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Thesis, 2016 Fev25-2 FINAL UNIVERSIDADE DE LISBOA FACULDADE DE MEDICINA DENTÁRIA RELATIONSHIP BETWEEN HAPPINESS, STRESS AND MUSCULOSKELETAL DISORDERS IN PORTUGUESE DENTISTS MARIA DO ROSÁRIO OLIVEIRA MEXIA ESTEVES Orientadores: Doutor Alexandre Josué Costa Cabeleira da Silva Cavalheiro Doutora Carla Marina Madureira de Matos Moleiro Doutora Nancy da Silva (San Jose State University, USA) Tese especialmente elaborada para obtenção do grau de Doutor em Medicina Dentária, Especialidade de Dentisteria Conservadora 2016 UNIVERSIDADE DE LISBOA FACULDADE DE MEDICINA DENTÁRIA RELATIONSHIP BETWEEN HAPPINESS, STRESS AND MUSCULOSKELETAL DISORDERS IN PORTUGUESE DENTISTS MARIA DO ROSÁRIO OLIVEIRA MEXIA ESTEVES Orientadores: DOUTOR ALEXANDRE JOSUÉ COSTA CABELEIRA DA SILVA CAVALHEIRO DOUTORA CARLA MARINA MADUREIRA DE MATOS MOLEIRO DOUTORA NANCY DA SILVA (SAN JOSÉ STATE UNIVERSITY, USA) Tese especialmente elaborada para obtenção do grau de Doutor em Medicina Dentária, Especialidade de Dentisteria Conservadora Júrí: Presidente: Doutor Mário Filipe Cardoso de Matos Bernardo, Professor Catedrático e Presidente do Conselho Científico da Faculdade de Medicina Dentária da Universidade de Lisboa Vogais: Doutora Eunice Virgínia Valdez Faria Bidarra Palmeirão Carrilho, Professora Associada com Agregação da Faculdade de Medicina da Universidade de Coimbra Doutora Maria Augusta Duarte Gaspar, Professora Auxiliar Convidada da Faculdade de Ciências Humanas da Universidade Católica Portuguesa Doutora Carla Marina Madureira de Matos Moleiro, Professora Auxiliar da Escola de Ciências Sociais e Humanas do ISCTE-Instituto Universitário de Lisboa Doutor Mário Pinto Simões, Professor Auxiliar com Agregação da Faculdade de Medicina da Universidade de Lisboa Doutor António Emílio Peixoto Vasconcelos Tavares, Professor Catedrático Jubilado da Faculdade de Medicina Dentária da Universidade de Lisboa Doutor Alexandre Josué Costa Cabeleira da Silva Cavalheiro, Professor Auxiliar da Faculdade de Medicina Dentária da Universidade de Lisboa 2016 Relationship Between Hapiness, Stress and Musculoskeletal Disorders in Portuguese Dentists … may all beings, as numerous as space is vast, be peaceful and happy… To my sons Miguel and Frederico III IV _________________________________________________Table of Contents TABLE OF CONTENTS TABLE OF CONTENTS ........................................................................................ V LIST OF TABLES .............................................................................................. XIII LIST OF FIGURES ........................................................................................... XVII LIST OF APPENDIX .......................................................................................... XXI LIST OF ABREVIATIONS ................................................................................ XXIII PREAMBLE .................................................................................................... XXVII Personal Thanks ............................................................................ XXIX SUMMARY .................................................................................................... XXXV RESUMO .................................................................................................... XXXIX Introdução ................................................................................... XXXIX Estudo1: ........................................................................................... XLI Estudos 2 e 3 ................................................................................. XLIII CHAPTER I GENERAL PURPOSE AND THEORETICAL INTRODUCTION .................................................................................. 1 GENERAL PURPOSES ....................................................................... 1 THEORETICAL INTRODUCTION ........................................................ 2 THE ART OF BEING A DENTIST .................................................. 3 The influence of Age and Gender ........................................... 5 HEALTH ......................................................................................... 6 EMOTIONS .................................................................................... 8 Neurobiology of Emotions ..................................................... 12 Emotional fluctuation ............................................................. 19 Emotional Regulation ............................................................ 21 Emotional Regulation Strategies ........................................... 25 STRESS ....................................................................................... 31 Stress and neurology ............................................................ 34 Chronic Stress ....................................................................... 35 Stress and MSDs .................................................................. 37 Stress among doctors and dentists ....................................... 38 The etiology of stress among dentists ................................... 40 MUSCULOSKELETAL DISORDERS (MSDs) ............................. 42 Definition ............................................................................... 42 History ................................................................................... 43 Importance ............................................................................ 43 Prevalence in Europe ............................................................ 44 Prevalence in Portugal .......................................................... 45 Symptoms and Complaints of MSDs ..................................... 45 Chronic pain .......................................................................... 46 Back pain ........................................................................ 47 V MSDs among Dentists .......................................................... 48 Most prevalent MSDs for dentists ................................... 49 Etiology/ Risk Factors ..................................................... 51 Consequences of MSDs ................................................. 54 Influence of Age and Gender .......................................... 55 Prevention of MSDs .............................................................. 56 Ergonomics ..................................................................... 57 Body postures ................................................................. 61 Stress, Musculoskeletal Disorders (MSDs) and Positive and Negative Emotions ................................................................ 62 POSITIVE APPROACH ............................................................... 63 Positive Psychology .............................................................. 63 Subjective Well-being (SWB) ................................................ 66 Hedonic and Eudaimonic Approaches of Happiness ....................................................................... 68 Hedonism ................................................................. 69 Eudaimonia .............................................................. 70 Hedonic adaptation .................................................. 71 Positive Emotions (PE) ......................................................... 72 Attitude, Moods, Affects .................................................. 76 Atittude ..................................................................... 76 Mood ........................................................................ 77 Affect ........................................................................ 78 Broaden-and-build Theory .............................................. 82 Neuroplasticity ....................................................................... 84 Positive Psychology Interventions (PPI) ............................... 85 Self generated thoughts .................................................. 92 Flourishing ...................................................................... 93 Meditation ....................................................................... 94 HAPPINESS .............................................................................. 101 Definition ............................................................................. 105 Happy people ...................................................................... 109 Strategies to improve happiness ......................................... 113 Fluctuation ........................................................................... 119 The role of some demographic factors ................................ 121 Age ............................................................................... 121 Marriage and Gender .................................................... 122 Countries ...................................................................... 124 Religiosity and Friends ................................................. 127 Income/ Money ............................................................. 128 Most common scales for assessment of happiness ............ 132 CHAPTER II VALIDATION OF SUBJECTIVE HAPINESS SCALES ON PORTUGUESE PEOPLE, STUDY1 ................................................ 137 Objectives ........................................................................................ 137 Type of Study ................................................................................... 137 Methodology ..................................................................................... 138 Procedures
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