Assessing the associations between mental disorders, cardiovascular risk factors, and cardiovascular disease : the CoLaus/PsyCoLaus study

Background: Cardio-vascular diseases (CVD), their well established risk factors (CVRF) and mental disorders are common and co-occur more frequently than would be expected by chance. However, the pathogenic mechanisms and course determinants of both CVD and mental disorders have only been partially identified.Methods/Design: Comprehensive follow-up of CVRF and CVD with a psychiatric exam in all subjects who participated in the baseline cross-sectional CoLaus study (2003-2006) (n=6'738) which also included a comprehensive genetic assessment. The somatic investigation will include a shortened questionnaire on CVRF, CV events and new CVD since baseline and measurements of the same clinical and biological variables as at baseline. In addition, pro-inflammatory markers, persistent pain and sleep patterns and disorders will be assessed. In the case of a new CV event, detailed information will be abstracted from medical records. Similarly, data on the cause of death will be collected from the Swiss National Death Registry. The comprehensive psychiatric investigation of the CoLaus/PsyCoLaus study will use contemporary epidemiological methods including semi-structured diagnostic interviews, experienced clinical interviewers, standardized diagnostic criteria including threshold according to DSM-IV and sub-threshold syndromes and supplementary information on risk and protective factors for disorders. In addition, screening for objective cognitive impairment will be performed in participants older than 65 years.Discussion: The combined CoLaus/PsyCoLaus sample provides a unique opportunity to obtain prospective data on the interplay between CVRF/CVD and mental disorders, overcoming limitations of previous research by bringing together a comprehensive investigation of both CVRF and mental disorders as well as a large number of biological variables and a genome-wide genetic assessment in participants recruited from the general population.

Fetal alcohol spectrum disorders in Finnish children and adolescents : diagnosis, cognition, behavior, adaptation and brain metabolic alterations

Alcohol consumption during pregnancy can potentially affect the developing fetus in devastating ways, leading to a range of physical, neurological, and behavioral alterations most accurately termed Fetal Alcohol Spectrum Disorders (FASD). Despite the fact that it is a preventable disorder, prenatal alcohol exposure today constitutes a leading cause of intellectual disability in the Western world. In Western countries where prevalence studies have been performed the rates of FASD exceed, for example, autism spectrum disorders, Down’s syndrome and cerebral palsy. In addition to the direct effects of alcohol, children and adolescents with FASD are often exposed to a double burden in life, as their neurological sequelae are accompanied by adverse living surroundings exposing them to further environmental risk. However, children with FASD today remain remarkably underdiagnosed by the health care system. This thesis forms part of a larger multinational research project, The Collaborative Initiative on Fetal Alcohol Spectrum Disorders (the CIFASD), initiated by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) in the U.S.A. The general aim of the present thesis was to examine a cohort of children and adolescents growing up with fetal alcohol-related damage in Finland. The thesis consists of five studies with a broad focus on diagnosis, cognition, behavior, adaptation and brain metabolic alterations in children and adolescents with FASD. The participants consisted of four different groups: one group with histories of prenatal exposure to alcohol, the FASD group; one IQ matched contrast group mostly consisting of children with specific learning disorder (SLD); and two typically-developing control groups (CON1 and CON2). Participants were identified through medical records, random sampling from the Finnish national population registry and email alerts to students. Importantly, the participants in the present studies comprise a group of very carefully clinically characterized children with FASD as the studies were performed in close collaboration with leading experts in the field (Prof. Edward Riley and Prof. Sarah Mattson, Center for Behavioral Teratology, San Diego State University, U.S.A; Prof. Eugene Hoyme, Sanford School of Medicine, University of South Dakota, U.S.A.). In the present thesis, the revised Institute of Medicine diagnostic criteria for FASD were tested on a Finnish population and found to be a reliable tool for differentiating among the subgroups of FASD. A weighted dysmorphology scoring system proved to be a valuable additional adjunct in quantification of growth deficits and dysmorphic features in children with FASD (Study 1). The purpose of Study 2 was to clarify the relationship between alcohol-related dysmorphic features and general cognitive capacity. Results showed a significant correlation between dysmorphic features and cognitive capacity, suggesting that children with more severe growth deficiency and dysmorphic features have more cognitive limitations. This association was, however, only moderate, indicating that physical markers and cognitive capacity not always go hand in hand in individuals with FASD. Behavioral problems in the FASD group proved substantial compared to the typically developing control group. In Study 3 risk and protective factors associated with behavioral problems in the FASD group were explored further focusing on diagnostic and environmental factors. Two groups with elevated risks for behavioral problems emerged: length of time spent in residential care and a low dysmorphology score proved to be the most pervasive risk factor for behavioral problems. The results underscore the clinical importance of appropriate services and care for less visibly alcohol affected children and highlight the need to attend to children with FASD being raised in institutions. With their background of early biological and psychological impairment compounded with less opportunity for a close and continuous caregiver relationship, such children seem to run an especially great risk of adverse life outcomes. Study 4 focused on adaptive abilities such as communication, daily living skills and social skills, in other words skills that are important for gradually enabling an independent life, maintain social relationships and allow the individual to become integrated into society. The results showed that adaptive abilities of children and adolescents growing up with FASD were significantly compromised compared to both typically-developing peers and IQ-matched children with SLD. Clearly different adaptive profiles were revealed where the FASD group performed worse than the SLD group, who in turn performed worse than the CON1 group. Importantly, the SLD group outperformed the FASD group on adaptive behavior in spite of comparable cognitive levels. This is the first study to compare adaptive abilities in a group of children and adolescents with FASD relative to both a contrast group of IQ-matched children with SLD and to a group of typically-developing peers. Finally, in Study 5, through magnetic resonance spectroscopic imaging (MRS) evidence of longstanding neurochemical alterations were observed in adolescents and young adults with FASD related to alcohol exposure in utero 14-20 years earlier. Neurochemical alterations were seen in several brain areas: in frontal and parietal cortices, corpus callosum, thalamus and frontal white matter areas as well as in the cerebellar dentate nucleus. The findings are compatible with neuropsychological findings in FASD. Glial cells seemed to be more affected than neurons. In conclusion, more societal efforts and resources should be focused on recognizing and diagnosing FASD, and supporting subgroups with elevated risk of poor outcome. Without adequate intervention children and adolescents with FASD run a great risk of marginalization and social maladjustment, costly not only to society but also to the lives of the many young people with FASD.

Preparing for CRIS: Challenges and Opportunities for Systems Integration at Finnish Universities

Poster at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Condiciones de trabajo saludables. Análisis de los estudios realizados en Colombia y Europa en el periodo 2002-2012

INTRODUCCIÓN. El presente trabajo explora las condiciones de trabajo saludables más frecuentemente estudiadas en Colombia y Europa en el período 2002 a 2012. OBJETIVO. Este trabajo busca definir los avances en investigación de las condiciones de trabajo saludables que presentaron Colombia y Europa en el período 2002 a 2012, a través de: el análisis del concepto de salud en el trabajo desde diferentes enfoques e investigaciones; el análisis los modelos sobre condiciones saludables en el trabajo; así como la revisión, consolidación y análisis documental alrededor del estado del arte de la investigación sobre los aspectos relacionados con las condiciones psicosociales del trabajo. METODO. Investigación documental, a través de la búsqueda en base de datos y posterior consolidación, sistematización y análisis de la literatura científica que evaluaban aspectos relacionados con las condiciones de trabajo saludable, en Colombia y Europa, durante el período 2002-2012. RESULTADOS. En la revisión documental se encontró que la implementación de ambientes saludables a nivel organizacional es un esfuerzo y compromiso de los empresarios, los trabajadores y la sociedad para mejorar el bienestar de las personas en el trabajo que representa una responsabilidad social empresarial, así como una ventaja competitiva sostenible en el sector económico. De igual manera, se resalta el avance que presenta Europa y España en el desarrollo de estudios nacionales de las condiciones detrabajo saludables frente a Colombia que aún no ha tenido investigaciones de representatividad nacional.

Experiencia en nefrectomía: serie de casos de cuatro años

Introducción: Las indicaciones por las cuales un paciente requiere una nefrectomía son múltiples: las neoplasias, la hidronefrosis y la exclusión funcional son las principales. En manos expertas la nefrectomía es un procedimiento seguro, especialmente porque en la actualidad el abordaje por excelencia es realizar una técnica mínimamente invasiva con conservación de nefronas. Se presenta el análisis de la experiencia en Mederi, Hospital Universitario Mayor en esta intervención. Metodología: Se realizó una serie de casos de pacientes llevados a nefrectomía entre mayo de 2008 y mayo de 2012. Se incluyeron la totalidad de los casos. Resultados: Se analizaron 72 registros, 49 mujeres y 25 hombres; 13 de ellas fueron laparoscópicas. La edad promedio fue de 58,6 años. El tiempo medio operatorio fue 169,23 minutos (118-220 minutos). El sangrado operatorio promedio fue de 680,63 ml (IC95%: 2,83-1358 ml). El tiempo de hospitalización promedio fue de 4,88 días IC95%. La mayoría de los pacientes se distribuyeron en estadios medios de la enfermedad tumoral, con poco compromiso ganglionar y metástasis; el diagnóstico histológico y estadio dominante fueron el carcinoma de células renales grado 3 de Fuhrman respectivamente. Se reportan 13 casos de compromiso de la capsula de Gerota y 11 con compromiso del hilio. Discusión: La experiencia en nefrectomía de la institución es muy positiva por el bajo número de mortalidad y complicaciones. En cuanto a la técnica, es importante promover la técnica laparoscópica

Los comportamientos del liderazgo y su relación con el desarrollo de los modelos de gestión

El propósito de este trabajo de investigación teórica, es lograr basados en el estudio de variables del entorno empresarial, como lo son los modelos de negocio, comportamiento, cultura y complejidad organizacional, estructurar un artículo que invite a la reflexión sobre la incidencia del comportamiento de los líderes para con los modelos de gestión. Con base en la información recolectada, se observan patrones funcionales en el comportamiento de las organizaciones, derivados de los modelos de comportamiento de quienes las dirigen. Las implicaciones podrían ser calificadas de favorables o desfavorables, si se les asocia como condición relevante en la perdurabilidad de las mismas en el tiempo.

Internal validity of the Swedish Maternal Health Care Register

Background: The Swedish Maternal Health Care Register (MHCR) is a national quality register that has been collecting pregnancy, delivery, and postpartum data since 1999. A substantial revision of the MHCR resulted in a Web-based version of the register in 2010. Although MHCR provides data for health care services and research, the validity of the MHCR data has not been evaluated. This study investigated degree of coverage and internal validity of specific variables in the MHCR and identified possible systematic errors. Methods: This cross-sectional observational study compared pregnancy and delivery data in medical records with corresponding data in the MHCR. The medical record was considered the gold standard. The medical records from nine Swedish hospitals were selected for data extraction. This study compared data from 878 women registered in both medical records and in the MHCR. To evaluate the quality of the initial data extraction, a second data extraction of 150 medical records was performed. Statistical analyses were performed for degree of coverage, agreement and correlation of data, and sensitivity and specificity. Results: Degree of coverage of specified variables in the MHCR varied from 90.0% to 100%. Identical information in both medical records and the MHCR ranged from 71.4% to 99.7%. For more than half of the investigated variables, 95% or more of the information was identical. Sensitivity and specificity were analysed for binary variables. Probable systematic errors were identified for two variables. Conclusions: When comparing data from medical records and data registered in the MHCR, most variables in the MHCR demonstrated good to very good degree of coverage, agreement, and internal validity. Hence, data from the MHCR may be regarded as reliable for research as well as for evaluating, planning, and decision-making with respect to Swedish maternal health care services.

A contribuição do Programa Gaúcho de Qualidade e Produtividade para a gestão do conhecimento em empresas de serviços contábeis

A sobrevivência de uma empresa no cenário atual, de incertezas e mudanças contínuas, depende cada vez mais de sua capacidade de gerenciar seu recurso mais importante: o conhecimento. Uma empresa que investe permanentemente na qualificação e aprendizagem de seus empregados está preparada para enfrentar os desafios da concorrência cada vez maior. Neste sentido, a gestão empresarial voltada para o aumento dos níveis de qualidade produtividade, assim como para a gestão do conhecimento, é fundamental para toda empresa, independente de seu setor, tamanho ou localização. A partir deste contexto, o objetivo deste trabalho é identificar a contribuição do Programa Gaúcho de Qualidade e Produtividade (PGQP) na gestão do conhecimento em empresas de serviços contábeis no Estado do Rio Grande do Sul (RS). O PGQP é um programa de qualificação voltado para o aprimoramento de produtos e serviços das empresas do RS, objetivando o beneficio ao consumidor final. Este programa está estruturado com base nos Fundamentos e Critérios para a Excelência em Gestão elaborados pela Fundação Nacional da Qualidade, os quais, entre outros aspectos, identificam os processos relacionados às informações e conhecimentos como importantes para um sistema eficaz de gestão empresarial. O setor das empresas de serviços contábeis no Estado possui um Comitê específico para trabalhar em parceira com o PGQP. auxiliando as empresas a implementarem o Programa. Assim, para a realização da pesquisa foram selecionadas dez empresas que aderiram ao PGQP e outras 11 que não implementaram. Para os gestores destas empresas, foi aplicado um questionário contendo questões fechadas e abertas, relacionadas às práticas de gestão do conhecimento realizadas na empresa, e também a percepção e comprometimento dos empregados em relação às mesmas. Nas questões fechadas, utilizou-se uma escala de frequência, para medir a realização de práticas relacionadas aos elementos construtivos da gestão do conhecimento do modelo de Probst, Raub e Romhardt (2002), que são: identificação, aquisição, desenvolvimento, compartilhamento e distribuição, utilização e retenção do conhecimento. Estes elementos são apresentados no Referencial Teórico, juntamente com a discussão sobre os conceitos de conhecimento, sua geração e gestão. Os resultados encontrados permitem concluir que a implementação do PGQP contribui positivamente para a gestão do conhecimento, uma vez que no grupo de empresas que aderiram ao Programa, as médias de frequência das práticas de gestão do conhecimento foram superiores as do outro grupo. Além disto, as respostas às questões abertas também permitiram inferir conclusões da mesma natureza.

Análise da maturidade organizacional para implantação de gestão da qualidade na imprensa pública angolana - estudo de caso: televisão pública de Angola

Neste Estudo de Caso, procuramos analisar em que abrangência a Televisão Pública de Angola está madura para implantação de um Sistema de Gestão voltado para a Qualidade, sendo a partida uma organização com características de uma empresa tradicional, ou seja, que nunca experimentou efetivamente nenhum Sistema de Gestão da Qualidade. Para chegarmos à resposta do nosso problema, utilizamos como instrumento de análise, o Modelo de Gestão da Excelência, da Fundação Nacional da Qualidade, assente numa análise qualitativa e quantitativa, fundamentada nos oito critérios da excelência da FNQ, utilizando como recurso de análise da maturidade, o software e-MEG, também da FNQ, que permitiu compreender o grau de maturidade da TPA e identificar os fatores críticos de sucesso na implantação de uma gestão da qualidade, na Televisão Pública de Angola. O nosso estudo é também um diagnóstico organizacional da TPA, pois lança alguns subsídios para auxiliar na redução dos fatores que inibem a implantação de Gestão da Qualidade, no único órgão público de Televisão de Angola. Importa referir que um maior investimento nos recursos humanos, maior controle e avaliação dos processos resultantes de um planejamento estratégico na base dos fundamentos da qualidade, alinhado à estrutura da organização, com foco numa governança para resultados impactantes na vida dos colaboradores, da sociedade e do meio ambiente em que a organização está inserida, são fundamentais para a materialização de uma gestão solidamente fundamentada na qualidade.

Os princípios da organização focada na estratégia: um estudo em empresas vencedoras do prêmio nacional de qualidade

The Balanced Scorecard (BSC) has been used as a communication tool and strategy monitoring, helping organizations alignment, inserting a new vision with integrated use of performance indicators nonfinancial together with some financial measures. Their proper use leads to a new management style, focused on management strategies, using for this, basically three dimensions: strategy, which should be translated as the primary responsibility for the organizational agenda, the focus that should be concentrated, and the organization with the mobilization of employees. This paper deals with theoretical considerations about strategies, strategic planning, BSC and principles of the organization focused on strategy (OFE). Describes a study of four companies that won the National Quality Award - PNQ, among which, three have adopted the BSC and adopts a particular model of strategic management. The research aimed to make an analysis of the companies regarding adherence to the five principles of OFE, proposed by the BSC, seeking to answer whether the use of BSC is a prerequisite for accession to the Principles of OFE. The results showed that the BSC is a strategic management model that promotes focus and organizational alignment and is a major facilitator in the process, however, cannot be considered a prerequisite for accession to the principles of the OFE, because the four companies studied, including the one that adopt its own model of strategic management, have great levels of adherence to such principles. Making the organization focused on strategy can be considered a natural movement essential for the strategic management, which is not necessarily conditioned by the use of BSC

Gestão da informação na cadeia produtiva do jornalismo impresso

Pós-graduação em Comunicação - FAAC

Estudo de caso de avaliação dos ativos intangíveis utilizando o modelo de excelência de gestão do prêmio nacional da qualidade

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Qualidade do ensino na educação infantil: um estudo a partir dos documentos do Ministério da Educação

This study is linked to the Group of Studies and Research in Educational Policy, GREPPE (interinstitutional group) - Section Rio Claro. In this study, the goal is to identify and analyze the quality of teaching concepts in early childhood education in official documents of the Ministry of Education: National Quality Parameters for Early Childhood Education and Quality Indicators in Early Childhood Education. The aim is to contribute to other research group on supply conditions in municipal and private institutions have agreements. The identification and analysis of such documents, can contribute even as a basis for further studies on public policies for Early Childhood Education. The research will be conducted by means of document analysis and theoretical study on the subject

O modelo de excelência de gestão do prêmio nacional da qualidade - PNQ: análise da evolução dos critérios de excelência

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Tuberculosis in HIV-Negative and HIV-Infected Patients in a Low-Incidence Country: Clinical Characteristics and Treatment Outcomes

Background In Switzerland and other developed countries, the number of tuberculosis (TB) cases has been decreasing for decades, but HIV-infected patients and migrants remain risk groups. The aim of this study was to compare characteristics of TB in HIV-negative and HIV-infected patients diagnosed in Switzerland, and between coinfected patients enrolled and not enrolled in the national Swiss HIV Cohort Study (SHCS). Methods and Findings All patients diagnosed with culture-confirmed TB in the SHCS and a random sample of culture-confirmed cases reported to the national TB registry 2000–2008 were included. Outcomes were assessed in HIV-infected patients and considered successful in case of cure or treatment completion. Ninety-three SHCS patients and 288 patients selected randomly from 4221 registered patients were analyzed. The registry sample included 10 (3.5%) coinfected patients not enrolled in the SHCS: the estimated number of HIV-infected patients not enrolled in the SHCS but reported to the registry 2000–2008 was 146 (95% CI 122–173). Coinfected patients were more likely to be from sub-Saharan Africa (51.5% versus 15.8%, P<0.0001) and to present disseminated disease (23.9% vs. 3.4%, P<0.0001) than HIV-negative patients. Coinfected patients not enrolled in the SHCS were asylum seekers or migrant workers, with lower CD4 cell counts at TB diagnosis (median CD4 count 79 cells/µL compared to 149 cells/µL among SHCS patients, P = 0.07). There were 6 patients (60.0%) with successful outcomes compared to 82 (88.2%) patients in the SHCS (P = 0.023). Conclusions The clinical presentation of coinfected patients differed from HIV-negative TB patients. The number of HIV-infected patients diagnosed with TB outside the SHCS is similar to the number diagnosed within the cohort but outcomes are poorer in patients not followed up in the national cohort. Special efforts are required to address the needs of this vulnerable population.