysbiosis with a probable translocation of bacteria and/or pathogen-derived factors from the intestine to the liver. Gut microbiota contribute to the progression of chronic liver diseases as well as hepatocellular carcinoma. The administration of probiotics modulating gut microbiota could improve all chronic liver diseases. Conclusions This review provides an update on malnutrition status linked to epigenetics and the potential benefit of some probiotics on the management of ESLD patients. In support of this view and to reveal the constant and growing interest in this field, some clinical trials are reported.

Intravenous immunoglobulin (IVIG) products are known to have beneficial immunomodulatory effects on several inflammatory and autoimmune disorders. These effects could be attributed to a different inhibitory action on complement factors, but other mechanisms could be implicated, e.g., immunocomplexes development and/or anti-idiotypic antibodies. Positive results on the reduction of anti-Human Leukocyte Antigens (HLA) antibodies in highly sensitized patients have also been found. The present study focuses on the effect of IVIG on the reduction of Panel Reactive Antibody level and crossmatch positivity in sensitized patients awaiting kidney transplantation.The study was performed adapting an in vitro assay on sensitized patients' sera in waiting list for kidney transplantation. Sera of twelve highly sensitized patients were evaluated for the cytotoxicity inhibition after 10% IVIG treatment.A reduction of anti- HLA antibody levels was observed in 75% (9/12) of treated patients in vitro, while 25% (3/12) resulted unresponsiveness. Particularly, our data showed a significantly higher Panel Reactive Antibody reduction for T lymphocytes (p0.010) than B lymphocytes (p0.032).In this study, we have used an in vitro assay to investigate susceptibility to desensitization with IVIG treatment of sensitized patient sera. These findings reveal that the variable effect of IVIG on reducing Panel Reactive Antibody in our immunized patients could be attributed to a different inhibitory action on complement, likely due to the type and the titre of anti-HLA antibodies.

Objectives: To assess the impact of the increase in user fees on the demand for primary health care in the Parque Family Health Unit, to compare consultation rates in the Parque FHU between January 1and May 31, 2011, and the same period in 2012, and to identify factors associated with patient demand for care in this unit. Design: Retrospective longitudinal, observational and analytical. Setting: Parque Family Health Unit, North Lisbon Health Centres Group (ACES Lisboa Norte) Population: Patients of the Parque Family Health Unit. Methods: A convenience sample of patients was selected from the health records of the Family Health Unit. The Student’s t-test, Anova, Pearson correlation and Spearman correlation were used with statistical significance set at the 5% level. Results:We analyzed the records of 338 patients. The majority were female (n = 241; 71,3%), with a mean age of 57 years (standard deviation = 18,92). There was an increase in the consultation rate from 2011 to 2012. The mean number of visits was 0.87 (IC95% 0.623-1.129, p < 0.01). Older patients, patients with more illnesses, and those taking daily medication had higher visiting rates (p < 0.05). There were fewer visits made by patients with a higher monthly income (p < 0.05). A positive correlation between the number of illnesses and the number of medical visits was observed in patients exempt from user fees. Conclusions: In 2012 the number of visits to the Health Unit increased. Advanced age, a larger number of illnesses and daily medication use were associated with a greater number of visits. Higher economic status was associated with lower visiting rates in both study periods. The increase in user fees did not have a negative impact on patient demand for primary health care in the Parque Family Health Unit., Objectivos: Averiguar o impacte do aumento das taxas moderadoras na procura dos cuidados de saúde primários na USF do Parque. Comparar as afluências às consultas na USF do Parque nos períodos homólogos de 1 de Janeiro a 31 de Maio dos anos 2011 e 2012. Identificar outros factores relevantes na afluência dos utentes às consultas da USF. Tipo de Estudo: Longitudinal retrospectivo, Observacional e Analítico. Local: USF do Parque, ACES Lisboa Norte. População: Utentes utilizadores da USF do Parque. Métodos:Amostragem por conveniência. Colheita de dados realizada através de questionário e consulta dos registos informáticos da USF. Análise dos resultados através do programa SPSS Statistics versão 19, com nível de significância estatística de 5%, com recurso aos testes t de Student, Anova, correlação de Pearson e correlação de Spearman. Resultados: Foram analisados 338 doentes com predomínio do sexo feminino (n = 241; 71,3%), com uma média de idades de 57 anos (DP = 18,92). Registou-se um aumento do número de consultas de 2011 para 2012 de 0,87 consultas por utente (IC95%: 0,623-1,129) (p < 0,01). Utentes mais idosos, com mais patologias e medicação diária apresentam maior afluência às consultas (p < 0,05). Houve menos consultas em utentes cujo rendimento mensal do agregado é elevado (p < 0,05). Verificou-se ainda uma correlação positiva superior entre o número total de patologias e consultas na população isenta, em 2012 (p < 0,05). Conclusões: O número de consultas em 2012 foi superior a 2011. A idade avançada, a multipatologia e a medicação diária justificam um maior número de consultas de seguimento. Um maior rendimento económico contribuiu para uma menor afluência em ambos os períodos. O aumento das taxas moderadoras não apresentou um impacte negativo no recurso às consultas da USF do Parque.

Clinical guidelines have the potential to increase health gains, but also to cause harm. In this opinion article we state some misgivings about the application of the Portuguese National Health Directorate's guideline type 2 diabetes therapy: metformin in primary care. We seek to highlight guideline wording that may allow for multiple interpretations (alternatives to monotherapy with metformin, hierarchy of drugs to be associated with metformin, and metformin contraindications). Furthermore, we argue that it seems that choosing a glycemic target of 6.5% in a normative document to be applied in the general population may have unforeseen consequences. publishersversion published

A prescrição de um ou mais agentes farmacológicos constitui a forma de terminar a maior parte das consultas médicas. O modo como os medicamentos são utilizados tem consequências óbvias para a saúde dos indivíduos e das populações e para a utilização eficiente dos recursos de saúde disponíveis. Este assunto interessa aos decisores políticos, aos profissionais de saúde, aos doentes e ao público em geral.

Apresentam-se os resultados de um estudo destinado a caracterizar e avaliar a adequação da prescrição de antibióticos para infecções respiratórias por parte dos médicos de Medicina Geral e Familiar (MF). Para o efeito, foi inquirida, entre os meses de Dezembro de 2001 e Janeiro de 2002, uma amostra aleatória de MF, estratificada por etapas sucessivas, quanto ao tipo de antibiótico prescrito em infecções do foro respiratório. Participaram no estudo, enviando pelo menos uma ficha adequadamente preenchida, 247 médicos de Clínica Geral e da carreira de Medicina Geral e Familiar. Foi avaliado um total de 2.200 prescrições, correspondendo a 2.257 indicações. A idade média dos doentes foi de 31,87. As indicações para a prescrição de antibióticos com 100 ou mais inquéritos válidos foram, por ordem decrescente de frequência, a amigdalite (663, 29,38%), bronquite (430, 19,05%), otite (315, 13,96%), sinusite (232, 10,28%), faringite (228, 10,10%), rinite/rinofaringite (212, 9,39%), e a pneumonia (116, 5,14%). Os grupos ATC3 de antimicrobianos mais prescritos foram, por ordem decrescente de frequência, os betalactâmicos/ penicilinas (50,55%), os macrólidos (23,09%), as cefalosporinas (14,77%), as quinolonas (8,32%), as tetraciclinas (2,45%) e as sulfonamidas/trimetoprim (0,59%). No referente ao nível ATC5, o antimicrobiano mais prescrito foi a associação amoxicilina/ácido clavulânico (35,36%), a qual foi, também, o antibiótico mais prescrito em cada uma das situações clínicas referidas. No que respeita ao perfil dos fármacos escolhidos para cada indicação, foram evidenciadas situações de clara inadequação, salientando-se a larga e não justificada utilização da associação amoxicilina/ácido clavulânico no tratamento da amigdalite/faringite. Os antibióticos foram frequentemente prescritos em situações clínicas nas quais não estão formalmente indicados e as recomendações do FEM quanto a fármacos de primeira linha apenas foram observadas para a pneumonia. Os autores concluem pela possibilidade de obter benefícios clínicos e económicos significativos melhorando a prática clínica corrente nesta área específica através de intervenções apropriadas., The authors present the results from a prospective study aimed at the characterization and evaluation of the adequateness of the prescription of antimicrobials for systemic use in respiratory infections in primary care. For the purposes of the study, ten similar questionnaires concerning the type of antibiotic which was prescribed for respiratory tract infections were submitted to a sample of general practitioners (GP), randomized by successive staging, at the national level, between December 2001 and January 2002. Two hundred forty seven GP have participated in the study by sending back, at least, one adequately filled questionnaire. A total of 2200 prescriptions were evaluated, corresponding to 2257 therapeutic indications. Mean patient’s age was 31.87 years. The indications leading to antibiotic prescription in those with 100 or more validated questionnaires were tonsillitis (663, 29.38%), bronchitis (430, 19.05%), otitis (315, 13.96%), sinusitis (232, 10.28%), pharyngitis (228, 10.10%), rhinitis/rhinopharyngitis (212, 9.39%) and pneumonia (116, 5.14%). The most frequently prescribed antimicrobials at the ATC3 level were betalactam/penicillins (50.55%), macrolides (23.09%), cephalosporins (14.77%), quinolones (8.32%), tetracyclines (2.45% and sulphonamides/trimethoprim (0.59%). At the ATC5 level, the most frequently prescribed antimicrobial was amoxycillin/clavulanic acid (35.36%), which was also the most frequently prescribed antibiotic for each individual indication. As far as the choice for the antibiotic for each indication is concerned, some inadequacies were detected, namely regarding the large and unjustified use of amoxycillin/clavulanic acid for the treatment of tonsillitis. Also, antimicrobials were frequently prescribed for situations for which they are not currently formally indicated, and the recommendations of the European Drug Formulary regarding first-line treatment for the concerned indications were not observed, with the exception of pneumonia. The authors conclude that significant clinical and economic benefit may be obtained by improving current clinical practice through appropriate interventions.

Submitted by Sofia Amador (sofiamador@fm.ul.pt) on 2012-03-20T10:07:27Z No. of bitstreams: 1 Antibióticos_tracto_respiratório.pdf: 184859 bytes, checksum: 7b8a8adb5630b22d4bcb75abbd3200fa (MD5) Made available in DSpace on 2012-03-20T11:48:24Z (GMT). No. of bitstreams: 1 Antibióticos_tracto_respiratório.pdf: 184859 bytes, checksum: 7b8a8adb5630b22d4bcb75abbd3200fa (MD5) Previous issue date: 2004

Submitted by Sofia Amador (sofiamador@fm.ul.pt) on 2012-03-19T11:41:04Z No. of bitstreams: 1 Cuidados comunitarios_ hospitalares.pdf: 71622 bytes, checksum: 472f1d09872f6fbc6e85d998d39d5a8c (MD5) Made available in DSpace on 2012-03-19T14:03:38Z (GMT). No. of bitstreams: 1 Cuidados comunitarios_ hospitalares.pdf: 71622 bytes, checksum: 472f1d09872f6fbc6e85d998d39d5a8c (MD5) Previous issue date: 2000

To determine the number and type of HIV tests requested in general practice (GP) and in hospital outpatient clinics, to identify principle risk behaviors, to determine the percentage of HIV positive tests and to identify possible factors associated with the request of HIV tests. METHODS: Cross-sectional, analytical and observational study, involving 80 GPs and 45 hospital specialists in the region of Lisbon. All requests for HIV tests were analysed during a 12 month period. RESULTS: 936 HIV tests were requested, with a mean of 12.47 in GP and 0.69 in the hospital. Risk behaviors observed were mainly heterosexual contacts and intravenous drug abuse (IVDA). The motives of the requests mainly were pregnancy, risk behaviors in GP and the presence of symptoms suggesting HIV infection in the hospital. The initiative of the request came from doctors in 70% of the cases. The percentage of HIV positive tests (ELISA + Western blot) was 4.2% in GP and 32% in the hospital. According to risk behaviors, the percentage of seropositivity was 33% in homo/bisexuals, 13% in IVDA, 7% in heterosexuals with risk behaviors and 0.2% in individuals with unidentified risk behaviors. CONCLUSIONS: The patterns of request of HIV tests differ in hospital and in GP. In a significant percentage of cases, no informed consent was obtained prior to HIV testing, both in hospital and GP. This study may serve as an indicator of the need for information and education programs concerning HIV testing directed to health professionals and the general population., Objectivos: Determinar o numero e o tipo de testes serológicos para o VIH solicitados em consultas de clinica geral e em consultas hospitalares, identificar os principais comportamentos de risco, determinar a percentagem de seropositividade para o VIR e identificar possíveis factores associados ao pedido dos testes. Métodos: Estudo de observação, transversal e analítico, com a participação de 80 clínicos gerais e 45 especialistas hospitalares. Foram analisados todos os pedi dos de testes serológicos para o VIR feitos durante 1 ano. Resultados: Foram pedidos 936 testes para o VIR, sendo a media por medico de 12,47 na clinica geral e 0,69 no hospital. Os comporta mentos de risco mais vezes observados foram os contactos heterossexuais de risco e a toxicodependência. Os principais motivos de pedido foram a gravidez e a existência de comportamentos de risco na clinica geral e a suspeita de infecção VIH no hospital. A iniciativa do pedido partiu do medico em mais de 70% dos casos. Numa percentagem significativa de casos os testes foram pedidos numa fase em que poderia não ter ocorrido ainda a seropositivação. A percentagem de seropositivos para o VIR (ELISA Westernblot) foi de 4,2% nas consultas de clinica geral e 32% no hospital. A percentagem de seropositividade foi de 33% nos homo/bissexuais, 13% nos toxico dependentes, 7% nos heterossexuais com comportamento sexual de risco e 0,2% nos indivíduos sem factores de risco. Conclusões: Os padrões de pedido dos testes serológicos para o VIR são significativamente diferentes a nível da clinica geral e do hospital. Parecem verificar-se algumas atitudes menos adequadas por parte dos médicos, nomeadamente a ausência de consentimento esclarecido dos doentes antes da realização dos testes, numa percentagem significativa de casos. Estudos deste tipo podem constituir indicadores importantes da percepção do risco de infecção pelo VIR por parte da população em geral e dos próprios profissionais de saúde, permitindo avaliar da necessidade de determinados programas de intervenção, nomeadamente campanhas de informação e formação.

Copyright © 1989 by The Journal of Rheumatology Publishing Co. Ltd., Agranulocytosis and liver injury is described in a patient with Reiter's syndrome of 3 years duration who received pyrazinobutazone for 6 weeks before the development of the clinical picture reported. Other causes of agranulocytosis and hepatic damage were excluded and a lymphocyte transformation test to the drug revealed significant lymphocyte proliferation in response to the drug. This suggests a hypersensitivity reaction as the mechanism for this previously unrecognized association of adverse effects to pyrazinobutazone.

Copyright © 2020 IOS Press All rights reserved., Plant sterols have been reported to decrease plasma concentrations of cholesterol without any side effects. To evaluate the effects on plasma cholesterol concentrations and the hemorheological parameters, we performed a study with hypercholesterolemic patients (n=19) treated with phytosterol-enriched milk (2 g/day). Hypercholesterolemic patients (n=15) of matched age drinking equal type of milk but without phytosterols were used as control group. Concentrations of total cholesterol, HDL-C, LDL-C and hemorheological parameters were measured in the beginning, after 15 and 30 days of milk intake. After 15 days of beverage intake, hypercholesterolemic subjects treated with phytosterol-enriched milk showed a significant decrease in plasma concentrations of total cholesterol and LDL-C by 9.62% (p, This study was supported by grant from Lactogal S.A. of Portugal.

Tese de mestrado, Epidemiologia, Universidade de Lisboa, Faculdade de Medicina, 2017 Submitted by Fernando João Machado (fjmachado@fm.ul.pt) on 2018-06-20T14:10:33Z No. of bitstreams: 1 11541_Tese.pdf: 2688645 bytes, checksum: 084916603228370e799d07fe4b059d05 (MD5) Made available in DSpace on 2018-06-20T14:10:43Z (GMT). No. of bitstreams: 1 11541_Tese.pdf: 2688645 bytes, checksum: 084916603228370e799d07fe4b059d05 (MD5) Previous issue date: 2017

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2017-07-18T14:09:07Z No. of bitstreams: 1 SaraDPeixoto.pdf: 652136 bytes, checksum: 8d86d31d6f4a47398a39e2bfe571208b (MD5) Made available in DSpace on 2017-10-30T15:31:38Z (GMT). No. of bitstreams: 1 SaraDPeixoto.pdf: 652136 bytes, checksum: 8d86d31d6f4a47398a39e2bfe571208b (MD5) Previous issue date: 2016

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2016-06-09T11:58:09Z No. of bitstreams: 1 InesFMLoureiro.pdf: 347701 bytes, checksum: 60d1f46281f22c42394d3e0191608380 (MD5) Made available in DSpace on 2016-06-09T16:18:56Z (GMT). No. of bitstreams: 1 InesFMLoureiro.pdf: 347701 bytes, checksum: 60d1f46281f22c42394d3e0191608380 (MD5) Previous issue date: 2014

Tese de mestrado, Epidemiologia, Faculdade de Medicina, Universidade de Lisboa, 2012 Submitted by Lucília Mateus (luciliamateus@fm.ul.pt) on 2012-06-21T12:26:36Z No. of bitstreams: 1 647104_Tese.pdf: 3194295 bytes, checksum: 4a50247e401bd2954575cc0dfb4542a0 (MD5) Made available in DSpace on 2012-06-22T13:50:58Z (GMT). No. of bitstreams: 1 647104_Tese.pdf: 3194295 bytes, checksum: 4a50247e401bd2954575cc0dfb4542a0 (MD5) Previous issue date: 2012