R - Teses de Doutoramento / Doctoral Theses
Permanent URI for this collection
Browse
Browsing R - Teses de Doutoramento / Doctoral Theses by Sustainable Development Goals (SDG) "03:Saúde de Qualidade"
Now showing 1 - 10 of 32
Results Per Page
Sort Options
- Adaptação portuguesa da differentiation of self scale - revisedPublication . Abreu, Daniela Mendes Cunha; Lima, Vânia Andrea Sousa Gonçalves MoreiraO presente estudo tem como objetivo analisar as propriedades psicométricas da versão portuguesa da Differentiation of Self Scale – Revised (DSS-R), que avalia a Diferenciação do Self em adultos. A amostra é composta por 132 adultos portugueses, dos quais 108 do sexo feminino e 24 do sexo masculino. A DSS-R avalia cinco dimensões: Posição do Eu, Reatividade Emocional, Fusão com os Outros, Corte Emocional e Dominância sobre os Outros. Foram realizadas análises descritivas, seguidas de análise fatorial exploratória (método da máxima verosimilhança, com rotação Oblimin), bem como a avaliação da fiabilidade do instrumento, através da consistência interna. As validades convergente e divergente foram examinada com base nas correlações com o Questionário de Avaliação das Relações Familiares Básicas (CERFB) e com o Inventário de Ansiedade Estado-Traço (STAI-Y), respetivamente. Os resultados revelaram uma boa consistência interna, evidências de validade fatorial e correlações significativas, sustentando a utilização da DSS-R em contextos de investigação com a população portuguesa.
- Algoritmos clínicos de apoio à tomada de decisão em enfermagem no cuidado à pessoa com ferida complexaPublication . Silva, Raquel Marques; Alves, Paulo Jorge Pereira; Lopes, MarcosIntroduction: The impact of wounds significantly affects the quality of life and places a substantial burden on healthcare systems. Clinical algorithms are believed to aid clinical reasoning and decision-making by nurses, thereby improving care for individuals with wounds. Objective: To develop and evaluate computerized clinical algorithms to support nursing decision-making in the care of adults with complex wounds. Methods: This mixed-methods study, comprising both qualitative and quantitative approaches, was structured in three phases. In the first phase, preliminary studies were conducted to design clinical algorithms, including a scoping review (according to JBI), a descriptive study using two online focus groups (13 participants, thematic analysis), and a prospective cohort study [data collection performed by nurses through mobile application (app), for six months, in nine Portugal health units, during the follow-up period for up to five weeks with six assessments and the healing time was the main outcome]. In the second phase focused on constructing clinical algorithms based on a deductive knowledge model using "if-then" logic and the Outcome-Present State-Test model, and achieving a consensus among experts and a consensus of judges developed to evaluate the content created through online questionnaires submitted to 105 participants. In the third phase, the constructed clinical algorithms were implemented in an app through a prospective cohort study (data collection performed by nurses through an app, for six months, in seven Portugal health units, during the follow-up period for up to four weeks, with three assessments. Up to three health ethics commissions approved the studies. Results: The scoping review and cohort study revealed primarily that local factors related to wound characteristics have a greater impact on healing than systemic or demographic factors. Features to be incorporated into an app for wound care should include image capture, professional communication, decision support, and action safety promotion. Clinical algorithms were created to support wound type diagnosis and therapeutic planning for intermediate and comprehensive wound monitoring, based on clinical reasoning with an emphasis on outcomes and the analysis of multiple conditions. Thirteen logical conditions for wound type, 40 informational alerts, 10 general recommendations, and 32 specific recommendations were successfully validated, with no items eliminated, and all achieved content evaluation indices statistically equal to or greater than 0.8 or within confidence intervals. In implementation, the overall agreement between the nurse's diagnosis and the algorithm-suggested diagnosis was moderate at 0.406 (CI 0.243-0.569). For therapeutic plan support algorithms, 85.3% and 90.3% of nurses followed the recommendations for comprehensive and intermediate monitoring, respectively. Alerts issued were evaluated with means of 4.34 (SD=0.82) for comprehensive monitoring and 4.33 (SD=0.97) for intermediate monitoring, on a scale of 1 to 5. Conclusion: The identified evidence on prognostic factors for delayed healing and the developed assessment tool allow nurses to improve reliability in characterizing individuals with wounds, anticipate complications, and individualize interventions. The successful implementation of clinical algorithms has practical applicability to improve care quality, reduce subjectivity in clinical reasoning and decision, and enhance action safety by incorporating updated evidence and innovative technology.
- Assessing the fair value of Fielmann AG : an equity valuation approachPublication . Bernsmann, Malte; Martins, José TudelaThis thesis presents an equity valuation of Fielmann AG as of December 31, 2025. The analysis applies a Discounted Cash Flow model as the primary valuation method, complemented by relative valuation based on a peer group of comparable companies. Sensitivity analyses are conducted to examine the impact of key assumptions such as revenue growth, discount rates, and terminal value estimations. The study further discusses alternative valuation approaches, including the Adjusted Present Value, Dividend Discount Model, and Residual Income methods, but concludes that they are less suitable for Fielmann AG’s business model. The Discounted Cash Flow method yields an implied share price of €60.65, about 7% above the market price as of June 30, 2025, supported by conservative growth and discounting assumptions. relative valuation produces a wide range, but its average of €62.20 supports the Discounted Cash Flow method result. The convergence of methods supports a target price of €61.43, implying an 8.3% upside. Given the limited upside potential, the findings support a HOLD recommendation, while Fielmann AG’s strong competitive position in the DACH region, resilient vertically integrated model, and international growth prospects still suggest an attractive risk-return profile in a volatile market environment.
- Bem-estar espiritual da pessoa idosa : contributos na capacidade de autocuidadoPublication . Tavares, Maria de Fátima Caixeiro da Cunha; Vieira, MargaridaUm número crescente de estudos relacionados com a espiritualidade/ religiosidade e bemestar espiritual evidenciam resultados positivos no domínio da saúde. Contudo a evidência científica não é unânime quanto à relação entre a espiritualidade e a capacidade de autocuidado da pessoa idosa. Objetivos: Analisar a relação entre o Bem-estar Espiritual e Capacidade de Autocuidado em pessoas idosas; compreender a relação entre as dimensões do Bem-estar espititual e as dimensões da Capacidade de Autocuidado, assim como, analisar a relação entre as variáveis sociodemográficas e autoperceção do estado de saúde no Bem-estar Espiritual e na Capacidade de Autocuidado. Metodologia: Estudo de natureza não experimental, transversal, quantitativo de tipo descritivo e correlacional, desenvolvido em duas etapas. A primeira etapa refere-se ao processo de tradução, adaptação cultural e validação da Exercise of Self-care Agency Scale (ESCA) para a versão portuguesa em pessoas idosas residentes em contexto domiciliário. A segunda etapa visou dar resposta aos objetivos propostos e integrou 400 pessoas idosas residentes em contexto domiciliário. Resultados: Do processo de tradução, adaptação e validação da ESCA, apresenta-se um instrumento constituído por 29 itens com características psicométricas adequadas para utilização em pesquisas futuras (escala global α = .871). O género, idade, escolaridade e autoperceção do estado de saúde, demonstram estar associados a diferenças significativas no Bem-estar espiritual, com resultados superiores no género feminino, nas pessoas mais idosas, em níveis mais baixos de escolaridade e nas pessoas idosas que se autopercecionam como incapazes de cuidar de si. A idade, escolaridade e a autoperceção do estado de saúde, demonstram estar associados a diferenças significativas em algumas das dimensões da capacidade de autocuidado. O Bem-estar espiritual, nas suas dimensões constituintes Fé pessoal, Prática religiosa e Paz espiritual, explicam 16% capacidade de autocuidado. A influência das dimensões do Bem-estar espiritual na autoperceção do estado de saúde, mediado pela Capacidade de autocuidado, revelou que a Paz espiritual agindo positivamente sobre o Autoconceito, Iniciativa e responsabilidade e atividade para o autocuidado detém uma influência positiva na autoperceção de saúde. A Fé pessoal e a Prática religiosa constituem-se como impulsionadoras da capacidade de autocuidado, desempenhando um papel fundamental nas pessoas idosas que se autopercecionam como incapazes de cuidar de si. Conclusões: O Bem-estar espiritual constitui-se como um tipo de apoio capaz de potenciar a capacidade de autocuidado. Como tal, os enfermeiros, integrando uma abordagem holística do cuidar, devem promover o bem-estar espiritual da pessoa idosa no decorrer dos processos de saúde/doença. Implicações do estudo para a educação em enfermagem e investigação foram discutidas.
- Carga de trabalho do enfermeiro de família na gestão da doença crónica : um contributo para a construção de uma matriz de referência para a dotação seguraPublication . Dantas, Maria Jacinta Pereira; Figueiredo, Maria Henriqueta de Jesus SilvaEnquadramento: A doença crónica é uma condição de saúde que se manifesta cada vez com maior expressão a nível mundial. As doenças crónicas como a diabetes, doenças cardiovasculares, entre outras afetam oito em cada 1dez pessoas com mais de 65 anos na Europa, e cerca de 80% dos orçamentos de saúde em toda a EU são gastos no tratamento destas doenças. O aumento das doenças crónicas tem impacte na vida das populações e coloca exigências e desafios aos sistemas de saúde e aos seus profissionais. Os cuidados de enfermagem podem e contribuem substancialmente, para a redução da morbimortalidade e para a eficiência dos sistemas de saúde. A carga de trabalho desajustada tem vindo a ser associada a eventos adversos, nomeadamente à probabilidade do aumento do número de mortes, aumento de infeções do trato urinário, úlceras por pressão, infeções respiratórias, insatisfação com os cuidados dos enfermeiros por parte dos utentes, insatisfação profissional e fracos resultados das instituições de saúde. Neste sentido, a dotação segura de enfermeiros relaciona-se com a prestação de cuidados seguros, de qualidade e de elevada complexidade, numa diversidade de contextos. Objetivos: O presente estudo pretendeu a construção de uma matriz orientadora para a determinação da dotação segura de Enfermeiros de Família (EF), considerando a carga de trabalho associada à dimensão dos cuidados à pessoa com doença crónica em contexto dos CSP. Definiram-se como objetivos centrais da investigação: construir e validar um instrumento que permitisse identificar as intervenções realizadas pelos EF na consulta à pessoa com doença crónica; identificar preditores da carga de trabalho; determinar a carga de trabalho na consulta; desenvolver um modelo de previsão da carga de trabalho e construir uma matriz de referência para a dotação segura de EF para a gestão da doença crónica. Metodologia: No propósito de alcançar os resultados pretendidos elaborou-se um desenho de investigação constituído por três etapas designadas por: base do projeto, edificação e consolidação do projeto. Em cada etapa foram realizados estudos nos quais se adotaram metodologias e instrumentos distintos. Na etapa 1, realizou-se um estudo em dois momentos: construção e validação do instrumento de avaliação da carga de trabalho dos enfermeiros de família, para tal recorreu-se à técnica de Delphi e, na verificação da aplicabilidade prática através de um estudo piloto de cariz quantitativo, descritivo exploratório, numa amostra de 16 enfermeiros de família e 196 pessoas com doença crónica (DM, HTA, HIPO). Na etapa 2 realizou-se um estudo eminentemente quantitativo, transversal e analítico com o qual se pretendeu identificar as intervenções realizadas pelos EF na consulta à pessoa com doença crónica e determinar a consequente carga trabalho. Recorreu-se a uma amostra de 509 pessoas portadoras de doença crónica inscritos no ACeS com diagnóstico ativo de doença, e 50 EF em exercício em unidades de saúde familiar e unidade de cuidados de saúde personalizados. Na etapa 3 concretizou-se um estudo eminentemente qualitativo com recurso a grupos focais, pretendeu-se validar uma fórmula de cálculo de horas seguras para a gestão da doença crónica e definir uma matriz de dotação segura. Resultados: Na primeira etapa da investigação construiu-se um instrumento designado por Instrumento de Avaliação da Carga de Trabalho do Enfermeiro de Família (IACTENFF). O instrumento é composto por cinco dimensões que correspondem à abrangência da atuação dos EF em contexto dos CSP. Validou-se o conteúdo do instrumento e verificou-se a aplicabilidade prática das grelhas IACTENFF-CE-DIA; IACTENFF-CE-HTA; IACTENFF-CE-HIPO que constituem a dimensão da Gestão da Doença Crónica (GDC). Verificou-se que mais de 90% das intervenções dos EF estavam previstas no instrumento o que permite determinar a carga de trabalho. Na etapa 2 foram identificadas as intervenções que EF realiza no âmbito da gestão da doença crónica (AC1, AC2, AC3). A carga de trabalho do EF na consulta à pessoa com doença crónica foi definida por intervenções do tipo avaliar, ensinar, monitorizar, acolhimento, procedimentos de continuidade de cuidados entre outros. Estas intervenções permitem identificar a dimensão dos cuidados assistenciais e não assistenciais, sendo que os cuidados assistenciais contribuem de forma mais significativa para a carga de trabalho. A carga de trabalho é traduzida pelo tempo de consulta para cada área clínica correspondendo ao tempo médio de 44,4 min (AC1), 43,8 min (AC2) e 35,5 min (AC3). Foram gerados modelos de previsão do cálculo da carga de trabalho a partir das intervenções realizadas no domínio assistencial e não assistencial. Verificou-se uma distribuição equitativa da carga de trabalho pelas respetivas áreas clínicas do EF âmbito do ACeS. Na última etapa da investigação foi validada a proposta de fórmula que permite determinar o peso da gestão da doença crónica na carga total de trabalho do EF, determinou-se o valor de 772h/anuais como horas seguras para a gestão da doença crónica. Conclusão: A evidência comprovou que o instrumento IACTENFF – Gestão de Doença Crónica (GDC) é válido. Os modelos de previsão de carga de trabalho gerados podem servir de referência para determinar a composição das equipas de enfermagem, principalmente no contexto de USF/UCSP. A matriz de dotação pode servir de referência e ser utilizada ao nível micro (no contexto de unidade funcional), a nível macro (no contexto de ACeS) ou a nível nacional, na medida em que identifica valores de horas seguras. A utilização de instrumentos precisos para determinar o dimensionamento das equipas de enfermagem nas USF/UCSP poderá permitir ao enfermeiro prestar cuidados seguros e de qualidade. Estes resultados são um passo na discussão de como organizar a prestação de cuidados de saúde, principalmente sobre como determinar o tamanho adequado de uma equipa de enfermagem. A organização dos cuidados de saúde é um assunto complexo, que exige estudos direcionados no sentido de melhorar o cuidado à pessoa com doença crónica.
- Consumer adoption intention in wearable fitness devices : the role of changing pricing modelsPublication . Probst, Moritz Cyril; Borges, MónicaThe wearable fitness device market is currently undergoing a transformation from traditional ownership-based pricing models to subscription-based pricing models. This study examines how these pricing models affect price value, a key determinant of consumer adoption intention as defined by the UTAUT2 framework. A quantitative survey of 265 valid respondents was conducted to assess price value perceptions across three key dimensions that differentiate the pricing models: the amplitude of the initial investment, periodic pricing, and the potential for higher cost of subscription-based models. The results show no significant impact of the initial investment or periodic pricing on price value perceptions, challenging previous research suggesting that subscription models offer benefits through lower barriers to entry and temporal framing. However, when considering the potentially higher cost of subscriptions, subscription based pricing models showed lower price value perceptions. This suggests that ownership based pricing may provide a strategic advantage in driving consumer adoption. Nonetheless, it was acknowledged that the perceptual drawbacks of subscription models may be offset by their operational and financial benefits for businesses, depending on their objectives. This study contributes to the academic literature by improving the understanding of cost perceptions in the wearable fitness device market and highlights the need for future research to refine methodologies and to include more diverse samples to increase generalizability.
- Convenience over functionality : the impact of anxiety on consumer financial decision-making behaviors in university studentsPublication . Ehrenbrandtner, Ingrid Anna; Mendonça, CristinaIn recent decades, growing attention has been paid to the role of emotions in financial decisionmaking. Anxiety, in particular, has emerged as a significant factor influencing consumer spending behaviors. Using a survey-based methodology, in this thesis I examine the impact of state anxiety and financial anxiety on convenience-seeking spending among university students and explore how financial anxiety influences the relationship between state anxiety and spending behaviors. The findings of this dissertation demonstrate that state anxiety increases convenience-seeking spending while reducing functional spending, with financial anxiety showing an even stronger influence. An exploratory mediation analysis further reveals that financial anxiety mediates the relationship between state anxiety and convenience-seeking spending, highlighting its role as a key mechanism linking broader emotional states to financial behaviors. Consequently, this thesis contributes to a better understanding of the relationship between anxiety and consumer financial decision-making, distinguishing the effects of state and financial anxiety on specific spending patterns. By addressing these dynamics, this research provides a foundation for future studies and interventions to mitigate anxiety-driven financial behaviors and support more informed decision-making.
- Design of paper-based analytical devices for chemical and biochemical assays of biomarkers in biological fluids of non-invasive collectionPublication . Ferreira, Francisca Teixeira Soares da Mota; Mesquita, Raquel Beatriz Ribeiro de; Rangel, Antonio Osmaro Santos SilvaEnsuring basic healthcare access around the world remains a challenge, particularly in lowincome regions. In response, international initiatives such as the Sustainable Development Goals (SDGs) and the World Health Organization (WHO) guidelines emphasize the need to develop innovative, accessible, and cost-effective diagnostic tools. Point-of-care testing has emerged as an ideal solution, enabling rapid and decentralized analysis. Among these type of devices, microfluidic paper-based analytical devices (µPADs) have gained attention due to their affordability, portability, and ease of use, making them a particularly valuable tool in resource-limited locations. The purpose of the work presented throughout this thesis was to design and develop innovative point-of-care methodologies based on the µPAD approach for the determination of several healthrelated parameters, that could serve as an adding tool in the diagnosis and monitoring of several health conditions. The use of biological samples of non-invasive collection, such as saliva and urine, enhances diagnostic accessibility, particularly in point-of-care settings where traditional sample collection may be impractical or even impossible. Additionally, this thesis also explores the use of colorimetric detection methods, a straightforward approach to quantifying the targeted analytes by producing visible colour changes. To further improve the specificity and accuracy of these diagnostic tools, enzymatic reactions were incorporated into some of the developed µPADs. The first developed device was dedicated to the quantification of total iron in urine samples by using the colorimetric reaction of bathophenanthroline with iron (II) coupled with hydroxylamine, a well-known reducing agent capable of converting iron (III) in iron (II). To handle the potential colour of the urine samples, a sample blank was included in the device. This feature was vital to ensure the applicability of the developed μPAD, as urine may present a wide variability of colour range, from light yellow to brownish. The determination of nitrate was also accomplished in urine samples with a newly developed µPAD. This device included the enzymatic reaction of nitrate reductase to perform the conversion of nitrate to nitrite and the Griess reagent which provided the colorimetric detection of the resulting nitrite. In order to delay the vertical flow and increase the extent of the enzymatic reaction, a hydrophilic membrane layer was also incorporated into the device. The small porosity of this membrane also led to the retention of the compound responsible for the colour of urine, enabling a direct analysis of the samples. The next devices developed performed the quantification of NHX and urea in saliva samples but with a more complex approach. Not only were the devices composed of four layers, but the detection relies on the diffusion of NH3 (g) through a gas-diffusion membrane to produce a colorimetric change of a pH indicator. The hydrophobicity of this membrane also helped eliminate possible interferences of the saliva sample in the colorimetric reaction, since it did not allow the sample to pass through the membrane and reach the colour reagent. The urea determination was accomplished by including urease in the device, since it selectively catalyzes the dissociation of urea in ammonia and carbon dioxide. The urease activity determination was accomplished using a similar structure and reactions to the one used for the urea µPAD. However, the determination itself was achieved using the kinetic capabilities of the enzyme by correlating to the urease activity with the variation of the signal obtained between two different enzymatic reaction times. This strategy not only allowed a more accurate quantification but also suppressed the influence of NHX already present in the samples. The last device developed using the µPAD structure approach was to quantify glucose in saliva samples. With only two layers in its composition, this device uses a combination of two enzymatic reactions. First, glucose oxidase converts glucose into gluconic acid and hydrogen peroxide, then followed by the release of oxygen from hydrogen peroxide performed by peroxidase. The colorimetric detection is accomplished with the oxidation of o-dianisidine. In this work, a correlation between the concentration of glucose in saliva and blood was also successfully established, using #5 saliva samples of diabetic patients and the correspondent glucometer measurements provided by the patients. A rather different approach was used to perform the semi-quantitative analysis of E. coli DNA. Instead of developing a µPAD, an option was made to design a barcode-style lateral flow strip that would allow the semi-quantitative detection of E. coli. The amplification of the DNA in the sample was performed using the Loop-Mediated Isothermal Amplification (LAMP) technique since it can be performed at a constant temperature and provides high sensitivity and specificity results. The developed methodology, although requiring further optimization, showed reliable performance and offers a rapid, cost-effective method for E. coli detection. Overall, this thesis demonstrates the potential of microfluidic paper-based analytical devices and lateral flow assays as innovative, cost-effective diagnostic tools for point-of-care applications. By addressing critical challenges such as sample complexity, reagent stability, and measurement accuracy, the developed devices enhance accessibility to reliable testing, particularly in resourcelimited settings. Their affordability and ease of use further emphasize their role in expanding diagnostic capabilities outside traditional laboratory environment.
- O discipulado como fundamento da evangelização limiar da radicalidade do Evangelho na IgrejaPublication . Viega, Eduardo Nzinga; Rodrigues, Luís Miguel FigueiredoThis dissertation explores the theme of discipleship as the foundation of evangelisation and the radical nature of the Gospel in the Church. It aims to understand how discipleship manifests itself through evangelisation, especially in the context of Salesian youth ministry, where the formation and accompaniment of young people is essential. This study explores discipleship in the light of Sacred Scripture, the Church's magisterium and tradition, emphasising that a personal relationship with Christ qualifies the disciple who wants to be a living witness to the Gospel. The formation of a disciple in volves the will and freedom of the young person; only in this way will they be able to give a conscious response to their Christian vocation, enabling them to become agents of transformation and inspiration in their environment. In reflecting on the missionary and community dimension of discipleship, this work emphasises the importance of belonging to the Church as a place of service and spiritual growth. In this way, discipleship is identified not only as a path to personal holiness, but also as the foundation for building a culture of communion, and an essential encounter for building the values of the Gospel in today's world.
- Efeito do modelo de enfermeiro de referência nos resultados em saúde da pessoa idosa com multimorbilidade no hospital : estudo quasi-experimentalPublication . Gonçalves, Maria Isabel Rodrigues; Jesus, Élvio de; Nunes, ElisabeteIntroduction: Average life expectancy is increasing, as is the likelihood of chronic disease in the elderly population, which may increase the need for health services. With regard to hospital care and in particular inpatient care, organizing care according to the primary nursing model could be an effective way of improving health outcomes for older people with multimorbidity. Aim: To analyze the effect of the primary nursing care organization model on therapeutic self-care and satisfaction with nursing care in hospitalized elderly people with multimorbidity. Methodology: A quantitative paradigm was used and a quasi-experimental study with a control group was carried out. Two inpatient units with identical characteristics were selected from a private hospital in the Lisbon region. In the intervention unit, the primary nursing model was introduced to organize nursing care, while in the control unit the usual organization of delivering care was maintained. The sample was obtained by convenience, the participants were elderly people with multimorbidity, 106 in the intervention group and 100 in the control group. The Therapeutic Self-Care Scale (Portuguese version) was applied at admission, leaving the unit and follow-up, and the Citizen Satisfaction with Nursing Care Scale (ESCCE) at leaving the unit to participants from both units. Results: The main results showed that on admission to the inpatient unit, participants had different mean self-care scores, which were lower in the intervention group (t (191.045) = - 2.24; p = 0.026). At the time of discharge, the intervention group had a positive and higher variation in mean self-care scores compared to admission than the control group (t (192.67) = 2.28; p = 0.024). At follow-up, there were no significant differences in self-care between the two groups in relation to discharge (t (204.00) = 0.91; p = 0.363). Between follow-up and admission, the intervention group had a positive and higher change in mean self-care scores compared to the control group (t (187.55) = 2.68; p = 0.008). In terms of satisfaction, the intervention group also had higher satisfaction scores than the control group, but the difference was not statistically significant (t (204.00) = 1.09; p = 0.138). Conclusion: Organizing care around the primary nursing model had a positive impact on the health outcomes of hospitalized elderly people with multimorbidity, particularly in terms of therapeutic self-care skills. Although more studies are needed, especially experimental ones, these results already have an impact on clinical practice and the management of nursing services, reflected in quality indicators that are sensitive to x nursing care. In education, the primary nursing model encourages students to focus on continuity and coordination of care, which are essential to caring for elderly people with multimorbidity.