Advances and challenges in oral health after a decade of the “Smiling Brazil” Program

ABSTRACT OBJECTIVE To analyze oral health work changes in primary health care after Brazil’s National Oral Health Policy Guidelines were released. METHODS A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. RESULTS Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people’s participation and social control; and intersectorial actions. CONCLUSIONS Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

Direcção e gestão de obra – obra de arte – Ponte sobre o Rio Lombe – Angola

Este relatório diz respeito ao trabalho desenvolvido em ambiente de estágio académico numa empreitada de Obra Pública, compreendendo a construção da nova ponte sobre o rio Lombe, na EN230, Estrada N’Dalatando – Malanje, Província de Malanje, República de Angola. O estágio foi realizado na CONDURIL – Engenharia, S.A. – Sucursal Angola, empresa dedicada à execução de obras de engenharia civil e obras públicas, com uma vasta experiencia profissional nesta área de actividade. O objectivo deste relatório, para além da descrição de todos os trabalhos práticos de execução da obra, é de transcrever os conhecimentos adquiridos ao longo do estágio, nomeadamente no que concerne aos dos processos de ‘Gestão, Coordenação e Planeamento’, imputáveis as funções da ‘Direcção Técnica de Obra’ durante toda a fase de execução da empreitada, estando o principal foco na descrição das actividades referentes ao controlo da obra.

Relatório de estágio Direcção e gestão de obra - Obra de Arte Ponte sobre o rio Lombe – Angola

Mestrado em Engenharia Civil - Tecnologia e Gestão das Construções

Gestão de risco: articulação com o planeamento estratégico e a contabilidade de gestão: estudo aplicado a empresas não financeiras do concelho de Vila do Conde

Este trabalho de investigação tem como objetivo analisar se as empresas do concelho de Vila do Conde, efetuam planeamento estratégico, contabilidade de gestão e/ou gestão de risco. Pretende-se ainda verificar se o facto de existir articulação entre estas três áreas da empresa influencia o resultado do seu EBIT (Earning Before Interest and Taxes). Através da literatura relevante, verificou-se que o planeamento estratégico, a contabilidade de gestão e a gestão de risco têm progredido de modo a responder às mudanças do meio envolvente onde as empresas estão a operar. Contudo, em termos práticos, este estudo permitiu verificar que a implementação da gestão de risco e da contabilidade de gestão no tecido empresarial de Vila do Conde tem sido muito lenta. Os dados foram recolhidos através dum inquérito eletrónico efetuado a 505 empresas do concelho de Vila do Conde de diversas atividades económicas pertencentes aos três grandes sectores (serviços, indústria e comércio). De acordo com os resultados obtidos, concluiu-se que apenas 17% das empresas do concelho de Vila do Conde efetuam simultâneamente planeamento estratégico, contabilidade de gestão e gestão de risco. Conclui-se ainda que as empresas do concelho de Vila do Conde que efetuam em simultâneo planeamento estratégico, contabilidade de gestão e gestão de risco apresentam em média um EBIT (2010) aparenta ser superior às que não fazem planeamento estratégico, contabilidade de gestão e gestão de risco.

Gestão e Direcção de Obra

Este relatório diz respeito ao trabalho desenvolvido em ambiente de estágio curricular na construção de um empreendimento comercial na zona de Oeiras, compreendendo a construção de um edifício, infra-estruturas enterradas e arranjos exteriores. O estágio foi realizado na Volare – Gestão de Projectos, S.A., empresa dedicada à execução de obras de construção civil destinadas ao grupo Ibersol. Embora todas as áreas de gestão abordadas no estudo sejam de extrema importância, as áreas de gestão do custo, gestão das compras e gestão do tempo revelam-se ainda extremamente valorizadas pelas empresas de construção – o que faz com continuem a existir derrapagens orçamentais e incumprimento de prazos. Só uma gestão rigorosa, eficiente e capaz de abraçar todas as áreas de conhecimentos abordadas, tornará possível alcançar os patamares de satisfação das empresas e dos clientes. O presente relatório mostra que o gestor de obras deve possuir grande capacidade de liderança, de comunicação e negociação O objectivo deste relatório, para além da descrição de todos os trabalhos práticos de execução da obra, é de transcrever os conhecimentos aplicados ao longo do estágio, nomeadamente no que concerne aos dos processos de ‘Gestão, Coordenação e Planeamento’, directamente ligados as funções da ‘Direcção Técnica de Obra’ durante toda a fase de execução da empreitada, estando o principal foco na descrição das actividades referentes ao controlo da obra.

A simulation model for lean, agile, resilient and green supply chain management: practices and interoperability assessment

Dissertação para obtenção do Grau de Mestre em Engenharia e Gestão Industrial

Modeling and visualization of medical anesthesiology acts

Dissertação para obtenção do Grau de Mestre em Engenharia Informática

Canine rabies epidemiology in Araçatuba and neighborhood, Northwestern São Paulo State - Brazil

Epidemiological characteristics of canine rabies in the northwest region of São Paulo State (Araçatuba region), Brazil, from 1993 to 1997 are presented. Out of 1,984 dogs, a total of 351 (17.7%) were positive for rabies diagnosis; 89% (312/351) of these occurred in urban areas and 85% (266/312) of the urban positive cases were among owned dogs. The mean age of the rabid dogs was 34 months and 61% were male. Aggressive behavior was observed in 77% of rabid dogs, followed by lack of coordination and paralysis (42%) and 48% of these dogs were responsible biting people or other animals. Information about vaccination status was obtained from 182 records and 51% of rabid dogs were non-vaccinated. The number of unvaccinated rabid dogs indicates a low vaccination index and this factor added to the high dog/man ratio must have contributed to the canine rabies epizootic observed in the studied area.

Needs assessment of people with severe mental illnesses and their families in Azerbaijan

RESUMO: Os indivíduos com doença mental grave, assim como os seus familiares, podem ser caracterizados como uma população em que ocorre uma combinação complexa de necessidades médicas e psicossociais, nomeadamente a nível do diagnóstico e do acesso aos serviços de saúde mental. A avaliação de necessidades pode fornecer informações importantes para o desenvolvimento de intervenções eficazes, tanto a nível da população como a nível individual. Este estudo teve como objetivo determinar as diferentes necessidades reportadas pelos pacientes com doença mental grave e seus familiares , assim como investigar as possíveis relações entre o estado de necessidades e as variáveis sócio-demográficas e clínicas. Simultaneamente, o estudo teve como objetivo avaliar a sobrecarga familiar e a satisfação dos utentes com os serviços de saúde mental. Foi elaborado um estudo transversal, realizado numa amostra de conveniência de cinquenta díades de paciente/membro da família, seguidos em regime de ambulatório no Centro Nacional de Saúde Mental. Foram utilizados como instrumentos de avaliação um questionário sociodemográfico, a Escala Breve de Avaliação Psiquiátrica (BPRS), o questionário de Avaliação de Necessidades de Camberwell (CAN), o Questionário de Avaliação do Envolvimento (IEQ) e a Escala de Verona de Satisfação com os Serviços (VSSS). As mais frequentes necessidades não-satisfeitas foram o ‘sofrimento psicológico’, as ‘atividades sociais’ e os ‘benefícios sociais’. O estudo mostrou uma sobrecarga significativa nas famílias que cuidam de pessoas com doença mental grave, que se correlacionou com as suas opiniões sobre as necessidades dos pacientes e teve um impacto negativo sobre o bem-estar psicológico. Os três mais importantes predictores de sofrimento psíquico em familiares foram o sexo, a situação laboral e a relação com o paciente. A avaliação da satisfação com os serviços revelou a existência de um hiato significativo entre os serviços prestados e os serviços desejados, reportados pelos pacientes e seus familiares. A maioria dos participantes do estudo desejavam ter um trabalho protegido, ou receber ajuda para encontrar emprego. Os resultados deste estudo poderão ser usados para fins de planeamento desenvolvimento e avaliação de serviços de saúde mental no Azerbeijão. Algumas recomendações sobre a melhoria dos serviços de saúde mental para pacientes com doença mental grave e suas famílias são feitas na secção final do trabalho.----------ABSTRACT: Patients suffering from severe mental illness, in addition to their family members, may be characterized as a population with a complex combination of medical and psychosocial needs, which are under-recognized and under-addressed by mental health services. At the same time, needs assessment provides important information necessary for developing effective interventions at both population and individual level. The study was aimed to determine various needs perceived by patients with SMI and their family members, as well as to find out possible relations between the needs and socio-demographic and clinical variables. Similarly the study was intended to evaluate family burden and users’ satisfaction with services. This was a cross-sectional study conducted on a convenience sample. Fifty dyads of a patient and family member applying for out-patient services to the National Mental Health Centre participated in the study. Sociodemographic questionnaire, Brief Psychiatric Rating Scale, Camberwell Assessment of Need, Involvement Evaluation Questionnaire, and Verona Service Satisfaction Scale were used as assessment tools. The most prominent unmet needs reported by people with SMI and their relatives were psychological distress, social activities and welfare benefits. The study showed significant burden in families caring for people with SMI, which correlated with their views about patients’ needs and had a negative impact on the psychological well-being. The three most important predictors of psychological distress in family members were gender, employment status and relationship to patient. Evaluation of satisfaction with services pointed out the gap between provided and desired services reported by patients and their relatives. Most of study participants wished to have sheltered work, or receive help in finding employment. The results of this study may be used for the purposes of mental health service planning, development and evaluation in our country. Some recommendations on improvement of mental health services for patients with SMI and their families have been made in the conclusion.

Form tutors in the joint teaching of music: perspectives and experiences

In the Portuguese school system, form tutors (FTs) are an intermediate education management structure. The form tutor is responsible for a position of coordination and orientation with a «threefold function»: a relationship with students, relationship with the student’s family and relationship with other class teachers. The joint teaching of music is a part of the educational system in basic education. It is optional and provides musical and instrumental training to students who are interested in taking it. In order to achieve this, there is a system, subject to protocols, between general education schools and schools specializing in teaching music. There is also the position of FT in specialized schools and it also includes a «threefold function». However, these FTs have the additional role of representing music teachers at the class council, which is held at the general education school. Thus, in these cases, both FTs have a fourth joint area, between the music school and the general education school, which makes the relationship between them even more complex. This paper is based on the analysis of empirical data obtained from the testimonies of FTs regarding their representations and experiences in leadership and the coordination of teachers among schools in which there is a joint teaching system. The aim of collecting narratives is to look into some of the main challenges and confrontations related to leadership issues, which we assume to be the focus of those who have the role of form tutor in that specific context.

Investigating the long term planning framework for the Galway Bay community from climate change.

This research looked at the scientific evidence available on climate change and in particular, projections on sea level rise which ranged from 0.5m to 2m by the end of the century. These projections were then considered in an Irish context. A review of current policy in Ireland revealed that there was no dedicated Government policy on climate change or coastal zone management. In terms of spatial planning policy, it became apparent that there was little or no guidance on climate change either at a national, regional or local level. Therefore, to determine the likely impacts of sea level rise in Ireland based on current spatial planning practice and policy, a scenario-building exercise was carried out for two case study areas in Galway Bay. The two case study areas were: Oranmore, a densely populated town located to the east of Inner Galway Bay; and Tawin Island, a rural dispersed community, located to the south east of Inner Galway Bay. A ‘best’ and ‘worse’ case scenario was envisaged for both areas in terms of sea level rise. In the absence of specific climate change policies it was projected that in the ‘best’ case scenario of 0.5m sea level rise, Tawin Island would suffer serious and adverse impacts while Oranmore was likely to experience slight to moderate impacts. However, in the ‘worse’ case scenario of a 2m sea level rise, it was likely that Tawin Island would be abandoned while many houses, businesses and infrastructure built within the floodplain of Oranmore Bay would be inundated and permanently flooded. In this regard, it was the author’s opinion that a strategic and integrated climate change policy and adaptation plan is vital for the island of Ireland that recognises the importance of integrated land use and spatial planning in terms of mitigation and adaptation to climate change.

Groundwater vulnerability and protection in County Tipperary (South Riding), Ireland

The aim of the project was to determine the extent and quality of the groundwater in Tipperary South Riding with a view to developing a groundwater protection plan which would allow the Local Authority to manage, protect and develop the groundwater as efficiently as possible. The geology of the area varies with topography. The low-lying areas of the county comprise mainly Carboniferous limestones while the elevated regions consist of sandstones and shales of Upper Carboniferous, Devonian and Silurian ages. Deformation of these rocks decreases in magnitude moving northwards over the area; the Southern Synclines having suffered the effects of the Hercynian orogeny and the northern region exhibiting Caledonian orogenic trends. Quaternary (subsoil) deposits are found throughout the area and are of variable thickness and permeability. Till is the most widespread deposit with discontinuous pockets of sand and gravel in various proportions, and some marl, alluvium and peat in places. The principal aquifers of the area are the Kiltorcan sandstone formation and various limestone units within the Carboniferous succession. 50 % of south Tipperary constitutes either regionally or locally important aquifers. Secondary permeabilities created by structural deformation, dolomitisation, karstification and weathering processes create high transmissivities and often have large well yields. Specific baseflow analysis highlighted the complexity of the aquifers and proved that the lower part of the Suir river system is a major groundwater resource region. The hydrochemistry and water quality of the local authority groundwater sources was examined briefly. The majority of south Tipperary is underlain by limestone or Quaternary deposits derived from limestone and, consequently, calcium/magnesium bicarbonate waters predominate. The quality of the groundwater in south Tipperary demonstrates that the main concern originates from the presence of E.coli, and Total coliforms. The primary sources of contamination are from farmyard wastes and septic tanks. The vulnerability of groundwater to diffuse and point sources of pollution has been found to be dependent on the overlying soil, subsoil and the thickness of the unsaturated zone. A conceptual rather than quantitative approach is used and it is found that approximately 60% of south Tipperary is designated as being extremely or highly vulnerable. The groundwater protection plan was devised subsequent to an understanding of the aquifer systems, an assessment of the vulnerability, and a review of the Irish planning system and environmental law. It is recommended that the plan be integrated into the county development plan for legislative purposes. A series of acceptability matrices were devised to restrict potentially polluting activities in vulnerable areas while maintaining a balance between protection of the groundwater resource and the need to site essential developments.

Objective analysis of gait coordination for total knee arthroplasty outcome

Introduction: Coordination is a strategy chosen by the central nervous system to control the movements and maintain stability during gait. Coordinated multi-joint movements require a complex interaction between nervous outputs, biomechanical constraints, and pro-prioception. Quantitatively understanding and modeling gait coordination still remain a challenge. Surgeons lack a way to model and appreciate the coordination of patients before and after surgery of the lower limbs. Patients alter their gait patterns and their kinematic synergies when they walk faster or slower than normal speed to maintain their stability and minimize the energy cost of locomotion. The goal of this study was to provide a dynamical system approach to quantitatively describe human gait coordination and apply it to patients before and after total knee arthroplasty. Methods: A new method of quantitative analysis of interjoint coordination during gait was designed, providing a general model to capture the whole dynamics and showing the kinematic synergies at various walking speeds. The proposed model imposed a relationship among lower limb joint angles (hips and knees) to parameterize the dynamics of locomotion of each individual. An integration of different analysis tools such as Harmonic analysis, Principal Component Analysis, and Artificial Neural Network helped overcome high-dimensionality, temporal dependence, and non-linear relationships of the gait patterns. Ten patients were studied using an ambulatory gait device (Physilog®). Each participant was asked to perform two walking trials of 30m long at 3 different speeds and to complete an EQ-5D questionnaire, a WOMAC and Knee Society Score. Lower limbs rotations were measured by four miniature angular rate sensors mounted respectively, on each shank and thigh. The outcomes of the eight patients undergoing total knee arthroplasty, recorded pre-operatively and post-operatively at 6 weeks, 3 months, 6 months and 1 year were compared to 2 age-matched healthy subjects. Results: The new method provided coordination scores at various walking speeds, ranged between 0 and 10. It determined the overall coordination of the lower limbs as well as the contribution of each joint to the total coordination. The difference between the pre-operative and post-operative coordination values were correlated with the improvements of the subjective outcome scores. Although the study group was small, the results showed a new way to objectively quantify gait coordination of patients undergoing total knee arthroplasty, using only portable body-fixed sensors. Conclusion: A new method for objective gait coordination analysis has been developed with very encouraging results regarding the objective outcome of lower limb surgery.

The economy of the Beijing Olympic Games: An analysis of first impacts and prospects

This paper was presented at the International Sport Business Symposium, held by the Capital University of Economics and Business in Beijing, in 2008. The speakers, Ferran Brunet, as a professor at the Autonomous University of Barcelona and Zuo Xinwen, as a member of Beijing Development and Reform Commission, both set out to analyze changes in the economic and social development of the city which were undertaken with the aim to celebrate the 2008 Olympic Games. They discuss aspects as a transformation in the mode of economic growth, resources of the Organizing Committee, investments related to the Games, transport and communications, industries, the balance of urban and rural development, urban construction and management service and operations into a well-off society.

Screening for health impacts in Local Area Planning in Donegal County Council (2004)

In 2004 an interagency team consisting of members the North Western Health Board and Donegal County Council commissioned the IPH to conduct a HIA screening exercise on planning policy in Donegal. This involved an overview of literature, analysis of policy documents, contact with Planning Officers and observation of public consultation meetings. Following completion of the final report, the intention is to produce a user-friendly template to enable planners to incorporate a health dimension into their decision making.