Case-control study on infant mortality in Southern Brazil

OBJECTIVE: To identify risk factors associated with infant mortality and, more specifically, with neonatal mortality. METHODS: A case-control study was carried out in the municipality of Caxias do Sul, Southern Brazil. Characteristics of prenatal care and causes of mortality were assessed for all live births in the 2001-2002 period with a completed live-birth certificate and whose mothers lived in the municipality. Cases were defined as all deaths within the first year of life. As controls, there were selected the two children born immediately after each case in the same hospital, who were of the same sex, and did not die within their first year of life. Multivariate analysis was performed using conditional logistic regression. RESULTS: There was a reduction in infant mortality, the greatest reduction was observed in the post-neonatal period. The variables gestational age (<36 weeks), birth weight (<2,500 g), and 5-minute Apgar (<6) remained in the final model of the multivariate analysis, after adjustment. CONCLUSIONS: Perinatal conditions comprise almost the totality of neonatal deaths, and the majority of deaths occur at delivery. The challenge for reducing infant mortality rate in the city is to reduce the mortality by perinatal conditions in the neonatal period.

Risk-factors for antepartum fetal deaths in the city of São Paulo, Brazil

OBJECTIVE: To assess risk factors for antepartum fetal deaths. METHODS: A population-based case-control study was carried out in the city of São Paulo from August 2000 to January 2001. Subjects were selected from a birth cohort from a linked birth and death certificate database. Cases were 164 antepartum fetal deaths and controls were drawn from a random sample of 313 births surviving at least 28 days. Information was collected from birth and death certificates, hospital records and home interviews. A hierarchical conceptual framework guided the logistic regression analysis. RESULTS: Statistically significant factors associated with antepartum fetal death were: mother without or recent marital union; mother's education under four years; mothers with previous low birth weight infant; mothers with hypertension, diabetes, bleeding during pregnancy; no or inadequate prenatal care; congenital malformation and intrauterine growth restriction. The highest population attributable fractions were for inadequacy of prenatal care (40%), hypertension (27%), intrauterine growth restriction (30%) and absence of a long-standing union (26%). CONCLUSIONS: Proximal biological risk factors are most important in antepartum fetal deaths. However, distal factors - mother's low education and marital status - are also significant. Improving access to and quality of prenatal care could have a large impact on fetal mortality.

Relatório de estágio

Relatório de Estágio apresentado ao Instituto Superior de Contabilidade para a obtenção do Grau de Mestre em Auditoria Orientada por Dr. Rodrigo Mário de Oliveira Carvalho e Dr. Álvaro Manuel de Sousa Carvalho

Reabilitação de edifícios: enquadramento e estudo da reabilitação num grupo empresarial

Dissertação para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização em Edificações

Informal learning recognition through a cloud ecosystem

Learning and teaching processes, like all human activities, can be mediated through the use of tools. Information and communication technologies are now widespread within education. Their use in the daily life of teachers and learners affords engagement with educational activities at any place and time and not necessarily linked to an institution or a certificate. In the absence of formal certification, learning under these circumstances is known as informal learning. Despite the lack of certification, learning with technology in this way presents opportunities to gather information about and present new ways of exploiting an individual’s learning. Cloud technologies provide ways to achieve this through new architectures, methodologies, and workflows that facilitate semantic tagging, recognition, and acknowledgment of informal learning activities. The transparency and accessibility of cloud services mean that institutions and learners can exploit existing knowledge to their mutual benefit. The TRAILER project facilitates this aim by providing a technological framework using cloud services, a workflow, and a methodology. The services facilitate the exchange of information and knowledge associated with informal learning activities ranging from the use of social software through widgets, computer gaming, and remote laboratory experiments. Data from these activities are shared among institutions, learners, and workers. The project demonstrates the possibility of gathering information related to informal learning activities independently of the context or tools used to carry them out.

Audiometric profile of civilian pilots according to noise exposure

OBJECTIVE To evaluate the audiometric profile of civilian pilots according to the noise exposure level. METHODS This observational cross-sectional study evaluated 3,130 male civilian pilots aged between 17 and 59 years. These pilots were subjected to audiometric examinations for obtaining or revalidating the functional capacity certificate in 2011. The degree of hearing loss was classified as normal, suspected noise-induced hearing loss, and no suspected hearing loss with other associated complications. Pure-tone air-conduction audiometry was performed using supra-aural headphones and acoustic stimulus of the pure-tone type, containing tone thresholds of frequencies between 250 Hz and 6,000 Hz. The independent variables were professional categories, length of service, hours of flight, and right or left ear. The dependent variable was pilots with suspected noise-induced hearing loss. The noise exposure level was considered low/medium or high, and the latter involved periods > 5,000 flight hours and > 10 years of flight service. RESULTS A total of 29.3% pilots had suspected noise-induced hearing loss, which was bilateral in 12.8% and predominant in the left ear (23.7%). The number of pilots with suspected hearing loss increased as the noise exposure level increased. CONCLUSIONS Hearing loss in civilian pilots may be associated with noise exposure during the period of service and hours of flight.

Auditoria aos municípios estudo de caso: uma aplicação à área Metropolitana do Porto

Dissertação de Mestrado apresentada ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Auditoria , sob orientação do Mestre Fernando Teixeira Pinto e co-orientação da Doutora Alcina Augusta de Sena Portugal Dias.

Fonte de Iluminação LED – Avaliação dos Efeitos Fotobiológicos no Olho e Pele

Tendo por referência a diretiva 2006/95/CE, o trabalho desenvolvido no contexto da disciplina de Dissertação/Projeto/Estágio do Mestrado de Engenharia de Instrumentação e Metrologia, decorreu nas instalações do IEP (Instituto Electrotécnico Português) e teve como objetivo principal o desenvolvimento de um procedimento de avaliação dos efeitos fotobiológicos no olho e pele provocados por fontes de emissão contínua (LED), doravante designado método alternativo ao de referência. Os dois métodos, alternativo e de referência, utilizam respectivamente um foto-radiómetro multicanal e um espetro-radiómetro. O procedimento desenvolvido (método alternativo) de acordo com a norma EN/IEC62471) consiste na aquisição dos valores de irradiância com recurso a um foto-radiómetro e posterior determinação dos valores da radiância, com os quais se faz a avaliação dos efeitos fotobiológicos, para fontes de luz LED (Light Emitting Diode) ou GLS (General Lighting Service). A consulta detalhada da norma EN/IEC62471 e a pesquisa sobre os conceitos, definições, equipamentos e metodologias relacionadas com o tema em causa, constituiu o primeiro passo deste projecto. Com recurso aos dois equipamentos, uma fonte de luz LED (módulo de 12 lâmpadas LED) é avaliada em relação aos perigos (ou riscos) actínico UV e UV-A, ao perigo da luz azul e ainda o perigo térmico na retina e térmico na pele, permitindo fazer uma análise comparativa dos resultados. O método alternativo revelou-se bastante flexível e eficaz, proporcionando bons resultados em termos da irradiância e radiância dos referidos efeitos fotobiológicos. A comparação destes resultados com os valores limites de exposição mencionados na norma EN/IEC6247 permitiu afirmar que a fonte de luz LED avaliada não representa perigo fotobiológico para a saúde humana e classifica-se no grupo de risco “isento”. Uma vez cumpridos os objectivos, entendeu-se que seria uma mais-valia para o trabalho já realizado, estudar outro caso prático. Sendo assim, fez-se a avaliação da radiação de apenas um dos LED´s que constituíam a fonte usada nos ensaios anteriores, com o espetro-radiómetro (método de referência) e com uma distância de 200 mm entre a fonte e o medidor. Neste caso verificaram-se diferenças significativas nas quantidades obtidas quando comparadas com os valores normativos. Concluiu-se que o efeito fotobiológico da luz azul insere-se no grupo de “isento”, sem perigo para a saúde. Contudo, o efeito térmico da retina apresenta um aumento considerável da quantidade de radiância, embora dentro do grupo de risco “isento”. Esta classificação de grupos de risco. Face aos resultados obtidos, pode confirmar-se que as lâmpadas LED apresentam segurança fotobiológica, atendendo aos baixos valores de irradiância e radiância dos efeitos fotobiológicos estudados. Pode ainda afirmar-se que a utilização do foto-radiómetro em alternativa ao espetro-radiómetro se revela mais eficaz do ponto de vista de metodologia prática. Este trabalho demonstra a robustez desses dois equipamentos de avaliação dos efeitos fotobiológicos, e procura estabelecer uma linha de orientação para a prevenção dos efeitos adversos na pele e olhos de todos os seres humanos sujeitos à radiação ótica artificial. Quanto às incertezas de medições, em relação ao processo de medição com foto-radiómetro, a sua estimação não se realizou, devido a não rastreabilidade entre as medições indicadas pelo fabricante, no certificado de calibração e as medidas realizadas por outras entidades. Contudo, é propõe-se a sua realização em trabalhos futuros dentro desse âmbito. As incertezas dos resultados de medições com espetro-radiómetro foram parcialmente estimadas. Atendendo às potencialidades do sistema de medição, propõe-se como trabalho futuro, a aplicação da norma IEC62478, que faz parte da aplicação da norma EN/IEC62471 na avaliação do efeito da luz azul, com base na determinação da temperatura de cor correlacionada (CCT) de lâmpadas ou sistemas de lâmpadas incluindo luminárias. Os valores de irradiância e radiância adquiridos nos processos de avaliação, tanto com foto-radiómetro como espectro-radiómetro foram gravados em ficheiro Excel para um CD e anexados a este trabalho.

Self-assessment of writing skills: a reliable and valid tool in an efl classroom

Trabalho de projecto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Ensino da Língua Inglesa

Estudio de la gestión de la variable ambiental en la generación termoeléctrica

En la actualidad, el cambio climático es uno de los temas de mayor preocupación para la población mundial y los científicos de todo el mundo. Debido al crecimiento de la población de forma exponencial, la demanda de energía aumenta acorde con ello, por lo que las actividades de producción energética aumentan consecuentemente, siendo éstas las principales causantes de la aceleración del cambio climático. Pese a que muchos países previamente habían apostado por la producción energética mediante tecnologías limpias a partir de energías renovables, hoy en día es imposible prescindir de los combustibles fósiles pues, junto a la energía nuclear, suponen el mayor porcentaje dentro del mix energético de los países más grandes del mundo, por lo que el cambio debe ser global y con todos los países implicados al unísono. Por ello, los países desarrollados decidieron acordar una serie de leyes y normas para la regulación y el control de la expansión energética en el mundo, mediante programas de incentivo a las empresas para la producción de energía limpia, libre de emisiones, sustituyendo y mejorando los procesos tecnológicos para que garanticen un desarrollo sostenible. De esta forma, se conseguiría también reducir la dependencia energética de los países productores de los recursos fósiles más importantes y a su vez, ayudar a otros sectores a diversificar su negocio y mejorar así la economía de las áreas colindantes a las centrales de producción térmica. Gracias a estos programas de incentivo o, también llamados mecanismos de flexibilidad, las empresas productoras de energía, al acometer inversiones en tecnologia limpia, dejan de emitir gases de efecto invernadero a la atmósfera. Por tanto, gracias al comercio de emisiones y al mercado voluntario, las empresas pueden vender dichas emisiones aumentando la rentabilidad de sus proyectos, haciendo más atractivo de por sí el hecho de invertir en tecnología limpia. En el proyecto desarrollado, se podrá comprobar de una forma más extensa todo lo anteriormente citado. Para ello, se desarrollará una herramienta de cálculo que nos permitirá analizar los beneficios obtenidos por la sustitución de un combustible fósil, no renovable, por otro renovable y sostenible, como es la biomasa. En esta herramienta se calcularán, de forma estimada, las reducciones de las emisiones de CO2 que supone dicha sustitución y se hallará, en función del valor de las cotizaciones de los bonos de carbono en los diferentes mercados, cuál será el beneficio económico obtenido por la venta de las emisiones no emitidas que supone esta sustitución. Por último, dicho beneficio será insertado en un balance económico de la central donde se tendrán en cuenta otras variables como el precio del combustible o las fluctuaciones del precio de la electricidad, para hallar finalmente la rentabilidad que supondría la inversión de esta adaptación en la central. Con el fin de complementar y aplicar la herramienta de cálculo, se analizarán dos casos prácticos de una central de carbón, en los cuales se decide su suscripción dentro del contexto de los mecanismos de flexibilidad creados en los acuerdos internacionales.

Multiple causes of death related to Chagas' disease in Brazil, 1999 to 2007

INTRODUCTION: Chagas' disease is a major public health problem in Brazil and needs extensive and reliable information to support consistent prevention and control actions. This study describes the most common causes of death associated with deaths related to Chagas' disease (underlying or associated cause of death). METHODS: Mortality data were obtained from the Mortality Information System of the Ministry of Health (approximately 9 million deaths). We analyzed all deaths that occurred in Brazil between 1999 and 2007, where Chagas' disease was mentioned on the death certificate as underlying or associated cause (multiple causes of death). RESULTS: There was a total of 53,930 deaths related to Chagas' disease, 44,543 (82.6%) as underlying cause and 9,387 (17.4%) as associated cause. The main diseases and conditions associated with death by Chagas' disease as underlying cause included direct complications of cardiac involvement, such as conduction disorders/arrhythmias (41.4%) and heart failure (37.7%). Cerebrovascular disease (13.2%), ischemic heart disease (13.2%) and hypertensive diseases (9.3%) were the main underlying causes of deaths in which Chagas' disease was identified as an associated cause. CONCLUSIONS: Cardiovascular diseases were often associated with deaths related to Chagas' disease. Information from multiple causes of death recorded on death certificates allows reconstruction of the natural history of Chagas' disease and suggests preventive and therapeutic potential measures more adequate and specifics.

Da prova: na atuação policial e no âmbito da infração tributária

Relatório de atividade profissional de mestrado em Direito Judiciário

Medical care and deaths due to coronary artery disease in Brazil, 1980-1999

OBJECTIVE: To estimate the frequency of medical care preceding deaths due to coronary artery diseases (CAD) in different Brazilian regions and capitals and to describe trends in medical care from 1980 to 1999. METHODS: Information on medical care preceding deaths due to coronary artery diseases/acute myocardial infarction in adults > 20 years from 1980 to 1999 was collected in the DATASUS, the databank of the Brazilian Health Ministry. Sex, states, and capitals selected for 1999 were analyzed in the study. Medical care was stratified as follows: with, without, and ignored medical care. The descriptive analysis comprised frequencies, ratios of frequency, test for proportions, and increments or reductions in frequencies. RESULTS: Acute myocardial infarction (AMI) represented 75 to 85% of the CAD in the period; the frequency of deaths with medical care ranged from 48.9 to 63%, and that of ignored medical care ranged from 27.2 to 41.5%. The frequency of other CAD with medical care ranged from 56 to 76%. The frequency of deaths preceded by medical care decreased by 17.8%, and that with ignored medical care increased by 36.5% (RF=2). The values for the other CAD were -20.2% and +64.6% (RF=44.4). Deaths preceded by medical care were more frequent in females at all ages and in all Brazilian regions. CONCLUSION: The results show a high frequency of sudden death and suggest errors in diagnosis or codification and overestimation of the statistics about mortality. Validation of the death certificate diagnosis and frequent surveillance are required.

A comparative study in two secondary schools aimed at improving their energy management: Archbishop McHale College Tuam, Coláiste Cholmcille Indreabhánn

Climate change is a crisis that is going to affect all of our lives in the future. Ireland is expected to have increased storms and rain throughout the country. This will affect our lives greatly unless we do something to change it. In an attempt to try and reduce the impacts of climate change, countries across the world met to address the problem. The meeting became known as the Kyoto Protocol. The Kyoto protocol set out objectives for each developed country to achieve with regards to carbon emissions to the same levels as 1990 levels. Due to the economy in Ireland being at a low point in 1990, Ireland was given a target of 13% carbon emissions above 1990 levels. In order to meet targets Ireland produced two energy papers, the green paper and the white paper. The green paper identified drivers for energy management and control; they were security of energy supply, economic competitiveness and environmental protection. The white paper produced targets in which we should aim to achieve to try and address the green papers drivers. Within the targets was the plan to reduce energy consumption in the public sector by 33% by 2020 through energy conservation measures. Schools are part of the public sector that has targets to reduce its energy consumption. To help to achieve targets in schools initiatives have been developed by the government for schools. Energy audits should be performed in order to identify areas where the schools can improve their current trends and show where they can invest in the future to save money and reduce the schools overall environmental footprint. Grants are available for the schools for insulation through the energy efficiency scheme and for renewable energy technologies through the ReHeat scheme. The promotion of energy efficient programs in schools can have a positive effect for students to have an understanding. The Display Energy Certificate is a legal document that can be used to understand how each school is performing from an energy perspective. It can help schools to understand why they need to change their current energy management structure. By improving the energy management of the schools they then improve the performance on the Display Energy Certificate. Schools should use these tools wisely and take advantage of the grants available which can in the short to long term help them to save money and reduce their carbon footprint.

One-year Mortality after an Acute Coronary Event and its Clinical Predictors: The ERICO Study

Background:Information about post-acute coronary syndrome (ACS) survival have been mostly short-term findings or based on specialized, cardiology referral centers.Objectives:To describe one-year case-fatality rates in the Strategy of Registry of Acute Coronary Syndrome (ERICO) cohort, and to study baseline characteristics as predictors.Methods:We analyzed data from 964 ERICO participants enrolled from February 2009 to December 2012. We assessed vital status by telephone contact and official death certificate searches. The cause of death was determined according to the official death certificates. We used log-rank tests to compare the probabilities of survival across subgroups. We built crude and adjusted (for age, sex and ACS subtype) Cox regression models to study if the ACS subtype or baseline characteristics were independent predictors of all-cause or cardiovascular mortality.Results:We identified 110 deaths in the cohort (case-fatality rate, 12.0%). Age [Hazard ratio (HR) = 2.04 per 10 year increase; 95% confidence interval (95%CI) = 1.75–2.38], non-ST elevation myocardial infarction (HR = 3.82 ; 95%CI = 2.21–6.60) or ST elevation myocardial infarction (HR = 2.59; 95%CI = 1.38–4.89) diagnoses, and diabetes (HR = 1.78; 95%CI = 1.20‑2.63) were significant risk factors for all-cause mortality in the adjusted models. We found similar results for cardiovascular mortality. A previous coronary artery disease diagnosis was also an independent predictor of all-cause mortality (HR = 1.61; 95%CI = 1.04–2.50), but not for cardiovascular mortality.Conclusion:We found an overall one-year mortality rate of 12.0% in a sample of post-ACS patients in a community, non-specialized hospital in São Paulo, Brazil. Age, ACS subtype, and diabetes were independent predictors of poor one‑year survival for overall and cardiovascular-related causes.