Evaluation of a Brief Intervention to Assist Health Visitors and Community Practitioners to Engage with Fathers as Part of the Healthy Child Initiative

Aims: To improve engagement of Health Visitors and Community Practitioners delivering the Healthy Child Programme with fathers. To evaluate a one-day, father-focused workshop with a supporting handbook for Practitioners. To identify institutional and organisational barriers to engagement with fathers. Background: The UK government policy encourages health professionals to engage with fathers. This derives from robust evidence that fathers’ early involvement with their children impacts positively on emotional, behavioural and educational development. Yet, there is little evidence that the importance of engaging fathers is reflected in Health Visitor training or that primary-care services are wholly embracing father-inclusive practice. The Fatherhood Institute (FI), a UK charity, has developed a workshop for Practitioners delivering the Healthy Child Programme. Method: A ‘before and after’ evaluation study, comprising a survey followed by telephone interviews, evaluated the impact of the FI workshop on Health Visitors’ and Community Practitioners’ knowledge, attitudes and behaviour in practice. A total of 134 Health Visitors and Community Practitioners from eight NHS Trusts in England attended the workshop from November 2011 to January 2014 at 12 sites. A specially constructed survey, incorporating a validated questionnaire, was administered before the workshop, immediately afterwards and three months later. Telephone interviews further explored participants’ responses. Findings: Analysis of the questionnaire data showed that the workshop and handbook improved participants’ knowledge, attitudes and behaviour in practice. This was sustained over a three-month period. In telephone interviews, most participants said that the workshop had raised their awareness of engaging fathers and offered them helpful strategies. However, they also spoke of barriers to engagement with fathers. NHS Trusts need to review the training and education of Health Visitors and Community Practitioners and take a more strategic approach towards father-inclusive practice and extend services to meet the needs of fathers.

Communities of practice as professional and organizational development strategy in local public health organizations in Québec, Canada : an evaluation model

Communities of practice (CoPs) are among the professional development strategies most widely used in such fields as management and education. Though the approach has elicited keen interest, knowledge pertaining to its conceptual underpinnings is still limited, thus hindering proper assessment of CoPs' effects and the processes generating the latter. To address this shortcoming, this paper presents a conceptual model that was developed to evaluate an initiative based on a CoP strategy: Health Promotion Laboratories are a professional development intervention that was implemented in local public health organizations in Montreal (Quebec, Canada). The model is based on latest theories on work-group effectiveness and organizational learning and can be usefully adopted by evaluators who are increasingly called upon to illuminate decision-making about CoPs. Ultimately, validation of this conceptual model will help advance knowledge and practice pertaining to CoPs as well as professional and organizational development strategies in public health.

Conocimientos, actitudes y prácticas nutricionales en diabéticos tipo 2 que integran los clubes de Diabéticos Urbanos, Cuenca, 2015

Se realizó un estudio descriptivo, en una muestra probabilística calculada con un universo finito de 682 pacientes; el tamaño de la muestra fue de 245; se calculó en base al 95% de confianza, actitudes buenas del 50% y 5% de error diferencia. Los datos de conocimientos, actitudes y prácticas se obtuvieron por entrevista directa; para la tabulación y análisis de los datos se utilizó el software SPSS, versión 2015. Resultados La edad fluctuó entre 40-85 años, la mediana, 67 años. El 72,25 % fueron mujeres, el 56,32 %, casados, y el 65,31%, tenían instrucción básica. El nivel de conocimientos buenos en nutrición fue del 12,65%, regulares, el 61,23% y malos, el 26,12%. Actitudes buenas, el 10,20%, regulares, el 64,90% y malas, el 24,90%. El 15,51%, tuvo buenas prácticas, regulares, el 58,78%, y malas, el 25,71%. Conclusiones La frecuencia de conocimientos, actitudes y prácticas regulares fueron superiores al 50%.

Healthcare providers’ knowledge, attitude and behaviour towards breast cancer diagnosis and treatment in Malaysia – a mini systematic review

Breast cancer is the most common cancer among women in Malaysia. Therefore, it is important for the public to be educated on breast cancer and to know the steps that need to be taken to detect it early. Healthcare providers are in a unique position to provide public health education due to their good knowledge of health issues and their roles in healthcare. A systematic review of studies conducted from 2008 till 2015 was undertaken to analyze the knowledge, attitudes and behavior of Malaysian healthcare providers regarding breast cancer, in an attempt to obtain an overall picture of how wellequipped the healthcare providers are to provide optimal breast cancer education, and to ascertain their perceptions and actual involvement in such education. The systematic review was conducted via a primary search of various databases and journal websites, and a secondary search of references cited in eligible studies. Criteria for eligibility include studies conducted in Malaysia and published from the year 2008 to 2015, and written in English language. A total of fifteen articles were identified and reviewed but only two studies were eligible for this review. The findings suggest that future and current Malaysian healthcare providers have moderate knowledge of breast cancer, showed a positive disposition towards involvement in breast cancer education, but displayed poor involvement.

Prevalência da infecção por HPV e perfil das mulheres frente ao exame de papanicolau no município de São José de Mipibú/RN.

The Human Papillomavirus (HPV) infection is the major sexually transmitted disease all over the world. There are many factors associated to infection and the virus persistency in the organism. This study aims to evaluate the women's knowledge, attitudes and practice about the Papanicolaou test (Pap), as well as analyze the HPV and Chlamydia trachomatis infections prevalences in sexually active women from the city of São José do Mipibu/RN/Brazil. This research was divided in two steps (step I and step II), using different methodologies and samples each. The samples collected in each step, even socio-demographic or from uterus cervix, are from different patients e were analyzed separated. In step I was evaluated 267 rural and urban zone women s knowledge, attitudes and practices about the Pap by home interview. In the step II were included 605 women with age ranged from 15 to 71 years old, with mean of 33,5 years old and from each one were collected two cervical samples, one for Pap and other for molecular biology, beside the epidemiological interview to investigate the correlation between prevalence of HPV infection and risk factors. To molecular analyses, the samples were processed using a mammal rapid DNA extraction technique protocol. For C. trachomatis DNA detection were used the CP24/27 primers, and GP5+/GP6+ to HPV. PCR products were analyzed by electrophoresis on 8% polyacrylamide gels, followed by silver staining. The results of the step I showed that, in spite of only 46,1% of the interviewed women they have demonstrated to possess appropriate knowledge on the Pap test, the attitude and practice proportions were significantly larger, 63,3% and 64,4% respectively. The largest education degree presented association with adaptation of the knowledge, attitudes and practice, while neglect, lack of solicitation of the exam for the doctor and shame, came as main barriers for the accomplishment of the exam. In the stage II the HPV general prevalence was 28,9%, being 26,7% in the women with normal cytology or benign alterations, 26,7% in the ones that had atypical squamous cells of undetermined significance (ASC-US) and 80% in those with Low grade squamous intraepithelial lesion (LSIL). the HPV infection prevalence was larger in the patients with up to 30 years of age and in the unmarried women, and those that had more than one sexual partner presented larger infection risk. The results show that the sexual relationship with multiple partners increased the infection risk for HPV and consequently the possibility of the occurrence of lesions uterine cervix

A Brazilian Original Pedagogical Approach To The Teaching Of Neurology.

The two-arm Clinical Decisions/Diagnostic Workshop (CD/DW) approach to undergraduate medical education has been successfully used in Brazil. Present the CD/DW approach to the teaching of stroke, with the results of its pre-experimental application and of a comparative study with the traditional lecture-case discussion approach. Application of two questionnaires (opinion and Knowledge-Attitudes-Perceptions-KAP) to investigate the non-inferiority of the CD/DW approach. The method was well accepted by teachers and students alike, the main drawback being the necessarily long time for its completion by the students, a feature that may better cater for different educational needs. The comparative test showed the CD/DW approach to lead to slightly higher cognitive acquisition as opposed to the traditional method, clearly showing its non-inferiority status. The CD/DW approach seems to be another option for teaching neurology in undergraduate medical education, with the bonus of respecting each learner`s time.

Relações entre conteúdo e forma de conhecimentos e práticas pedagógicas em Geociências: imaginário de futuros professores numa disciplina de licenciatura

Pesquisas e reflexões sobre ensino, história e epistemologia das Ciências da Terra têm sido desenvolvidas, em grande parte, intimamente associadas às práticas docentes dos professores/pesquisadores universitários. Nessa mesma perspectiva, buscamos neste trabalho compreender relações que os estudantes de licenciatura em Geografia estabelecem entre o conteúdo/forma trabalhado numa disciplina universitária e o conteúdo/forma profissional, ou seja, pensado na relação com a escola básica, com o tornar-se professor. As respostas dos estudantes a uma questão por nós formulada indicou como eles representaram uma das atividades desenvolvidas na disciplina na relação com seu imaginário sobre ser professor da educação básica. As análises mostraram também que essas significações se produzem de maneiras muito diferentes entre os estudantes, fazendo intervir no imaginário a partir do qual essas significações se produzem, aspectos da memória escolar de alguns estudantes e da maneira como representam o conhecimento escolar e as práticas de ensino na disciplina Geografia da educação básica. As análises mostraram que a atividade não é transparente quanto ao que seja o "conteúdo" de ensino da atividade, posto que essas significações são o trabalho de diferentes memórias discursivas, implicado em diferentes posições-aluno. Este estudo aponta para a importância de considerar e para a possibilidade de trabalhar com os imaginários dos futuros professores sobre ensino na relação que estabelecem com os conteúdos/formas em suas disciplinas científicas universitárias.

Forest certification in Amazonia: standards matter

Forest Stewardship Council (FSC) certification promises international consumers that `green-label` timber has been logged sustainably. However, recent research indicates that this is not true for ipe (Tabebuia spp.), currently flooding the US residential decking market, much of it logged in Brazil. Uneven or non-application of minimum technical standards for certification could undermine added value and eventually the certification process itself. We examine public summary reports by third-party certifiers describing the evaluation process for certified companies in the Brazilian Amazon to determine the extent to which standards are uniformly applied and the degree to which third-party certifier requirements for compliance are consistent among properties. Current best-practice harvest systems, combined with Brazilian legal norms for harvest levels, guarantee that no certified company or community complies with FSC criteria and indicators specifying species-level management. No guidelines indicate which criteria and indicators must be enforced, or to what degree, for certification to be conferred by third-party assessors; nor do objective guidelines exist for evaluating compliance for criteria and indicators for which adequate scientific information is not yet available to identify acceptable levels. Meanwhile, certified companies are expected to monitor the long-term impacts of logging on biodiversity in addition to conducting best-practice forest management. This burden should reside elsewhere. We recommend a clarification of `sustained timber yield` that reflects current state of knowledge and practice in Amazonia. Quantifiable verifiers for best-practice forest management must be developed and consistently employed. These will need to be flexible to reflect the diversity in forest structure and dynamics that prevails across this vast region. We offer suggestions for how to achieve these goals.

From idola conceptiones to discourse analysis: A response to Bart Crum

Crum's notion of idola as a conceptual fallacy is interesting, somewhat helpful, yet potentially limiting in a critique of research in PE if one is to accept a postmodern or poststructuralist position. In line with a poststructuralist position, a strength in Crum's application of idola is the recognition that research in PE is constituted by the researcher and their social world which, in turn, constitutes the researcher. Limitations to Crum's idola thesis arise when the notion is used to suggest that as a result of the researcher's lack of conceptual clarity, the quest for knowledge or truth about PE pedagogy is undermined as this assumes that meanings can be unequivocal and precede a linear research process. In contrast, this response argues that a priority in research should be to examine how, and under what conditions, particular discourses come to shape PE practices in schools and universities. In a postmodern world, conceptual clarity should not be the goal but rather a coming to understand how PE knowledge and practice is being constructed across sites and contexts.

Behaviour of caregivers to protect their infants from exposure to the sun in Queensland, Australia.

Exposure to the sun by infants has been demonstrated to increase the risk of the development of melanoma and other skin cancers later in life. A cohort of 508 women who delivered healthy Caucasian babies were followed up at 1 year to determine their knowledge, attitudes and practices regarding sun protection towards themselves and their child. In addition, the 1-year-old infants were assessed by a trained nurse for the number of nevi they had on their skin. Results indicate caregivers reported a high level of sun-protection practices towards their child, with 93% of the caregivers reporting usually or always placing the child in the shade when going outside. Further, 81% of the caregivers reported usually or always placing a hat on the child, while 64% reported usually or always applying sunscreen to the child's exposed skin. Interestingly, only 61% of the caregivers reported that they stayed in the shade to reduce sun exposure and only 42% wore a hat when out in the sun. Mother's own personal sun-protection methods predicted the method of sun protection that she would most likely use for the child. While children appear to be reasonably protected from the sun, they are influenced by their mother's own behaviors.

Conhecimento e formação de futuros professores dos primeiros anos – o sentido de número racional

Nos últimos anos o conhecimento do professor tem vindo a ser reconhecido como um dos aspetos nucleares no, e para o, desenvolvimento do conhecimento matemático dos alunos. Atendendo a essa centralidade, a formação deverá focar-se onde é, efetivamente, necessária, de modo a potenciar um incremento do conhecimento dos alunos, pelo conhecimento (e práticas) dos professores. Sendo os números racionais um dos tópicos problemáticos para os alunos, é fundamental identificar quais as situações matematicamente (mais) críticas para os professores de modo que, pela formação facultada, possam deixar de o ser. Neste artigo, tendo por foco o conhecimento matemático do professor e as suas especificidades, discutimos alguns aspetos desse conhecimento de futuros professores sobre números racionais, em concreto o sentido de número racional, identificando as suas componentes mais problemáticas e equacionando alguns dos porquês em que se sustentam. Terminamos com algumas considerações sobre implicações para a formação de professores e responsabilidade dos seus formadores.

Educação alimentar infantil: potencialidades de estudantes de educação de infância

Resumo: Na promoção de comportamentos alimentares saudáveis ao longo da vida. que deve iniciar-se o mais precocemente possível, a educação alimentar é um elemento chave. O jardim-de-infância é um espaço efectivo na implementação de projectos de educação alimentar, onde os educadores de infância são actores imprescindíveis. Este estudo teve como objectivo desenvolver uma metodologia apropriada para identificar as capacidades de estudantes de educação de infância e avaliar as suas aptidões no contexto da educação alimentar infantil. A população alvo do estudo foram estudantes do 4ºano da licenciatura em educação de infância de instituições públicas e privadas da área metropolitana de Lisboa (n=287). Construiu-se um videograma, integrador dos domínios da aprendizagem (cognitivo e afectivo) e dos factores associados aos comportamentos em saúde (predisponentes, capacitadores e de esforço). A construção dos questionários estruturou-se em: conhecimentos-atitudes-comportamentos.Pretendia-se que os estudantes transmitissem a sua opinião, de acordo com os questionários.Os estudantes manifestaram conhecimentos, no âmbito da alimentação infantil e da utilidade e aplicabilidade da educação alimentar.Nenhum estudante apresentou conhecimentos negativos, numa escala de zero a 18 valores, 86,9% obtiveram uma classificação entre 11 e 17 valores e 13,1% a classificação máxima.A atitude dos estudantes revelou-se consensual com o desejável, 98,5% apresentaram atitudes positivas face aos aspectos estruturadores das actividades de educação alimentar.No domínio do "saber fazer" 51,0% dos estudantes demonstraram fragilidades no seu desempenho/comportamento. Em conclusão, a utilização do questionário demonstrou ser apropriado para a medição dos conhecimentos, das atitudes e como forma de os estudantes, após visionarem o videograma, espelharem o seu desempenho/comportamento face à representação do educador de infância. A taxa de resposta nunca foi inferior a 98,9% (n=284). No domínio dos conhecimentos, os estudantes manifestaram concepções positivas no campo da alimentação infantil e da educação alimentar. As atitudes enfatizaram-se no domínio afectivo, nos aspectos relacionais e comunicacionais. No domínio dos comportamentos, 91,8% dos estudantes apresentaram dificuldades na identificação dos aspectos menos correctos do desempenho dos actores do video, o que pode sugerir lacunas no âmbito do "saber fazer". Abstract:Nutrition education is key element to promote lifelong healthy eating behaviours and it must begin since early stages of life. Nursery schools are an effective space in the implementation of nutrition education projects, where the nursery teachers are indispensable actors. The aim of this study was to develop an appropriate methodology to identify nursery education student´s skills and evaluate their attitudes in the childhood nutrition education's context. The study's population were students of the 4th degree in private and public nursery education universities in Lisbon metropolitan area (n=287). A video integrator of learning domains (cognitive and affective) and of factors associated with health behaviours (predisposing, enabling and reinforcing) was developed. Questionnaire´s construction was structured in: knowledge-attitudes-behaviours.According to the questionnaires students were asked to transmit their opinion. Students revealed knowledge, in the scope of the childhood nutrition and in utility and applicability of nutrition education. No students presented negative results in knowledge ina zero - 18 scale; 86,9% students obtained a classification between 11 and 17 and the maximum classification was obtained by 13.1% students. Student's attitude was according to win the desirable, 98,5% student´s revealed positive attitudes in the nutrition education's structure aspects of chilhood activities.In the domain of the "know to do" 51,0% of students showed fragilities in their performance/behaviour. In conclusion, the questionnaire´s utilization confirm to be appropriated in measurement knowledge and attitudes and also, after watching the video, as a way for students reflect their performance/behaviour face to the nursery teacher´s representation. Answer´s rate was never lower than 98.9% (n=284). In the knowledge's domain students demonstrated positive conceptions in the childhood nutrition and nutrition education's fields. Attitudes were emphasized in the effective domain in the communication and relational aspects. In behaviour's domain 91.8% students presented difficulties in identifying the less correct aspects of the video actor's performance what may suggest gaps in the "know to do" scope.

Schistosomiasis mansoni in an area of low transmission: II. Risk factors for infection

Risk factors for Schistosoma mansoni infection were identified using a 1:1 matched case-control design. The work was conducted in the municipality of Pedro de Toledo, São Paulo State, Brazil, an area where the snail host is Biomphalaria tenagophila. Information on water contact patterns, knowledge, attitudes and pratices (kap), socioeconomic and sanitary conditions were obtained by mean of questionnaires. The crude odds ratio estimates and the adjusted odds ratio estimates using the logistic regression model are presented. Most of the examined individuals admitted recent water contacts (90.6% of the cases). The most frequent reason for contact was swimming, playing and fishing and the preferential site of contact was the river. According to the logistic regression technique, the main risk factors for infection were: a) water contact through swimming, playing and fishing; b) fording; c) bad hygiene. We concluded that recreational activities are the main reasons for schistosomiasis transmission in Pedro de Toledo and leisure alternatives should be offered to the local population.

A questão visual na oftalmologia pediátrica da região de Lisboa

RESUMO: Na parte inicial incluem-se algumas notas sucintas com base no panorama científico,histórico e cultural da visão considerada segundo três abordagens - o olho (o olho humano na especificidade da sua posição filogenética, elemento anátomo-funcional básico do sistema visual ao qual o cérebro pertence), os olhos (unidades gémeas essenciais do rosto na sua actividade consensual e conjugada da binocularidade), o olhar (carregado de expressão psicológica e o seu efeito sobre o observador, sinal para o comportamento e criador de sentimentos, sedimentado em obras de arte e em formas de superstição dos povos). Segue-se a apresentação de um estudo descritivo transversal, como contribuição para o conhecimento do estado de saúde visual da população infantil da região de Lisboa e determinar factores que o influenciam. Entre Outubro de 2005 e Agosto de 2006 examinaram-se 649 crianças com idade inferior a 10 anos da Consulta de Oftalmologia Pediátrica dos Serviços de Assistência Médico-Social do Sindicato dos Bancários do Sul e Ilhas (SAMS). Colheram-se dados respeitantes a mais de 250 variáveis primárias que cobriram a maior parte dos itens do exame oftalmológico habitual. Na análise dos dados teve-se especialmente em conta a idade, com um papel decisivo nas principais fases de desenvolvimento do sistema visual. No caso das crianças de 6 a 7 anos de idade põem-se lado a lado resultados dos SAMS e das Escolas. A profusão de dados numéricos ditou a necessidade da determinação frequente da significância estatística dos resultados de subgrupos. Alguns resultados do estudo, na sua maioria do grupo SAMS: Crianças de 6-7 anos, 71,1% (SAMS) e 91,5% (Escolas) não tinham sido examinadas com menos de 4 anos. Frequência global de alterações miópicas 9,4%, de alterações hipermetrópicas 25,3%, umas e outras com variações acentuadas com a idade. Estrabismo convergente 3,9%. Ambliopia 2,6% (13/491 crianças >=4 anos de idade), mais frequente no sexo feminino, naquelas que tiveram a sua 1ª observação depois dos 4 anos e em que os pais não aderiam à terapêutica prescrita. Objectivos específicos ocuparam-se da acuidade visual e da refracção ocular. O estudo comparativo da refractometria automática sem e com cicloplegia permitiu evidenciar que o teste da acuidade visual é insuficiente, por si só, para fazer o diagnóstico correcto. A análise dos antecedentes familiares oftalmológicos demonstrou a importância do seu conhecimento e pôs em evidência, entre outras, as seguintes relações: 10 pag1.qxp 27-11-2001 18:28 Page 10 Índice Geral 11 Crianças com antecedentes de alterações miópicas têm maior frequência de diagnóstico de alterações miópicas e de refracção negativa, uma taxa mais elevada de correspondência quantitativa diagnóstico/refracção nas alterações miópicas. Estas crianças também têm, em geral, características inversas no que diz respeito a alterações hipermetrópicas. Crianças com antecedentes de alterações hipermetrópicas têm maior frequência de diagnóstico de alterações hipermetrópicas. Crianças com antecedentes de estrabismo têm maior frequência de diagnóstico de estrabismo convergente manifesto e de esodesvios no seu todo. Crianças com antecedentes familiares de astigmatismo têm maior frequência de diagnóstico de astigmatismo. Traçam-se alguns perfis oftalmológicos infantis que permitem apreciar de forma sinóptica um conjunto de parâmetros da saúde da visão. Os dados colhidos sobre a aderência dos pais à terapêutica prescrita e sobre a atitude em relação ao uso de óculos assim como os dados sobre o comportamento da criança na sala de aula e dificuldades de aprendizagem foram em geral escassos para permitirem tirar conclusões, embora mostrem indícios a investigar futuramente. Paralelamente ortoptistas e enfermeiras efectuaram um rastreio escolar da acuidade visual <0,8 e de alterações da motilidade ocular extrínseca que abrangeu 520 alunos do 1º ano do 1º ciclo do ensino básico (2005/2006) das escolas públicas da cidade de Lisboa. 101 destas crianças foram observadas no consultório da autora, umas referidas a partir do rastreio, outras como controlo deste. Quanto à acuidade visual o valor preditivo do teste negativo foi de 91% mas o do teste positivo de apenas 67% (33% de falsos positivos, consequentemente uma alta taxa de sobrerreferenciação). A qualidade do rastreio efectuado por ortoptistas foi inferior à do efectuado por enfermeiras. O rastreio não teve qualidade aceitável. Foi feito um inquérito a médicos e enfermeiros de centros de saúde sobre conhecimentos, atitudes e práticas em relação com os cuidados de oftalmologia pediátrica. Discutem-se os resultados, tiram-se conclusões e fazem-se recomendações susceptíveis de contribuir para uma melhor saúde visual das crianças. ABSTRACT: Firstly some brief remarks are made based on the scientific, historical and cultural panorama of the human vision with regard to three approaches: the eye (the human eye in its specific filogenetic place, fundamental anatomofunctional element of the visual system in interaction with the brain), the eyes (essential twin units of the face with their consensual and conjugated binocular activity), the gaze (psychologicaly overloaded, a means to express oneself and to influence the observer, a guide to other persons' behaviour, consolidated in works of art and in people's traditional superstitious believes and ways of thinking). A report is made on a cross-sectional descriptive study whose goal is to contribute to the knowledge of the level of visual health of children in the Lisbon Region and to identify factors which determine it. Between October 2005 and August 2006 649 children under 10 years were observed at the pediatric ophthalmologic consultation in the SAMS (Serviços de Assistência Médico-Social do Sindicato dos Bancários do Sul e Ilhas). Data were collected concerning more than 250 primary variables covering most itens of the usual ophthalmological examination. Special attention was paid to children's age since it plays a crucial role in main stages of visual system development. In the case of children age 6 to 7 SAMS and school results are often put side by side. On account of the great number of numerical data it was often necessary to look at the degree of statistical significancy of differencies between subgroups. Some of the study's results (mostly SAMS): Children age 6 to 7 - 71,1% (SAMS) and 91,5% (Schools) had not an ophthalmologic examination before 4 years old. Total frequency of myopic disorders 9,4%, of hypermetropic disorders 25,3%, both showing great differences between age groups; convergent strabismus 3,9%; amblyopia 2,6% (13/491 children over 3 years old), more frequent among little girls, in those with 1st examination after 4 years old and in those whose parents didn´t complied to the therapy ordered for the child. Specific objectives dealt with visual acuity and ocular refraction. The comparison of automatic refractometry without and with cycloplegy showed that visual acuity testing is often not enough for a correct diagnosis. Eye disorders in the family history proved to be a very important information. Analysis of corresponding data disclosed a lot of relationships among others: 12 pag1.qxp 27-11-2001 18:28 Page 12 Índice Geral 13 Children with a family history of myopic disorders have more frequently a diagnosis of myopic disorders and a negative refraction, a higher rate of quantitative diagnosis/refraction matching concerning myopic disorders. Those children have in general inverse characteristics regarding hypermetropic disorders. Children with a family history of hypermetropic disorders have more frequently a diagnosis of hypermetropic disorders. Children with a family history of strabismus have more frequently a diagnosis of manifest convergent strabismus and all forms of esodeviations. Children with a family history of astigmatism have more frequently a diagnosis of astigmatism. Ophthalmologic profiles are drawn allowing to take into account in a synoptic way a set of visual health parameters. Data on parents' compliance with therapy ordered for the child, and attitudes regarding child's glass wearing, as well as data on child's behaviour in the classroom and learning difficulties were as a rule too few to allow conclusions but still need more studies in the future. Orthoptists and nurses performed in the same study period a screening of visual acuity <0,8 and of ocular motility disorders addressed to children of 1srt degree of public schools (term 2005/2006) in the town of Lisbon. 520 of such children were screened. 101 of them were examined by the author in her medical office; some were refered, the others taken as a control. Regarding visual acuity the predictive value of a negative test was 91% but the predictive value of a positive test was only 67% (33% of false positive results, consequently a too high rate of overreferal). Performed by orthoptists screening quality was inferior in comparison with screening done by nurses. On the whole this screening had not the required quality. A survey on physicians' and nurses' knowledge, attitudes and practices related to pediatric ophthalmologic care was carried out in health centers. Results are discussed, conclusions drawn. Some suggestions are made aiming at a better children's visual health.

Protecção radiológica do doente em tomografia computorizada

RESUMO - A preocupação com os conhecimentos, atitudes, crenças e práticas, no que concerne à utilização de radiações ionizantes para fins de diagnóstico, e a sensibilização de todos os agentes envolvidos, médicos, técnicos, físicos, utentes e responsáveis pela Saúde Publica, relativamente aos níveis de radiação emitida nos exames de Tomografia Computorizada (TC), assume particular importância no domínio da Saúde Pública, na medida em que é necessário influenciar o desenvolvimento de práticas que promovam, auditem e garantam a prestação do controlo da qualidade radiológica e dosimétrica nos serviços de Radiologia a nível Nacional. Para tal, e no âmbito da publicação de estudos já realizados ao nível da União Europeia, ―Orientações Europeias dos Critérios de Qualidade para a Tomografia Computorizada (1999) ‖, é proposto estabelecer orientações na realização de estudos que permitam, numa primeira fase, estabelecer a comparação com os resultados obtidos pelos mecanismos de Controlo da Qualidade (CQ), analisar e proceder aos ajustes (se necessário) e, numa segunda fase, implementar uma moldura sistemática de avaliação periódica dos níveis de dose de radiação por exame TC e que permita a monitorização dos dados. Nesse sentido, propõe-se a realização de um Estudo Nacional que envolva a rede hospitalar pública, privada e universitária, partindo da metodologia utilizada em estudos prévios noutros países da Europa, como seja, selecção do equipamento de TC existente na Instituição Hospitalar, onde serão reunidas informações através do preenchimento de questionários relativos ao equipamento a utilizar. Serão recolhidos dados relativos ao utente, ao equipamento e parâmetros de aquisição de imagem, que permitam identificar os níveis de referência de diagnóstico (NRD) em TC, na realidade Portuguesa. Foi efectuado um estudo piloto numa instituição EPE e os valores obtidos não são significativos, nem podem assumir valor preditivo dado o reduzido tamanho da amostra. Apesar disso, sugerem a existência de parâmetros que podem ser alterados e com isso podem fazer variar a dose de radiação utilizada. ENSP/UNL Maria de Fátima Vaz de Carvalho 5 Espera-se obter com este estudo, como foi referido, a base do estabelecimento dos NRD em TC em Portugal. ----------------- ABSTRACT - The purpose of this study, in an empirical point of view, emerges from concern with the knowledge, attitudes, beliefs and practices regarding the use of ionizing radiation for diagnostic purposes and awareness of all actors involved, medical physical, technical, and responsible public health for the development of practices that promote, audited and ensure the provision of radiological quality control and dosing in radiology service at national level. In view of the complexity and characteristics involved in relation to ionizing radiation, all assume their part in protecting the physical integrity of each user and a global perspective, to ensure the safeguarding of public health, while global and globalizing factor. To this end, and in the context of the publication of studies already carried out at European Union level, "European guidelines for quality criteria for computed tomography", it is proposed to establish guidelines in conducting studies to initially establish the comparison with the results obtained by QC and make adjustments if necessary, and subsequently implement a systematic periodic assessment frame that allows monitoring of data. Accordingly, it is proposed to conduct a national study involving the public network, private and University hospitals, that extends from the methodology used in previous studies in other countries of Europe, as is, selection of equipment of existing CT in Hospital Institution, where information will be gathered by filling out questionnaires concerning the equipment to be used. Data will be collected for the wearer, equipment and parameters of image acquisition, identifying diagnostic reference levels (NRD) in CT in Portuguese fact. A pilot study was carried out in an institution EPE and the values obtained are not significant, nor can they take predictive value given the small sample size. Despite this, suggest the existence of parameters that can be changed and this can vary the dose of radiation used It is hoped to get with this study, as mentioned, the basis of the establishment of NRD in CT in Portugal.