Assessment of integration of the leprosy program into primary health care in Aracaju, state of Sergipe, Brazil

INTRODUCTION: The aim of this study was to assess the epidemiological and operational characteristics of the Leprosy Program before and after its integration into the Primary healthcare Services of the municipality of Aracaju-Sergipe, Brazil. METHODS: Data were drawn from the national database. The study periods were divided into preintegration (1996-2000) and postintegration (2001-2007). Annual rates of epidemiological detection were calculated. Frequency data on clinico-epidemiological variables of cases detected and treated for the two periods were compared using the Chi-squared (χ2) test adopting a 5% level of significance. RESULTS: Rates of detection overall, and in subjects younger than 15 years, were greater for the postintegration period and were higher than rates recorded for Brazil as a whole during the same periods. A total of 780 and 1,469 cases were registered during the preintegration and postintegration periods, respectively. Observations for the postintegration period were as follows: I) a higher proportion of cases with disability grade assessed at diagnosis, with increase of 60.9% to 78.8% (p < 0.001), and at end of treatment, from 41.4% to 44.4% (p < 0.023); II) an increase in proportion of cases detected by contact examination, from 2.1% to 4.1% (p < 0.001); and III) a lower level of treatment default with a decrease from 5.64 to 3.35 (p < 0.008). Only 34% of cases registered from 2001 to 2007 were examined. CONCLUSIONS: The shift observed in rates of detection overall, and in subjects younger than 15 years, during the postintegration period indicate an increased level of health care access. The fall in number of patients abandoning treatment indicates greater adherence to treatment. However, previous shortcomings in key actions, pivotal to attaining the outcomes and impact envisaged for the program, persisted in the postintegration period.

Simplified wind turbine models for wind energy integration into power systems

This paper analyses the boundaries of simplified wind turbine models used to represent the behavior of wind turbines in order to conduct power system stability studies. Based on experimental measurements, the response of recent simplified (also known as generic) wind turbine models that are currently being developed by the International Standard IEC 61400-27 is compared to complex detailed models elaborated by wind turbine manufacturers. This International Standard, whose Technical Committee was convened in October 2009, is focused on defining generic simulation models for both wind turbines (Part 1) and wind farms (Part 2). The results of this work provide an improved understanding of the usability of generic models for conducting power system simulations.

Barriers preventing the successful integration of mental health services into Primary Health Care in Nigeria : a mixed methods approach

RESUMO: A Nigéria tem uma população estimada em cerca de 170 milhões de pessoas. O número de profissionais de saúde mental é muito diminuto, contando apenas com 150 psiquiatras o que perfaz aproximadamente um rácio de psiquiatra: população de mais de 1:1 milhão de pessoas. O Plano Nacional de Saúde Mental de 1991 reconheceu esta insuficiência e recomendou a integração dos serviços de saúde mental nos cuidados de saúde primários (CSP). Depois de mais de duas décadas, essa política não foi ainda implementada. Este estudo teve como objetivos mapear a estrutura organizacional dos serviços de saúde mental da Nigéria, e explorar os desafios e barreiras que impedem a integração bem-sucedida dos serviços de saúde mental nos cuidados de saúde primários, isto segundo a perspectiva dos profissionais dos cuidados de saúde primários. Com este objetivo, desenvolveu-se um estudo exploratório sequencial e utilizou-se um modelo misto para a recolha de dados. A aplicação em simultâneo de abordagens qualitativas e quantitativas permitiram compreender os problemas relacionados com a integração dos serviços de saúde mental nos CSP na Nigéria. No estudo qualitativo inicial, foram realizadas entrevistas com listagens abertas a 30 profissionais dos CSP, seguidas de dois grupos focais com profissionais dos CSP de duas zonas governamentais do estado de Oyo de forma a obter uma visão global das perspectivas destes profissionais locais sobre os desafios e barreiras que impedem uma integração bem-sucedida dos serviços de saúde mental nos CSP. Subsequentemente, foram realizadas entrevistas com quatro pessoas-chave, especificamente coordenadores e especialistas em saúde mental. Os resultados do estudo qualitativo foram utilizados para desenvolver um questionário para análise quantitativa das opiniões de uma amostra maior e mais representativa dos profissionais dos CSP do Estado de Oyo, bem como de duas zonas governamentais locais do Estado de Osun. As barreiras mais comummente identificadas a partir deste estudo incluem o estigma e os preconceitos sobre a doença mental, a formação inadequada dos profissionais dos CPS sobre saúde mental, a perceção pela equipa dos CSP de baixa prioridade de ação do Governo, o medo da agressão e violência pela equipa dos CSP, bem como a falta de disponibilidade de fármacos. As recomendações para superar estes desafios incluem a melhoria sustentada dos esforços da advocacia à saúde mental que vise uma maior valorização e apoio governamental, a formação e treino organizados dos profissionais dos cuidados primários, a criação de redes de referência e de apoio com instituições terciárias adjacentes, e o engajamento da comunidade para melhorar o acesso aos serviços e à reabilitação, pelas pessoas com doença mental. Estes resultados fornecem indicações úteis sobre a perceção das barreiras para a integração bem sucedida dos serviços de saúde mental nos CSP, enquanto se recomenda uma abordagem holística e abrangente. Esta informação pode orientar as futuras tentativas de implementação da integração dos serviços de saúde mental nos cuidados primários na Nigéria.------------ABSTRACT: Nigeria has an estimated population of about 170 million people but the number of mental health professionals is very small, with about 150 psychiatrists. This roughly translates to a psychiatrist:population ratio of more than 1:1 million people. The National Mental Health Policy of 1991 recognized this deficiency and recommended the integration of mental health into primary health care (PHC) delivery system. After more than two decades, this policy has yet to be implemented. This study aimed to map out the organizational structure of the mental health systems in Nigeria, and to explore the challenges and barriers preventing the successful integration of mental health into primary health care, from the perspective of the primary health care workers. A mixed methods exploratory sequential study design was employed, which entails the use of sequential timing in the combined methods of data collection. A combination of qualitative and uantitative approaches in sequence, were utilized to understand the problems of mental health services integration into PHC in Nigeria. The initial qualitative phase utilized free listing interviews with 30 PHC workers, followed by two focus group discussions with primary care workers from two Local Government Areas (LGA) of Oyo State to gain useful insight into the local perspectives of PHC workers about the challenges and barriers preventing successful integration of mental health care services into PHC. Subsequently, 4 key informant interviews with PHC co-ordinators and mental health experts were carried out. The findings from the qualitative study were utilized to develop a quantitative study questionnaire to understand the opinions of a larger and more representative sample of PHC staff in two more LGAs of Oyo State, as well as 2 LGAs from Osun State. The common barriers identified from this study include stigma and misconceptions about mental illness, inadequate training of PHC staff about mental health, low government priority, fear of aggression and violence by the PHC staff, as well as non-availability of medications. Recommendations for overcoming these challenges include improved and sustained efforts at mental health advocacy to gain governmental attention and support, organized training and retraining for primary care staff, establishment of referral and supportive networks with neighbouring tertiary facilities and community engagement to improve service utilization and rehabilitation of mentally ill persons. These findings provide useful insight into the barriers to the successful integration of mental health into PHC, while recommending a holistic and comprehensive approach. This information can guide future attempts to implement the integration of mental health into primary care in Nigeria.

Modulation of electrical stimulation applied to human physiology and clinical diagnostic

The use, manipulation and application of electrical currents, as a controlled interference mechanism in the human body system, is currently a strong source of motivation to researchers in areas such as clinical, sports, neuroscience, amongst others. In electrical stimulation (ES), the current applied to tissue is traditionally controlled concerning stimulation amplitude, frequency and pulse-width. The main drawbacks of the transcutaneous ES are the rapid fatigue induction and the high discomfort induced by the non-selective activation of nervous fibers. There are, however, electrophysiological parameters whose response, like the response to different stimulation waveforms, polarity or a personalized charge control, is still unknown. The study of the following questions is of great importance: What is the physiological effect of the electric pulse parametrization concerning charge, waveform and polarity? Does the effect change with the clinical condition of the subjects? The parametrization influence on muscle recruitment can retard fatigue onset? Can parametrization enable fiber selectivity, optimizing the motor fibers recruitment rather than the nervous fibers, reducing contraction discomfort? Current hardware solutions lack flexibility at the level of stimulation control and physiological response assessment. To answer these questions, a miniaturized, portable and wireless controlled device with ES functions and full integration with a generic biosignals acquisition platform has been created. Hardware was also developed to provide complete freedom for controlling the applied current with respect to the waveform, polarity, frequency, amplitude, pulse-width and duration. The impact of the methodologies developed is successfully applied and evaluated in the contexts of fundamental electrophysiology, psycho-motor rehabilitation and neuromuscular disorders diagnosis. This PhD project was carried out in the Physics Department of Faculty of Sciences and Technology (FCT-UNL), in straight collaboration with PLUX - Wireless Biosignals S.A. company and co-funded by the Foundation for Science and Technology.

An internationalisation research project into the German market for the Portuguese canned seafood company COFACO.

This project is aimed to analyse the German market of canned fish, in order to find out if there is potential of entering the market for the Portuguese canned seafood company named COFACO. The purpose of this foreign market research, carried out for COFACO, is to highlight the main key aspects of the current German seafood market, founded out through a deep analysis. Moreover, the work project is also aimed to give the company suggestions regarding the Brand, the Product and the Distribution strategy to implement in order to succeed, once considered the opportunity to enter the market.

Managing talent through developmental job experiences (DJE): The mediating role of DJE between HPWS and employees' outcomes

In the competitive landscape of the 21st century, effectively managing human capital in firms is considered to be a potential source of sustainable performance. Therefore, in this study, we tested the influence of high-performance work systems, as a talent management tool, on employees’ experience of developmental jobs. Then, we tested the mediating effect of such experiences on employees’ engagement, exhaustion, performance and turnover intention. With a sample of 254 employees of a diversity of companies and sectors of activity, our findings demonstrated that high-performance practices increase engagement, via the promotion of developmental experiences of fit, which improves performance and decreases turnover intention. Besides, those practices do not control for the pressure dimension of the developmental job experiences that increases exhaustion and turnover intention despite not worsening performance.

A mediated moderation study to explain the negative relationship between job insecurity and employee supportive voice

Double degree

Integration of speech-processing technologies into Activobank's client interaction process

This dissertation analyzes the possibilities of utilizing speech-processing technologies to transform the user experience of ActivoBank’s customers while using remote banking solutions. The technologies are examined through different criteria to determine if they support the bank’s goals and strategy and whether they should be incorporated in the bank’s offering. These criteria include the alignment with ActivoBank’s values, the suitability of the technology providers, the benefits these technologies entail, potential risks, appeal to the customers and impact on customer satisfaction. The analysis suggests that ActivoBank might not be in a position to adopt these technologies at this point in time.

The impact of job insecurity on adaptive performance via burnout

Difficult and unpredictable times, due to economic instability, lead employees to feel high job insecurity. Organizations’ only way to subsistence is to search innovative ways of solving problems and find creative solutions. This study focuses on the impact that job insecurity has on adaptive performance, a recent measure integrating the response of creativity, reactivity in the face of emergencies, interpersonal adaptability, training effort, and handling work stress, and, mediated by burnout. From the responses of two questionnaires (????????1=252; ????????2=145), we conclude that job insecurity leads to exhaustion, but not to disengagement. In turn, it is the latter that demonstrates to have negative relations with some measures of adaptive performance. Thus, it is crucial to understand how organizations can minimize the inherent process.

Analysis of the detection coefficient for the association between leprosy and pregnancy in the integration region of Carajas, State of Para, Brazil

Introduction The association between leprosy and pregnancy is currently poorly understood and has been linked to serious clinical consequences. Methods A retrospective study between 2007 and 2009 was performed in the integration region of Carajás, Brazil on a population of pregnant lepers, with non-lepers of ages 12-49 years serving as the reference population. Results Twenty-nine pregnant lepers were studied during the study period. The detection rates (DRs) for the studied association were 4.7 in 2007, 9.4 in 2008, and 4.3 in 2009. Conclusions The Carajás region presented a medium pattern of endemicity during most of the study period, with a high DR found in 2008.

The integration of online advertising into social media

This study examined user-generated (UG) advertising in the context of social media networks. The focus was on how people, whether an expert in the area, a non-expert or a friend, influence the reader of the advertisement. Furthermore, the study analyzed how the certainty level of the UG advertisement influences the person viewing the ad. The study showed that for the friend source a high certainty message was more persuasive. However, regarding the certainty no significant results were found for the expert and non-expert. Further, the type of the source had a considerable impact on persuasion. Someone that we personally know (e.g., a friend) was rated most positive for all analyzes variables. This shows that with the rising usage of social media there are great opportunities for new effective advertising strategies that could include a new type of an endorser – friends.

Assessing the role of social networks on migrant labor market outcomes: Evidence from a representative immigrant survey

What role do social networks play in determining migrant labor market outcomes? We examine this question using data from a random sample of 1500 immigrants living in Ireland. We propose a theoretical model formally predicting that immigrants with more contacts have additional access to job offers, and are therefore better able to become employed and choose higher paid jobs. Our empirical analysis confirms these findings, while focusing more generally on the relationship between migrants’ social networks and a variety of labor market outcomes (namely wages, employment, occupational choice and job security), contrary to the literature. We find evidence that having one more contact in the network is associated with an increase of 11pp in the probability of being employed and with an increase of about 100 euros in the average salary. However, our data is not suggestive of a network size effect on occupational choice and job security. Our findings are robust to sample selection and other endogeneity concerns.

A behavioral perspective on the effects of using performance measurement systems in the companies: Evidence from a case study

The effects of PMSs on the people’s behaviour represent a high degree of relevance in the context of an organization performance and success. Thus, motivational and behavioural consequences of performance measurements are far from being totally understood (Franco-Santos et al., 2012). This work project (WP) purposes going further regarding the consequences/effects on people’s behaviour of using PMSs in organizations. The researcher conducted 11 interviews to managers during a nine-month internship as a controller in a Portuguese multi-national company. The evidence from this WP suggests that the way how managers understand a PMS determines a lot the way how they behave. Data also supports that PMSs influences in several ways motivation, perceptions, participation and job-related stress of managers.