The family health system: analysis of a health survey in Sao Paulo, Brazil

Background The Family Health Strategy (FHS) has been implemented as a strategy for primary care improvement in Brazil. Working with teams that include one doctor, one nurse, auxiliary nurses and community health workers in predefined areas, the FHS began in 1994 (known then as the Family Health Program) and has since grown considerably. The programme has only recently undergone assessment of outcomes, in contrast to more routine evaluations of infrastructure and process. Methods In 2001, a health survey was carried out in two administrative districts (with 190 000 inhabitants) on the outskirts of the city of Sao Paulo, both partially served by the FHS. Chronic morbidity (hypertension, diabetes and ischaemic heart disease) of individuals aged 15 or older was studied in areas covered and not covered by the programme. Stratified univariate analysis was applied for sex, age, education, income, working status and social insurance of these populations. Multivariate analysis was applied where applicable. Results There was a distinct pattern in the morbidity profile of these populations, suggesting differentiated self-knowledge on chronic disease status in the areas served by the FHS. Conclusion The FHS can increase population awareness of chronic diseases, possibly through increasing access to primary care.

Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA Study

Introduction: Work disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries. Methods: The Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses. Results: At the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score. Conclusions: Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.

Nonadiabatic Coherent Evolution of Two-Level Systems under Spontaneous Decay

In this Letter we extend current perspectives in engineering reservoirs by producing a time-dependent master equation leading to a nonstationary superposition equilibrium state that can be nonadiabatically controlled by the system-reservoir parameters. Working with an ion trapped inside a nonideal cavity, we first engineer effective interactions, which allow us to achieve two classes of decoherence-free evolution of superpositions of the ground and excited ionic levels: those with a time-dependent azimuthal or polar angle. As an application, we generalize the purpose of an earlier study [Phys. Rev. Lett. 96, 150403 (2006)], showing how to observe the geometric phases acquired by the protected nonstationary states even under nonadiabatic evolution.

A correct enthalpy relationship as thermal comfort index for livestock

Researchers working with thermal comfort have been using enthalpy to measure thermal energy inside rural facilities, establishing indicator values for many situations of thermal comfort and heat stress. This variable turned out to be helpful in analyzing thermal exchange in livestock systems. The animals are exposed to an environment which is decisive for the thermoregulatory process, and, consequently, the reactions reflect states of thermal comfort or heat stress, the last being responsable for problems of sanity, behavior and productivity. There are researchers using enthalpy as a qualitative indicator of thermal environment of livestock such as poultry, cattle and hogs in tropical regions. This preliminary work intends to check different enthalpy equations using information from classical thermodynamics, and proposes a direct equation as thermal comfort index for livestock systems.

Knowledges and practices of successful literacy teachers (Brazil, 1950-1980)

Significant changes have marked Brazilian education in the period focused on by this research. Aiming to understand the configurations of the teaching profession in that period, this work focuses on the issue of the school success in the area of literacy by means of an analysis of the practices of literacy teachers who were at work between the 1950s and 1980s. The research is based on life-history accounts. The study aimed at describing the various experiences of these teachers identifying the knowledges and practices that sustained their successful literacy work as well as the various factors of a social, religious, political, familiar or other nature that, in the history of each of these teachers, favoured the development of a pedagogical style of literacy particular to each one of them. Despite the peculiarities and originality of each history, the success in the literacy process, as the defining feature of the profile of the four teachers, results from two main aspects: first, the autonomy that each one managed to keep in the development of his/her teaching work, particularly in the organisation of the teaching practices that indicated greater chances of a pupil`s learning to read and write; second, their trust in the capacity of every child for learning, independently of his/her social, economic and cultural conditions. Based on this evidence it is argued that the success of the pedagogical work, particularly during the early years of schooling, lies in an ethics of the teaching work with a double implication: first, it requires the teachers` dedication to their pupils, and second, it requires respect for the work of the teacher, so that she/he can maintain her/his autonomy and inventiveness. These aspects indicate the need for reflection on teaching work and a review of current teacher education policies, particularly the policies targeted at teachers working with literacy practices.

A randomized trial of a problem-based learning approach for teaching epidemiology

Purpose. To conduct a controlled trial of traditional and problem-based learning (PBL) methods of teaching epidemiology. Method. All second-year medical students (n = 136) at The University of Western Australia Medical School were offered the chance to participate in a randomized controlled trial of teaching methods fur an epidemiology course. Students who consented to participate (n = 80) were randomly assigned to either a PBL or a traditional course. Students who did not consent or did not return the consent form (n = 56) were assigned to the traditional course, Students in both streams took identical quizzes and exams. These scores, a collection of semi-quantitative feedback from all students, and a qualitative analysis of interviews with a convenience sample of six students from each stream were compared. Results. There was no significant difference in performances on quizzes or exams between PBL and traditional students. Students using PBL reported a stronger grasp of epidemiologic principles, enjoyed working with a group, and, at the end of the course, were more enthusiastic about epidemiology and its professional relevance to them than were students in the traditional course. PBL students worked more steadily during the semester but spent only marginally more time on the epidemiology course overall. Interviews corroborated these findings. Non-consenting students were older (p < 0.02) and more likely to come from non-English-speaking backgrounds (p < 0.005). Conclusions. PBL provides an academically equivalent but personally far richer learning experience. The adoption of PBL approaches to medical education makes it important to study whether PBL presents particular challenges for students whose first language is not the language of instruction.

The effects of adolescent cannabis use: How should the empirical evidence inform drug policy for young people? : Meeting abstract

Ethics as a subject is now consistently taught in medical schools within Australia. The theoretical Ethical models used, and the associated clinical discussions, vary between schools. Registrars have further theoretical Ethics teaching within Psychiatry Fellowship Training, and ongoing clinical work that is likely to provide exposure to complex and frequent Ethical dilemmas. As Psychiatry Trainees approach subspecialty training in Child and Adolescent Psychiatry they therefore have a rich experience of both theoretical Ethics teaching and clinical exposure to Ethical issues. In this symposium, the difficulties Child and Adolescent Psychiatry Trainees may have in the integration of multiple theoretical Ethical models are discussed. It is suggested that these difficulties make Ethics Teaching for Child and Adolescent Psychiatry Trainees particularly challenging. This is important given the complex Ethical issues often present when working with Children and their Families. The three main Ethical models of Deontology, Virtue Ethics and Consequentialism are described and their usefulness for the Child and Adolescent Psychiatrist examined. Limitations of these models, and “Four Principles” approaches (such as that of Beauchamp and Childress), for Child and Adolescent Psychiatry, are also considered. Clinical cases are included for discussion. Finally, the ways in which these models may be used to enhance Child and Adolescent Psychiatry Training, and subsequent clinical practice as a Child and Adolescent Psychiatrist, are discussed. The integration of different theoretical Ethical models is considered, with implications identified for clinical practice.

Childhood Trauma and Children`s Emerging Psychotic Symptoms: A Genetically Sensitive Longitudinal Cohort Study

Objective: Using longitudinal and prospective measures of trauma during childhood, the authors assessed the risk of developing psychotic symptoms associated with maltreatment, bullying, and accidents in a nationally representative U. K. cohort of young twins. Method: Data were from the Environmental Risk Longitudinal Twin Study, which follows 2,232 twin children and their families. Mothers were interviewed during home visits when children were ages 5, 7, 10, and 12 on whether the children had experienced maltreatment by an adult, bullying by peers, or involvement in an accident. At age 12, children were asked about bullying experiences and psychotic symptoms. Children`s reports of psychotic symptoms were verified by clinicians. Results: Children who experienced maltreatment by an adult (relative risk=3.16, 95% CI=1.92-5.19) or bullying by peers (relative risk=2.47, 95% CI=1.74-3.52) were more likely to report psychotic symptoms at age 12 than were children who did not experience such traumatic events. The higher risk for psychotic symptoms was observed whether these events occurred early in life or later in childhood. The risk associated with childhood trauma remained significant in analyses controlling for children`s gender, socioeconomic deprivation, and IQ; for children`s early symptoms of internalizing or externalizing problems; and for children`s genetic liability to developing psychosis. In contrast, the risk associated with accidents was small (relative risk=1.47, 95% CI=1.02-2.13) and inconsistent across ages. Conclusions: Trauma characterized by intention to harm is associated with children`s reports of psychotic symptoms. Clinicians working with children who report early symptoms of psychosis should inquire about traumatic events such as maltreatment and bullying.

Effects of biomass burning on nasal mucociliary clearance and mucus properties after sugarcane harvesting

Objective: Biofuel from sugarcane is widely produced in developing countries and is a clean and renewable alternative source of energy. However, sugarcane harvesting is mostly performed after biomass burning. The aim of this study was to evaluate the effects of harvesting after biomass burning on nasal mucociliary clearance and the nasal mucus properties of farm workers. Methods: Twenty seven sugarcane workers (21-45 years old) were evaluated at the end of two successive time-periods: first at the end of a 6-month harvesting period (harvesting), and then at the end of a 3-month period without harvesting (non-harvesting). Nasal mucociliary clearance was evaluated by the saccharine transit test, and mucus properties were analyzed using in vitro mucus contact angle and mucus transportability by sneeze. Arterial blood pressure, heart rate, respiratory rate, pulse oximetry, body temperature, associated illness, and exhaled carbon monoxide were registered. Results: Data are presented as mean values (95% confidence interval). The multivariate model analysis adjusted for age, body-mass index, smoking status and years of working with this agricultural practice showed that harvesting yielded prolonged saccharine transit test in 7.83 min (1.88-13.78), increased mucus contact angle in 8.68 degrees (3.18-14.17) and decreased transportability by sneeze in 32.12 mm (-44.83 to -19.42) compared with the non-harvesting period. No significant differences were detected in any of the clinical parameter at either time-period. Conclusion: Sugarcane harvesting after biomass burning negatively affects the first barrier of the respiratory system in farm workers by impairing nasal mucociliary clearance and inducing abnormal mucus properties. (C) 2011 Elsevier Inc. All rights reserved.

A tick salivary protein targets cathepsin G and chymase and inhibits host inflammation and platelet aggregation

Platelet aggregation and acute inflammation are key processes in vertebrate defense to a skin injury. Recent studies uncovered the mediation of 2 serine proteases, cathepsin G and chymase, in both mechanisms. Working with a mouse model of acute inflammation, we revealed that an exogenous salivary protein of Ixodes ricinus, the vector of Lyme disease pathogens in Europe, extensively inhibits edema formation and influx of neutrophils in the inflamed tissue. We named this tick salivary gland secreted effector as I ricinus serpin-2 (IRS-2), and we show that it primarily inhibits cathepsin G and chymase, while in higher molar excess, it affects thrombin activity as well. The inhibitory specificity was explained using the crystal structure, determined at a resolution of 1.8 angstrom. Moreover, we disclosed the ability of IRS-2 to inhibit cathepsin G-induced and thrombin-induced platelet aggregation. For the first time, an ectoparasite protein is shown to exhibit such pharmacological effects and target specificity. The stringent specificity and biological activities of IRS-2 combined with the knowledge of its structure can be the basis for the development of future pharmaceutical applications. (Blood. 2011;117(2):736-744)

Longitudinal study of veterinarians from entry to the veterinary course to ten years after graduation: career paths

Objective To map out the career paths of veterinarians during their first 10 years after graduation, and to determine if this could have been predicted at entry to the veterinary course. Design Longitudinal study of students who started their course at The University of Queensland in 1985 and 1986, and who completed questionnaires in their first and fifth year as students, and in their second, sixth and eleventh year as veterinarians. Methods Data from 129 (96%) questionnaires completed during the eleventh year after graduation were coded numerically then analysed, together with data from previous questionnaires, with SAS System 7 for Windows 95. Results Ten years after they graduated, 80% were doing veterinary work, 60% were in private practice, 40% in small animal practice and 18% in mixed practice. The equivalent of 25% of the working time of all females was taken up by family duties. When part-time work was taken into account, veterinary work constituted the equivalent of 66% of the group working full-time. That 66% consisted of 52% on small animals, 7% on horses, 6% on cattle/sheep and 1% on pigs/poultry. Those who had grown up on farms with animals were twice as likely to be working with farm animals as were those from other backgrounds. Forecasts made on entry to the veterinary course were of no value in predicting who would remain in mixed practice. Conclusions Fewer than one-fifth of graduates were in mixed practice after 10 years, but the number was higher for those who grew up on farms with animals. Forecasts that may be made at interview before entry to the course were of little value in predicting the likelihood of remaining in mixed veterinary practice.

How well do general practitioners deliver palliative care? A systematic review

General practitioners (GPs) deliver the majority of palliative care to patients in the last year of life. This article seeks to examine the nature of GP care, perceptions of the GPs themselves and others of that care, the adequacy of palliative care training, issues relating to accessibility of GPs to palliative care patients, and strategies that may be of use in encouraging more effective delivery of palliative care by GPs. Medline and PubMed databases from 1966 to 2000 were searched, and 135 references identified. Sixty-six of these described studies relevant to GP palliative care. GPs value this part of their work. Most of the time, patients appreciate the contribution the GP makes to palliative care particularly if the GP is accessible, takes time to listen, allows patient and carer to ventilate their feelings, and is seen to be making efforts made regarding symptom relief. However, reports from bereaved relatives suggest that palliative care is performed less well in the community than in other settings. GPs express discomfort about their competence to perform palliative care adequately. They tend to miss symptoms which are not treatable by them, or which are less common. However, with appropriate specialist support and facilities, GPs have been shown to deliver sound and effective care. GP comfort working with specialist teams increases with exposure to this form of patient management, as does the understanding of the potential other team members have in contributing to the care of the patient. Formal arrangements engaging GPs to work with specialist teams have been shown to improve functional outcomes, patient satisfaction, improve effective use of resources and improve effective physician behaviour in other areas of medicine. Efforts by specialist services to develop formal involvement of GPs in the care of individual patients, may be an effective method of improving GP palliative care skills and appreciation of the roles specialist services can play.

Relat??rio final do projeto desenvolvimento de capacidade de lideran??a (Brasil-Canad??)

Desde o in??cio de 2000, a Canada School of Public Service (CSPS) e a Escola Nacional de Administra????o P??blica (ENAP) demonstraram interesse na possibilidade de coopera????o para desenvolver capacidades de gest??o de servidores p??blicos brasileiros. Um acordo assinado em 2003, inicialmente foi planejado para ser uma parceria de tr??s anos entre as duas escolas. No entanto, a parceria continua at?? hoje e agora estamos no final do segundo, e ??ltimo projeto de coopera????o t??cnica financiado pela Canadian International Development Agency (CIDA) entre Brasil e Canad??, denominado ???Desenvolvimento da Capacidade de Governan??a???. Este relat??rio representa o resultado deste segundo projeto, o qual ampliou o esfor??o de capacita????o da primeira parceria, focando agora em funcion??rios p??blicos mais pr??ximos da "linha de frente" da presta????o de servi??os, aumentando assim a efic??cia do governo nessas ??reas. O projeto mostrou ser bem-sucedido, principalmente, porque seguiu de perto os princ??pios do desenvolvimento eficaz e sustent??vel. Considerando a sua miss??o de desenvolver compet??ncias de servidores p??blicos, a ENAP deu prioridade, dentro deste projeto de coopera????o com o Canad??, a atividades que visam refor??ar a capacidade de governan??a do pa??s, trabalhando em conjunto com escolas em cinco regi??es: Norte, Nordeste, Centro-Oeste, Sudeste e Sul, com especial ??nfase nas ??reas mais pobres do pa??s, localizadas nas regi??es Norte e Nordeste. Foram participantes-chave neste projeto: i) seis escolas brasileiras regionais de administra????o p??blica; ii) uma das principais institui????es acad??micas do Canad?? - Queen's University, e iii) o Minist??rio do Desenvolvimento Social e Combate ?? Fome e tr??s Secretarias de Ra??a, Direitos Humanos e Pol??ticas para as Mulheres. Neste projeto, a CSPS compartilhou suas metodologias em educa????o a dist??ncia, lideran??a e gest??o p??blica. Trabalhando com parceiros brasileiros, ela tamb??m transferiu e adaptou curr??culos e conte??dos de seus cursos. A CIDA forneceu $1.845.000,00 por meio da Programa de Interc??mbio de Conhecimentos para a Promo????o da Eq??idade (PIPE) Brasil-Canad??. A ENAP e as EPBs contribu??ram com $993,752 e a CSPS contribuiu com material de curso, conhecimento e apoio t??cnico no valor de $ 1.000.000

Comprometimento no trabalho de gestores p??blicos em uma autarquia estadual no Brasil

O objetivo deste artigo ?? compreender a percep????o dos gestores, que atuam com o planejamento estrat??gico de uma organiza????o p??blica, sobre o construto de comprometimento no trabalho, bem como a influ??ncia dessa percep????o em suas pr??ticas cotidianas de gest??o. Para tanto, realizou-se, inicialmente, pesquisa bibliogr??fica focando quest??es relacionadas ao sentido e natureza do construto, bem como sobre os estudos realizados sobre o tema do comprometimento no contexto da administra????o p??blica. Em seguida, foram coletados dados com gestores mediante entrevista com roteiro semiestruturado, os quais foram analisados por meio da t??cnica de an??lise de conte??do. As evid??ncias indicam que os gestores associam o v??nculo ao trabalho a quest??es atitudinais e de inten????es comportamentais e que suas pr??ticas cotidianas s??o influenciadas pela percep????o de comprometimento dos indiv??duos, admitindo que as decis??es tomadas, motivadas por essa percep????o, podem trazer consequ??ncias negativas tanto para a organiza????o quanto para o indiv??duo.

Transformando burocracias para financiar os mais pobres: a evolu????o do Pronaf Cr??dito Grupo B

Institui????es banc??rias tradicionalmente n??o oferecem servi??os financeiros, principalmente cr??dito produtivo, aos grupos de mais baixa renda. Considerando-se a rigidez do sistema financeiro em trabalhar com os mais pobres, o presente artigo descreve o processo de cria????o e aperfei??oamento de uma pol??tica p??blica de microcr??dito rural dentro do Programa Nacional de Fortalecimento da Agricultura Familiar (Pronaf). S??o apresentadas as motiva????es para altera????es no desenho da linha de cr??dito, assim como as mudan??as normativas, de fontes e de agentes operadores, efetuadas em cada ano-safra para tornar poss??vel superar os desafios apresentados pela burocracia do Sistema Nacional de Cr??dito Rural ??? SNCR. O texto apresenta ainda o impacto no n??mero de contrata????es resultante das diversas medidas tomadas. Finalmente, ?? feito um balan??o das principais li????es aprendidas assim como dos desafios atuais de maior qualifica????o do microcr??dito e integra????o com outras pol??ticas p??blicas.