Impact of a nutritional counseling program on prevention of HAART-related metabolic and morphologic abnormalities

The advent of highly active antiretroviral therapy (HAART) improved HIV infection prognosis. However, adverse metabolic and morphologic effects emerged, highlighting a lack of investigation into the role of nutritional interventions among this population. The present study evaluated the impact of a nutritional counseling program on prevention of morphologic and metabolic changes in patients living with HIV/AIDS receiving HAART. A 12-month randomized clinical trial was conducted with 53 adults of both genders in use of HAART. Subjects were allocated to either an intervention group (IG) or a control group (CG). Nutritional counseling was based on the promotion of a healthy diet pattern. Anthropometrical, biochemical, blood pressure, and food intake variables were assessed on four separate occasions. Sub scapular skin-fold results showed a significant tendency for increase between time 1 (Mean IG = 14.9 mm; CG = 13.6 mm), time 3 (Mean IG = 16.7 mm; CG = 18.2 mm), and time 4 (Mean IG = 16.4 mm; CG = 17.7 mm). Lipid percentage intake presented a greater increase among controls (time 1 mean = 26.3%, time 4 mean = 29.6%) than among IG subjects (time 1 mean = 29.1%, time 4 mean = 28.9%). Moreover, participants allocated to the IG presented an increase in dietetic fiber intake of almost 10 grams. The proposed nutritional counseling program proved to be effective in improving diet by reducing fat consumption and increasing fiber intake.

Communication in Smoking Cessation and Self-management : a study at Nurse-led COPD-clinics in Primary Health Care

ABSTRACTThe general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD.Designs: Observational, prospective observational and experimental designs were used.Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker.Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

The effects of attitudes and personality traits on mode choice

We hypothesise that differences in people's attitudes and personality traits lead them to attribute varying importance to environmental considerations, safety, comfort, convenience and flexibility. Differences in personality traits call be revealed not only in the individuals' choice of transport, but also in other actions of their everyday lives-such as how much they recycle, whether they take precautions or avoid dangerous pursuits. Conditioning on a set of exogenous individual characteristics, we use indicators of attitudes and personality traits to form latent variables for inclusion in an, otherwise standard, discrete mode choice model. With a sample of Swedish commuters, we find that both attitudes towards flexibility and comfort, as well as being pro-environmentally inclined, influence the individual's choice of mode. Although modal time and cost still are important, it follows that there are other ways, apart from economic incentives, to attract individuals to the, from society's perspective, desirable public modes of transport. Our results should provide useful information to policy-makers and transportation planners developing sustainable transportation systems.

Role of headmasters, teachers and supervisors in knowledge transfer about occupational health and safety to pupils in vocational education

Background Young people are at an increased risk for illness in working life. The authorities stipulate certain goals for training in occupational health and safety (OHS) in vocational schools. A previous study concluded that pupils in vocational education had limited knowledge in the prevention of health risks at work. The aim of the current study, therefore, was to study how OHS training is organized in school and in workplace-based learning (WPL).   Method The study design featured a qualitative approach, which included interviews with 12 headmasters, 20 teachers, and 20 supervisors at companies in which the pupils had their WPL. The study was conducted at 10 upper secondary schools, located in Central Sweden, that were graduating pupils in four vocational programs.   Result The interviews with headmasters, teachers, and supervisors indicate a staggered picture of how pupils are prepared for safe work. The headmasters generally give teachers the responsibility for how goals should be reached. Teaching is very much based on risk factors that are present in the workshops and on teachers’ own experiences and knowledge. The teaching during WPL also lacks the systematic training in OHS as well as in the traditional classroom environment.   Conclusion Teachers and supervisors did not plan the training in OHS in accordance with the provisions of systematic work environment management. Instead, the teachers based the training on their own experiences. Most of the supervisors did not get information from the schools as to what should be included when introducing OHS issues in WPL.

Young peoples’ entrance to the workplace : Introduction to occupational health and safety

Negative outcomes of a poor work environment are more frequent among young workers. The aim of the current study was to study former pupils’ conditions concerning occupational health and safety by investigating the workplaces’, safety climate, the degree of implementation of SWEM and the their introduction programs. Four branches were included in the study: Industrial, Restaurant, Transport and Handicraft, specialising in wood. Semi-structured dialogues were undertaken with 15 employers at companies in which former pupils were employed. They also answered a questionnaire about SWEM. Former pupils and experienced employees were upon the same occasion asked to fill in a questionnaire about safety climate at the workplace. Workplace introduction programs varied and were strongly linked to company size. Most of the former pupils and experienced employees rated the safety climate at their company as high, or good. Employers in three of the branches rated the SWEM implemented at their workplaces to be effective. The Industry companies, which had the largest workplaces, gave the most systematic and workplace introduction for new employees. There are no results from this study explaining the fact that young workers have a higher risk for workplace accidents.

Therapeutic Discourse and the American Public Philosophy: On American Liberalism's Troubled Relationship with Psychology

I explore the main currents of postwar American liberalism. One, sociological, emerged in response to the danger of mass movements. Articulated primarily by political sociologists and psychologists and ascendant from the mid-fifties till the mid-seventies, it heralded the "end of ideology." It emphasized stability, elitism, positive science and pluralism; it recast normatively sound politics as logrolling and hard bargaining. I argue that these normative features, attractive when considered in isolation, taken together led to a vicious ad hominem style in accounting for views outside the postwar consensus. It used pseudo-scientific literature in labeling populists, Progressives, Taft conservatives, Goldwaterites, the New Left and others "pathological," viz. mentally ill. Hence, "therapeutic discourse." I argue that philosophical liberalism, which reasserts the role of political theory in working out norms and adjudicating disagreement, is a more profitable way of thinking about and defending from critics liberalism. I take the philosopher John Rawls as the tradition's modern representative. This inquiry is important because the themes of sociological liberalism are making a comeback in American public discourse, and with them perhaps the baggage of therapeutic discourse. I present a cautionary tale.

Estudo experimental sobre a precisão e validade dos escores introversão-extroversão de uma adaptação brasileira do Maudsley Personality Inventory de H.J. Eysenck

O propósito dos trabalhos experimentais expostos na presente dissertação foi o de estudar a versão brasileira do Maudaley Personality Inventory. de Eysench. no que diz respeito à sua dimensão bipolar introversão-extroversão. A adaptação brasileira (devida à Professora Riva Bauzer) foi aplicada por duas vezes a 70 estudantes, de quatro turmas do Colégio Batista Shepard, que são nossos alunos de psicologia. Paralelamente a esta aplicação, foi aplicado por duas vezes sucessivas, aos mesmos alunos, um questionário por nós organizado. Nele era pedida a cada um uma avaliação subjetiva do grau de introversão-extroversão dos respectivos colegas de classe. Desse modo tivemos a possibilidade de avaliar: a) o coeficiente de precisão do questionário; b) o coeficiente de precisão do Maudeley Personality Inventory; c) o coeficiente de validade do Maudaley Persona lity Inventory, tomando o questionário como critério de validação. Entretanto, nao terminaram ai nossos trabalhos. Por meio do coeficiente de correlação bisserial, foi estimado o poder discriminante de cada uma das questões do Maudsley Personality Inventory, assim como seu grau de "popularidade". Esta é uma denominação por nós atribuida à porcentagem de sujeitos que assinalaram a questão no sentido de extroversão. Estes elementos abrem caminho para a realização de pesquisas ulteriores com a finalidade de aperfeiçoar a versão brasileira do Maudsley Personality Inventory.

Rendimento acadêmico e sua relação com os estilos de personalidade de estudantes universitários

One of the Psychology challenges, especially among the assessment and educational areas, is to understand and predict individual differences. In this context, this research aimed to verify the personality styles of students with high and low academic performance. The study included 236 university students from Petrolina-PE and Juazeiro-BA campus of the UNIVASF (Universidade Federal do Vale do São Francisco). They were uniformly distributed in four disciplines (medicine, psychology, administration and civil engineering), 10 students from each semester (five highest scores average students and five lowest scores average students) took place of the sample. The Millon Index Personality Styles (MIPS) was applied to analyze the personality/behavioral styles of the students. The MIPS is a 180 dichotomous (true/false) item scale. It was also developed and applied a questionnaire about the students characteristics and their academic information. Descriptive and central tendency statistics analysis (mean, standard deviation, frequency and percentage) were done to provide sample information. Then we performed a Mann-Whitney test in the overall sample and in each course and a factorial ANOVA. The results suggest that the university population is heterogeneous and there are significant differences (p <0.05) between the personality styles of students with high and low academic performance, when analyzing the overall sample and in courses of different areas of knowledge. Students of Medicine who have higher performance as personality styles prevalent the conformism and compliance, while students with lower income in this course, the styles are: innovation and discrepancy. Psychology students with higher income are more systematic and lower income students to score significantly on accommodation. The civil engineering students of the two groups differed only in personality style intuition, being such a style more characteristic of higher income students. Students of Management with higher yield stand out more in the style of the doubt and lower yields in these styles: individual, reflection and discrepancy. This study is correlational, but had an exploratory nature because there are no studies about this relationship in Brazil. Therefore, it provided a better understanding of the action characteristics of students with high and low academic performance. Further studies using the Big Five Personality Factors instruments are required because it is the most used model in understanding the influence of personality on students performance. This way, the relation between personality and academic performance will be better discussed. Otherwise, it will be possible to compare with the existing studies in the area

Guidelines for the integration of certifiable management systems in industrial companies

Organizations often operate in turbulent environments characterized by intense competitiveness, constant technological progress, new market requirements, and scarce natural resources. This scenario imposes the constant need for change in the operation and companies' management. The integration of certifiable management systems is an effective alternative in this sense. The objective of the present study is to propose guidelines for the integration of the ISO 9001 Quality Management System (QMS), ISO 14001 Environmental Management System (EMS) and OHSAS 18001 Occupational Health and Safety Management System (OHSMS) in industrial companies. These guidelines were developed based on a theoretical framework and on the results from fourteen case studies performed in Brazilian industrial companies. The proposed guidelines were divided into three phases: A) integration planning, b) integration development, and c) integration control and improvement.

Significados do corpo no trabalho em indivíduos com diagnóstico de ler

Pós-graduação em Saúde Coletiva - FMB

Trabalho e estresse: identificação do estresse e dos estressores ocupacionais em trabalhadores de uma unidade administrativa de uma instituição pública de ensino superior (IES)

The article presents survey of public servants of a Higher Education Institution (HEI) that aimed to diagnose the presence of stress in this population, the stress phase in which individuals find themselves and the prevalence of symptoms, whether physical or psychological. This study aimed to characterize the symptomatology of the population experiencing stress and major stressors of the work context where participants act. The survey revealed that 46.6% of the participants are experiencing stress, mostly found in the resistance phase with predominantly psychological symptoms. Among the major stressors of work contexts, stood the physical environment of the workplace, sector infrastructure work, the process of professional performance evaluation adopted by IES, low recognition given to the work done and the small number of servers in certain sectors . The results revealed the presence of stress advancement of this sample and the need for appropriate policy actions and management practices of people who aim to act to minimize this phenomenon.

Adolescents’ Occupational and Educational Aspirations and Expectations: Links to High School Activities and Adult Educational Attainment

This longitudinal study explored adolescents’ future-oriented cognitions, current activities, and later educational attainment using data from 317 adolescents (55% female; mean age = 14.98 years, SD = 0.85) followed into early adulthood. Aspirations and expectations regarding work and education showed modest stability from year to year. Exploration of the reciprocal relations between these cognitions and adolescents’ activities supported both unidirectional and bidirectional effects, with different patterns emerging for aspirations and expectations. In multiple regression analyses, future-oriented cognitions predicted adult educational attainment; follow- up analyses indicated that the effect of adolescents’ expectations was partially mediated by participation in extracurricular activities. These results suggest a potentially important influence of adolescents’ future-oriented cognitions on their current behavior and future attainments.

The workers role in knowledge management and sustainability policies

Based on the concepts of sustainability and knowledge management, this article seeks to identify points of contact between the two themes through an exploratory study of existing literature. The first objective is to find, in international literature, the largest number of papers jointly related to the theme of knowledge management and sustainability. In these documents, the authors looked at the kind of relationship existing between the two themes and what the benefits introduced in organizations are. Based on an ergonomic point of view, the second objective of this article is to analyze the role of the worker (whether at the strategic or operational level) and his importance in this context. The results demonstrate that there is very little literature that addresses the two themes together. The few papers found, however, can be said to show the many advantages of introducing sustainability policies supported by adequate knowledge management. Very little has been studied with regards to the role of workers, which could be interpreted as meaning that little importance is given to the proactive role they may play. On the other hand, there is a high potential for future research in these areas, based on the high level of consideration of workers in knowledge management and sustainability literature, as well as in literature in the areas of ergonomics and sociology.

Evaluation of the capability of decentralized management of epidemiological surveillance in the state of Bahia

Evaluative research into the capability of decentralized management of epidemiological vigilance (EV) was conducted in the operational, organizational and sustainable dimensions in the state of Bahia, Brazil. The quantitative approach was used in the construction of a baseline, with primary data obtained through an online questionnaire answered by thirty-eight municipal EV managers. In the qualitative approach to analyze the context and assess the management capability of municipalities in two case studies, techniques adapted to the analysis of discursive practices were used. This was done through semi-structured interviews with managers of regional and municipal government, health workers and representatives of the municipal health council. The case studies showed that the municipality with enhanced management capability is that in which the manager has the greatest potential of using the resources of his position, in addition to his ability to control, negotiate and coordinate with other actors. Due to decentralization of EV, considering the shared nature of management between the three spheres of government, there is a marked variation in the management capability of municipalities, determined by social, economic, political inequalities and management mechanisms adopted.

The role of evaluation in decision-making in the management of health services

The management of health services is a complex administrative practice due to the breadth of the field of health and the need to reconcile individual, corporate and collective interests that are not always convergent. In this context, the evaluation needs to have specific characteristics in order to fulfill its role. The scope of this study was to establish the characteristics that the evaluation for the management of health services should have to contribute to decision-making. Usefulness, opportunity, feasibility, reliability, objectivity and directionality represent the set of principles upon which the evaluation should be based. Evaluations should lead to decisions that guarantee not only their efficiency and effectiveness but also their implementation. The evaluation process should ensure that decisions involve all stakeholders in order to render the implementation of decisions feasible, and take into account the health needs of the population and the goals set for the services. The scope of this article is to elicit a debate among different stakeholders in the evaluation in the hope that it can contribute to the reflection on the real usefulness of evaluations in which the political component in management has been increasingly prevalent.