Health self-assessment by hemodialysis patients in the Brazilian Unified Health System

ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62), and reporting some (OR = 2.17; 95%CI 1.66–2.84) or a lot of (OR = 2.74; 95%CI 2.04–3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84). CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.

Assessment of medical courses in Brazil using student-completed questionnaires. Is it reliable?

INTRODUCTION: Debates about the quality of medical education have become more evident in the recent past, and as a result several different assessment methods have been refined for that purpose. The use of questionnaires filled out by medical students to assess the quality of lectures is one of the most common methods employed in our milieu. However, the reliability of this investigation method has not yet been systematically tested. The authors present the reliability of a specific form applied to the fourth grade medical students during the clinical psychiatry course. METHOD: Eighty-one fourth grade medical students were instructed to complete a form immediately after each clinical psychiatry lecture. Thirty-four students (42%) failed to turn in the forms after the final lecture. These students were given an identical form to assess the lectures in a retrospective fashion. The grades given by both groups of students for each performed lecture and the number of students who have graded an unperformed lecture were compared. Statistical significance for both groups was determined by means of the chi-square test (p< 0.05). RESULTS: Eighteen out of the 34 students who filled out the forms retrospectively (53%) rated the unperformed lecture, whereas only 5 out of the 47 students who filled out the forms during the course (11%) did so. This is statistically significant (p< 0.05). There was no statistical difference for the grades given to the lectures that were actually performed. DISCUSSION: The authors concluded the low reliability rate of the retrospective evaluation warrant a continuous assessment method during the course.

Risk assessment in a research laboratory during sol–gel synthesis of nano-TiO2

The occupational risks in the nanotechnology research laboratories are an important topic since a great number of researchers are involved in this area. The risk assessment performed by both qualitative and quantitative methods is a necessary step for the management of the occupational risks. Risk assessment could be performed by qualitative methods that gather consensus in the scientific community. It is also possible to use quantitative methods, based in different technics and metrics, as indicative exposure limits are been settled by several institutions. While performing the risk assessment, the information on the materials used is very important and, if it is not updated, it could create a bias in the assessment results. The exposure to TiO2 nanoparticles risk was assessed in a research laboratory using a quantitative exposure method and qualitative risk assessment methods. It was found the results from direct-reading Condensation Particle Counter (CPC) equipment and the CB Nanotool seem to be related and aligned, while the results obtained from the use of the Stoffenmanager Nano seem to indicate a higher risk level.

Evaluation cardiologique préopératoire avant chirurgie non cardiaque: stratification du risque cardiovasculaire [Preoperative cardiac assessment before non-cardiac surgery: cardiac risk stratification].

Perioperative cardiac events occurring in patients undergoing non-cardiac surgery are a common cause of morbidity and mortality. Current guidelines recommend an individualized approach to preoperative cardiac risk stratification prior to non-cardiac surgery, integrating risk factors both for the patient (active cardiac conditions, clinical risk factors, functional capacity) and for the planned surgery. Preoperative cardiac investigations are currently limited to high-risk patients in whom they may contribute to modify the perioperative management. A multidisciplinary approach to such patients, integrating the general practitioner, is recommended in order to define an individualized peri-operative strategy.

Le Resident Assessment Instrument-Home-Care (RAI-Domicile): ce que le médecin de premier recours doit savoir [The Resident Assessment Instrument Home care: what primary care physician needs to know].

Following the decision of the Swiss Association for Home Care Services to adopt the Resident Assessment Instrument (RAI), the RAI-Home Care is gradually implemented in all home care services in Switzerland. Based on a comprehensive geriatric assessment, the RAI not only allows to establish an individualized plan of care, but also generates quality indicators and a case-mix classification system that helps financing and planning resources. This article describes the five steps of the RAI-Home Care process and discusses the strengths, future and limitations of the RAI.

Beliefs and practices in the assessment of workplace pollutants

OBJECTIVES: A survey was undertaken among Swiss occupational hygienists and other professionals to identify the different exposure assessment methods used, the contextual parameters observed and the uses, difficulties and possible developments of exposure models for field application. METHODS: A questionnaire was mailed to 121 occupational hygienists, all members of the Swiss Occupational Hygiene Society. A shorter questionnaire was also sent to registered occupational physicians and selected safety specialists. Descriptive statistics and multivariate analyses were performed. RESULTS: The response rate for occupational hygienists was 60%. The so-called expert judgement appeared to be the most widely used method, but its efficiency and reliability were both judged with very low scores. Long-term sampling was perceived as the most efficient and reliable method. Various determinants of exposure, such as emission rate and work activity, were often considered important, even though they were not included in the exposure assessment processes. Near field local phenomena determinants were also judged important for operator exposure estimation. CONCLUSION: Exposure models should be improved to integrate factors which are more easily accessible to practitioners. Descriptors of emission and local phenomena should also be included.

Evaluation gériatrique des patients agés candidats a un remplacement valvulaire aortique percutané [Geriatric assessment in old patients candidate to transcatheter aortic implantation].

Aortic stenosis mostly occurs among old-old patients. Once symptoms appear, prognosis is guarded, with 2-year mortality as high as 50%. Transcatheter Aortic Valve Implantation (TAVI) is a new therapeutic option in patients at very high surgical risk, who are mostly older persons. However, TAVI is associated with some complications, and patient selection remains a challenge. Comprehensive geriatric assessment (CGA) identifies patients with medical and functional problems likely to affect the TAVI post-operative course. Collaboration between cardiologists and geriatricians will likely become a standard approach to enhance the assessment of these frail patients and identify those most likely to benefit from TAVI.

Iowa Fen Rapid Assessment Method for Wetlands v. 1 Quantitative Rating, 2016

Rapid assessment methods are valuable tools for collecting information about the quality and status of natural systems. However, they are not a substitute for detailed surveys of those systems. Users of this method should consider that the method may under-score or over-score the site that’s assessed, especially when the site is not a typical fen (i.e. a sedge meadow could score lower than fens, but in-fact be a relatively high quality sedge meadow). This assessment can be used throughout most of the spring, summer and fall period, however the ideal “index period” would be from late May through early October when native plant communities, as well as invasive species, are most apparent.

The spiritual needs model: spirituality assessment in the geriatric hospital setting

Clinicians increasingly agree that it is important to assess patients' spirituality and to incorporate this dimension into the care of elderly persons, in order to enhance patient-centered care. However, models of integrative care that take into account the spiritual dimension of the patient are needed in order to promote a holistic approach to care. This research defines a concept of spirituality in the hospitalized elderly person and develops a model on which to base spirituality assessment in the hospital setting. The article presents in detail the different stages in the conceptualization of The Spiritual Needs Model.

A modified structural stress method for fatigue assessment of welded structures

Fatigue life assessment of weldedstructures is commonly based on the nominal stress method, but more flexible and accurate methods have been introduced. In general, the assessment accuracy is improved as more localized information about the weld is incorporated. The structural hot spot stress method includes the influence of macro geometric effects and structural discontinuities on the design stress but excludes the local features of the weld. In this thesis, the limitations of the structural hot spot stress method are discussed and a modified structural stress method with improved accuracy is developed and verified for selected welded details. The fatigue life of structures in the as-welded state consists mainly of crack growth from pre-existing cracks or defects. Crack growth rate depends on crack geometry and the stress state on the crack face plane. This means that the stress level and shape of the stress distribution in the assumed crack path governs thetotal fatigue life. In many structural details the stress distribution is similar and adequate fatigue life estimates can be obtained just by adjusting the stress level based on a single stress value, i.e., the structural hot spot stress. There are, however, cases for which the structural stress approach is less appropriate because the stress distribution differs significantly from the more common cases. Plate edge attachments and plates on elastic foundations are some examples of structures with this type of stress distribution. The importance of fillet weld size and weld load variation on the stress distribution is another central topic in this thesis. Structural hot spot stress determination is generally based on a procedure that involves extrapolation of plate surface stresses. Other possibilities for determining the structural hot spot stress is to extrapolate stresses through the thickness at the weld toe or to use Dong's method which includes through-thickness extrapolation at some distance from the weld toe. Both of these latter methods are less sensitive to the FE mesh used. Structural stress based on surface extrapolation is sensitive to the extrapolation points selected and to the FE mesh used near these points. Rules for proper meshing, however, are well defined and not difficult to apply. To improve the accuracy of the traditional structural hot spot stress, a multi-linear stress distribution is introduced. The magnitude of the weld toe stress after linearization is dependent on the weld size, weld load and plate thickness. Simple equations have been derived by comparing assessment results based on the local linear stress distribution and LEFM based calculations. The proposed method is called the modified structural stress method (MSHS) since the structural hot spot stress (SHS) value is corrected using information on weld size andweld load. The correction procedure is verified using fatigue test results found in the literature. Also, a test case was conducted comparing the proposed method with other local fatigue assessment methods.

Assessment in CLIL

The aim of this talk is to explore assessment in higher education and support for learners during their academic education. It investigates the assessment methods that provide success for universities and learners. Universities which implement CLIL should assess learners who would like to attend a programme in English without taking account of their English language qualifications. This assessment should be done in writing, listening and comprehension, speaking and reading and comprehension. In the literature, formative and summative assessments are considered. Formative assessment is ongoing, 'more complex as its intention is to be directly diagnostics with a view to immediately impacting on learner's next steps' (Coyle et al, 2010). Summative assessment occurs at the end of the term or course. McKay, 2006 divides assessment into three phases: design, operationalization and administration phase. If these three phases can't be embedded in the classroom as they are, they can be introduced as a set of questions; why?, how? and what?

Assessment of Young Learners’ English Proficiency in Bilingual Content Instruction CLIL

This applied linguistic study in the field of second language acquisition investigated the assessment practices of class teachers as well as the challenges and visions of language assessment in bilingual content instruction (CLIL) at primary level in Finnish basic education. Furthermore, pupils’ and their parents’ perceptions of language assessment and LangPerform computer simulations as an alternative, modern assessment method in CLIL contexts were examined. The study was conducted for descriptive and developmental purposes in three phases: 1) a CLIL assessment survey; 2) simulation 1; and 3) simulation 2. All phases had a varying number of participants. The population of this mixed methods study were CLIL class teachers, their pupils and the pupils’ parents. The sampling was multi-staged and based on probability and random sampling. The data were triangulated. Altogether 42 CLIL class teachers nationwide, 109 pupils from the 3rd, 4th and 5th grade as well as 99 parents from two research schools in South-Western Finland participated in the CLIL assessment survey followed by an audio-recorded theme interview of volunteers (10 teachers, 20 pupils and 7 parents). The simulation experimentations 1 and 2 produced 146 pupil and 39 parental questionnaires as well as video interviews of volunteered pupils. The data were analysed both quantitatively using percentages and numerical frequencies and qualitatively employing thematic content analysis. Based on the data, language assessment in primary CLIL is not an established practice. It largely appears to be infrequent, incidental, implicit and based on impressions rather than evidence or the curriculum. The most used assessment methods were teacher observation, bilingual tests and dialogic interaction, and the least used were portfolios, simulations and peer assessment. Although language assessment was generally perceived as important by teachers, a fifth of them did not gather assessment information systematically, and 38% scarcely gave linguistic feedback to pupils. Both pupils and parents wished to receive more information on CLIL language issues; 91% of pupils claimed to receive feedback rarely or occasionally, and 63% of them wished to get more information on their linguistic coping in CLIL subjects. Of the parents, 76% wished to receive more information on the English proficiency of their children and their linguistic development. This may be a response to indirect feedback practices identified in this study. There are several challenges related to assessment; the most notable is the lack of a CLIL curriculum, language objectives and common ground principles of assessment. Three diverse approaches to language in CLIL that appear to affect teachers’ views on language assessment were identified: instrumental (language as a tool), dual (language as a tool and object of learning) and eclectic (miscellaneous views, e.g. affective factors prioritised). LangPerform computer simulations seem to be perceived as an appropriate alternative assessment method in CLIL. It is strongly recommended that the fundamentals for assessment (curricula and language objectives) and a mutual assessment scheme should be determined and stakeholders’ knowledge base of CLIL strengthened. The principles of adequate assessment in primary CLIL are identified as well as several appropriate assessment methods suggested.

Evaluating land-use related environmental impacts of biomass value chains for decision-support : Comparison and testing of methodologies proposed for environmental life cycle assessment

Life cycle assessment (LCA) is one of the most established quantitative tools for environmental impact assessment of products. To be able to provide support to environmentally-aware decision makers on environmental impacts of biomass value-chains, the scope of LCA methodology needs to be augmented to cover landuse related environmental impacts. This dissertation focuses on analysing and discussing potential impact assessment methods, conceptual models and environmental indicators that have been proposed to be implemented into the LCA framework for impacts of land use. The applicability of proposed indicators and impact assessment frameworks is tested from practitioners' perspective, especially focusing on forest biomass value chains. The impacts of land use on biodiversity, resource depletion, climate change and other ecosystem services is analysed and discussed and the interplay in between value choices in LCA modelling and the decision-making situations to be supported is critically discussed. It was found out that land use impact indicators are necessary in LCA in highlighting differences in impacts from distinct land use classes. However, many open questions remain on certainty of highlighting actual impacts of land use, especially regarding impacts of managed forest land use on biodiversity and ecosystem services such as water regulation and purification. The climate impact of energy use of boreal stemwood was found to be higher in the short term and lower in the long-term in comparison with fossil fuels that emit identical amount of CO2 in combustion, due to changes implied to forest C stocks. The climate impacts of energy use of boreal stemwood were found to be higher than the previous estimates suggest on forest residues and stumps. The product lifetime was found to have much higher influence on the climate impacts of woodbased value chains than the origin of stemwood either from thinnings or final fellings. Climate neutrality seems to be likely only in the case when almost all the carbon of harvested wood is stored in long-lived wooden products. In the current form, the land use impacts cannot be modelled with a high degree of certainty nor communicated with adequate level of clarity to decision makers. The academia needs to keep on improving the modelling framework, and more importantly, clearly communicate to decision-makers the limited certainty on whether land-use intensive activities can help in meeting the strict mitigation targets we are globally facing.

Student self-assessment a feedback seeking strategy through competence evaluation

There is a body of literature that suggests that student self-assessment is a main goal in higher education (Boud et al., 1995; Tan, 2008); moreover new forms of work organization require a high level of skills and competences. The efforts to deal with competence gaps could be developed at many levels, such as employers, educational institutions, individuals and public agents. Employers could put into practice competence development programs to moderate these gaps. Educational institutions can restructure the curriculum to support students in attaining the competences that are essential in the labour market. Individuals themselves may deploy their resources (time and money) in general or specific competence training. Further, government agencies could fund competence promotion programs. Such challenges for education drive change in learning curricula and method, to properly include the competences required for developing global workers who can move beyond basic competence, to enhanced flexibility and adaptability. In performance assessment methods, there is a shift from the traditional exam-based assessments to more innovative task assessment, which considers performance in multiple different tasks carry out by students. ICTs make it technologically feasible to carry out a complete and complex selfassessment of competences, which provides immediate results to students or other recipients. In the case of students, the evaluation of competences is relevant as developing competences is part - if not all - of the objectives of education. Therefore, it is an important element of the quality of educational organizations (e.g., universities), and of their organizational success. Further, educational organizations may put special emphasis on some differentiating competences, which can be a means of positioning and differentiation from competitors. Competence assessment is an instrument to make students conscious of their strengths and weaknesses, leading to higher motivation to develop their own learning career

Stock assessment for fishery management - A framework guide to the stock assessment tools of the Fisheries Management Science Programme (FMSP)

This document provides guidelines for fish stock assessment and fishery management using the software tools and other outputs developed by the United Kingdom's Department for International Development's Fisheries Management Science Programme (FMSP) from 1992 to 2004. It explains some key elements of the precautionary approach to fisheries management and outlines a range of alternative stock assessment approaches that can provide the information needed for such precautionary management. Four FMSP software tools, LFDA (Length Frequency Data Analysis), CEDA (Catch Effort Data Analysis), YIELD and ParFish (Participatory Fisheries Stock Assessment), are described with which intermediary parameters, performance indicators and reference points may be estimated. The document also contains examples of the assessment and management of multispecies fisheries, the use of Bayesian methodologies, the use of empirical modelling approaches for estimating yields and in analysing fishery systems, and the assessment and management of inland fisheries. It also provides a comparison of length- and age-based stock assessment methods. A CD-ROM with the FMSP software packages CEDA, LFDA, YIELD and ParFish is included.