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Funding Information: Medical writing support for this article was provided by Paula Pinto, PhD, of PMA – Pharmaceutical Medicine Academy and was funded by Bial. All authors contributed equally to this work and should be considered co-first authors for this study. Funding Information: This article was funded by Bial. Bial provided all necessary scientific bibliography and funded medical writing support and publishing charges. The authors did not receive direct funding for the writing of this article. Publisher Copyright: © 2021 Cardoso et al. The well-recognized individual heterogeneity within COPD patients has led to a growing interest in greater personalization in the approach of these patients. Thus, the treatable traits strategy has been proposed as a further step towards precision medicine in the management of chronic airway disease, both in stable phase and acute exacerbations. The aim of this paper is to perform a critical review on the treatable traits strategy and propose a guide to approach COPD patients in the light of this new concept. An innovative stepwise approach is proposed – a multidisciplinary model based on two distinct phases, with the potential to be implemented in both primary care and hospital settings. The first phase is the initial and focused assessment of a selected subset of treatable traits, which should be addressed in all COPD patients in both settings (primary care and hospital). As some patients may present with advanced disease at diagnosis or may progress despite this initial treatment requiring a more specialized assessment, they should progress to a second phase, in which a broader approach is recommended. Beyond stable COPD, we explore how the treatable traits strategy may be applied to reduce the risk of future exacerbations and improve the management of COPD exacerbations. Since many treatable traits have already been related to exacerbation risk, the strategy proposed here represents an opportunity to be proactive. Although it still lacks prospective validation, we believe this is the way forward for the future of the COPD approach. publishersversion published

Background: Chronic obstructive pulmonary disease (COPD) is frequently associated with exertional oxygen desaturation, which may be evaluated using the 6-minute walking test (6MWT). However, it is a time-consuming test. The 1-minute sit-to-stand test (1STST) is a simpler test, already used to evaluate the functional status. The aim of this study was to compare the 1STST to the 6MWT in the evaluation of exertional desaturation. Methods: This was a cross-sectional study including 30 stable COPD patients who performed the 6MWT and 1STST on the same day. Six-minute walking distance (6MWD), number of 1STST repetitions (1STSTr), and cardiorespiratory parameters were recorded. Results: A significant correlation was found between the 6MWD and the number of 1STSTr (r = 0.54, p = 0.002). The minimum oxygen saturation (SpO2) in both tests showed a good agreement (intraclass correlation coefficient (ICC) 0.81) and correlated strongly (r = 0.84, p &lt, 0.001). Regarding oxygen desaturation, the total agreement between the tests was 73.3% with a fair Cohen&rsquo, s kappa (&kappa, = 0.38, p = 0.018), and 93.33% of observations were within the limits of agreement for both tests in the Bland&ndash, Altman analysis. Conclusion: The 1STST seems to be a capable tool of detecting exercise-induced oxygen desaturation in COPD. Because it is a less time- and resources-consuming test, it may be applied during the outpatient clinic consultation to regularly evaluate the exercise capacity and exertional desaturation in COPD.

The objective of the present study was to characterize the duration of the phenological stages, the agronomic characteristics and grain yield in soybean cultivars with contrasting cycles and indeterminate growth type, submitted to different fertilization investment environments under no-tillage system in the central region of Minas Gerais. The work was conducted under field conditions, in an experimental area of Embrapa Maize and Sorghum, in Sete Lagoas, MG, in the harvest of 2015/2016. Ten soybean cultivars with different relative maturity groups (RMG) were studied, representing almost all RMG materials currently sown in Minas Gerais, in two environments with different levels of fertilizer investment. The variables were submitted to analysis of joint variance, in order to verify the existence of interaction between cultivars and investment in fertilization environments. Fertilizer investment levels influence grain yield of soybean cultivars of contrasting cycles. The higher height of the soybean plants implies higher lodging and lower grain yield. This situation is aggravated by the greater investment in fertilization. The difference between the cycles of the cultivars is in the duration of the vegetative stages, being greater in the later cultivars. Made available in DSpace on 2017-12-05T23:31:27Z (GMT). No. of bitstreams: 1 Evaluationsoybean.pdf: 340935 bytes, checksum: a35debaa8e2cafc2030b39e54e84f556 (MD5) Previous issue date: 2017-12-05

Respiratory diseases, like COPD, gradually impairs a patient’s overall physical ability and reduces health-related quality of life. Respiratory rehabilitation (RR) has proved to have clinical benefits in some pathologies but there is a lack of long-term results. The objective of this study was to examine the 5-year mortality and prognostic factors in a RR program. A retrospective analysis of the patients integrated into RR program in 2014 was conducted. 73 cases were considered, with a male predominance of 72.6% (median age of 66.0 years). The majority of the patients had obstructive diseases as COPD in 77.1% and Asthma in 5.7%. The others had various diagnoses belonging to diffuse lung diseases (7.1%), bronchiectasis (4.3%) and restrictive syndromes (2.9%). The median FEV1 was 43.1% and a median of meter walked in the 6-MWT of 420.0 m. 6 patients (8.2%) did not complete the program, 4 of them quit and the other 2 died during the program. 46.6% repeated the program, 27.4% repeated for ≤3 years and 24.7% for ≥3years. 17.8% maintained domiciliary exercises after program. At the end of the 5-year follow-up, only 61.6% of the patients were alive. 57.7% died in the context of exacerbation. Lower values of FVC (p=0.038), distance walked in 6-MWT (p=0.024) and superior values of PASP (p In this real-world retrospective study, we found satisfactory maintenance of the RR program, either in the hospital or at home, and 5-year mortality of 38.4%. The major prognostic factors were the value of FVC, 6-MWT distance and PASP. RR is an unvalued tool to patients with respiratory diseases and it’s crucial to identify the precociously the patients to refer to RR.

Comprehensive understanding of COPD phenotypes, incorporating simple, widely used and meaningful outcomes (e.g., functional status), might contribute to personalise patients’ assessment and management. We described COPD phenotypes and developed a classification tree for its prediction. A cross-sectional study was conducted with patients with COPD. Data collection included airway obstruction (FEV1pp); comorbidities (Charlson comorbidity index); functional status (one-minute sit-to-stand test [1-minSTS]) and impact of the disease (COPD assessment test [CAT]). Clustering analysis using k-medoids was used to explore existent phenotypes. A classification tree was generated with 70% of the sample. The remaining 30% was used for its validation, i.e., to determine its prediction ability to identify the correct phenotype. Accuracy/agreement (Cohen’s Kappa) were determined. 364 patients with COPD (67yrs; 76%male; FEV1 57±21pp) participated. Four phenotypes (C1, C2, C3, C4) were found (Fig. 1): two presenting severe (C1, C4) and two mild-to-moderate (C2, C3) airflow obstruction; two low (C1, C2) and two high (C3, C4) impact of the disease; two low (C3, C4) and two high (C1, C2) functional status. The classification tree established cut-offs for these variables and correctly classified 85% of new individuals in their phenotype (Cohen’s Kappa=0.8). Meaningful and easily available assessments were able to differentiate COPD phenotypes and may guide patient-centred interventions.

Growing evidence about the importance of identification of central sleep apnoea (CSA) is increasing, especially in heart failure. Despite the intense research in CSA’s field, many questions remain open regarding the pathophysiology, the impact on prognosis and the best treatment approach. Therefore, we aimed to review recent evidence concerning patient selection and treatment options in CSA. Considering the aetiology of CSA, optimization of medical therapy or withdrawal of substances/exposures is the first step. Because CSA often persists regardless of medical treatment, targeted treatment for CSA must be considered mainly with positive airway pressure (PAP). Furthermore, studies on recent therapies such as phrenic neurostimulation appear to offer promising options for the future.

Background: Functional impairment is a critical consequence of COPD. The 1-minute sit-to-stand (1STS) is a valid and reliable test to measure this health domain in patients with COPD, with established reference values. We aimed to quantify the prevalence of functional impairment in patients with COPD and identify the distribution of this impairment across disease stages. Methods: A cross-sectional study with patients with COPD and healthy age-/gender-matched controls was conducted. Spirometry, the modified British Medical Research Council questionnaire (mMRC) and the 1STS were collected. Patients were grouped by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifications. Differences between groups were explored with Kruskal-Wallis and Bonferroni-adjusted pairwise comparisons. Results: 366 patients with COPD (76% male, 67±10y, FEV1 56±21pp) and 345 controls (70% male, 67±9y, FEV1104±21pp) participated. 50% of the patients presented functional impairment (i.e., performed below 80%predicted). Patients with COPD presented lower functional ability than controls, independently of the GOLD grade/group (Fig. 1). The most symptomatic patients (i.e., GOLD B and D) had the lowest functional levels. Conclusion: Functional ability is reduced in patients with COPD in all GOLD grades/groups, especially in the most symptomatic. Future studies should explore therapeutic interventions to address this problem.

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease, and there is a clinical need for validated markers and biomarkers that can contribute to the assessment of patients, risk prediction, treatment guidance, and assessment of response. Although according to the 2018 GOLD guidelines clinically useful biomarkers for COPD patients in stable condition have yet to be identified, several clinical markers and biomarkers have been proposed for COPD. These include isolated clinical markers, such as symptoms and Health Status assessment, exercise tests, function tests and imaging, and also composite scores and molecular markers.However, and despite strong efforts to identify useful markers in an attempt to improve prognostic and therapeutic approaches, results have not been consistent and expectations of relying on these markers in near future are faint.Current approaches to COPD have shifted from treating the disease to treating the individual patient. There is a clear need to identify treatable traits, focusing more on the patient and not on the disease, in order to implement an increasingly personalized treatment of COPD in the clinic, leading to true precision medicine. There is a need to identify combinations of clinical markers and biomarkers, genetic markers, and phenotypes that can guide the personalized therapy of COPD patients.This critical review will therefore focus not only on currently established markers and biomarkers in COPD but also on possible future approaches toward precision medicine. Keywords: COPD, Markers, Biomarkers, Treatable traits, Precision medicine

Rationale: Evidence supporting the association of chronic obstructive pulmonary disease or airflow obstruction with use of solid fuels is conflicting and inconsistent. Objectives: To assess the association of airflow obstruction with self-reported use of solid fuels for cooking or heating. Methods: We analyzed 18,554 adults from the BOLD (Burden of Obstructive Lung Disease) study, who had provided acceptable post-bronchodilator spirometry measurements, and information on use of solid fuels. The association of airflow obstruction with use of solid fuels for cooking or heating was assessed by sex, within each site, using regression analysis. Estimates were stratified by national income and meta-analyzed. We performed similar analyses for spirometric restriction, chronic cough, and chronic phlegm. Measurements and Main Results: We found no association between airflow obstruction and use of solid fuels for cooking or heating (odds ratio [OR] for men, 1.20 [95% confidence interval (CI), 0.94–1.53]; OR for women, 0.88 [95% CI, 0.67–1.15]). This was true for low-/middle- and high-income sites. Among never-smokers, there was also no evidence of an association of airflow obstruction with use of solid fuels (OR for men, 1.00 [95% CI, 0.57–1.76]; OR for women, 1.00 [95% CI, 0.76–1.32]). Overall, we found no association of spirometric restriction, chronic cough, or chronic phlegm with the use of solid fuels. However, we found that chronic phlegm was more likely to be reported among female never-smokers and those who had been exposed for 20 years or longer. Conclusions: Airflow obstruction assessed from post-bronchodilator spirometry was not associated with use of solid fuels for cooking or heating.

RESUMO - Neste trabalho, objetivou-se avaliar a resposta do milho a adubacao NPK, em semeadura realizada nos meses de janeiro e fevereiro, sucedendo a cultura da soja, em Rio Verde-GO. O experimento foi conduzido em delineamento de blocos casualizados, num esquema fatorial 4x2, constituido por quatro opcoes de adubacao NPK na semeadura, com ou sem adubacao nitrogenada de cobertura. Foram cultivados os hibridos P 30F53 YH e DKB 310 PRO, no primeiro e segundo anos, respectivamente, e coletados os dados de altura de plantas e de espigas, numero de espigas, de fileiras por espiga, de graos por fileira, massa de 1.000 graos e produtividade. A produtividade de graos do milho safrinha e influenciada pelas epocas de semeadura que definem as condicoes de disponibilidade hidrica, e pela adubacao nitrogenada em cobertura, sem expressar resposta a adubacao NPK na semeadura, que, em janeiro, favorece a produtividade, por conciliar melhor a distribuicao de chuvas no final da fase de desenvolvimento vegetativo e na fase reprodutiva, etapas criticas para o potencial produtivo do milho. Independentemente da epoca de cultivo e da adubacao NPK na semeadura, a aplicacao de N em cobertura promove ganho significativo de produtividade da cultura. Palavras-chave: sucessao de culturas, adubacao de manutencao, veranico, Zea mays L. SECOND-SEASON CORN RESPONSE TO FERTILIZATION IN TWO SEEDING TIMES ABSTRACT - This study aimed to evaluate the response of maize to NPK fertilization in sowing in January and February, succeeding soybean crop, in Rio Verde, State of Goias, Brazil. The experiment was conducted in a randomized block design in a 4x2 factorial scheme, and it consisted of four NPK options in seeding time, with or without nitrogen topdressing. Hybrids P 30F53 YH and DKB 310 PRO were grown in the first and second year, respectively. We collected the data of plant height, ears height, number of ears, number of rows per ear, number of grains by row, thousand kernel weight and productivity. The productivity of second-season maize grain is influenced by sowing time, which defines the conditions of water availability, and the nitrogen fertilization, without expressing response to NPK fertilizer at sowing. Seeding in January favors productivity to reconcile better distribution of rainfall at the end of the vegetative growth phase and reproductive phase, critical steps for the production of maize potential. Regardless of the growing season and NPK fertilization at sowing, application of N topdressing promotes significant productivity gain. Keywords: crop succession, fertilization, nutrient requirements, dry spell, Zea mays L.

Introducing cultivars of high productive potential with adequate agronomic management has contributed to the increase of maize yield in Brazil. This study aimed to characterize the extraction and exportation of micronutrients by modern maize hybrids grown in no-tillage system in the Cerrado region (Brazilian Savannah) with two fertilization levels. We established two crop environments with differentiated levels of soil fertilization, use of products for seed treatment and leaf fertilization, in which four transgenic hybrids were grown. For each environment, we used an experimental design of randomized blocks with four replicates. There were eleven plant samplings during the crop cycle to quantify dry mass production and Cu, Fe, Mn and Zn extraction. Micronutrient uptake is increased when a hybrid with higher potential for biomass production grows in an environment with greater supply of nutrients. Uptake persists throughout the maize cycle, including during the final stages of the reproductive phase, showing late demand for the crop. On average, after tasseling, about 39, 50, 42, and 49% of the total Cu, Fe, Mn and Zn absorption still occurs, respectively. Total uptake of Cu, Fe, Mn and Zn are, respectively, around 8, 199, 58 and 40 g to produce a tonne of grain, from which 23, 5, 8, and 42% are exported by the harvest. Micronutrient uptake and exportation rates for the studied transgenic hybrids are lower than the ones previously reported in Brazil and in works abroad. Keywords Made available in DSpace on 2019-01-12T23:32:55Z (GMT). No. of bitstreams: 1 Uptakeexportation.pdf: 658811 bytes, checksum: 33b9a7e9300c8f4d5310d6f4fd158ea7 (MD5) Previous issue date: 2019-01-11

RESUMO - Neste trabalho, objetivou-se avaliar a produtividade da forragem e graos de milho e do capim braquiaria em consorcio, submetidos a diferentes niveis de sombreamentos proporcionados pelos renques de eucaliptos, em sistema de Integracao Lavoura-Pecuaria-Floresta, na regiao de Sete Lagoas-MG. O experimento foi conduzido na area experimental da Embrapa Milho e Sorgo, em Sete Lagoas-MG, em area de cultivo de eucalipto ( Eucalyptus urophylla , clone AEC 1528) implantado em 29 de outubro de 2013, em espacamento 15x2 m entre plantas. Em 24 de novembro de 2015, foi realizada a semeadura simultânea em sistema plantio direto do milho (AG 8088 VT PRO) consorciado com capim braquiaria ( Urochloa brizantha cv. Marandu) em espacamentos de 0,70 m entre linhas, a uma distância de 1 metro entre a primeira linha de semeadura do milho/braquiaria e os renques de eucalipto. As produtividades de graos e forragem de milho e de milho mais capim entre os renques de eucalipto foram semelhantes as produtividades em pleno sol a partir de 3,8 m de distância entre as linhas de milho e os renques de eucalipto. A produtividade de graos e de forragens foi diretamente influenciada pela reducao da distância entre as linhas de semeadura e os renques de eucalipto com tres anos de implantacao em espacamento de 15x2. O componente arboreo no sistema de Integracao Lavoura-Pecuaria- Floresta altera o ambiente no sub-bosque, reduzindo a incidencia de radiacao fotossinteticamente ativa entre os renques, diminuindo diretamente as produtividades de forragem e graos de milho em cultivo consorciado com U. brizantha . Palavras-chave : Zea mays , U. brizantha , eucalipto, cultivo consorciado. GRAIN AND FORAGE PRODUCTION IN THE FUNCTION OF LUMINOUS AVAILABILITY IN INTEGRATED CROP-LIVESTOCK-FORESTRY SYSTEMS ABSTRACT - The objective of this work was to evaluate the productivity of grass and maize forage, and maize grains submitted to different levels of shade provided by the eucalypt trees, in Integrated Crop-Livestock-Forest system, in the region of Sete Lagoas, State of Minas Gerais, Brazil. The experiment was carried out in the experimental area of Embrapa Milho e Sorgo, in Sete Lagoas, MG, in an area of eucalypt ( Eucalyptus urophylla , clone AEC 1528) implanted on October 29, 2013, spaced 15x2 m between plants. On November 24, 2015, no-tillage system (AG 8088 VT PRO) was intercropped with Brachiaria grass ( Urochloa brizantha cv. Marandu) at 0.70 m between rows, at distance of 1 meter between the first sowing line of maize/Brachiaria and eucalypt rows. The yields of maize forage, maize grains and Brachiaria among the eucalypt rows were similar to the productivities in full sun from 3.8 m distance between maize and eucalypt lines. Grain yield and maize fodder yields were directly influenced by the reduction of the distance between the sowing lines and the eucalypt rows with three years of implantation at 15x2 spacing. The arboreal component in Integrated Crop-Livestock-Forest system alters the environment in the sub-forest, reducing the incidence of photosynthetically active radiation among the ranks, directly reducing forage and maize grains yields in intercropping system with U. brizantha . Keywords: Zea mays , U. brizantha , eucalypt, intercropping system.

Maritime Spatial Planning (MSP) is bringing new challenges to planning and management in the marine realm, namely on the environmental assessment of the new plans and projects. Portugal is developing its first MSP instrument, PSOEM (Plano de Situacao do Ordenamento do Espaco Maritimo), since 2015 and published it on December 2019. This paper focuses on a particular stage of the Strategic Environmental Assessment (SEA) of PSOEM regarding the assessment of the activities/uses that may significantly affect Natura 2000 marine network during the Plan's implementation in the Mainland subdivision. Over the years, progress has been made in researching and assessing the environmental impacts of maritime activities/uses. However, its application to practice raised several challenges and limitations. The methodological approach presented in this paper was developed to overcome knowledge, data and time constraints. Some of the limitations are a consequence of the MSP approach itself adopted in Portugal, namely the low technical detail on future uses and activities, which is required and desirable at this level of planning. Others relate with the lack of spatially explicit data on marine habitats and species distribution preserved under Natura 2000 network, which is not fully established in the marine environment. The adopted methodology started with the characterization and mapping of the conservation values and the pressures arising from the potential activities/uses. It followed with the assessment of their impacts and finally with the identification of mitigation measures, which were then adopted by the PSOEM as good practices. As new knowledge is generated and more information is collected, this tailor-made approach can be easily adapted and improved to keep supporting decision-making throughout PSOEM's implementation. The method can be easily adapted and transferred to other contexts, not only within the Portuguese maritime area, and could be made available to stakeholders that wish to invest in blue growth.

Introduction: Elderly patients have age-related changes in their sleep, with increased risk for obstructive sleep apnea (OSA). However, there is still scarce data about the characteristics of OSA in these patients. Objectives: To compare the characteristics of OSA in the elderly and younger patients. Methods: Retrospective study including patients with OSA (apnea hypopnea index (AHI) =5), divided in two groups: elderly (=65 years) and younger patients ( Results: 328 patients were diagnosed with OSA. In the elderly group (n=92), there were higher mean body mass index (BMI=29.9±8 kg/m2), Mallampati class IV (55%), Beck depression score (median 9±15), complaints of nocturia, erectile dysfunction and impaired libido. On the other hand, daily somnolence, respiratory pauses, snoring and headaches were more prevalent in younger patients. Sleep study results revealed higher wakes after sleep onset (WASO=119±56 minutes, p=0.253) and AHI (22±26, p Conclusions: OSA is common in the elderly, increasing morbidity and mortality. In this analysis, we found marked differences in terms of symptoms and sleep study results, between young and older patients, so OSA in the elderly may require a different management.

Introduction: Sleep apnea (SA) is a highly prevalent disorder. Due to its costs and the crescent testing demand scores, such as the NoSAS, have been developed to recognize individuals at higher risk of SA. Aim: To evaluate the clinical utility of the NoSAS and to compare it with the STOP-BANG score. Methods: Retrospective analysis of patients who underwent a sleep study for suspected SA from January 2017 to September 2018. For each questionnaire, patients were divided into high and low risk. SPSS software was used for statistical analysis. Results: A total of 91 patients (60.4% male), with mean age of 54.0±14.1 years and mean BMI of 29.6±6.1kg/m2 were included. The mean NoSAS was 10.1±4.4 and STOP-BANG was 4.34±1.5. The NoSAS showed a moderate and significant correlation with the STOP-BANG (r=0.73;p Conclusions: The NoSAS and STOP-BANG seem to have a similar discrimination in this Portuguese cohort. In our sample, STOP-BANG seems to have more sensitivity but less specificity than NoSAS. Larger studies are needed to confirm our results concerning the clinical impact of NoSAS.

Background: Pulmonary rehabilitation (PR) has demonstrated patients’ physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit. Methods: A 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patientcaregivers) will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea (modified Medical Research Council Questionnaire), fatigue (Checklist of individual strength and Functional assessment of chronic illness therapy – fatigue), cough and sputum (Leicester cough questionnaire and Cough and sputum assessment questionnaire), impact of the disease (COPD Assessment Test), emotional state (The Hospital Anxiety and Depression Scale), number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion (Family Adaptation and Cohesion Scale). Other clinical outcomes will be peripheral (biceps and quadriceps-hand held dynamometer, 1 or 10 repetition-maximum) and respiratory (maximal inspiratory and expiratory pressures) muscle strength, muscle thickness and cross sectional area (biceps brachialis, rectus femoris and diaphragm-ultrasound imaging), exercise capacity (six-minute walk test and one-minute sit to stand test), balance (brief-balance evaluation systems test) and physical activity (accelerometer). Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted.Discussion: This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases. Trial registration: The trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 10th January, 2019 (registration number: NCT03799666). Keywords: Exercise training, Education and psychosocial support, Chronic respiratory diseases, Primary healthcare, Cost-benefit. This work, was funded by Fundo Europeu de Desenvolvimento Regional (FEDER) - Comissão Diretiva do Programa Operacional Regional do Centro and by Fundação para a Ciência e Tecnologia - FCT (SAICT-POL/23926/2016), and partially funded by Programa Operacional Competitividade e Internacionalização (COMPETE), through COMPETE 2020 (POCI-01-0145- FEDER-016701 and POCI-01-0145-FEDER-007628) and FCT (UID/BIM/04501/ 2013 and UID/BIM/04501/2019). CJ has a post-doctoral grant (SFRH/BPD/ 115169/2016) funded by FCT, co-financed by the European Social Fund (POCH) and Portuguese national funds from MCTES (Ministério da Ciência, Tecnologia e Ensino Superior). published

Pulmonary rehabilitation (PR) is an evidence-based intervention to manage chronic respiratory diseases (CRD), but its benefits diminish over time. Web-based approaches may have a key-role in supporting patients to comply with their maintenance action plan, if familiarity with this technology exist. This study explored if patients with CRD have access to digital technology and if they feel confident in using it. This was a cross-sectional study with patients referred to community-based PR programs. Patients were surveyed regarding the use of the internet, computers, smartphones/tablets and cell phones. Their confidence in using these technologies was assessed using a scale from 0 (not at all confident) to 10 (completely confident). Patients were considered confident when a score >5 was selected. A multivariate logistic regression to predict use of internet was performed using the Enter method. 141 patients (61% male; 67±11y) were included. Chronic obstructive pulmonary disease (60%) and asthma (18%) were the most common diagnoses. Most patients (n=115; 81.6%) used digital technology, namely smartphone/tablets (44%), computers (38%) and cell phones (37%). 114 (81%) patients reported to be confident in using these devices (Median-M 7, Interquartile-IQR 5-9.5). More than half (n=75; 53%) used the internet and 85% of them felt confident in using it (M 8, IQR 5.75-10). Lower age (odds ratio-OR=.935; 95%CI .889-.982) and higher level of education (OR=3.633; 95%CI 2.093-6.307) explained 46% of the variance in internet use. Patients with CRD have access to and feel confident in using digital technologies. Digital technologies may be promising for self-management/maintenance strategies in this population. published

RESUMO - No Brasil Central, a produtividade e a demanda nutricional do milho em sucessao a soja cultivada no verao sao dependentes das condicoes climaticas ao longo do ciclo. Sendo assim, objetivou-se com esse trabalho quantificar a extracao e exportacao de nutrientes pelo milho, em funcao da epoca de semeadura e da adubacao fornecida na safrinha de 2014, em Rio Verde-GO. Em cada epoca de semeadura (29/01/2014 e 25/02/2014) foi conduzido um experimento em delineamento de blocos casualizados, com quatro repeticoes, num esquema fatorial 4x2, sendo quatro adubacoes de semeadura (00-00-00, 00-50-50, 25-50-50 e 50-50-50 kg ha-1 de N-P2O5-K2O), com ou sem adubacao nitrogenada em cobertura (0 ou 50 kg ha-1 de N). Ao final do ciclo, foram avaliados o rendimento de graos e o acumulo de nutrientes nos componentes da parte aerea. Foram determinadas a extracao e a exportacao de nutrientes. O desenvolvimento e a extracao de nutrientes pelo milho safrinha sao influenciados pela epoca de cultivo, assim como pela adubacao nitrogenada em cobertura, sem, contudo, ser afetados pela adubacao NPK realizada na semeadura. Ha maior producao de biomassa seca e produtividade de graos com a semeadura em janeiro em comparacao a fevereiro. O cultivo na primeira epoca e o nitrogenio em cobertura resultam em maior extracao da maioria dos nutrientes, sem necessariamente implicar maiores taxas de exportacao com a colheita dos graos. Em media, a exportacao por tonelada de graos produzida foi de 14,2; 1,5; 2,8; 0,07; 0,7 e 1,0 kg de N, P, K, Ca, Mg e S; e de 2; 12; 4 e 16 g de Cu, Fe, Mn e Zn, respectivamente. Esses valores implicam doses relativamente baixas de fertilizantes na adubacao de manutencao para repor a exportacao na colheita do milho safrinha. Palavras-chave : sucessao de culturas, extracao, exportacao, requerimentos nutricionais, Zea mays L. OFF-SEASON CORN NUTRIENT DEMAND ACCORDING TO THE SOWING DATE AND FERTILIZATION ABSTRACT - In Central Brazil, productivity and nutritional demand of corn in succession to soybeans grown in summer are dependent on climatic conditions throughout the cycle. Therefore, the objective of this work was to quantify the extraction and exportation of nutrients by off-season corn, according to the sowing date and fertilization in Rio Verde, State of –Goias, Brazil. In each sowing time (01/29/2014 and 02/25/2014), a randomized complete block design experiment was carried out, with four replications, in a 4x2 factorial scheme, with four sowing fertilizations (00- 00-00, 00 -50-50, 25-50-50 and 50-50-50 kg ha-1 of N-P2O5-K2O), with or without nitrogen fertilization (0 or 50 kg ha-1 N). At the end of the cycle, grain yield and nutrient accumulation in shoot components were evaluated. The extraction and export of nutrients were determined. The growing season and the sidedress nitrogen influence the development and extraction of nutrients by the off-season corn, without, however, being affected by the NPK fertilization at sowing. There is higher production of dry biomass and grain yield with sowing in January compared to February. First-season cultivation and sidedress nitrogen result in greater extraction of most nutrients, without necessarily implying higher export rates with grain harvest. On average, the export per ton of grain produced was 14.2, 1.5, 2.8, 0.07, 0.7, and 1.0 kg for N, P, K, Ca, Mg and S; and 2, 12, 4, and 16 g for Cu, Fe, Mn and Zn, respectively. These values result in relatively low amounts of fertilizers in the maintenance fertilization to replace the nutrients exported by the grain harvest. Keywords : succession crops, extraction, export, nutrient requirements, Zea mays L.

Objective To describe the implementation, main intervention areas and initial results of the Integrated Strategy for the Promotion of Healthy Eating (EIPAS) in Portugal. Methods EIPAS was published as a Law, in December of 2017, as a result of a collaboration between several ministries, including the Finance, Internal Affairs, Education, Health, Economy, Agriculture, and Sea Ministries, aiming at improving the dietary habits of the Portuguese population. The working group, led by the Ministry of Health, developed this strategy for over a year. The framework produced was based on WHO and European Commission recommendations as well as on relevant data from the last Portuguese dietary intake survey (2015/2016). EIPAS also reflects the results of a public hearing, including the food industry, among others, and the experience gathered, since 2012, through the National Programme for the Promotion of Healthy Eating. It considers the ‘health in all policies’ challenge set by WHO and has four different strategic areas, namely (1) creation of healthier food environments, (2) improvement of the quality and accessibility of healthy food choices for consumers, (3) promotion and development of literacy, in order to encourage healthy food choices, and (4) promotion of innovation and entrepreneurship. In order to achieve these goals, a set of 51 actions was established and assigned to the seven ministries involved. Results Under the scope of this strategy, Portugal has already implemented several actions, including (1) definition of standards for food availability at all public healthcare institutions; (2) implementation of a sugar tax on sweetened beverages; (3) implementation of a voluntary agreement with the food industry sector for food reformulation (work in progress); (4) design of a proposal for an interpretative model of front-of-pack food labelling; (5) improvement of the nutritional quality of food aid programmes for low-income groups; and (6) regulation of marketing of unhealthy foods to children. Conclusions For the first time, Portugal has a nutrition policy based on the WHO concept of ‘health in all policies’ and on the national data on food intake. The implementing process of all 51 actions and the inherent complexities and difficulties found so far have made this process be an authentic political and social laboratory that deserves to be followed.

© Journal of Thoracic Disease. All rights reserved., The Global Alliance against Chronic Respiratory Diseases (GARD) is a voluntary network of national and international organizations, institutions and agencies led by the World Health Organization (WHO), working towards the vision of a world where all people breathe freely (1). GARD is supporting WHO in successfully implementing the WHO’s Global Action Plan for the Prevention and Control of Noncommunicable Diseases (NCDs) 2013–2020. The GARD report on GARD activities is published on a regular basis. Collaboration among GARD countries is critical for sharing experiences and providing technical assistance to developing countries based on each country’s needs (2). The annual GARD meeting is a unique opportunity for assembling all of the GARD participants from developed and developing countries: European countries, North and South American Countries, China, Vietnam as well as Eastern Mediterranean, and African countries. Coordinator for Management of NCDs in the WHO Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention (Cherian Varghese) is present at this meeting. The annual meeting of GARD is a forum for exchanging opinions in order to improve care for chronic respiratory diseases (CRDs) and to achieve the GARD goal—a world where all people breathe freely. Experts—in collaboration with WHO—are helping developing countries to achieve their projects regarding teaching, research and programming for CRD. Each year, there is a poster presentation session on country activities. Each participant is able to present his/her country activities that have been achieved since the last meeting. This is followed by discussion. In this paper, we summarize the posters presented during the 11th GARD general meeting. We hope that this will give readers of the GARD section an opportunity to learn for their countries. We can find all posters on the link: https://gard-breathefreely.org/resources-poster/.

Resumo Ao longo de todo o meu período de estágio na CALCOB - Cooperativa Agrícola de Oliveira do Bairro e Vagos, C.R.L., tive a oportunidade de desenvolver diversas atividades nos departamentos ligados à área financeira, tendo realizado tarefas relacionadas com os serviços de contabilidade e gestão da cooperativa e efetuado diversas atividades diárias de controlo e registos. No seguimento das atividades efetuadas durante o estágio e no seu respetivo enquadramento com o Mestrado de Gestão de Empresas Agrícolas, que me encontro a finalizar, defini como tema do meu relatório de estágio a análise e compreensão da importância das informações obtidas através contabilidade como suporte para a tomada de decisões por parte da equipa de gestão da CALCOB. É assim objetivo do presente documento compreender até que ponto a prática do registo diário e contabilístico das operações da cooperativa (e a consequente construção de mapas e relatórios de contas) serve de fonte para uma melhor e mais sustentada tomada de decisões por parte dos gestores da cooperativa, tendo como objetivo último o aumento da eficiência e da rentabilidade da cooperativa, garantindo a sua sustentabilidade e a melhoria da qualidade do serviço prestado aos seus parceiros. Palavras-Chave: Contabilidade, Gestão, Serviços Administrativo-Financeiros, Cooperativa Agrícola. Mestrado em Gestão de Empresas Agrícolas Abstrat Throughout my internship at CALCOB - Cooperativa Agrícola de Oliveira do Bairro and Vagos, CRL, I had the opportunity to develop several activities in the administrative/financial department, having performed tasks related to accounting and management services and carried out several daily control activities. Following the activities carried out during the internship and in its respective framework with the Master’s degree in Agricultural Business Management that I am currently finishing, I defined as my internship report’ subject the analysis and understanding of the importance of the information obtained through accounting as a support tool for the decision-making process carried out by CALCOB’s management team. It is therefore the purpose of this document to understand at what extent the practice of daily and accounting operations recording of the cooperative (plus consequent construction of accounting maps and reports) serves as a source for a better and more sustained decision-making process by the cooperative managers, with the ultimate goal of increasing the cooperative efficiency and profitability, guaranteeing its sustainability and improving the quality of service provided to its partners. Keywords: Accounting, Management, Administrative Services, Agricultural Cooperative

Os sistemas de integração de atividades, em propriedades agropecuárias, possibilitam uma série de efeitos positivos à produção, à região e, principalmente, aos agricultores. Nesse sentido, destacam-se os benefícios da integração lavoura-pecuária-floresta, em Minas Gerais, onde boa parte dos agricultores pratica a monocultura e depende da versatilidade de produção para manutenção das atividades nos campos. No artigo abaixo, são discutidos aspectos relacionados à produção integrada de culturas anuais, como milho, soja, feijão, arroz, sorgo e milheto, com espécies florestais e forrageiras, visando à produção dos grãos, manutenção da oferta de alimento para o gado, por período maior, e produção de madeira. As técnicas apresentadas levam em consideração características das propriedades, fatores agronômicos, econômicos e sociais. Além dos ganhos técnicos, as propriedades com atividades integradas contribuem para a sustentabilidade de produção e para o bem estar social no meio agrícola, uma vez que há proteção a recursos do meio ambiente, como a água, a microbiota edáfica benéfica, insetos, outros organismos que atuam como inimigos naturais, dentre outros. Adicionalmente, as atividades possibilitam a otimização na utilização dos recursos da propriedade, principalmente a mão-de-obra. São apresentados resultados de pesquisas recentes que comprovam os pontos positivos, assim como detalhes técnicos sobre os organismos estudados e futuros sistemas de manejo, aplicação e manutenção da tecnologia.

Objetivou-se, com este trabalho, avaliar parâmetros qualitativos e quantitativos de milho, sorgo e milheto na regiao Central de Minas Gerais para producao de forragem. Foram analisadas seis estrategias de producao: milho; sorgo; milho na safra e milheto (cv. ADR500) na safrinha; milho na safra e milheto (cv. BRS1503) na safrinha; sorgo e manutencao da rebrota na safrinha; e sorgo com manutencao da rebrota sem adubacao. Avaliaram-se a produtividade de materia seca e os teores de proteina bruta, fibras em detergente acido e neutro. O tratamento com o plantio de sorgo em outubro, e conducao da rebrota, utilizando-se adubacao de cobertura com nitrogenio apresentou o melhor desempenho produtivo. Por outro lado, o plantio de sorgo na safra, e nao conducao da rebrota, possibilitou os piores resultados. Adicionalmente, a utilizacao de milheto, como cultura posterior ao milho, tambem promoveu as melhores produtividades.

Background: There is a great heterogeneity in the prevalence of Chronic Obstructive Pulmonary Disease (COPD) across the world. The Burden of Obstructive Lung Disease (BOLD) initiative was started to measure the prevalence of COPD in a standardized way. We aimed to estimate the prevalence of COPD in Portuguese adults aged 40 years or older of a target population of 2,700,000 in the Lisbon region, in accordance with BOLD protocol. Methods: A stratified, multi-stage random sampling procedure was used which included 12 districts. The survey included a questionnaire with information on risk factors for COPD and reported respiratory disease and a post-bronchodilator spirometry performed at survey centres. Results: For the 710 participants with questionnaires and acceptable spirometry, the overall weighted prevalence of GOLD stage I+ COPD was 14.2% (95% C.I. 11.1, 18.1), and stage II+ was 7.3% (95% C.I. 4.7, 11.3). Unweighted prevalence was 20.2% (95% C.I.17.4, 23.3) for stage I+ and 9.5% (95% C.I. 7.6, 11.9) for stage II+. Prevalence of COPD in GOLD stage II+ increased with age and was higher in men. The prevalence of GOLD stage I+ COPD was 9.2% (95% C.I. 5.9, 14.0) in never smokers versus 27.4% (95% C.I. 18.5, 38.5) in those who had smoked â¥20 pack-years. The agreement between previous doctor diagnosis and spirometric diagnosis was low, with 86.8% of underdiagnosed individuals. Conclusions: The 14.2% of COPD estimated prevalence indicates that COPD is a common disease in the Lisbon region. In addition, a large proportion of underdiagnosed disease was detected. The high prevalence of COPD with a high level of underdiagnosis, points to the need of raising awareness of COPD among health professionals, and requires more use of spirometry in the primary care setting. Resumo: Introdução: A prevalência da doença pulmonar obstrutiva crónica (DPOC) apresenta valores muito heterogéneos em todo o mundo. A iniciativa Burden of Obstructive Lung Disease (BOLD) foi desenvolvida para que a prevalência da DPOC possa ser avaliada com metodologia normalizada. O objetivo deste estudo foi estimar a prevalência da DPOC em adultos com 40 ou mais anos numa população alvo de 2 700 000 habitantes na região de Lisboa, de acordo com o protocolo BOLD. Métodos: A amostra foi estratificada de forma aleatória multifaseada selecionando-se 12 freguesias. O inquérito compreendia um questionário com informação sobre fatores de risco para a DPOC e doença respiratória autoreportada; adicionalmente, foi efetuada espirometria com prova de broncodilatação. Resultados: Foram incluídos 710 participantes com questionário e espirometria aceitáveis. A prevalência estimada da DPOC na população no estádio GOLD I+ foi de 14,2% (IC 95%: 11,1; 18,1) e de 7,3% no estádio ii+ (IC 95%: 4,7; 11,3). A prevalência não ajustada foi de 20,2% (IC 95%: 17,4; 23,3) no estádio i+ e de 9,5% (IC 95%: 7,6; 11,9) no estádio ii+. A prevalência da DPOC no estádio GOLD II+ aumentou com a idade, sendo mais elevada no sexo masculino. A prevalência estimada da DPOC no estádio GOLD I+ foi de 9,2% (IC 95%: 5,9; 14,0) nos não fumadores versus 27,4% (IC 95%: 18,5; 38,5) nos fumadores com carga tabágica de â¥Â 20 Unidades Maço Ano. Detetou-se uma fraca concordância entre a referência a diagnóstico médico prévio e o diagnóstico espirométrico, com 86,8% de subdiagnósticos. Conclusões: O achado de uma prevalência estimada da DPOC de 14,2% sugere que esta é uma doença comum na região de Lisboa, contudo com uma elevada proporção de subdiagnósticos. Estes dados apontam para a necessidade de aumentar o grau de conhecimento dos profissionais de saúde sobre a DPOC, bem como a necessidade de maior utilização da espirometria nos cuidados de saúde primários. Keywords: COPD prevalence, BOLD study, Burden of Obstructive Lung Disease, Airway obstruction, Palavras-chave: Prevalência da doença pulmonar obstrutiva crónica, Estudo Burden of Obstructive Lung Disease, Obstrução das vias aéreas

Resumo: Introdução: A prevalência da doença pulmonar obstrutiva crónica (DPOC) apresenta valores muito heterogéneos em todo o mundo. A iniciativa Burden of Obstructive Lung Disease (BOLD) foi desenvolvida para que a prevalência da DPOC possa ser avaliada com metodologia uniformizada. O objetivo deste estudo foi estimar a prevalência da DPOC em adultos com 40 ou mais anos numa população alvo de 2 700 000 habitantes na região de Lisboa, de acordo com o protocolo BOLD. Métodos: A amostra foi estratificada de forma aleatória multifaseada selecionando-se 12 freguesias. O inquérito compreendia um questionário com informação sobre fatores de risco para a DPOC e doença respiratória autoreportada; adicionalmente, foi efetuada espirometria com prova de broncodilatação. Resultados: Foram incluídos 710 participantes com questionário e espirometria aceitáveis. A prevalência estimada da DPOC na população no estadio GOLD I+ foi de 14,2% (IC 95%: 11,1; 18,1) e de 7,3% no estadio ii+ (IC 95%: 4,7; 11,3). A prevalência não ajustada foi de 20,2% (IC 95%: 17,4; 23,3) no estadio i+ e de 9,5% (IC 95%: 7,6; 11,9) no estadio ii+. A prevalência da DPOC no estadio GOLD II+ aumentou com a idade, sendo mais elevada no sexo masculino. A prevalência estimada da DPOC no estadio GOLD I+ foi de 9,2% (IC 95%: 5,9; 14,0) nos não fumadores versus 27,4% (IC 95%: 18,5; 38,5) nos fumadores com carga tabágica de â¥Â 20 Unidades Maço Ano. Detetou-se uma fraca concordância entre a referência a diagnóstico médico prévio e o diagnóstico espirométrico, com 86,8% de subdiagnósticos. Conclusões: O achado de uma prevalência estimada da DPOC de 14,2% sugere que esta é uma doença comum na região de Lisboa, contudo com uma elevada proporção de subdiagnósticos. Estes dados apontam para a necessidade de aumentar o grau de conhecimento dos profissionais de saúde sobre a DPOC, bem como a necessidade de maior utilização da espirometria nos cuidados de saúde primários. Abstract: Background: There is a great heterogeneity in the prevalence of Chronic Obstructive Pulmonary Disease (COPD) demonstrates a great heterogeneity across the world. The Burden of Obstructive Lung Disease (BOLD) initiative was started to measure the prevalence of COPD in a standardized way. We aimed to estimate the prevalence of COPD in Portuguese adults aged 40 years or older of a target population of 2,700 000 in the Lisbon region, in accordance with BOLD protocol. Methods: A stratified, multi-stage random sampling procedure was used which included 12 districts. The survey included a questionnaire with information on risk factors for COPD and reported respiratory disease and a post-bronchodilator spirometry performed at survey centres. Results: For the 710 participants with questionnaires and acceptable spirometry, the overall weighted prevalence of GOLD stage I+ COPD was 14.2% (95% C.I. 11.1, 18.1), and stage II+ was 7.3% (95% C.I. 4.7, 11.3). Unweighted prevalence was 20.2% (95% C.I.17.4, 23.3) for stage I+ and 9.5% (95% C.I. 7.6, 11.9) for stage II+. Prevalence of COPD in GOLD stage II+ increased with age and was higher in men. The prevalence of GOLD stage I+ COPD was 9.2% (95% C.I. 5.9, 14.0) in never smokers versus 27.4% (95% C.I. 18.5, 38.5) in those who had smoked >20 pack-years. The agreement between previous doctor diagnosis and spirometric diagnosis was low, with 86.8% of underdiagnosed individuals. Conclusions: The 14.2% of COPD estimated prevalence indicates that COPD is a common disease in the Lisbon region. In addition, a large proportion of underdiagnosed disease was detected. The high prevalence of COPD with a high level of underdiagnosis, points to the need of raising awareness of COPD among health professionals, and requires more use of spirometry in the primary care setting. Palavras-chave: Prevalência da doença pulmonar obstrutiva crónica, Estudo Burden of Obstructive Lung Disease, Obstrução das vias aéreas, Keywords: Chronic Obstructive Pulmonary Disease prevalence, Burden of Obstructive Lung Disease, Airway obstruction

O presente estudo tem como objectivo, estudar a relação da Felicidade Subjectiva com a Satisfação com a Vida, o Florescimento e o Bem-estar Subjectivo. A amostra foi composta por um total de 216 participantes estudantes universitários portugueses dos quais 88 (40,7%) são do sexo masculino e 128 do sexo feminino (59,3%), em que a média das idades é de 25,56 anos (DP=7, 55). Os instrumentos utilizados foram a escala de Felicidade Subjectiva (Lyubomirsky & Lepper, 1999), a escala de satisfação com a vida (Diener, Emmons, Larsen & Griffin, 1985), a escala Experiência Positivas e Negativas (Diener, Wirtz, Tov, Kim-Prieto, Choi, Oishi & Biswas-Diener em 2008), e a escala de florescimento (Diener, Wirtz, Tov, Kim-Priento, Choi, Oishi e Biswas-Diener, 2010), e ainda um questionário sociodemográfico. Verificaram-se uma associação positiva entre a felicidade subjectiva, satisfação com a vida, florescimento e experiências positivas, bem como uma associação negativa entre felicidade subjectiva, satisfação com a vida, florescimento e experiências negativas. Como variáveis preditoras da felicidade subjectiva, identificaram-se, as experiências positivas, a satisfação com a vida, e o florescimento, que explicam 44,2% da variância da felicidade subjectiva., The present study aims to examine the relations between the Subjective Happiness and Satisfaction with Life, Flourishing, and Subjective Well-Being. Our sample counts with the participation of 216 Portuguese university students, of which 88 (40,7%) are males and 128 (59,3%) are females. The average age of the students is 25,56 years old (SD = 7,55). The measures used in this study consist of the Subjective Happiness Scale (Lyubomirsky & Lepper, 1999), the Satisfaction with Life Scale (Diener, Emmons, Larsen & Griffin, 1985), the Scale of Positive and Negative Experience (Diener, Wirtz, Tov, Kim- Prieto, Choi, Oishi & Biswas-Diener, 2008), the Flourishing Scale (Diener, Wirtz, Tov, Kim- Priento, Choi, Oishi & Biswas-Diener, 2010), and also a sociodemographic questionnaire. Positive association were found between subjective happiness, satisfaction with life, flourishing and positive experiences, as well as a negative association between subjective happiness, satisfaction with life, flourishing and negative experiences. Positive experiences, satisfaction with life and flourishing were identified as predictors of the subjective happiness, accounting for 44,2% of the variance in subjective happiness., Orientação: Américo Baptista

Resumo: A espirometria não atingiu ainda a divulgação que se justificaria em patologia respiratória, ou indivíduos que se encontram em risco relativamente a esta patologia, cujo diagnóstico é insuficiente, havendo um escasso conhecimento, e consequente controlo, dos custos atribuíveis a estas doenças, com destaque para a doença pulmonar obstrutiva crónica (DPOC).O PNEUMOBIL, iniciativa que visa esta divulgação entre fumadores e ex-fumadores, foi reactivado, após 10 anos de aplicação em Portugal, revelando agora, numa amostra de 5324 indivíduos, em que cerca de 50% ainda mantêm os hábitos tabágicos, sejam do sexo masculino ou feminino, que houve uma elevada prevalência de obstrução detectada por espirometria (30% e 25%, respecti-vamente) nas pessoas rastreadas perto de centros de saúde (grupo público) e em empresas (grupo privado). Este risco não se explica em regra por exposição ocu-pacional, nem se relaciona com a maioria dos sintomas respiratórios, muito frequentes nos rastreados. Apenas a dispneia (OR=1,28; p=0,02) e os episódios frequentes de expectoração (OR=1,21; p=0,008) ou de bronquite aguda (OR=1,31; p=0,05) revelam al-guma relação com a obstrução. O reconhecimento prévio da DPOC é muito reduzi-do e a presença de obstrução não se correlaciona (p=0,204) com o assumir da condição de portador.Rev Port Pneumol 2009; XV (5): 803-846 Abstract: The use of spirometry is not yet widespread enough in chronic respiratory or at-risk patients whose diagnosis is incomplete. There is scarce knowledge and inadequate management of the burden of these diseases, particularly chronic obstructive pulmonary disease (COPD).Pneumobil, an initiative aimed at raising awareness among smokers and ex-smokers, was reactivated 10 years after its launch in Portugal. It found a large prevalence of bronchial obstruction as measured by spirometry (30% and 25% in men and women respectively) in a sample of 5324 smoke-exposed individuals, 50% current smokers, screened at state or business (private company group) health institutions. This risk is neither mainly attributable to occupational exposure nor mainly related to respiratory symptoms, which were very common in our population. Only dyspnoea (OR=1.28; p=0.02) and frequent episodes of sputum production (OR=1.21; p=0.008) or acute bronchitis (OR=1.31; p=0.05) were somewhat related to bronchial obstruction. Prior knowledge of COPD is rare and bronchial obstruction is not correlated (p=0.204) to a possible diagnosis of COPD.Rev Port Pneumol 2009; XV (5): 803-846 Palavras-chave: Fumo do tabaco, obstrução brôn-quica, DPOC, PNEUMOBIL, Key-words: Tobacco smoke, bronchial obstruction, COPD, PNEUMOBIL

Orientador: Sylvia Maria Ciasca Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas Resumo: O presente estudo teve como objetivo geral comparar a avaliação cognitiva, as funções corticais superiores e o desempenho escolar pré e pós-treino de soluções de problemas em crianças com o diagnóstico de Transtorno de Déficit de Atenção e Hiperatividade e como objetivos específicos: caracterizar idades, sexo, escolaridade dos pacientes que chegam ao Ambulatório de Neuro-Dificuldades de Aprendizagem com queixa primária de desatenção e hiperatividade; avaliar os aspectos cognitivos, aspectos das funções corticais superiores e de desempenho escolar de crianças com TDAH; comparar a avaliação cognitiva das funções corticais superiores e desempenho escolar pré e pós-treino de soluções de problemas; avaliar prospectivamente por meio dos dados obtidos na avaliação neuropsicológica pré e pós treino. Participaram deste estudo 13 crianças, que compuseram o GP, com média etária de 9 anos e 08 crianças que compuseram o GC, com média etária de 9, 2 anos, num total de 21 crianças com diagnóstico de TDAH. Os materiais utilizados para avaliação neuropsicológica pré e pós-treino: termo de consentimento livre e esclarecido, WISC III, TLN-C, TDE, Teste de Trilhas e TCLP; para o treino de soluções de problemas foram realizados 04 encontros com os pais, com o objetivo de orientação e 10 sessões com a criança, com o objetivo de trabalhar as funções executivas. Como resultado foi encontrado que 64,45% das crianças avaliadas tiveram diagnóstico confirmado de TDAH, na sua maioria do sexo masculino com idade média de 9 anos, em relação ao desempenho cognitivo. Os dois grupos apresentaram QI dentro da média, com melhor desempenho em atividades verbais do que de execução; em relação aos índices fatoriais o GP apresentou uma melhora após o treino de soluções de problemas em velocidade de processamento ao comparar com GC; o GP apresentou um melhor desempenho após o treino nos subtestes de semelhanças, aritmética e dígitos. Na avaliação das funções corticais superiores o GP apresentou uma melhora após o treino em memória, em desempenho escolar apresentou uma melhora em relação a série em leitura e escrita e em relação a idade em leitura; em relação a atenção o GP mostrou uma diminuição no número de erros e um aumento no tempo da realização da atividade. Abstract: This study had, as a general purpose, compare the general cognitive assessment, the higher cortical functions and the scholar performance before and after a training of solution problems in children diagnosed with the Disorder and Hyperactivity of Attention Deficit and also had as specific objectives: characterize age, sex and education of the patients that arrive at the Clinic of Neuro-learning Disabilities with primary complaint of inattention and hyperactivity; evaluate the cognitive aspects of higher cortical functions and scholar performance of children with ADHD, compare the cognitive evaluation of higher cortical functions and scholar performance before and after a training of solution problems; evaluate prospectively by means of data obtained in the neuropsychological assessment before and after training. The study included 13 children who composed the GP, with an average age of 9 years old and 08 children who composed the GC, with an average age of 9,2 years old, a total of 21 children diagnosed with ADHD. The materials used for neuropsychological assessment pre and post-training were: term of free and informed consent, WISC III, TLN-C, TDE, Trail Making Test and TCLP; for intervention, 04 meetings were conducted with the parents in order to guide and 10 sessions with the child in order to work the executive functions. The results found that 64.45% of the assessed children had a confirmed diagnosis of ADHD, mostly male with an average age of 9 years old, in relation to the cognitive performance. Both groups were within the average IQ, with better performance in verbal activities than in execution ones; in relation to the factorials indexes, the GP showed improvement after the training for solutions of problems in processing speed when compared to GC, the GP showed a better performance after the training in subtests of similarities, arithmetic and digits. In the assessing of higher cortical functions, the GP showed an improvement after training in memory; in the scholar performance, it showed an improvement for the series in reading and writing and in relation to age in reading; in relation to attention, the GP had revealed a decrease in the number of errors and an increase in the time of completion of the activity. Doutorado Ciências Biomédicas Doutor em Ciências Médicas

This study evaluated two cases of Apert's syndrome, through phonological, cognitive, and neuropsychological instruments and correlated the results to complementary exams. In short, this study reveals the necessity of application of neuropsychological, cognitive and phonological evaluation and correlation of the results with complementary testings because significant differences can be present in the Apert's syndrome.