Qual a eficácia clínica do sistema CEREC com os seus diferentes materiais para reabilitação em prótese fixa e sobre implantes?

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

China's new day; a study of events that have led to its coming, by Isaac Taylor Headland.

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Nurse-led behavioral management of diabetes and hypertension in community practices: a randomized trial.

BACKGROUND: Several trials have demonstrated the efficacy of nurse telephone case management for diabetes (DM) and hypertension (HTN) in academic or vertically integrated systems. Little is known about the real-world potency of these interventions. OBJECTIVE: To assess the effectiveness of nurse behavioral management of DM and HTN in community practices among patients with both diseases. DESIGN: The study was designed as a patient-level randomized controlled trial. PARTICIPANTS: Participants included adult patients with both type 2 DM and HTN who were receiving care at one of nine community fee-for-service practices. Subjects were required to have inadequately controlled DM (hemoglobin A1c [A1c] ≥ 7.5%) but could have well-controlled HTN. INTERVENTIONS: All patients received a call from a nurse experienced in DM and HTN management once every two months over a period of two years, for a total of 12 calls. Intervention patients received tailored DM- and HTN- focused behavioral content; control patients received non-tailored, non-interactive information regarding health issues unrelated to DM and HTN (e.g., skin cancer prevention). MAIN OUTCOMES AND MEASURES: Systolic blood pressure (SBP) and A1c were co-primary outcomes, measured at 6, 12, and 24 months; 24 months was the primary time point. RESULTS: Three hundred seventy-seven subjects were enrolled; 193 were randomized to intervention, 184 to control. Subjects were 55% female and 50% white; the mean baseline A1c was 9.1% (SD = 1%) and mean SBP was 142 mmHg (SD = 20). Eighty-two percent of scheduled interviews were conducted; 69% of intervention patients and 70% of control patients reached the 24-month time point. Expressing model estimated differences as (intervention--control), at 24 months, intervention patients had similar A1c [diff = 0.1 %, 95 % CI (-0.3, 0.5), p = 0.51] and SBP [diff = -0.9 mmHg, 95% CI (-5.4, 3.5), p = 0.68] values compared to control patients. Likewise, DBP (diff = 0.4 mmHg, p = 0.76), weight (diff = 0.3 kg, p = 0.80), and physical activity levels (diff = 153 MET-min/week, p = 0.41) were similar between control and intervention patients. Results were also similar at the 6- and 12-month time points. CONCLUSIONS: In nine community fee-for-service practices, telephonic nurse case management did not lead to improvement in A1c or SBP. Gains seen in telephonic behavioral self-management interventions in optimal settings may not translate to the wider range of primary care settings.

Have climate induced changes in zooplankton communities led to poor conditions for larval fish growth? A test on cod larvae on the UK shelf

Climate effects have been shown to be at least partly responsible for the reorganisation in the plankton ecosystem on the shelf seas of NW Europe over the last 50 years. Most fish larvae feed primarily on zooplankton, so changes in zooplankton quantity, quality and seasonal timing have been hypothesized to be a key factor affecting their survival. To investigate this we have implemented a 1-dimensional trophodynamic growth model of cod larvae for the waters around the UK covering the period 1960 to 2003. Larval growth is modelled as the difference between the amount of food absorbed by the larva and its various metabolic costs. Prey availability is based upon the biomass and size of available preys (i.e. adults and nauplii copepods and cladocerans) taken from the Continuous Plankton Recorder dataset. Temperature and wind forcing are also taken into account. Results suggest that observed changes in plankton community structure may have had less impact than previously suggested. This is because changes in prey availability may be compensated for by increased temperatures resulting in little overall impact on potential larval growth. Stock recovery, at least in the short term is likely to be more dependent upon conserving the year classes recruited to allow spawning stock biomass to rebuild. If as our model suggests, the larvae are still able to survive in the changing environment, reduction in fishing on the adults is needed to allow the stock to recover.

Desperately Seeking Finance? The Demand for Finance by Women Owned and Led Businesses

The study reported here addresses some issues on gender, entrepreneurship and finance that have been identified as problematic in the literature. For example, much of the research to date is based on the assumption of entrepreneurship as male entrepreneurship; few studies have controlled for structural characteristics that may impact on the relationship between owner gender and a venture's ability to raise finance; and women are less likely than men to seek growth and external financing. Through the conduct of in-depth semi-structured interviews, an attempt has been made to give `voice' to women's intrinsically interesting experiences as the enactment of a situated practice, and not just in comparison with the assumed norm of male entrepreneurial activity. The findings suggest that when variables such as individual and firm characteristics are controlled for, generalizations found in the literature may not be supported. Further, the paper highlights that neither women entrepreneurs nor their businesses are homogeneous in nature and that greater heterogeneity in the study of female entrepreneurship in general, and access to finance in particular, is required.

Use and access to ICT in students of public secondary schools in Chihuahua City, Mexico: inclusion in teaching and digital literacy

This paper addresses the issue of the digital divide in students of public secondary schools at Chihuahua City, Mexico. It seeks to identify potential inequality of opportunities with regards to subjects’ access to information, knowledge and education through the ICT (internet, mobile telephony, broadband and television). The study takes three schools as investigative stage, using the survey as a data collection instrument, identifying patterns of behavior regarding: general knowledge of them, access to computer equipment and internet, and characterization of their use. Other aspects of analysis are the identification of the educational level of parents and access to technology resources available for academic and non-academic purposes in various application areas (home, school and social environment). The proposal concludes, that it is through the recollection of alternatives suggested by the teachers themselves to incorporate ICT for teaching purposes in a systematic and planned fashion, whose greatest reflection manifests in better digital literacy indicators.

Obesity in People with Learning Disabilities: the impact of nurse led health screenings and health promotion activities

Background. Obesity appears to be more common among people with intellectual disabilities, with few studies focusing on achieving weight reduction. Aim. Firstly, to follow up people identified as overweight and obese following special health screening clinics and to determine the actions taken. Secondly, to evaluate the impact of health promotion classes on participants' weight loss. Methods. A clinic led by two learning disbaility nurses was held for all people aged 10 years and over (n=464) who attended special services within the area of one Health and Social Services Trust in Northern Ireland. In a second study, the nurses organised health promotion classes for 20 people over a 6 - 8 week period. Findings. The health screen identified 64% of adults and 26% of 10 - 19 year olds as being overweight or obese. Moreover, those aged 40 - 49 years who were obese had significantly higher levels of blood pressure. However, information obtained from a follow up questionnaire sent after 3 months suggested that of the 122 people identified for wiehgt reduciton, action had been taken for only 34% of them and only three were reported to have lost weight. The health promotion classes, however, led to a significant reduction in weight and body mass index scores. Conclusion. Health screening per se has limited impact on reducing obesity levels in this client group. Rather, health personnel such as general practitioners, nurses and health promotion staff need to work in partnership with service staff, carers and people with intellectual disabiltieis to create more active lifestyles.

No longer Sukumbasis: Challenges in grassroots-led squatter resettlement program in Kathmandu with special reference to Kirtipur Housing Project.

The paper is the outcome of a systematic effort to study and analyze the experiences of the Kirtipur Housing Project (KHP), the first ever grassroots-led squatter resettlement project in Kathmandu. It is widely hailed as a success story as it has been able to provide a legal, affordable and good quality housing solution to the Sukumbasis through grassroots mobilization. The paper analyses the dynamics of this mobilization and the roles of different actors to show how community empowerment, civil actions and local government interests have converged to create a constructive partnership in line with wider enabling principles. Apart from meeting the narrowly defined objective to rehouse 44 households, the project reflects capacity of the community, quite apart from lobbying and protest, in areas of project planning and management. While no grassroots mobilisation can be expected to replicate in a dynamic environment, the paper draws some policy insights that indicate the ability of the grassroots mobilization in Kathmandu to continue and grow. Conversely, the lessons learned from the project also point to limitations in terms lack of prerequisite critical mass or economic benefits to influence the government to prepare a policy framework under which it can foster in a more structured way.

Clinical pharmacy-led disease and medicine management programme for patients with COPD

center dot The concept of self-management plans for patients with chronic obstructive pulmonary disease (COPD) is derived from their success in asthma management.