Cuidados de saúde primários: as regras do jogo

Enquadramento – A reforma dos Cuidados de Saúde Primários (CSP) é um facto irreversível. Uma “onda” de reforma percorre igualmente grande parte dos países ocidentais exigindo uma reflexão sobre o processo. Objetivo – Descrever a reforma em curso nos CSP e identificar os potenciais factores de sucesso e insucesso dos serviços públicos de cuidados de saúde primários. Metodologia – Análise crítica da literatura. Resultados e conclusões – A eficiência, eficácia e equidade de acesso aos cuidados de saúde são insuficientes. Mudanças organizacionais estão a ser operadas alterando as relações e a cooperação inter‑profissional e inter‑organizacional. É evidente a tensão que existe entre as partes envolvidas. Novas formas organizacionais estão a ser criadas para garantir a viabilidade das reformas e equilíbrio dos sistemas. O novo modelo organizacional, se pretender garantir a sustentabilidade e a viabilidade dos cuidados primários, deverá assentar num equilíbrio de gestão de recursos e numa estratégia de saúde para todos que não significa saúde para tudo. ABSTRACT: Background – Primary Health Care (PHC) reform is a fact in several countries and is happening also in Portugal demanding a reflection on the process. Aim – To describe the PHC reform and to identify the factors of success or potential failure in PHC public services. Methods – Critical appraisal of the literature. Results and Conclusions – The efficiency, efficacy and access to health care are insufficient. Organizational changes are taking place altering inter‑professional and inter‑organizational cooperation and relationship. Tension among the parts involved is evident. New organizational models are being created to secure the sustainability of the reforms and the systems. The new models should provide a balanced management of the available resources, in a strategy of health for all that doesn’t mean health for everything.

Innovation through virtual communities of Practice: motivation and constraints in the knowledge-creation process

Communities of Practice are places which provide a sound basis for organizational learning, enabling knowledge creation and acquisition thus improving organizational performance, leveraging innovation and consequently increasing competitively. Virtual Communities of Practice (VCoP‟s) can perform a central role in promoting communication and collaboration between members who are dispersed in both time and space. The ongoing case study, described here, aims to identify both the motivations and the constraints that members of an organization experience when taking part in the knowledge creating processes of the VCoP‟s to which they belong. Based on a literature review, we have identified several factors that influence such processes; they will be used to analyse the results of interviews carried out with the leaders of VCoP‟s in four multinationals. As future work, a questionnaire will be developed and administered to the other members of these VCoP‟s

CVD of CrO(2): Towards a lower temperature deposition process

The deposition of highly oriented a-axis CrO(2) films onto Al(2)O(3)(0001) by atmospheric pressure (AP)CVD at temperatures as low as 330 C is reported. Deposition rates strongly depend on the substrate temperature, whereas for film surface microstructures the dependence is mainly on film thickness. For the experimental conditions used in this work, CrO(2) growth kinetics are dominated by a surface reaction mechanism with an apparent activation energy of (121.0 +/- 4.3) kJ mol(-1). The magnitude and temperature dependence of the saturation magnetization, up to room temperature, is consistent with bulk measurements.

New challenges in mathematics for the european higher education

In this paper we will talk about a math project submitted to the Lifelong Learning Programme. European higher education needs a reform in order to play its full role in the Europe of Knowledge. Modernisation of higher education is necessary in the areas of curricula (Bologna process), funding and governance so that higher education institutions can face the challenges posed by globalisation and contribute more effectively to the training and retraining of the European workforce. On the other hand Mathematics is an essential component of all educational systems. Mathematical literacy is being scrutinized in assessment efforts such as the OCDE Programme for International Student Assessment (PISA). This showed a low level in Europe. Due to the Bologna Process, which brought several didactical implications for Higher Education (HE) institutions, there is the need of lifelong learning. This evolution is in conflict with the earlier mentioned lack of competencies on basic sciences, such as Mathematics. Forced by this duality, efforts are combined to share expertise in the Math field and the integration of pedagogical methodologies becomes a necessity. Thus, several European countries have proposed an International Project to the Lifelong Learning Programme, Action ERASMUS Modernisation of Higher Education, to make institutions more attractive and more responsive to the needs of the labour market, citizens and society at large. One of the main goals of the project is to attract students to math through high-quality instructional units in an understandable, exciting and attractive way.

The (well) informed piano : internalization and growth process

The subject matter of this book is about piano methodology, including technical, musical, artistic, ethical and philosophical issues and reflections. The purpose of this work is to share a personal professional experience insight in the field of piano performance. This text assumes a certain continuity to the major contributions of artists like Ludwig Deppe, Tobias Matthay, Grigory Kogan, Heinrich Neuhaus and George Kochevitsky. At the same time, it tries to integrate and complement this selected literature, bringing new ideas and hints to specific professional issues.

Gestão de carreiras dos profissionais de saúde

Com a reforma da Administração Pública, implementada de forma mais integrada e abrangente pelo Governo socialista de José Sócrates (XVII Governo Constitucional), foi iniciada a reformulação das carreiras dos profissionais de saúde, nomeadamente a carreira médica e a carreira de enfermagem, continuando-se a aguardar a reformulação das carreiras dos técnicos superiores de saúde e dos técnicos de diagnóstico e terapêutica. As inúmeras mudanças que decorrem destas reformulações têm criado por sua vez um clima de receio e expectativa junto dos profissionais de saúde, o que aliado a um período de contingência e recessão económica, tem causado uma certa instabilidade. Embora fosse de reconhecimento geral que a anterior forma como se geria as carreiras dos profissionais de saúde, utilizando como critérios de progressão mecanismos automatizados com foco na antiguidade, não fosse a mais correcta, uma vez que não cumpria princípios de justiça e meritocracia, são agora levantadas inúmeras dúvidas com estas reformulações. A questão principal é se efectivamente virão dar resposta à necessidade de uma maior flexibilidade na evolução profissional, mais adequada aos contributos de cada colaborador, potenciando o desenvolvimento de competências. Concluiu-se então que as reformulações efectuadas nas carreiras dos profissionais de saúde não incentivam totalmente o desenvolvimento de competências ao longo da carreira, mas permitem de alguma forma uma maior flexibilidade na evolução profissional; possibilitando que esta se desenvolva de acordo com os contributos de cada colaborador, apesar de grandes entraves na aplicação à prática. A verdade é que não se conseguem atingir resultados somente através de resoluções por decreto, falta a transformação deste sistema meritocrático, existente no plano formal, numa prática social meritocrática. Para isso em todas as reformulações que ocorram deve-se, primeiro de tudo, sensibilizar os colaboradores para essa necessidade, informar e esclarecer dúvidas, ouvir as suas sugestões e incluí-los no processo de mudança. Só dessa forma se irá conseguir a sua aceitação, o seu apoio e implementar efectivamente novas práticas. Nesse sentido, espera-se que este trabalho contribua para um maior conhecimento acerca da gestão de carreiras, gestão de competências, avaliação de desempenho e meritocracia, bem como das alterações legislativas que têm vindo a ocorrer, sensibilizando para a necessidade de se efectuarem realmente reformulações nas carreiras dos profissionais de saúde, mas também promovendo o desenvolvimento de uma atitude pró-activa para que estas sejam mais meritocráticas.

Determinants of vaccination after the Colombian health system reform

OBJECTIVE: To assess the effects of individual, household and healthcare system factors on poor children's use of vaccination after the reform of the Colombian health system. METHODS: A household survey was carried out in a random sample of insured poor population in Bogota, in 1999. The conceptual and analytical framework was based on the Andersen's Behavioral Model of Health Services Utilization. It considers two units of analysis for studying vaccination use and its determinants: the insured poor population, including the children and their families characteristics; and the health care system. Statistical analysis were carried out by chi-square test with 95% confidence intervals, multivariate regression models and Cronbach's alpha coefficient. RESULTS: The logistic regression analysis showed that vaccination use was related not only to population characteristics such as family size (OR=4.3), living area (OR=1.7), child's age (OR=0.7) and head-of-household's years of schooling (OR=0.5), but also strongly related to health care system features, such as having a regular health provider (OR=6.0) and information on providers' schedules and requirements for obtaining care services (OR=2.1). CONCLUSIONS: The low vaccination use and the relevant relationships to health care delivery systems characteristics show that there are barriers in the healthcare system, which should be assessed and eliminated. Non-availability of regular healthcare and deficient information to the population are factors that can limit service utilization.

Towards an Academic Social Network for Bologna Process

The Bologna Process aimed to build a European Higher Education Area promoting student's mobility. The adoption of Bologna Declaration directives requires a self management distributed approach to deal with student's mobility, allowing frequent updates in institutions rules or legislation. This paper suggests a computational system architecture, which follows a social network design. A set of structured annotations is proposed in order to organize the user's information. For instance, when the user is a student its annotations are organized into an academic record. The academic record data is used to discover interests, namely mobility interests, among students that belongs the academic network. These ideas have been applied into a demonstrator that includes a mobility simulator to compare and show the student's academic evolution.

A student personal system for Bologna process mobility

The Bologna Process aimed to build a European Higher Education Area with the objective of promoting students mobility. The adoption of Bologna Declaration directives requires a decentralized approach that accelerates student's mobility, based on frequently updated legislation. This paper proposes a student personal system to manage student's academic information. This system is supported by a flexible model that integrates, for instance, knowledge about the student attended courses or about a course that the student wishes to apply. Essentially, this model holds a (i) Student's Academic Record with skills acquired in academic course units, professional experience or training and an (ii) Individual Studies Plan, which places the student in a particular (iii) Course Plan setting the curricular structure that the student wishes to apply.

Preparatory and field work phases in the qualitative empirical research process in management: the case studies approach

Purpose: The aim of this paper is to promote qualitative methodology within the scientific community of management. The specific objective is oriented to propose an empirical research process based on case study method. This is to ensure rigor in the empirical research process, that future research may follow a similar procedure to that is proposed. Design/methodology/approach: Following a qualitative methodological approach, we propose a research process that develops according to four phases, each with several stages. This study analyses the preparatory and field work phases and their stages. Findings: The paper shows the influence that case studies have on qualitative empirical research process in management. Originality/value:. Case study method assumes an important role within qualitative research by allowing for the study and analysis of certain types of phenomena that occur inside organisations, and in respect of which quantitative studies cannot provide an answer.

Distributed process execution in collaborative networks

Processes are a central entity in enterprise collaboration. Collaborative processes need to be executed and coordinated in a distributed Computational platform where computers are connected through heterogeneous networks and systems. Life cycle management of such collaborative processes requires a framework able to handle their diversity based on different computational and communication requirements. This paper proposes a rational for such framework, points out key requirements and proposes it strategy for a supporting technological infrastructure. Beyond the portability of collaborative process definitions among different technological bindings, a framework to handle different life cycle phases of those definitions is presented and discussed. (c) 2007 Elsevier Ltd. All rights reserved.

A criatividade na educação : enquadramento curricular e estratégias de facilitação na educação pré-escolar e 1º ciclo do Ensino Básico

Mestrado (PES II), Educação Pré-Escolar e Ensino do 1º Ciclo do Ensino Básico

Unlocking the technology-mediated learning process : insights and articulating actions for an institutional approach

This paper is part of the results from the project "Implementation Strategies and Development of an Open and Distance Education System for the University of the Azores" funded by the European Social Fund. http://hdl.handle.net/10400.3/2327

Characterization of airborne particles generated from metal active gas welding process

This study is focused on the characterization of particles emitted in the metal active gas welding of carbon steel using mixture of Ar + CO2, and intends to analyze which are the main process parameters that influence the emission itself. It was found that the amount of emitted particles (measured by particle number and alveolar deposited surface area) are clearly dependent on the distance to the welding front and also on the main welding parameters, namely the current intensity and heat input in the welding process. The emission of airborne fine particles seems to increase with the current intensity as fume-formation rate does. When comparing the tested gas mixtures, higher emissions are observed for more oxidant mixtures, that is, mixtures with higher CO2 content, which result in higher arc stability. These mixtures originate higher concentrations of fine particles (as measured by number of particles by cm 3 of air) and higher values of alveolar deposited surface area of particles, thus resulting in a more severe worker's exposure.

Complex question answering on semi-structured repositories: a user centric process enhanced with context

A Teia Mundial (Web) foi prevista como uma rede de documentos de hipertexto interligados de forma a criar uma espaço de informação onde humanos e máquinas poderiam comunicar. No entanto, a informação contida na Web tradicional foi/é armazenada de forma não estruturada o que leva a que apenas os humanos a possam consumir convenientemente. Consequentemente, a procura de informações na Web sintáctica é uma tarefa principalmente executada pelos humanos e nesse sentido nem sempre é fácil de concretizar. Neste contexto, tornou-se essencial a evolução para uma Web mais estruturada e mais significativa onde é dado significado bem definido à informação de forma a permitir a cooperação entre humanos e máquinas. Esta Web é usualmente referida como Web Semântica. Além disso, a Web Semântica é totalmente alcançável apenas se os dados de diferentes fontes forem ligados criando assim um repositório de Dados Abertos Ligados (LOD). Com o aparecimento de uma nova Web de Dados (Abertos) Ligados (i.e. a Web Semântica), novas oportunidades e desafios surgiram. Pergunta Resposta (QA) sobre informação semântica é actualmente uma área de investigação activa que tenta tirar vantagens do uso das tecnologias ligadas à Web Semântica para melhorar a tarefa de responder a questões. O principal objectivo do projecto World Search passa por explorar a Web Semântica para criar mecanismos que suportem os utilizadores de domínios de aplicação específicos a responder a questões complexas com base em dados oriundos de diferentes repositórios. No entanto, a avaliação feita ao estado da arte permite concluir que as aplicações existentes não suportam os utilizadores na resposta a questões complexas. Nesse sentido, o trabalho desenvolvido neste documento foca-se em estudar/desenvolver metodologias/processos que permitam ajudar os utilizadores a encontrar respostas exactas/corretas para questões complexas que não podem ser respondidas fazendo uso dos sistemas tradicionais. Tal inclui: (i) Ultrapassar a dificuldade dos utilizadores visionarem o esquema subjacente aos repositórios de conhecimento; (ii) Fazer a ponte entre a linguagem natural expressa pelos utilizadores e a linguagem (formal) entendível pelos repositórios; (iii) Processar e retornar informações relevantes que respondem apropriadamente às questões dos utilizadores. Para esse efeito, são identificadas um conjunto de funcionalidades que são consideradas necessárias para suportar o utilizador na resposta a questões complexas. É também fornecida uma descrição formal dessas funcionalidades. A proposta é materializada num protótipo que implementa as funcionalidades previamente descritas. As experiências realizadas com o protótipo desenvolvido demonstram que os utilizadores efectivamente beneficiam das funcionalidades apresentadas: ▪ Pois estas permitem que os utilizadores naveguem eficientemente sobre os repositórios de informação; ▪ O fosso entre as conceptualizações dos diferentes intervenientes é minimizado; ▪ Os utilizadores conseguem responder a questões complexas que não conseguiam responder com os sistemas tradicionais. Em suma, este documento apresenta uma proposta que comprovadamente permite, de forma orientada pelo utilizador, responder a questões complexas em repositórios semiestruturados.