Radiographic outcomes and evaluation of developmental dysplasia of the hip in children

The Developmental Dysplasia of the Hip (DDH), also know as Congenital Dislocation of the Hip, is common in infants and children and may persist into adulthood. The radiographic interpretation is highly conditioned by appropriate patient positioning and image quality criteria. The main goal of this study is to demonstrate the value of radiographic evaluation of DDH. Through the retrospective analysis of 65 radiographs of the hips, only 2 (3.1%) female patients with 1-2 years of age presented radiographic findings of DDH. The inappropriate field size and the improper placement and size of the gonadal shields, were the most common errors observed.

Treatment outcomes in pulmonary tuberculosis and associated factors worldwide: a systematic review and meta-analysis

Introduction - The increasing of TB burden is usually related to inadequate case detection, diagnosis and cure. Global targets for TB control, adopted by the World Health Organization (WHO), are to detect 70% of the estimated incidence of sputum smear-positive TB and to cure 85% of newly detected cases of sputum smear-positive TB. Factors associated with unsuccessful treatment outcomes are closely related to TB risk factors. Objectives - To describe treatment success rates in pulmonary TB cases and to identify factors associated with unsuccessful treatment outcomes, according to ad-hoc studies.

Physical activity during pregnancy and fetal outcomes: a case-control study

OBJECTIVE: To investigate the relationship between physical activity during the second trimester pregnancy and low birth weight, preterm birth, and intrauterine growth restriction. METHODS: Case-control study including 273 low birth weight newborns and 546 controls carried out in the city of São Paulo, Southeastern Brazil, in 2005. Low birth weight cases were grouped into two subsamples: preterm birth (n=117) and intrauterine growth restriction (n=134), with their related controls. Information was collected by means of interviews with mothers shortly after birth and transcription of medical records. Data were analyzed using conditional multiple and hierarchical logistic regression. RESULTS: Light physical activity for over 7 hours per day was shown to be protective against low birth weight (adjusted OR=0.61; 95% CI 0.39-0.94) with a dose-response relationship (p-value for trend=0.026). A similar trend was found for intrauterine growth restriction (adjusted OR=0.51; 95% CI 0.26-0.97). Homemaking activities were associated as a protective factor for both low birth weight and preterm birth (p-value for trend=0.013 and 0.035, respectively). Leisure-time walking was found to be protective against preterm birth. CONCLUSIONS: Mild physical activity during the second trimester of pregnancy such as walking has an independent protective effect on low birth weight, preterm birth, and intrauterine growth restriction.

Cultural organizations and communication in portuguese decentralization policy

This paper intends to show the Portuguese municipalities’ commitment, since the first decade of this century, in cultural facilities of municipal management and how it provided 12 of the 18 district capitals of mainland Portugal with cultural equipment, but after all we want to know if this effort resulted in a regular, diverse, and innovative schedule. Investing in urban regeneration, local governments have tried to convert cities’ demographic changes (strengthening of the most educated and professionally qualified groups) in effective cultural demands that consolidate the three axes of development competitiveness-innovation-creativity. What the empirical study to the programming and communication proposals of those equipment shows is that it is not enough to provide cities with facilities; to escape to a utilitarian conception of culture, there is a whole work to be done so that such equipment be experienced and felt as new public sphere. Equipment in which proposals go through a fluid bind, constructed through space and discourse with local community, devoted a diversified and innovative bet full filling development axis. This paper presents in a systematic way what contributes to this binding on the analyzed equipment.

Cultural organizations and communication in portuguese decentralization policy

This presentation intends to show to what extent the Portuguese municipalities’ commitment, from the first decade of this century, in cultural facilities of municipal management and which has provided 12 of the 18 district capitals of mainland Portugal with equipment, resulted in a regular, diverse and innovative schedule. Investing in urban regeneration, local government has tried to convert cities’ demographic changes (strengthening of the most educated and professionally qualified groups) in effective cultural demands that consolidate the three axes of development competitiveness-innovation-creativity. What the empirical study to the programming and communication proposals of those equipment shows is that it is not enough to provide cities with facilities; to escape to a utilitarian conception of culture, there is a whole work to be done so that such equipment be experienced and felt as new public sphere. Equipment in which proposals go through a fluid bind, constructed through space and discourse with local community, devotes a diversified and innovative bet full filling development axis. This paper presents in a systematic way what contributes to this binding on the analyzed equipment.

Payment for performance in the Family Health Programme: lessons from the UK Quality and Outcomes Framework

OBJECTIVE: Payment for performance financial incentive schemes reward doctors based on the quality and the outcomes of their treatment. In Brazil, the Ministry of Health is looking to scale up its use in public hospitals and some municipalities are developing payment for performance schemes even for the Family Health Programme. In this article the Quality and Outcomes Framework used in the UK since 2004 is discussed, as well as its experience to elaborate some important lessons that Brazilian municipalities should consider before embarking on payment for performance scheme in primary care settings.

Evaluation of dynamic pass-through of carbon prices into electricity prices – a cointegrated VECM analysis

This paper addresses the impact of the CO2 opportunity cost on the wholesale electricity price in the context of the Iberian electricity market (MIBEL), namely on the Portuguese system, for the period corresponding to the Phase II of the European Union Emission Trading Scheme (EU ETS). In the econometric analysis a vector error correction model (VECM) is specified to estimate both long–run equilibrium relations and short–run interactions between the electricity price and the fuel (natural gas and coal) and carbon prices. The model is estimated using daily spot market prices and the four commodities prices are jointly modelled as endogenous variables. Moreover, a set of exogenous variables is incorporated in order to account for the electricity demand conditions (temperature) and the electricity generation mix (quantity of electricity traded according the technology used). The outcomes for the Portuguese electricity system suggest that the dynamic pass–through of carbon prices into electricity prices is strongly significant and a long–run elasticity was estimated (equilibrium relation) that is aligned with studies that have been conducted for other markets.

Legal and political regulation of higher education in Portugal: an evolutionary perspective on the current policy issues and the problem of order

The higher education system in Europe is currently under stress and the debates over its reform and future are gaining momentum. Now that, for most countries, we are in a time for change, in the overall society and the whole education system, the legal and political dimensions have gained prominence, which has not been followed by a more integrative approach of the problem of order, its reform and the issue of regulation, beyond the typical static and classical cost-benefit analyses. The two classical approaches for studying (and for designing the policy measures of) the problem of the reform of the higher education system - the cost-benefit analysis and the legal scholarship description - have to be integrated. This is the argument of our paper that the very integration of economic and legal approaches, what Warren Samuels called the legal-economic nexus, is meaningful and necessary, especially if we want to address the problem of order (as formulated by Joseph Spengler) and the overall regulation of the system. On the one hand, and without neglecting the interest and insights gained from the cost-benefit analysis, or other approaches of value for money assessment, we will focus our study on the legal, social and political aspects of the regulation of the higher education system and its reform in Portugal. On the other hand, the economic and financial problems have to be taken into account, but in a more inclusive way with regard to the indirect and other socio-economic costs not contemplated in traditional or standard assessments of policies for the tertiary education sector. In the first section of the paper, we will discuss the theoretical and conceptual underpinning of our analysis, focusing on the evolutionary approach, the role of critical institutions, the legal-economic nexus and the problem of order. All these elements are related to the institutional tradition, from Veblen and Commons to Spengler and Samuels. The second section states the problem of regulation in the higher education system and the issue of policy formulation for tackling the problem. The current situation is clearly one of crisis with the expansion of the cohorts of young students coming to an end and the recurrent scandals in private institutions. In the last decade, after a protracted period of extension or expansion of the system, i. e., the continuous growth of students, universities and other institutions are competing harder to gain students and have seen their financial situation at risk. It seems that we are entering a period of radical uncertainty, higher competition and a new configuration that is slowly building up is the growth in intensity, which means upgrading the quality of the higher learning and getting more involvement in vocational training and life-long learning. With this change, and along with other deep ones in the Portuguese society and economy, the current regulation has shown signs of maladjustment. The third section consists of our conclusions on the current issue of regulation and policy challenge. First, we underline the importance of an evolutionary approach to a process of change that is essentially dynamic. A special attention will be given to the issues related to an evolutionary construe of policy analysis and formulation. Second, the integration of law and economics, through the notion of legal economic nexus, allows us to better define the issues of regulation and the concrete problems that the universities are facing. One aspect is the instability of the political measures regarding the public administration and on which the higher education system depends financially, legally and institutionally, to say the least. A corollary is the lack of clear strategy in the policy reforms. Third, our research criticizes several studies, such as the one made by the OECD in late 2006 for the Ministry of Science, Technology and Higher Education, for being too static and neglecting fundamental aspects of regulation such as the logic of actors, groups and organizations who are major players in the system. Finally, simply changing the legal rules will not necessary per se change the behaviors that the authorities want to change. By this, we mean that it is not only remiss of the policy maker to ignore some of the critical issues of regulation, namely the continuous non-respect by academic management and administrative bodies of universities of the legal rules that were once promulgated. Changing the rules does not change the problem, especially without the necessary debates form the different relevant quarters that make up the higher education system. The issues of social interaction remain as intact. Our treatment of the matter will be organized in the following way. In the first section, the theoretical principles are developed in order to be able to study more adequately the higher education transformation with a modest evolutionary theory and a legal and economic nexus of the interactions of the system and the policy challenges. After describing, in the second section, the recent evolution and current working of the higher education in Portugal, we will analyze the legal framework and the current regulatory practices and problems in light of the theoretical framework adopted. We will end with some conclusions on the current problems of regulation and the policy measures that are discusses in recent years.

Master's in autonomous systems: an overview of the robotics curriculum and outcomes at ISEP, Portugal

Robotics research in Portugal is increasing every year, but few students embrace it as one of their first choices for study. Until recently, job offers for engineers were plentiful, and those looking for a degree in science and technology would avoid areas considered to be demanding, like robotics. At the undergraduate level, robotics programs are still competing for a place in the classical engineering graduate curricula. Innovative and dynamic Master’s programs may offer the solution to this gap. The Master’s degree in autonomous systems at the Instituto Superior de Engenharia do Porto (ISEP), Porto, Portugal, was designed to provide a solid training in robotics and has been showing interesting results, mainly due to differences in course structure and the context in which students are welcomed to study and work

Effects of team task structure on team climate for innovation and team outcomes

In this cross-sectional study we analyzed, whether team climate for innovation mediates the relationship between team task structure and innovative behavior, job satisfaction, affective organizational commitment, and work stress. 310 employees in 20 work teams of an automotive company participated in this study. 10 teams had been changed from a restrictive to a more self-regulating team model by providing task variety, autonomy, team-specific goals, and feedback in order to increase team effectiveness. Data support the supposed causal chain, although only with respect to team innovative behavior all required effects were statistically significant. Longitudinal designs and larger samples are needed to prove the assumed causal relationships, but results indicate that implementing self-regulating teams might be an effective strategy for improving innovative behavior and thus team and company effectiveness.

Federalism and health policy: the intergovernmental committees in Brazil

OBJECTIVE To analyze the dynamics of operation of the Bipartite Committees in health care in the Brazilian states.METHODS The research included visits to 24 states, direct observation, document analysis, and performance of semi-structured interviews with state and local leaders. The characterization of each committee was performed between 2007 and 2010, and four dimensions were considered: (i) level of institutionality, classified as advanced, intermediate, or incipient; (ii) agenda of intergovernmental negotiations, classified as diversified/restricted, adapted/not adapted to the reality of each state, and shared/unshared between the state and municipalities; (iii) political processes, considering the character and scope of intergovernmental relations; and (iv) capacity of operation, assessed as high, moderate, or low.RESULTS Ten committees had advanced level of institutionality. The agenda of the negotiations was diversified in all states, and most of them were adapted to the state reality. However, one-third of the committees showed power inequalities between the government levels. Cooperative and interactive intergovernmental relations predominated in 54.0% of the states. The level of institutionality, scope of negotiations, and political processes influenced Bipartite Committees’ ability to formulate policies and coordinate health care at the federal level. Bipartite Committees with a high capacity of operation predominated in the South and Southeast regions, while those with a low capacity of operations predominated in the North and Northeast.CONCLUSIONS The regional differences in operation among Bipartite Interagency Committees suggest the influence of historical-structural variables (socioeconomic development, geographic barriers, characteristics of the health care system) in their capacity of intergovernmental health care management. However, structural problems can be overcome in some states through institutional and political changes. The creation of federal investments, varied by regions and states, is critical in overcoming the structural inequalities that affect political institutions. The operation of Bipartite Committees is a step forward; however, strengthening their ability to coordinate health care is crucial in the regional organization of the health care system in the Brazilian states.

Future gender relations in global restructuring processes case study evidence from knowledge-intensive, manufacturing and service occupations

Global restructuring processes have not only strong implications for European working and living realities, but also have specific outcomes with regard to gender relations. The following contribution analyses in which way global restructuring shapes current gender relations in order to identify important trends and developments for future gender (in)equalities at the workplace. On the basis of a large qualitative study on global restructuring and impacts on different occupational groups it argues that occupational belonging in line with skill and qualification levels are crucial factors to assess the further development of gender relations at work. Whereas global restructuring in knowledge-based occupations may provide new opportunities for female employees, current restructuring is going to deteriorate female labour participation in service occupations. In contrast, manufacturing occupations can be characterised by persistent gender relations, which do not change in spite of major restructuring processes at the work place. Taking the institutional perspective into account, it seems to be crucial to integrate the occupational perspective in order to apply adequate policy regulations to prevent the reinforcement of gender related working patterns in the near future.

Drilling delamination outcomes on glass and sisal reinforced plastics

Nowadays, fibre reinforced plastics are used in a wide variety of applications. Apart from the most known reinforcement fibres, like glass or carbon, natural fibres can be seen as an economical alternative. However, some mistrust is yet limiting the use of such materials, being one of the main reasons the inconsistency normally found in their mechanical properties. It should be noticed that these materials are more used for their low density than for their high stiffness. In this work, two different types of reinforced plates were compared: glass reinforced epoxy plate and sisal reinforced epoxy plate. For material characterization purposes, tensile and flexural tests were carried out. Main properties of both materials, like elastic modulus, tensile strength or flexural modulus, are presented and compared with reference values. Afterwards, plates were drilled under two different feed rates: low and high, with two diverse tools: twist and brad type drill, while cutting speed was kept constant. Thrust forces during drilling were monitored. Then, delamination area around the hole was assessed by using digital images that were processed using a computational platform previously developed. Finally, drilled plates were mechanically tested for bearing and open-hole resistance. Results were compared and correlated with the measured delamination. Conclusions contribute to the understanding of natural fibres reinforced plastics as a substitute to glass fibres reinforced plastics, helping on cost reductions without compromising reliability, as well as the consequence of delamination on mechanical resistance of this type of composites.

Problems in the regulatory policy of the drug market

OBJECTIVE Analyze the implementation of drug price regulation policy by the Drug Market Regulation Chamber.METHODS This is an interview-based study, which was undertaken in 2012, using semi-structured questionnaires with social actors from the pharmaceutical market, the pharmaceuticals industry, consumers and the regulatory agency. In addition, drug prices were compiled based on surveys conducted in the state of Sao Paulo, at the point of sale, between February 2009 and May 2012.RESULTS The mean drug prices charged at the point of sale (pharmacies) were well below the maximum price to the consumer, compared with many drugs sold in Brazil. Between 2009 and 2012, 44 of the 129 prices, corresponding to 99 drugs listed in the database of compiled prices, showed a variation of more than 20.0% in the mean prices at the point of sale and the maximum price to the consumer. In addition, many laboratories have refused to apply the price adequacy coefficient in their sales to government agencies.CONCLUSIONS The regulation implemented by the pharmaceutical market regulator was unable to significantly control prices of marketed drugs, without succeeding to push them to levels lower than those determined by the pharmaceutical industry and failing, therefore, in its objective to promote pharmaceutical support for the public. It is necessary reconstruct the regulatory law to allow market prices to be reduced by the regulator as well as institutional strengthen this government body.

Política de humanização em serviços de saúde – contributos para a definição de indicadores

A reforma dos cuidados de saúde primários (CSP), iniciada em 2005, visa melhorar o desempenho dos centros de saúde através da reorganização dos serviços em várias unidades funcionais, no sentido de resolver os problemas tendo em conta as necessidades a satisfazer, complementando-se entre si e assumindo compromissos de acessibilidade e qualidade nos cuidados de saúde prestados. Ao mesmo tempo, são criados órgãos de gestão e governação clínica que nunca antes existiram nos CSP, envolvendo a participação da comunidade. A optimização da gestão e da governação clínica permitiu organizar os serviços de saúde em Agrupamentos de Centros de Saúde (AGES), dando-lhes poderes e responsabilidades para solucionarem problemas e tomarem as decisões acertadas e céleres, já que conhecem melhor as necessidades de saúde das populações. As relações burocráticas são substituídas por relações de contratualidade, orientadas para obter melhores resultados em saúde. Partindo destes pressupostos, o estudo realizado pretende analisar a percepção de profissionais de saúde quanto à política de humanização dos CSP, bem como, identificar/construir indicadores que avaliem essa política, sendo um estudo de carácter exploratório e descritivo, à luz de uma abordagem qualitativa. Participaram neste estudo cinco profissionais de saúde da Administração Regional de Saúde (ARS) do Norte, lP, do Departamento de Contratualização, Departamento de Estudos e Planeamento da ARS Norte e do AGES Tâmega 11 - Vale Sousa Sul, seleccionados por conveniência e inquiridos por entrevista semi-estruturada. Os dados foram tratados através da análise de conteúdo com o apoio informático NVivo9. Os resultados apresentados, com base nas entrevistas realizadas aos participantes no estudo, sustentam que os actuais indicadores quantitativos contratualizados com as unidades funcionais, expressam a política de humanização num serviço de saúde, não coincidindo totalmente com as definições internacionais expressas neste estudo.