Toimintolaskennan hyödyntäminen prosessijohtamisen tukena julkisen sektorin terveydenhuolto-organisaatiossa

Tämän tutkielman tavoitteena on tutkia toimintolaskennan ja toimintojohtamisen käyttöä sekä hyödyntämistä prosessijohtamisen tukena. Työssä keskitytään tarkastelemaan ilmiötä julkisen sektorin terveydenhuoltoalalla. Tutkielmassa sovelletaan kvalitatiivista eli laadullista tutkimusmenetelmää. Tutkielma koostuu kahdesta osasta. Teoriaosassa käsitellään alan kirjallisuutta tieteellisten artikkelien valossa. Empiriaosassa selvitettiin tutkittavan organisaation kustannus- ja toimintolaskennan hyödyntämisestä prosessijohtamisen tukena. Aineistonkeruu empiirisen osion osalta toteutettiin avoimina ja strukturoimattomina haastatteluina. Tutkielman tuloksina muodostui ymmärrys organisaation kustannuslaskennan nykytilanteesta ja hyödyntämismahdollisuuksista prosessienkehittämisessä. Kustannus- ja toimintolaskentaa hyödynnetään nykyisin pääasiassa hinnoittelupäätöksiin. Kustannustietoja ei systemaattisesti hyödynnetä prosessienkehittämisessä eikä arvioitaessa potentiaalisia kehitys- ja parannuskohteita. Toimintolaskennan erityispiirteet tukevat kuitenkin sitä, että toimintolaskenta sopii terveydenhuolto-organisaatioon kustannuslaskentamalliksi. Voidaan todeta kustannuslaskennan tukevan Lean- kehitystyön kohdentamista ja tuloksien arviointia.

Proposta do modelo ABC na contabilidade de gestão das instituições de ensino superior : o caso da Universidade de Évora

O contexto actual vivido pelas Instituições de Ensino Superior tem requerido a adopção de sistemas de Contabilidade de Gestão mais precisos face às crescentes necessidades de informação de custos e de gestão. Deste modo, o principal propósito deste trabalho de investigação é estudar os recentes desenvolvimentos dos sistemas de Contabilidade de Gestão, enfatizando o Custeio baseado nas Actividades (ABC) como o modelo mais apropriado para responder a estas exigências informativas. Esta abordagem é complementada com a realização de um estudo de caso na Universidade de Évora, onde é aplicado empiricamente o ABC, sendo o mesmo apresentado como proposta de modelo na Contabilidade de Gestão destas organizações. Esta dissertação apresenta uma análise crítica e comparativa entre os distintos sistemas de custos tradicionais e a contabilidade por actividades, sendo ainda destacadas as potencialidades da metodologia ABC como plataforma para implementação de outros sistemas de informação baseados nas actividades, nomeadamente ao nível da gestão, do orçamento, dos preços de transferência e da gestão da qualidade total. Neste âmbito, com recurso a vários estudos de caso, são descritas as propriedades, as limitações e os resultados que mais se evidenciam pela implementação do sistema ABC nestas entidades. Os principais resultados desta investigação permitem concluir que embora os sistemas de custeio tradicionais apresentem um substrato conceptual totalmente válido, o sistema ABC evidencia uma estrutura conceptual mais credível, capaz de produzir informação mais precisa de apoio à tomada de decisão. No entanto, há algumas reservas que lhe são apontadas, em especial, no que respeita à relevância, utilidade e praticabilidade do método, e insuficiente documentação sobre os resultados obtidos. Pela aplicação empírica do sistema ABC na Universidade de Évora, conclui-se que a informação disponibilizada por este modelo é relevante, facilitadora e influencia o processo de tomada de decisão da sua gestão, e responde às exigências contabilísticas e de prestação de contas do POC-Educação e de outras entidades externas. ABSTRACT; The present context of Institutions of Higher Education has required adoption of more accurate Management Accounting systems due to increasing needs for information about costs and management. Thus, the main propose of this research is to study the recent developments of the Management Accounting systems, emphasizing the Activity-based Costing (ABC) as the most appropriate model that addresses these information requirements. This approach has been enriched through a case study at the University of Évora, where the ABC methodology was applied empirically, and presented as a proposed model of Management Accounting of these organizations. This dissertation presents a critical and comparative analysis between the traditional cost systems and the ABC, pointing out the potentialities of this methodology as a platform for implementation of other information systems based on activities, namely, with regard to management, budget, transfer pricing and total quality management. ln this context and supported by some case studies, the main properties, limitations and results of the implementation of the ABC system in these institutions have been described. The main results of this research indicate that although the traditional cost systems present a total valid conceptual structure, the ABC system provide a more credible conceptual structure, which is able to produce a more accurate information base for decision-making. However, there are some reservations that are considered, namely the relevance, utility, practicability, and insufficient documentation with regard to the obtained results. The empirical application of the ABC system at the University of Évora makes it possible to conclude that the information provided through the use of this model is relevant in terms of its influence in the decision-making process, and provides the answers to the accounting requirements of Education-POC and other external entities. NOTA: O volume II na página 228 contém a Matriz 10, que não foi digitalizado devido ao enorme formato que não permitiu ser digitalizado.

Implementação de um sistema de gestão da qualidade nas organizações escolares

A Qualidade é um dos fatores dinâmicos de competitividade e é, incontestavelmente, um dos pilares fundamentais para a construção do sucesso das organizações. O conceito de Qualidade não é de fácil definição, dado que é algo complexo e de difícil consenso. E muitas são as noções de Qualidade existentes na literatura, mas todas elas convergem num sentido único da busca da melhoria contínua e da excelência. Por outro lado, a implementação da Contabilidade de Gestão (designadamente o Custeio Baseado em Atividades - ABC) numa organização, sobretudo numa instituição de ensino, fornece recursos suficientes para a identificação dos melhores indutores de custo. Assim, toma-se inevitável observar as atividades, inquirir os colaboradores internos e externos, desenvolver e aplicar métodos quantitativos que monitorizem os processos e os procedimentos e, especialmente, que exista o empenho da gestão de topo, de modo a que a estratégia e a qualidade organizacional se inter-relacionem. Este trabalho apresenta diversos aspetos referentes à temática dos custos da qualidade (ou da não qualidade), a própria técnica contemporânea ABC e os principais resultados obtidos através da aplicação de listas de verificação e de um inquérito por questionário, junto dos alunos, colaboradores docentes e não docentes, com o objetivo de analisar a situação dos custos da qualidade baseados na contabilidade e avaliar o grau de satisfação/motivação com a qualidade do serviço prestado na sede do Agrupamento de Escolas do concelho de Estremoz. Os resultados do presente estudo evidenciaram alguns benefícios e dificuldades da aplicabilidade da Gestão da Qualidade numa instituição de ensino. A cultura organizacional deste tipo de instituições será um dos aspetos a ter em consideração, de modo a que os princípios da Gestão da Qualidade sejam implementados de forma harmoniosa e que poderá encaminhar essas organizações num verdadeiro percurso de qualidade, numa filosofia de melhoria contínua até à excelência. ABSTRACT: As a crucial factor for competitiveness, quality is undoubtedly one of the foundations on which a successful organization rests. The complexity surrounding the notion of quality makes it hard to reach a consensus about its meaning, and that is why it has so many different definitions. However, all of them have one thing in common - that it involves a continuous search for improvement and excellence. Nowadays, an organization that uses accounting methods to support management (namely the Activity-based Costing method) has the necessary means to identify where the main costs are originating from, particularly if the organization is somehow related to teaching. It is therefore inevitable to study activities, inquire everyone involved in the organization's activities, as well as develop and apply quantitative methods to monitor processes and procedures. Moreover, it is especially important that top management is fully committed to quality in order to reflect it on its strategy. This work focuses on several aspects pertaining costs associated with quality- and lack of quality­ and shows the Activity-based Costing method in particular, as well as the main results gathered from the verification lists and questionnaires made to students, teachers and staff, with the purpose of analyzing - based on accounting - the amount of costs derived from quality, and evaluating the degree of satisfaction and/or motivation as regards the quality of service provided at a group of schools in Portuguese region of Estremoz. The results of this study show that there are some benefits in applying quality management to teaching institutions, but there are also some difficulties. The organizational culture of these institutions is one aspect that should be taken into consideration, so that quality management principles can be implemented harmoniously. This may direct these organizations to the true path of quality, so they can continuously seek improvement and achieve excellence.

Modelo de Contabilidade Analítica aplicado à Direção de Abastecimento

A evidente competitividade de mercado que se regista na atualidade no meio empresarial, promove o esforço por parte dos organismos do Estado em controlar os seus gastos e maximizar a eficiência dos serviços, mantendo o nível de satisfação por parte do cliente. A Contabilidade Analítica tem a capacidade de custear os produtos ou as atividades de uma organização recorrendo a métodos de custeio como sejam, o método das Secções Homogéneas ou o Activity Based Costing. A presente dissertação, seguindo a metodologia de investigação em Ciências Socias, produz um modelo de custeio dos produtos e atividades de um organismo da Marinha Portuguesa, a Direção de Abastecimento. A construção do modelo, com recurso ao método de investigação estudo de caso, requere um estudo aprofundado da entidade e dos processos que realiza. A análise realizada permitiu definir o modelo de Secções Homogéneas com custeio acessório das atividades como o mais apropriado à organização em estudo. A constituição do modelo teórico permitiu a recolha dos procedimentos necessários à sua implementação, tendo sido verificada a exequibilidade do mesmo em SIGDN, com resultados positivos. Realizou-se acessoriamente um teste em condições reais ao modelo sendo possível obter resultados do custeio dos produtos e das atividades da Direção de Abastecimento. A investigação permitiu dar resposta a todas as questões enunciadas, cumprir os objetivos propostos e solucionar a problemática evidenciada. Foi assim possível, verificar a importância dada pela Marinha ao desenvolvimento da Contabilidade Analítica, efetuar uma análise profunda da organização da Direção de Abastecimento e criar um modelo de custeio dos produtos e atividades, capaz de acrescentar valor no suporte à tomada de decisão.

Aplicação do Sistema de Custeio Baseado em Atividades numa empresa de carroçarias

Com o progresso tecnológico verificou-se o aparecimento de tecnologias inovadoras e métodos sofisticados de produção, o aumento da concorrência e o acréscimo do nível de exigência dos clientes. A repartição dos custos baseados na mão-de-obra deixa de ter muito interesse, ao contrário dos custos indiretos, que passaram a ter um peso preponderante na estrutura de custos da maior parte das organizações, aparecendo, assim, novos desafios à Contabilidade Interna. Deste modo, em meados da década de 80 do século XX, Robert Kaplan e Robin Cooper desenvolveram o sistema de custeio baseado em atividades, vulgarmente conhecido por sistema ABC (Activity-Based Costing). Trata-se de um método de custeio capaz de superar as limitações dos sistemas de custeio tradicionais face à evolução económica e tecnológica. Com o passar dos anos este método foi-se aperfeiçoando e rapidamente se percebeu que permitia uma visão estratégica da empresa, ao identificar as suas potencialidades, os seus pontos fracos e as oportunidades de melhoria, refletindo com maior precisão e abrangência as dinâmicas organizacionais determinantes dos custos. Face ao exposto, o presente trabalho visou abordar a aplicação do sistema de custeio ABC numa empresa de fabricação de carroçarias para autocarros. Para o efeito utilizamos a metodologia do estudo de caso, baseando-nos no cálculo matricial para aplicar o sistema ABC na organização objeto de estudo. O trabalho realizado levou-nos a concluir que o sistema ABC é uma ferramenta de gestão que permite o apuramento dos custos indiretos de produção de uma forma mais precisa e racional do que os demais sistemas de custeio da contabilidade tradicional. Determinamos o custo de cada uma das atividades que compõem o processo de produção e apuramos que as atividades que consomem mais e menos recursos são, respetivamente, a atividade de Pintura e a atividade de Preparação para Entrega. A atividade Preparação para Entrega e a atividade Testes de Qualidade não acrescentam valor ao produto pela ótica do cliente e, por isso, o seu custo deve ser o mais reduzido possível. Por outro lado, foi possível concluir que os fatores que mais influenciaram a implementação do sistema ABC foram o apoio da gestão de topo, a familiaridade com outras ferramentas de gestão e a elevada formação dos recursos humanos.

Implementação da contabilidade analítica no Instituto Politécnico de Beja

A opção por uma gestão eficiente e eficaz é a resposta a dar à crescente racionalização de recursos que tem vindo a ser imposta às entidades públicas portuguesas e à qual não escapam as instituições que integram o sector do ensino superior. Assim sendo, estas entidades devem desenvolver e ao mesmo tempo, adoptar mecanismos que lhes permitam gerir recursos, quer os colocados à sua disposição, quer os gerados internamente, tendo em vista a sua optimização. Actualmente a prática da Contabilidade Analítica nas Instituições assume, cada vez mais, um papel dominante na análise e controlo dos custos, mas também dos proveitos e resultados por actividade. O objectivo da implementação deste Projecto, além de ser um desafio pessoal e Institucional, é uma obrigação legislativa, à qual pretendemos responder ao colocarmos em prática a Contabilidade Analítica, inserida no Plano Oficial de Contabilidade para o Sector Público - Sector da Educação, aprovado pela Portaria nº 794/2000, de 20 de Setembro. ABSTRACT: The choice of an efficient and effective management is the answer to the increasing rationalization of resources that have been imposed on portuguese public entities and of which the institutions from the higher education sector do not escape. Therefore, these entities must develop, and at the same time, adopt mechanisms that allow them to manage resources, both those placed at their disposal, and those that are internally generated, with an aim of optimization. Currently the practice of management accounting in the institutions assumes an increasingly a dominant role in the analysis and control of costs, but also in the income and earnings per activity. The purpose of implementing this project, besides being a personal and institutional challenge, is a legislative requirement that must be dealt with, by putting into practice the Management Accounting, inserted in the Official Accounting Plan for the Public Sector- Education Sector, approved by the Ordinance Nº 794/2000 of September 20.

Development and validation of a symptom-based activity index for adults with eosinophilic esophagitis.

BACKGROUND & AIMS: Standardized instruments are needed to assess the activity of eosinophilic esophagitis (EoE) and to provide end points for clinical trials and observational studies. We aimed to develop and validate a patient-reported outcome (PRO) instrument and score, based on items that could account for variations in patient assessments of disease severity. We also evaluated relationships between patient assessment of disease severity and EoE-associated endoscopic, histologic, and laboratory findings. METHODS: We collected information from 186 patients with EoE in Switzerland and the United States (69.4% male; median age, 43 y) via surveys (n = 135), focus groups (n = 27), and semistructured interviews (n = 24). Items were generated for the instruments to assess biologic activity based on physician input. Linear regression was used to quantify the extent to which variations in patient-reported disease characteristics could account for variations in patient assessment of EoE severity. The PRO instrument was used prospectively in 153 adult patients with EoE (72.5% male; median age, 38 y), and validated in an independent group of 120 patients with EoE (60.8% male; median age, 40.5 y). RESULTS: Seven PRO factors that are used to assess characteristics of dysphagia, behavioral adaptations to living with dysphagia, and pain while swallowing accounted for 67% of the variation in patient assessment of disease severity. Based on statistical consideration and patient input, a 7-day recall period was selected. Highly active EoE, based on endoscopic and histologic findings, was associated with an increase in patient-assessed disease severity. In the validation study, the mean difference between patient assessment of EoE severity (range, 0-10) and PRO score (range, 0-8.52) was 0.15. CONCLUSIONS: We developed and validated an EoE scoring system based on 7 PRO items that assess symptoms over a 7-day recall period. Clinicaltrials.gov number: NCT00939263.

Activity modeling in practice: a case-based guide to human-centered software engineering

The purpose of this study was to identify whether activity modeling framework supports problem analysis and provides a traceable and tangible connection from the problem identification up to solution modeling. Methodology validation relied on a real problem from a Portuguese teaching syndicate (ASPE), regarding courses development and management. The study was carried out with a perspective to elaborate a complete tutorial of how to apply activity modeling framework to a real world problem. Within each step of activity modeling, we provided a summary elucidation of the relevant elements required to perform it, pointed out some improvements and applied it to ASPE’s real problem. It was found that activity modeling potentiates well structured problem analysis as well as provides a guiding thread between problem and solution modeling. It was concluded that activity-based task modeling is key to shorten the gap between problem and solution. The results revealed that the solution obtained using activity modeling framework solved the core concerns of our customer and allowed them to enhance the quality of their courses development and management. The principal conclusion was that activity modeling is a properly defined methodology that supports software engineers in problem analysis, keeping a traceable guide among problem and solution.

Development and Validation of a Symptom-Based Activity Index for Adults with Eosinophilic Esophagitis

BACKGROUND & Aims: Standardized instruments are needed to assess the activity of eosinophilic esophagitis (EoE), to provide endpoints for clinical trials and observational studies. We aimed to develop and validate a patient-reported outcome (PRO) instrument and score, based on items that could account for variations in patients' assessments of disease severity. We also evaluated relationships between patients' assessment of disease severity and EoE-associated endoscopic, histologic, and laboratory findings. METHODS We collected information from 186 patients with EoE in Switzerland and the US (69.4% male; median age, 43 years) via surveys (n = 135), focus groups (n = 27), and semi-structured interviews (n = 24). Items were generated for the instruments to assess biologic activity based on physician input. Linear regression was used to quantify the extent to which variations in patient-reported disease characteristics could account for variations in patients' assessment of EoE severity. The PRO instrument was prospectively used in 153 adult patients with EoE (72.5% male; median age, 38 years), and validated in an independent group of 120 patients with EoE (60.8% male; median age, 40.5 years). RESULTS Seven PRO factors that are used to assess characteristics of dysphagia, behavioral adaptations to living with dysphagia, and pain while swallowing accounted for 67% of the variation in patients' assessment of disease severity. Based on statistical consideration and patient input, a 7-day recall period was selected. Highly active EoE, based on endoscopic and histologic findings, was associated with an increase in patient-assessed disease severity. In the validation study, the mean difference between patient assessment of EoE severity and PRO score was 0.13 (on a scale from 0 to 10). CONCLUSIONS We developed and validated an EoE scoring system based on 7 PRO items that assesses symptoms over a 7-day recall period. Clinicaltrials.gov number: NCT00939263.

Zeolite-based nanomaterials for the control of opportunistic pathogenic microorganisms

Dissertação de mestrado em Applied Biochemistry (área de especialização em Biomedicine)

Tuotannon budjettimallin uudistaminen elektroniikka-alan yrityksessä

Diplomityön tavoitteena on suunnitella ja toteuttaa tuotannon budjettimalli elektroniikka-alalla toimivalle yritykselle. Työn onnistumisen kannalta keskeistä on löytää vanhan budjettimallin puutteet sekä uudet tietotarpeet, joita tuotannon johto tarvitsee pyrittäessä kustannustehokkaaseen ja kannattavaan tuotantotoimintaan. Näiden tietojen pohjalta suunnitellaan ja toteutetaan uusi budjettimalli sekä kuvataan sen toimintaperiaatteet. Työn teoreettisessa osuudessa esitellään budjetoinnin tavoitteet, hyödyt, kritiikin kohteet sekä tyypillisen teollisuusyrityksen osabudjetit. Myös perinteiseen budjetointiin läheisesti liittyvät muodot ja sovellukset, kuten toimintopohjainen budjetointi, vastuualuelaskenta ja nollapohjabudjetointi esitellään. Budjettiseurannan ja eroanalyysin tärkeä merkitys tuodaan esiin. Ennen uuden mallin esittämistä tutkitaan vanhan budjettimallin toimintaperiaatteet ja heikkoudet. Empiirisessä osassa keskitytään tuotannon budjetin toimintaperiaatteisiin sen sisältämien osabudjettien kautta. Työn loppupuolella esitellään uuden budjettimallin antamat tulokset ja poikkeamat sekä arvioidaan budjettimallin toimivuutta. Budjettimallin tuottaman informaation pohjalta tuotannonjohtoa ja suunnittelua ryhdyttiin välittömästi tehostamaan välillisten kustannusten alentamiseksi. Tehostustoimet ilmenivät konkreettisesti positiivisena erona poikkeama-analyysissä suhteessa budjettiin. Rakennetun budjettimallin mallinnustarkkuus osoittautui hyväksi ja uudet esiin tuodut kustannuserät hyödylliseksi informaatioksi.

Improving anterior deltoid activity in a musculoskeletal shoulder model - an analysis of the torque-feasible space at the sternoclavicular joint.

Modelling the shoulder's musculature is challenging given its mechanical and geometric complexity. The use of the ideal fibre model to represent a muscle's line of action cannot always faithfully represent the mechanical effect of each muscle, leading to considerable differences between model-estimated and in vivo measured muscle activity. While the musculo-tendon force coordination problem has been extensively analysed in terms of the cost function, only few works have investigated the existence and sensitivity of solutions to fibre topology. The goal of this paper is to present an analysis of the solution set using the concepts of torque-feasible space (TFS) and wrench-feasible space (WFS) from cable-driven robotics. A shoulder model is presented and a simple musculo-tendon force coordination problem is defined. The ideal fibre model for representing muscles is reviewed and the TFS and WFS are defined, leading to the necessary and sufficient conditions for the existence of a solution. The shoulder model's TFS is analysed to explain the lack of anterior deltoid (DLTa) activity. Based on the analysis, a modification of the model's muscle fibre geometry is proposed. The performance with and without the modification is assessed by solving the musculo-tendon force coordination problem for quasi-static abduction in the scapular plane. After the proposed modification, the DLTa reaches 20% of activation.

Road Design for Future Maintenance : Life-cycle Cost Analyses for Road Barriers

The cost of a road construction over its service life is a function of design, quality of construction as well as maintenance strategies and operations. An optimal life-cycle cost for a road requires evaluations of the above mentioned components. Unfortunately, road designers often neglect a very important aspect, namely, the possibility to perform future maintenance activities. Focus is mainly directed towards other aspects such as investment costs, traffic safety, aesthetic appearance, regional development and environmental effects. This doctoral thesis presents the results of a research project aimed to increase consideration of road maintenance aspects in the planning and design process. The following subgoals were established: Identify the obstacles that prevent adequate consideration of future maintenance during the road planning and design process; and Examine optimisation of life-cycle costs as an approach towards increased efficiency during the road planning and design process. The research project started with a literature review aimed at evaluating the extent to which maintenance aspects are considered during road planning and design as an improvement potential for maintenance efficiency. Efforts made by road authorities to increase efficiency, especially maintenance efficiency, were evaluated. The results indicated that all the evaluated efforts had one thing in common, namely ignorance of the interrelationship between geometrical road design and maintenance as an effective tool to increase maintenance efficiency. Focus has mainly been on improving operating practises and maintenance procedures. This fact might also explain why some efforts to increase maintenance efficiency have been less successful. An investigation was conducted to identify the problems and difficulties, which obstruct due consideration of maintainability during the road planning and design process. A method called “Change Analysis” was used to analyse data collected during interviews with experts in road design and maintenance. The study indicated a complex combination of problems which result in inadequate consideration of maintenance aspects when planning and designing roads. The identified problems were classified into six categories: insufficient consulting, insufficient knowledge, regulations and specifications without consideration of maintenance aspects, insufficient planning and design activities, inadequate organisation and demands from other authorities. Several urgent needs for changes to eliminate these problems were identified. One of the problems identified in the above mentioned study as an obstacle for due consideration of maintenance aspects during road design was the absence of a model for calculating life-cycle costs for roads. Because of this lack of knowledge, the research project focused on implementing a new approach for calculating and analysing life-cycle costs for roads with emphasis on the relationship between road design and road maintainability. Road barriers were chosen as an example. The ambition is to develop this approach to cover other road components at a later stage. A study was conducted to quantify repair rates for barriers and associated repair costs as one of the major maintenance costs for road barriers. A method called “Case Study Research Method” was used to analyse the effect of several factors on barrier repairs costs, such as barrier type, road type, posted speed and seasonal effect. The analyses were based on documented data associated with 1625 repairs conducted in four different geographical regions in Sweden during 2006. A model for calculation of average repair costs per vehicle kilometres was created. Significant differences in the barrier repair costs were found between the studied barrier types. In another study, the injuries associated with road barrier collisions and the corresponding influencing factors were analysed. The analyses in this study were based on documented data from actual barrier collisions between 2005 and 2008 in Sweden. The result was used to calculate the cost for injuries associated with barrier collisions as a part of the socio-economic cost for road barriers. The results showed significant differences in the number of injuries associated with collisions with different barrier types. To calculate and analyse life-cycle costs for road barriers a new approach was developed based on a method called “Activity-based Life-cycle Costing”. By modelling uncertainties, the presented approach gives a possibility to identify and analyse factors crucial for optimising life-cycle costs. The study showed a great potential to increase road maintenance efficiency through road design. It also showed that road components with low investment costs might not be the best choice when including maintenance and socio-economic aspects. The difficulties and problems faced during the collection of data for calculating life-cycle costs for road barriers indicated a great need for improving current data collecting and archiving procedures. The research focused on Swedish road planning and design. However, the conclusions can be applied to other Nordic countries, where weather conditions and road design practices are similar. The general methodological approaches used in this research project may be applied also to other studies.

"An on-going individual adjustment" : a qualitative study of midwives' experiences counselling pregnant women on physical activity in Sweden

Background: In Sweden, midwives play prominent supportive role in antenatal care by counselling and promoting healthy lifestyles. This study aimed to explore how Swedish midwives experience the counselling of pregnant women on physical activity, specifically focusing on facilitators and barriers during pregnancy. Also, addressing whether the midwives perceive that their own lifestyle and body shape may influence the content of the counselling they provide. Methods: Eight focus group discussions (FGD) were conducted with 41 midwives working in antenatal care clinics in different parts of Sweden between September 2013 and January 2014. Purposive sampling was applied to ensure a variation in age, work experience, and geographical location. The FGD were digitally recorded, transcribed verbatim, and analyzed using manifest and latent content analysis. Results: The main theme- "An on-going individual adjustment" was built on three categories: "Counselling as a challenge"; "Counselling as walking the thin ice" and "Counselling as an opportunity" reflecting the midwives on-going need to adjust their counselling depending on each woman's specific situation. Furthermore, counselling pregnant women on physical activity was experienced as complex and ambiguous, presenting challenges as well as opportunities. When midwives challenged barriers to physical activity, they risked being rejected by the pregnant women. Despite risking rejection, the midwives tried to promote increased physical activity based on their assessment of individual needs of the pregnant woman. Some participants felt that their own lifestyle and body shape might negatively influence the counselling; however, the majority of participants did not agree with this perspective. Conclusions: Counselling on physical activity during pregnancy may be a challenging task for midwives, characterized by on-going adjustments based on a pregnant woman's individual needs. Midwives strive to find individual solutions to encourage physical activity. However, to improve their counselling, midwives may benefit from further training, also organizational and financial barriers need to be addressed. Such efforts might result in improved opportunities to further support pregnant women's motivation for performance of physical activity.

Antibacterial activity of four glass ionomer cements used in atraumatic restorative treatment

The in vitro antibacterial activity of four glass ionomer cements ( Fuji IX, Ketac Molar, Vidrion R and Vitromolar) indicated for Atraumatic Restorative Treatment ( ART) was studied against strains of bacteria involved in the development of oral diseases, Streptococcus mutans, Streptococcus sobrinus, Lactobacillus acidophilus and Actinomyces viscosus. The agar plate diffusion test was used for the cultures, which included chlorhexidine as a positive control. The results demonstrated that all the cements evaluated presented antibacterial activity. Based on the results of this study, it can be concluded that Fuji IX and Ketac Molar presented the most effective antibacterial activity considering the ART approach.