Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil

The scope of this study was to identify socioeconomic contextual and health care factors in primary care associated with maternal near misses and their marker conditions. This is an ecological study that used aggregated data of 63 clusters formed by the municipalities of State of Rio Grande do Norte, Brazil, using the Skater method of area regionalization, as the unit of analysis. The ratio of maternal near misses and their marker conditions were obtained from the Hospital Information System of the Brazilian Unified Health System. In multiple linear regression analysis, there was a significant association between maternal near misses and variables of poverty and poor primary health care. Hypertensive disorders were also associated with poverty and poor primary care and the occurrence of hemorrhaging was associated with infant mortality. It was observed that the occurrence of maternal near misses is linked to unfavorable socioeconomic conditions and poor quality health care that are a reflection of public policies that accentuate health inequalities.

Malaria prevention in north-eastern Tanzania: patterns of expenditure and determinants of demand at the household level.

Objective. This study aims to provide a better understanding of the amounts spent on different malaria prevention products and the determinants of these expenditures. Methods. 1,601 households were interviewed about their expenditure on malaria mosquito nets in the past five years, net re-treatments in the past six months and other expenditures prevention in the past two weeks. Simple random sampling was used to select villages and streets while convenience sampling was used to select households. Expenditure was compared across bed nets, aerosols, coils, indoor spraying, using smoke, drinking herbs and cleaning outside environment. Findings. 68% of households owned at least one bed net and 27% had treated their nets in the past six months. 29% were unable to afford a net. Every fortnight, households spent an average of US $0.18 on nets and their treatment, constituting about 47% of total prevention expenditure. Sprays, repellents and coils made up 50% of total fortnightly expenditure (US$0.21). Factors positively related to expenditure were household wealth, years of education of household head, household head being married and rainy season. Poor quality roads and living in a rural area had a negative impact on expenditure. Conclusion. Expenditure on bed nets and on alternative malaria prevention products was comparable. Poor households living in rural areas spend significantly less on all forms of malaria prevention compared to their richer counterparts. Breaking the cycle between malaria and poverty is one of the biggest challenges facing malaria control programmes in Africa.

The Barriers to the Integration of the Uterine Balloon Tamponade into South Africa and Ghana's Health Systems for the Management of Postpartum Hemorrhage

Background

Postpartum hemorrhage is the most significant contributor to maternal mortality globally, claiming 140,000 lives annually. Postpartum hemorrhage is a leading cause of maternal death in South Africa, with the literature indicating that 80 percent of the postpartum hemorrhage deaths in South Africa are avoidable. Ghana, as of 2010, witnesses 2700 maternal deaths annually, primarily because of poor quality of care in health facilities and services being difficult to access. As per WHO recommendations, uterotonics are integral to treating postpartum hemorrhage as soon as it is diagnosed. In case of persistent bleeding or limited availability of uterotonics, the uterine balloon tamponade (UBT) can be used as a second line of defense. If both these measures are unable to counter the bleeding, providers must perform surgical interventions. Literature on the UBT, as one tool in the protocol to address postpartum hemorrhage, has shown it to have success rates ranging from 60 to 100 percent. Despite the potential to lower the number of postpartum hemorrhage deaths in South Africa and Ghana, the UBT has not been incorporated widely in South Africa and Ghana. The aim of this study is to describe the barriers involved with integrating the UBT into South Africa and Ghana’s health systems to address postpartum hemorrhage.

Methods

The study took place in multiple sites in South Africa (Cape Town, Johannesburg, Durban and Mpumalanga) and in Accra, Ghana. South Africa and Ghana were selected because postpartum hemorrhage contributes greatly to their maternal mortality numbers and there is potential in both countries to lower those rates through greater use of the UBT. A total of 25 participants were interviewed through purposive sampling, snowball sampling and participant referrals, and included various categories of stakeholders integral to the integration process of a medical device. Individual in-depth interviews were used for data collection, with interview questions being tailored to each stakeholder category. The focus of the interviews was on the protocol used to counter postpartum hemorrhage, the frequency with which the UBT is used as part of the protocol, and the process of integrating it into the South Africa and Ghana’s health systems. The data collected were coded using NVivo and analyzed using content analysis.

Results

The barriers to integration of the uterine balloon tamponade to address postpartum hemorrhage in South Africa and Ghana were evident on the political, economic and health delivery levels. The results indicated that the barriers to integration in South Africa included the low recognition of postpartum hemorrhage as a problem, the lack of clarity surrounding the role of the Medicines Control Council as a regulatory body for medical devices, and low awareness of the UBT as an intervention to control postpartum hemorrhage. The barriers in Ghana were the cash constraints experienced by the Ghana Health Services to fund medical devices, a heavy reliance on donors for funding, and the lack of consistent knowledge on processes involving clinical trials for new medical devices in Ghana.

Conclusion

Existing literature on methods to counter postpartum hemorrhage to reduce maternal mortality has focused on and emphasized the efficacy of the UBT. Despite overwhelming evidence supporting the use of the UBT, many health systems across the world, particularly low-income countries, do not have access to the device owing to numerous barriers in integrating the device into obstetric care. This study illustrates the need to focus on incorporating the UBT into health systems for greater availability to health workers and its use as standard of care. Ultimately, this study can be used as a stepping-stone for more research on this subject, providing evidence to influence policymakers to integrate the UBT into their protocols for postpartum hemorrhage response.

Acoustic signalling reflects personality in a social mammal

Social interactions among individuals are often mediated through acoustic signals. If acoustic signals are consistent and related to an individual's personality, these consistent individual differences in signalling may be an important driver in social interactions. However, few studies in non-human mammals have investigated the relationship between acoustic signalling and personality. Here we show that acoustic signalling rate is repeatable and strongly related to personality in a highly social mammal, the domestic pig (Sus scrofa domestica). Furthermore, acoustic signalling varied between environments of differing quality, with males from a poor-quality environment having a reduced vocalization rate compared with females and males from an enriched environment. Such differences may be mediated by personality with pigs from a poor-quality environment having more reactive and more extreme personality scores compared with pigs from an enriched environment. Our results add to the evidence that acoustic signalling reflects personality in a non-human mammal. Signals reflecting personalities may have far reaching consequences in shaping the evolution of social behaviours as acoustic communication forms an integral part of animal societies.

The cost of a minimum essential food basket in Northern Ireland : Pilot study for two household types

A good diet and adequate food supply is central to promoting health and wellbeing. A poor quality diet is associated with higher rates of chronic diseases such as type 2 diabetes, obesity, cardiovascular disease and certain cancers. Social and economic conditions impact on diet quality which in turn contributes to health inequalities. This relationship is recognised and addressed at a policy level in NI through the Fitter Future for all framework(1). Access to a healthy diet requires transport, money and skills such as budgeting and food preparation. Food is the most flexible aspect of the household budget due to the fact the consumers can meet hunger and calorie needs on cheaper, nutritionally-poor foods.

Sintomatologia depressiva e sono

Os comportamentos depressivos são cada vez mais evidentes na sociedade atual e ocorrem normalmente, a partir da adolescência, sendo a sua incidência maior nas mulheres. Esses comportamentos, que se traduzem em sintomatologia depressiva interferem com vários aspetos do ser humano, desde a sua imagem corporal, aos seus estados nutricional e psicológico, até ao seu estado de saúde em geral, e ao seu padrão de sono. Este trabalho procura explorar as relações entre os hábitos e a qualidade do sono e a sintomatologia depressiva. Foram avaliados 100 profissionais de saúde com horários de trabalho irregulares e com idades compreendidas entre os 20 e os 65 anos : 54 do sexo feminino e 46 do sexo masculino. Aplicou-se um questionário onde se recolheram os seguintes dados: IMC, horário de trabalho, alimentação, consumo de substâncias estimulantes, sintomatologia depressiva, sonolência diurna e qualidade do sono. Relativamente ao IMC verificou-se que 44% dos inquiridos apresenta excesso de peso e 2% já se encontra em Obesidade grau I. Relativamente ao horário de trabalho, 74 % dos inquiridos referiu o turno da manhã como sendo o seu preferencial e 59% disse que o trabalho por turnos que não era vantajoso. Na avaliação da interferência do horário de trabalho por turnos nas diversas atividades extra profissionais verificou-se que quanto ao tempo de lazer 72 % dos inquiridos disse que interfere muito, na vida social e familiar 78 % dos inquiridos diz que interfere muito, nas atividades pessoais 60 % dos inquiridos disse que interfere muito e na alimentação 83 % dos inquiridos diz que interfere muito. Ainda na alimentação, verificou-se que 52% dos inquiridos acha que o tempo que tem disponível não é adequado a uma boa refeição pelo que se verificou uma frequência das refeições irregular nomeadamente ao pequeno almoço, que apenas 47% disse sempre tomar. Relativamente ao consumo de substâncias estimulantes a mais consumida é o café, uma vez que mais de metade (53%) dos inquiridos diz tomar sempre, segue-se o consumo de tabaco, o qual 44% dos inquiridos disse consumir sempre. Quanto ao exercício físico 68% dos inquiridos disse não praticar. Na presença de sintomatologia depressiva, verifica-se que a maior parte dos inquiridos (68%; n=68) apresenta uma sintomatologia depressiva mínima, 24% apresenta depressão ligeira e 8% (n=8) apresenta depressão moderada. A determinação da sonolência diurna, verifica-se que 28% (n=28) dos inquiridos apresenta pouca sonolência diurna, 65% apresenta moderada sonolência diurna e 7% apresenta Sonolência diurna excessiva. Quanto á qualidade do sono, verifica-se que 18 % dos inquiridos tem uma boa qualidade de sono, 53 % tem sono de má qualidade e 29% dos inquiridos apresenta distúrbio de sono. Estas evidências levaram a concluir que existe uma forte relação ente o sono e a sintomatologia depressiva, e que o horário de trabalho por turnos interfere na qualidade de vida dos indivíduos, sendo que a única forma de intervir está na prevenção, incentivando os trabalhadores a hábitos de vida saudáveis e a um controlo periódico do seu estado de saúde.

Processo de transição da pessoa estomizada da depêndencia de cuidado ao autocuidado: subsídios à enfermagem

Objetivou-se conhecer como a pessoa com estomia vivência o processo de transição da dependência de cuidados ao autocuidado à luz da Teoria das Transições de Meleis. Pesquisa exploratória, descritiva com abordagem qualitativa no Serviço de Estomaterapia do Hospital Universitário Dr Miguel Riet Corrêa Jr do Rio Grande/ RS/ Brasil com 27 pessoas com estomias definitivas por câncer. Os dados foram coletados nos mês de janeiro e fevereiro de 2014 por meio de entrevista com roteiro semiestruturado e submetidos à Análise de Conteúdo apoiada nas ideias da Teoria das Transições de Afaf I. Meleis. Constatou-se que a natureza da transição situou-se no processo tipo saúde/doença. A entrada no processo de transição deu-se a partir da consciência desencadeada pelo diagnóstico de câncer, reforçado pela cirurgia de estomização. O empenhamento surge ao dedicarem-se a construção do conhecimento para o autocuidado frente às mudanças na sua vida e na sua nova relação com seu corpo, mudando a visão de si, do mundo e dos outros. Destacou-se o espaço temporal como algo dinâmico e variavelmente indeterminável, sendo fundamental para que se organizem e reflitam acerca do seu novo viver, fortalecendo-se para que a transição progrida. Verificaram-se como fatores facilitadores do autocuidado a construção de um significado positivo à estomização, o preparo dessa experiência ainda no pré-operatório, a estabilidade emocional, a fé e a religiosidade e a sensação de normalidade adquirida a partir de uma imagem próxima da anterior. Referiram-se, ainda, ao fornecimento de forma gratuita pelo governo das bolsas coletoras, adjuvantes e acessórios e ao atendimento da equipe multiprofissional. Como fatores inibidores do processo de transição encontraram-se a visão distorcida de seu corpo, o despreparo para viver com a estomia, a instabilidade emocional, a desmotivação com afastamento de atividades prazerosas, o cuidado excessivo e/ou estendido e até mesmo a superproteção da família, as complicações como hérnias e prolapsos, a falta de atitudes positivas quanto à vida, a negação da bolsa coletora, as tentativas frustradas de omitir o uso da bolsa coletora, a falta do domínio do manuseio dos equipamentos, o afastamento do trabalho e as dificuldades financeiras. Além destas, o abandono do parceiro, atitudes negativas e estigmatizantes por parte da família e a baixa qualidade dos materiais fornecidos pelo governo. Como indicadores de resultados identificaram-se a confiança para realizar atividades anteriores, aceitação de sua situação, uma visão positiva de sua vida e da capacidade de compartilhar o seu cuidado com sua família. Considera-se a saída da transição quando este for capaz de dominar novas competências tanto para o cuidado físico ao realizar a troca da bolsa coletora quanto readequando sua imagem e autoconceito. Concluiu-se que o processo de transição da dependência de cuidados ao autocuidado da pessoa com estomia é complexo e carregado de subjetividades. É necessário que o enfermeiro estabeleça ações terapêuticas de enfermagem eficazes e eficientes, contribuindo para a promoção e reabilitação da saúde deste, auxiliando-o na aquisição de sua autonomia e independência, subsidiando seu autocuidado e bem-estar.

The evolution of imperfect mimicry in hoverflies

Ideas about the evolution of imperfect mimicry are reviewed. Their relevance to the colours patterns of hoverflies (Diptera, Syrphidae) are discussed in detail. Most if not all of the hoverflies labelled as mimetic actually are mimics. The apparently poor nature of their resemblance does not prevent them from obtaining at least some protection from suitably experienced birds. Mimicry is a dominant theme of this very large family of Diptera, with at least a quarter of all species in Europe being mimetic. Hoverfly mimics fall into three major groups according to their models, involving bumblebees, honeybees and social wasps. There are striking differences in the general levels of mimetic fidelity and relative abundances of the three groups, with accurate mimicry, low abundance and polymorphism characterizing the bumblebee mimics: more than half of all the species of bumblebee mimics are polymorphic. Mimics of social wasps tend to be poor mimics, have high relative abundance, and polymorphism is completely absent. Bumblebee models fall into a small number of Muellerian mimicry rings which are very different between the Palaearctic and Nearctic regions. Social wasps and associated models form one large Muellerian complex. Together with honeybees, these complexes probably form real clusters of forms as perceived by many birds. All three groups of syrphid mimics contain both good and poor mimics; some mimics are remarkably accurate, and have close morphological and behavioural resemblance. At least some apparently 'poor' mimetic resemblances may be much closer in birds' perception than we imagine, and more work needs to be done on this. Bumblebees are the least noxious and wasps the most noxious of the three main model groups. The basis of noxiousness is different, with bumblebees being classified as non-food, whereas honeybees and wasps are nasty-tasting and (rarely) stinging. The distribution of mimicry is exactly what would be expected from this ordering, with polymorphic and accurate forms being a key feature of mimics of the least noxious models, while highly noxious models have poor-quality mimicry. Even if the high abundance of many syrphid mimics relative to their models is a recent artefact of man-made environmental change, this does not preclude these species from being mimics. It seems unlikely that bird predation actually controls the populations of adult syrphids. Being rare relative to a model may have promoted or accelerated the evolution of perfect mimicry: theoretically this might account for the pattern of rare good mimics and abundant poor ones, but the idea is intrinsically unlikely. Many mimics seem to have hour-to-hour abundances related to those of their models, presumably as a result of behavioural convergence. We need to know much more about the psychology of birds as predators. There are at least four processes that need elucidating: (a) learning about the noxiousness of models; (b) the erasing of that learning through contact with mimics (extinction, or learned forgetting); (c) forgetting; (d) deliberate risk-taking and the physiological states that promote it. Johnston's (2002) model of the stabilization of imperfect mimicry by kin selection is unlikely to account for the colour patterns of hoverflies. Sherratt's (2002) model of the influence of multiple models potentially accounts for all the patterns of hoverfly mimicry, and is the most promising avenue for testing.

Qualidade do ar interior e conforto térmico : um estudo em espaços de estacionamento em Natal/RN

The recent tendency to utilize parking lots for other purposes has demonstrated that more time has been spent by visitors, mainly in great cities. Therefore, this paper investigates the thermal comfort and the air quality indoors in areas specifically used as parking lots by analyzing the direct relation between such environments and vehicular pollution. The thermal comfort and the quality of air indoors in parking lots with different architectonic typology (ground-floor and underground) are also studied, aiming to contribute to the proposition of suitable new areas designated to human usage. Field research was done, in two distinct periods within different weather conditions (January and July) in, two naturally cooled, parking lots located in Natal - RN. The internal environment agents were measured by using tools for air temperature, humidity, speed and direction; interviews with employees and visitors and chemical analysis through appropriate tools to analyze specific material, carbon monoxide and ozone. The results showed that chemical agents densely concentrate mostly in the closed parking space, aggravated by weather conditions, which dissatisfied the visitors. Still, it was shown that architectonic typology, alongside topographical aspects compromise internal environmental conditions, which increases the retention of pollution, leading to dissatisfactory thermal comfort levels and becoming less suitable for usage by visitors considering air and thermal comfort aspects. Consequently, they are not suitable for human stay due to the poor quality of the indoor air

Aplicación de la metodología Six Sigma para solucionar problemas de calidad en una empresa metalmecánica

En la actualidad muchas compañías enfocan sus esfuerzos en la chequera del cliente generando con esto una cortina de humo al interior de la empresa que hace que se descuiden los costos, se conviva con actividades que no agregan valor y se desconozcan las causas de los principales problemas de calidad que afectan al cliente. Este es el caso de la compañía metalmecánica objeto de esta investigación, la cual venía sobrellevando altos niveles de inventarios, reprocesos, problemas de calidad, falta de corresponsabilidad del personal, y otras situaciones que la estaban dejando vulnerable ante la competencia. Este fue el motivo que inspiró esta investigación en aras de validar una metodología de mejora continua para identificar, analizar, proponer, evaluar y reducir los costos de no calidad y sus implicaciones, de una forma ordenada, rigurosa y disciplinada. Posterior a la implementación del plan de acción los resultados no se hicieron esperar y la compañía mejoró su servicio al cliente sin incurrir en excesos de inventario, al igual que disminuyó sus sobrecostos de producción, los cuales eran generados en gran medida por problemas de calidad. Pero lo más significativo es que asimiló que esta metodología es un proceso continuo que no puede parar y que todo el personal de la empresa debe estar implicado.

O processo de implementação da educação do campo nas escolas do Núcleo Regional de Educação de Pato Branco: limites, desafios e possibilidades

This work is part of the Graduate Program in Regional Development of the Federal Technological University of Paraná, Pato Branco campus, the research line Education and Development. The line of research concerns the Regionality and Development. In this study, investigate sought the implementation of the Field Education Curriculum Guidelines in the State of Paraná, whose locus, SEED / PR, the NRE / Pato Branco and Field Schools belonging to the NRE. The theme is to respond to the research problem, to identify the limits and challenges of the implementation process of Rural Education in rural schools in the Regional Center of Pato Branco Education. Exploratory research covers a time frame comprising the years 2002-2014 in order to identify and analyze the documents and perceptions of the subjects that guide the implementation of the field of education in the state of Paraná. The results show that the education field has not yet overcame the challenge of implementing public policies, in particular the field of Education Curriculum Guidelines. In general, the texts point to the concerned school education with the urban environment, in an attempt to solve the problems related to truancy, low school enrollment,flunk, among others. The reality of the field displays more serious such problems, however, is visible the development of proposals in an attempt to achieve definitive solutions to the issues of the field. However, a positive factor is the increase in continuing education courses, some offered by the Department of Education Field Regional Center of Education, others initiatives by the own teacher, which demonstrate the concern in improving their teaching practices, concomitant with need to change the identity of the field school. In this sense, we seek to deepen the discussion in order to demystify the idea that the subject field to be synonymous with poor education, poor quality. Documents such as the Field Operational Guidelines established by the CNE - National Education Council in 2002, the Curriculum Guidelines field developed by SEED - Secretary of State and Education in the State of Paraná in 2004 and established as a public policy in 2010 provide data that allow make a study of public policy and educational field context in order to understand the challenges for the development of an education as culture, ways of life, history, finally, the specificities of the subject field.

Computational Foundations for Safe and Efficient Human-Robot Collaboration in Assembly Cells

Human and robots have complementary strengths in performing assembly operations. Humans are very good at perception tasks in unstructured environments. They are able to recognize and locate a part from a box of miscellaneous parts. They are also very good at complex manipulation in tight spaces. The sensory characteristics of the humans, motor abilities, knowledge and skills give the humans the ability to react to unexpected situations and resolve problems quickly. In contrast, robots are very good at pick and place operations and highly repeatable in placement tasks. Robots can perform tasks at high speeds and still maintain precision in their operations. Robots can also operate for long periods of times. Robots are also very good at applying high forces and torques. Typically, robots are used in mass production. Small batch and custom production operations predominantly use manual labor. The high labor cost is making it difficult for small and medium manufacturers to remain cost competitive in high wage markets. These manufactures are mainly involved in small batch and custom production. They need to find a way to reduce the labor cost in assembly operations. Purely robotic cells will not be able to provide them the necessary flexibility. Creating hybrid cells where humans and robots can collaborate in close physical proximities is a potential solution. The underlying idea behind such cells is to decompose assembly operations into tasks such that humans and robots can collaborate by performing sub-tasks that are suitable for them. Realizing hybrid cells that enable effective human and robot collaboration is challenging. This dissertation addresses the following three computational issues involved in developing and utilizing hybrid assembly cells: - We should be able to automatically generate plans to operate hybrid assembly cells to ensure efficient cell operation. This requires generating feasible assembly sequences and instructions for robots and human operators, respectively. Automated planning poses the following two challenges. First, generating operation plans for complex assemblies is challenging. The complexity can come due to the combinatorial explosion caused by the size of the assembly or the complex paths needed to perform the assembly. Second, generating feasible plans requires accounting for robot and human motion constraints. The first objective of the dissertation is to develop the underlying computational foundations for automatically generating plans for the operation of hybrid cells. It addresses both assembly complexity and motion constraints issues. - The collaboration between humans and robots in the assembly cell will only be practical if human safety can be ensured during the assembly tasks that require collaboration between humans and robots. The second objective of the dissertation is to evaluate different options for real-time monitoring of the state of human operator with respect to the robot and develop strategies for taking appropriate measures to ensure human safety when the planned move by the robot may compromise the safety of the human operator. In order to be competitive in the market, the developed solution will have to include considerations about cost without significantly compromising quality. - In the envisioned hybrid cell, we will be relying on human operators to bring the part into the cell. If the human operator makes an error in selecting the part or fails to place it correctly, the robot will be unable to correctly perform the task assigned to it. If the error goes undetected, it can lead to a defective product and inefficiencies in the cell operation. The reason for human error can be either confusion due to poor quality instructions or human operator not paying adequate attention to the instructions. In order to ensure smooth and error-free operation of the cell, we will need to monitor the state of the assembly operations in the cell. The third objective of the dissertation is to identify and track parts in the cell and automatically generate instructions for taking corrective actions if a human operator deviates from the selected plan. Potential corrective actions may involve re-planning if it is possible to continue assembly from the current state. Corrective actions may also involve issuing warning and generating instructions to undo the current task.

REASONS BEHIND THE USAGE OF ONLINE AD BLOCKING TOOLS

Online advertising has been growing rapidly since the mid-90s. In recent years, online advertising has become as relevant as an advertising medium as print and television are. However, despite the growth, the generally held consensus is that consumers are not interested in online advertisements. The arrival of online ad blocking tools has offered consumers a very effective way to avoid and block online advertisements. Although these tools have now been around for several years and the most popular software’s have hundreds of millions of active users, the phenomenon of ad blocking has gathered surprisingly little attention from academic marketing research. For this reason, ad blocking was chosen as the topic of this thesis study. The researcher was particularly interested in the reasons behind the usage of online ad blocking tools. The object of the empirical part of this study is to provide new and valid information regarding the reasons behind the usage of online ad blocking tools. The empirical research of this study consisted of a survey study that mixed both quantitative and qualitative elements. Although the sample size of the study was fairly limited, the study provided useful answers to individual research questions and provided new knowledge regarding the reasons behind the usage of online ad blocking and the phenomenon of ad blocking as a whole. The study provides further evidence that consumers are aware of online ad blocking tools and a significant portion of them are interested in using them. This study indicates that many of the consumers who do not have previous knowledge of these tools would actually be interested in them. The reason for the usage of online ad blocking tools varies from institutional reasons to instrumental reason, such as poor quality of the online advertisements. However, there were participants who were not interested in the usage of online ad blocking tools, and some of them reported to find online advertising useful. There also seems to be a concern among some consumers that online ad blocking will have a negative effect on online content in the future if the ad blocking will keep growing as a phenomenon. This certainly can be the case, and it is very interesting to see how the development of online ad blocking will shape the online advertising, how the advertising industry will respond to the growth of online ad blocking and how will the consumers respond to these changes.

Determinantes das perturbações musculoesqueléticas nos trabalhadores de cuidados pessoais em residências de apoio ao idoso

Introdução: O enfermeiro especialista em reabilitação é o profissional com competências e conhecimentos para, após o diagnóstico, implementar e monitorizar os resultados dos programas de redução do risco das perturbações musculosqueléticas relacionadas com o trabalho (PME), junto dos trabalhadores de cuidados pessoais em residências de apoio ao idoso, avaliando e introduzindo no processo de prestação de cuidados os necessários ajustamentos, promovendo assim, práticas mais seguras e eficazes. Assim, o presente estudo centrou-se em identificar os determinantes das PME nestes trabalhadores e suas repercussões na saúde. Métodos: Estudo de natureza quantitativa, de tipologia transversal e descritivocorrelacional, com recurso a uma amostra não probabilística por conveniência, constituída por 120 indivíduos, na sua maioria do género feminino (95,8%) e com uma média de idades de 43,21 anos (Dp=10,812 anos). Como instrumento de colheita de dados utilizou-se o inquérito de saúde e trabalho (INSAT), aferido para este domínio de investigação. Resultados: Estes cuidadores formais manifestam défices de saúde com principal relevância para os relacionados com a mobilidade física e dor, quer pela existência de constrangimentos de natureza física e biomecânica, organizacional e psicossocial, bem como de natureza individual. Os problemas de saúde identificados por estes trabalhadores, resultantes das condições e características do trabalho foram: dores de costas (90,8%), dores musculares e articulares (82,5%), varizes (64,2%), dores de cabeça (49,2%) e ansiedade ou irritabilidade (47,5%). Ser do género feminino, ter idade entre os 49-58 anos, ser viúvo ou divorciado, ter doenças crónicas, tomar medicação e efetuar horário diurno, revelaram-se como determinantes percursores das PME assim como, a nível laboral, as características e os constrangimentos organizacionais e relacionais relacionados com o esforço físico, a intensidade e tempo de trabalho, as exigências emocionais, a insuficiência de autonomia e a má qualidade das relações sociais. Conclusão: Estes resultados apontam para a necessidade de desenvolvimento de estratégias preventivas das PME neste grupo profissional, onde é fundamental a intervenção do enfermeiro de reabilitação na implementação de programas de promoção da saúde, gestão do stresse e riscos psicossociais e formação profissional. Palavras-chave: Doenças musculosqueléticas; Enfermagem de Reabilitação; Saúde Ocupacional.

Vinculação do Adulto e Sistema Comportamental de Prestação de Cuidados em Toxicodependentes integrados em Comunidade Terapêutica e em Programa de Metadona

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica