A advocacia em saúde como uma estratégia para a promoção da saúde

O conceito de promoção da saúde vem sendo desenvolvido há aproximadamente trinta anos e já está sedimentado. Atualmente, torna-se muito importante elaborar estratégias para sua implementação. O presente artigo é uma reflexão sobre a prática da advocacia em saúde enquanto estratégia para a implementação dos princípios e diretrizes da promoção da saúde. O ponto de partida é o questionamento sobre como conciliar os aspectos conceituais e metodológicos da promoção da saúde, considerados dentro de nossa realidade. A conclusão principal aponta para uma proposta de desenvolvimento de uma " Advocacia em Promoção da Saúde."

A contribution for thermoeconomic modelling: A methodology proposal

This work presents a thermoeconomic optimization methodology for the analysis and design of energy systems. This methodology involves economic aspects related to the exergy conception, in order to develop a tool to assist the equipment selection, operation mode choice as well as to optimize the thermal plants design. It also presents the concepts related to exergy in a general scope and in thermoeconomics which combines the thermal sciences principles (thermodynamics, heat transfer, and fluid mechanics) and the economic engineering in order to rationalize energy systems investment decisions, development and operation. Even in this paper, it develops a thermoeconomic methodology through the use of a simple mathematical model, involving thermodynamics parameters and costs evaluation, also defining the objective function as the exergetic production cost. The optimization problem evaluation is developed for two energy systems. First is applied to a steam compression refrigeration system and then to a cogeneration system using backpressure steam turbine. (C) 2010 Elsevier Ltd. All rights reserved.

Relationships between human resource dimensions and environmental management in companies: proposal of a model

This work deals with the main contributions of human resource dimensions for the environmental management in a company. While the specialized literature concerning the technical aspects of environmental management expands, there is a gap in the bibliography: integrated approaches between human resource dimensions and environmental management. An extensive bibliographical review was undertaken in order to systematize the human resource dimensions and their contributions concerning the effectiveness of the environmental management system. A model that analyses the relationships between these dimensions and the typical phases of an environmental management system is presented, within a perspective of application for academicians and managers. (c) 2006 Elsevier Ltd. All rights reserved.

Contributions of HRM throughout the stages of environmental management: methodological triangulation applied to companies in Brazil

The purpose of this research is to analyze the contribution of human resources management throughout the evolutionary stages of environmental management in Brazilian companies. A theoretical framework concerning environmental management and its evolution and the `greening` of the functional and competitive dimensions of human resource management were developed. A methodological triangulation was developed in two complimentary phases. In the first phase, data were collected from 94 Brazilian companies with ISO 14001 certification. The data collected were analyzed and processed using statistical techniques. The conclusions of the first phase supported the second phase of this empirical research. The second phase consisted of a study of multiple cases in four Brazilian companies. The results show evidence of the first known empirical study of contributions of human resource dimensions throughout the stages of environmental management in Brazilian manufacturing companies.

Proposal of a test specimen to evaluate the shear strength of vertical interfaces of running bond masonry walls

There is no normalized test to assess the shear strength of vertical interfaces of interconnected masonry walls. The approach used to evaluate this strength is normally indirect and often unreliable. The aim of this study is to propose a new test specimen to eliminate this deficiency. The main features of the proposed specimen are failure caused by shear stress on the vertical interface and a small number of units (blocks). The paper presents a numerical analysis based on the finite element method, with the purpose of showing the theoretical performance of the designed specimen, in terms of its geometry, boundary conditions, and loading scheme, and describes an experimental program using the specimen built with full- and third-scale clay blocks. The main conclusions are that the proposed specimen is easy to build and is appropriate to evaluate the sheaf strength of vertical interfaces of masonry walls.

Proposal of a High-Level Language for Writing Self Modifying Programs

This paper proposes a simple high-level programming language, endowed with resources that help encoding self-modifying programs. With this purpose, a conventional imperative language syntax (not explicitly stated in this paper) is incremented with special commands and statements forming an adaptive layer specially designed with focus on the dynamical changes to be applied to the code at run-time. The resulting language allows programmers to easily specify dynamic changes to their own program`s code. Such a language succeeds to allow programmers to effortless describe the dynamic logic of their adaptive applications. In this paper, we describe the most important aspects of the design and implementation of such a language. A small example is finally presented for illustration purposes.

Proposal for underwater structural analysis using the techniques of ESPI and digital holography

The purpose of this article is to study the application of the holographic interferometry techniques in the structural analysis of submarine environment. These techniques are widely used today, with applications in many areas. Nevertheless, its application in submarine environments presents some challenges. The application of two techniques, electronic speckle pattern interferometry (ESPI) and digital holography, comparison of advantages and disadvantages of each of them is presented. A brief study is done on the influence of water properties and the optical effects due to suspended particles as well as possible solutions to minimize these problems. (C) 2009 Elsevier Ltd. All rights reserved.

Methodological analysis of gamma tomography system for large random packed columns

Gamma ray tomography experiments have been carried out to detect spatial patterns in the porosity in a 0.27 m diameter column packed with steel Rashig rings of different sizes: 12.6, 37.9, and 76 mm. using a first generation CT system (Chen et al., 1998). A fast Fourier transform tomographic reconstruction algorithm has been used to calculate the spatial variation over the column cross section. Cross-sectional gas porosity and solid holdup distribution were determinate. The values of cross-sectional average gas porosity were epsilon=0.849, 0.938 and 0.966 for the 12.6, 37.9, and 76 mm rings, respectively. Radial holdup variation within the packed bed has been determined. The variation of the circumferentially averaged gas holdup in the radial direction indicates that the porosity in the column wall region is a somewhat higher than that in the bulk region, due to the effect of the column wall. (C) 2009 Elsevier Ltd. All rights reserved.

Proposal for DICOM Multiframe Medical Image Integrity and Authenticity

This paper presents a novel algorithm to successfully achieve viable integrity and authenticity addition and verification of n-frame DICOM medical images using cryptographic mechanisms. The aim of this work is the enhancement of DICOM security measures, especially for multiframe images. Current approaches have limitations that should be properly addressed for improved security. The algorithm proposed in this work uses data encryption to provide integrity and authenticity, along with digital signature. Relevant header data and digital signature are used as inputs to cipher the image. Therefore, one can only retrieve the original data if and only if the images and the inputs are correct. The encryption process itself is a cascading scheme, where a frame is ciphered with data related to the previous frames, generating also additional data on image integrity and authenticity. Decryption is similar to encryption, featuring also the standard security verification of the image. The implementation was done in JAVA, and a performance evaluation was carried out comparing the speed of the algorithm with other existing approaches. The evaluation showed a good performance of the algorithm, which is an encouraging result to use it in a real environment.

PROPOSAL OF A PERFORMANCE MEASURING SYSTEM APPLIED TO AGRICULTURAL MECHANIZATION

The leaders` organizations of several different sectors have as characteristic to measure their own performance in a systematic way. However, this concept is still unusual in agricultural enterprises, including the mechanization sector. Mechanization has an important role on the production costs and to know its performance is a key factor for the agricultural enterprise success. This work was generated by the importance that measurement of performance has for the management and the mechanization impact on the production costs. Its aim is to propose an integrated performance measurement system to give support to agricultural management. The methodology was divided in two steps: adjustment of a conceptual model based on Balanced Score Card - BSC; application of the model in a study case at sugar cane mill. The adjustment and the application of the conceptual model allowed to obtain the performance index in a systematic way, that are associated to: costs and deadline ( traditionally used); control and improvement on the quality of operations and support process; environmental preservation; safety; health; employees satisfaction; development of information systems. The adjusted model helped the development of the performance measurement system for the mechanized management systems and the index allows an integrated view of the enterprise, related to its strategic objectives.

The effects of work control and job demands on employee adjustment and work performance

The present study examined the effects of work control and job demands on employee adjustment and work performance using a multidimensional measure of work control (assessing levels of task control, decision control and work scheduling control). It was proposed that the negative effects of job demands and employee adjustment would be moderated by high levels of task control. It was also proposed that there would be evidence of main effects of both job demands and work control (particularly task-related levels of control) on employee adjustment. To test these predictions, a study of 135 university employees holding administrative positions was undertaken. Methodological improvements over previous research included the use of both self-reported adjustment measures and supervisor ratings of work performance as outcome variables, and the assessment of the predictor and outcome measures at different points in time (self-reported adjustment was assessed at both Times 1 and 2). The results revealed some support for the proposal that the effects of job demands would be buffered by high levels of task control, but not more peripheral aspects of work control. There were also significant main effects of task control on job satisfaction.

The game to play: expanding the co-opetition proposal through the strategic games matrix

Purpose - Using Brandenburger and Nalebuff`s 1995 co-opetition model as a reference, the purpose of this paper is to seek to develop a tool that, based on the tenets of classical game theory, would enable scholars and managers to identify which games may be played in response to the different conflict of interest situations faced by companies in their business environments. Design/methodology/approach - The literature on game theory and business strategy are reviewed and a conceptual model, the strategic games matrix (SGM), is developed. Two novel games are described and modeled. Findings - The co-opetition model is not sufficient to realistically represent most of the conflict of interest situations faced by companies. It seeks to address this problem through development of the SGM, which expands upon Brandenburger and Nalebuff`s model by providing a broader perspective, through incorporation of an additional dimension (power ratio between players) and three novel, respectively, (rival, individualistic, and associative). Practical implications - This proposed model, based on the concepts of game theory, should be used to train decision- and policy-makers to better understand, interpret and formulate conflict management strategies. Originality/value - A practical and original tool to use game models in conflict of interest situations is generated. Basic classical games, such as Nash, Stackelberg, Pareto, and Minimax, are mapped on the SGM to suggest in which situations they Could be useful. Two innovative games are described to fit four different types of conflict situations that so far have no corresponding game in the literature. A test application of the SGM to a classic Intel Corporation strategic management case, in the complex personal computer industry, shows that the proposed method is able to describe, to interpret, to analyze, and to prescribe optimal competitive and/or cooperative strategies for each conflict of interest situation.

Otolaryngology and Speech Therapy evaluation in the assessment of oropharyngeal dysphagia: a combined protocol proposal

Dysphagia is a symptom associated with an array of anatomical and functional changes which must be assessed by a multidisciplinary team to guarantee optimal evaluation and treatment, preventing potential complications. Aim: The aim of the present study is to present the combined protocol of clinical and swallowing videoendoscopy carried by ENT doctors and speech therapists in the Dysphagia Group of the ENT Department - University Hospital. Materials and Methods: Retrospective study concerning the use of a protocol made up of patient interview and clinical examination, followed by an objective evaluation with swallowing videoendoscopy. The exam was performed in 1,332 patients from May 2001 to December 2008. There were 726 (54.50%) males and 606 (45.50%) females, between 22 days and 99 years old. Results: We found: 427 (32.08%) cases of normal swallowing, 273 (20.48%) mild dysphagia, 224 (16.81%) moderate dysphagia, 373 (27.99%) severe dysphagia and 35 (2.64%) inconclusive exams. Conclusion: The combined protocol (Otolaryngology and Speech Therapy), is a good way to approach the dysphagic patient, helping to achieve early and safe deglutition diagnosis as far as disorder severity and treatment are concerned.

Proposal for the interaction of non-conventional partial agonists and catecholamines with the 'putative beta(4)-adrenoceptor' in mammalian heart

1. Evidence for a 'putative beta(4)-adrenoceptor' originated over 20 years ago when cardiostimulant effects were observed to nonconventional partial agonists, These agonists were originally described as beta(1)- and beta(2)-adrenoceptor antagonists; however, they cause cardiostimulant effects at much higher concentrations than those required to block beta(1)- and beta(2)-adrenoceptors. Cardiostimulant effects of non-conventional partial agonists have been observed in mouse, rat, guinea-pig, cat, ferret and human heart tissues, 2. The receptor is expressed in several heart regions, including the sinoatrial node, atrium and ventricle, 3. The receptor is resistant to blockade by most antagonists that possess high affinity for beta(1)- and beta(2)- adrenoceptors, but is blocked with moderate affinity by (-)-bupranolol and CGP 20712A. 4. The receptor is pharmacologically distinct from the beta(3)-adrenoceptor. Micromolar concentrations of beta(3)-adrenoceptor agonists have no agonist or blocking activity, The receptor is also resistant to blockade by a beta(3)-adrenoceptor-selective antagonist. 5. The receptor mediates increases in cAMP levels and cAMP-dependent protein kinase (PK) A activity in cardiac tissues. Phosphodiesterase inhibition potentiates the positive chronotropic and inotropic effects of non-conventional partial agonists. 6. The receptor mediates hastening of atrial and ventricular relaxation, which is consistent with involvement of a cAMP-dependent pathway. 7. The non-conventional partial agonist (-)-[H-3]-CGP 12177A labels the cardiac putative beta(4)-adrenoceptor, Non-conventional partial agonists compete for binding with affinities that are closely similar to their agonist potencies, Catecholamines compete for binding in a stereoselective manner with a rank order of affinity of (-)-R0363 > (-)-isoprenaline > (-)-noradrenaline greater than or equal to (-)-adrenaline much greater than (-)-isoprenaline, suggesting that catecholamines can interact with the receptor. 8. The putative beta(4)-adrenoceptor appears to be coupled to the G(s)-adenylyl cyclase system, which could serve as a guide to its future cloning, Activation of the receptor may plausibly improve diastolic function but could also mediate arrhythmias.

A Comparison of the Consensus and Clinical Definitions of Pancreatitis With a Proposal to Redefine Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Objectives: We evaluated the correlation between the consensus and clinical definitions of pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP), with the objective of updating and revising the definition of post-ERCP pancreatitis (PEP). Methods: Three hundred patients were subjected to serial serum amylase & lipase levels testing and abdominal computed tomography scan for abdominal pain after ERCP. Main outcome measures included the correlation between consensus and clinical definitions. Results: Using consensus criteria, 25 patients had acute pancreatitis (11 of mild and 14 of moderate severity). Forty-three patients had acute pancreatitis using the clinical definitions (18 of mild and 25 of moderate severity). At 4 hours, serum hyperamylasemia of under 1.5-fold and at 12 hours a serum hyperamylasemia of under 2-fold had a negative predictive value of 0.94 for development of PEP. Serum hyperamylasemia following ERCP had a poor positive predictive value for PEP. Conclusions: Clinical and consensus definitions are poorly correlated; use of the latter leads to significant underrecognition of PEP. The adoption of clinical definition results in uniformity of diagnosis of pancreatitis for clinical care and research. Serum amylase levels at 4 and 12 hours after ERCP have a high negative predictive value for PEP.