A comunicação organizacional e o atendimento ao público via 0800 no Departamento de Água e Esgoto de Bauru

Pós-graduação em Comunicação - FAAC

Wildlife Master Volunteers: A Multi-County Approach to Resolving Human-Wildlife Conflicts

The Wildlife Master (WM) Program in Colorado was modeled after the highly successful Master Gardener volunteer program. In 10 highly populated suburban counties with large rural areas surrounding the Denver Metro Area, Colorado State University (CSU) Cooperative Extension Natural Resources agents train, supervise and manage these volunteers in the identification, referral, and resolution of wildlife damage issues. High quality, research-based training is provided by university faculty and other professionals in public health, animal damage control, wildlife management and animal behavior. Inquiries are responded to mainly via telephone. Calls by concerned residents are forwarded to WMs who provide general information about human-wildlife conflicts and possible ways to resolve complaints. Each volunteer serves a minimum of 14 days on phone duty annually, calling in from a remote location to a voice mail system from which phone messages can be conveniently retrieved. Response time per call is generally less than 24 hours. During 2004, more than 2,000 phone calls, e-mail messages and walk-in requests for assistance were fielded by 100 cooperative extension WMs. Calls fielded by volunteers in one county increased five-fold during the past five years, from 100 calls to over 500 calls annually. Valued at the rate of approximately $18.00 per volunteer hour, the leveraged value of each WM was about $450 in 2005, based on 25 hours of service and training. The estimated value of the program to Colorado in 2004 was over $45,000 of in-kind service, or about one full-time equivalent faculty member. This paper describes components of Colorado’s WM Program, with guides to the set-up of similar programs in other states.

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil)

Background Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. Methods/design Multicentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis. Discussion This study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions. Trial registration ClinicalTrials.gov (NCT01698580)

L'interpretazione a distanza: Analisi di interazioni telefoniche mediate da interprete

Interpreter profession is currently changing: migration flows, the economic crisis and the fast development of ICTs brought unexpected changes in our societies and in traditional interpreting services all over. Remote interpreting (RI), which entails new methods such as videoconference interpreting and telephone interpreting (TI), has greatly developed and now sees interpreters working remotely and being connected to service users via videoconference set up or telephone calls. This dissertation aims at studying and analyzing the relevant aspects of interpreter-mediated telephone calls, describing the consequences for the interpreters in this new working field, as well as defining new strategies and techniques interpreters must develop in order to adjust to the new working context. For these purposes, the objectives of this dissertation are the following: to describe the settings in which RI is mostly used, to study the prominent consequences on interpreters and analyze real interpreter-mediated conversations. The dissertation deals with issues studied by the Shift project, a European project which aims at creating teaching materials for remote interpreting; the project started in 2015 and the University of Bologna and in particular the DIT - Department of Interpreting and Translation is the coordinating unit and promoting partner. This dissertation is divided into five chapters. Chapter 1 contains an outline of the major research related to RI and videoconference interpreting as well as a description of its main settings: healthcare, law, business economics and institution. Chapter 2 focuses on the physiological and psychological implications for interpreters working on RI. The concepts of absence, presence and remoteness are discussed; some opinions of professional interpreters and legal practitioners (LPs) concerning remote interpreting are offered as well. In chapter 3, telephone interpreting is presented; basic concepts of conversational analysis and prominent traits of interpreter-mediated calls are also explored. Chapter 4 presents the materials and methodology used for the analysis of data. The results, discussed in Chapter 5, show that telephone interpreting may be suitable for some specific contexts; however, it is clear that interpreters must get appropriate training before working in any form of RI. The dissertation finally offers suggestions for the implementation of training in RI for future interpreting students.

Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis

BACKGROUND: The retention of patients in antiretroviral therapy (ART) programmes is an important issue in resource-limited settings. Loss to follow up can be substantial, but it is unclear what the outcomes are in patients who are lost to programmes. METHODS AND FINDINGS: We searched the PubMed, EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS), Indian Medlars Centre (IndMed) and African Index Medicus (AIM) databases and the abstracts of three conferences for studies that traced patients lost to follow up to ascertain their vital status. Main outcomes were the proportion of patients traced, the proportion found to be alive and the proportion that had died. Where available, we also examined the reasons why some patients could not be traced, why patients found to be alive did not return to the clinic, and the causes of death. We combined mortality data from several studies using random-effects meta-analysis. Seventeen studies were eligible. All were from sub-Saharan Africa, except one study from India, and none were conducted in children. A total of 6420 patients (range 44 to 1343 patients) were included. Patients were traced using telephone calls, home visits and through social networks. Overall the vital status of 4021 patients could be ascertained (63%, range across studies: 45% to 86%); 1602 patients had died. The combined mortality was 40% (95% confidence interval 33%-48%), with substantial heterogeneity between studies (P<0.0001). Mortality in African programmes ranged from 12% to 87% of patients lost to follow-up. Mortality was inversely associated with the rate of loss to follow up in the programme: it declined from around 60% to 20% as the percentage of patients lost to the programme increased from 5% to 50%. Among patients not found, telephone numbers and addresses were frequently incorrect or missing. Common reasons for not returning to the clinic were transfer to another programme, financial problems and improving or deteriorating health. Causes of death were available for 47 deaths: 29 (62%) died of an AIDS defining illness. CONCLUSIONS: In ART programmes in resource-limited settings a substantial minority of adults lost to follow up cannot be traced, and among those traced 20% to 60% had died. Our findings have implications both for patient care and the monitoring and evaluation of programmes.

A survey of paediatric HIV programmatic and clinical management practices in Asia and sub-Saharan Africa--the International epidemiologic Databases to Evaluate AIDS (IeDEA)

INTRODUCTION There are limited data on paediatric HIV care and treatment programmes in low-resource settings. METHODS A standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia-Pacific (AP), Central Africa (CA), East Africa (EA), Southern Africa (SA) and West Africa (WA) to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web-based software program (REDCap). RESULTS A total of 64,552 children were under care at 63 clinics (AP, N=10; CA, N=4; EA, N=29; SA, N=10; WA, N=10). Most were in urban settings (N=41, 65%) and received funding from governments (N=51, 81%), PEPFAR (N=34, 54%), and/or the Global Fund (N=15, 24%). The majority were combined adult-paediatric clinics (N=36, 57%). Prevention of mother-to-child transmission was integrated at 35 (56%) sites; 89% (N=56) had access to DNA PCR for infant diagnosis. African (N=40/53) but not Asian sites recommended exclusive breastfeeding up until 4-6 months. Regular laboratory monitoring included CD4 (N=60, 95%), and viral load (N=24, 38%). Although 42 (67%) sites had the ability to conduct acid-fast bacilli (AFB) smears, 23 (37%) sites could conduct AFB cultures and 18 (29%) sites could conduct tuberculosis drug susceptibility testing. Loss to follow-up was defined as >3 months of lost contact for 25 (40%) sites, >6 months for 27 sites (43%) and >12 months for 6 sites (10%). Telephone calls (N=52, 83%) and outreach worker home visits to trace children lost to follow-up (N=45, 71%) were common. CONCLUSIONS In general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented.

Community preferences for cancer pain health states

The study's objective was to assess the reliability, acceptability, and concordance of cancer pain health states when using two utility assessment methods—simple rank order (RO) and numerical analogue scale (NAS). Additional aims were to describe the preferences of Hispanic and non-Hispanic community members toward cancer pain health states and identify predictors affecting these preferences. In this descriptive, cross-sectional study, telephone calls were made to a quota sample of 1,387 households that had telephone numbers listed for the Houston and surrounding Harris County area. Subjects (n = 302) within the general population completed a 20 minute telephone interview in their preferred language—English or Spanish. Study respondents assessed six cancer pain health states consisting of three attributes, pain intensity, presence of side effects, and interference with daily function. ^ Overall, the numerical analogue scale (NAS) had better test-retest reliability. Respondents were able to clearly distinguish the worst health state using both methods, but were not able to do so as clearly for less severe health states. Acceptability and subjects' ability to answer questions and complete the survey was high. Missing responses were low across methods for all health states. Concordance in the health state rankings was higher for the most severe health state in the non-Hispanic group, those in fair to poor health, males, and those $30,000 or greater income. Preferences for the less severe health states did not show much variation across methods. No significant predictors for health states were found except for ethnicity for a less severe health state when using the rank order method. ^ We found that the rank order (RO) and numerical analogue scale (NAS) are both robust in ranking the more severe cancer pain health states, e.g., moderate pain with three side effects. This study documents that RO and NAS methods to assess cancer pain preferences through a telephone-based approach among a relative diverse community dwelling, non-patient population for cancer pain health states represented a relatively valid and acceptable approach. ^

Follow-up care after a health fair screening in three Houston neighborhoods in 2008

Background. Each year thousands of people participate in mass health screenings for diabetes and hypertension, but little is known about whether or not those who receive higher than normal screening results obtain the recommended follow-up medical care, or what barriers they perceive to doing so. ^ Methods. Study participants were recruited from attendees at three health fairs in low-income neighborhoods in Houston, Texas Potential participants had higher than normal blood pressure (> 90/140 mgHg) or blood glucose readings (100 mm/dL fasting or 140 mm/dL random). Study participants were called at one, two, and three months and asked if they had obtained follow-up medical care; those who had not yet obtained follow-up care were asked to identify barriers. Using a modified Aday-Andersen model of health service access, the independent variables were individual and community characteristics and self-perceived need. The dependent variable was obtaining follow-up care, with barriers to care a secondary outcome. ^ Results. Eighty-two study participants completed the initial questionnaire and 59 participants completed the study protocol. Forty-eight participants (59% under an intent to treat analysis, 81% of those completing the study protocol) obtained follow-up care. Those who completed the initial questionnaire and who reported a regular source of care were significantly more likely to obtain follow-up care. For those who completed the study protocol the relationship between having a regular source of care and obtaining follow-up care approached but did not reach significance. For those who completed the initial questionnaire, self-described health status, when examined as a binary variable (good, very good, excellent, or poor, fair, not sure) was associated with obtaining follow-up care for those who rated their health as poor, fair, or not sure. While the group who completed the study protocol did not reach statistical significance, the same relationship between self-described health status of poor, fair, or not sure and obtaining follow-up care was present. The participants who completed the study protocol and described their blood pressure as OK or a little high were statistically more likely to get follow-up care than those who described it as high or very high. All those on oral medications for hypertension (12/12) and diabetes (4/4) who were told to obtain follow-up care did so; however, the small sample size allows this correlation to be of statistical significance only for those treating hypertension. ^ The variables significantly associated with obtaining follow-up care were having a regular source of care, self-described health status of poor, fair, or not sure, self-described blood pressure of OK or a little high, and taking medication for blood pressure. ^ At the follow-up telephone calls, 34 participants identified barriers to care; cost was a significant barrier reported by 16 participants, and 10 reported that they didn’t have time because they were working long hours after Hurricane Ike. ^ The study included the offer of access assistance: information about nearby safety-net providers, a visit to or information from the Health Information Center at their Neighborhood Center location, or information from Project Safety Net (a searchable web site for safety net providers). Access assistance was offered at the health fairs and then again at follow-up telephone calls to those who had not yet obtained follow-up care. Of the 48 participants who reported obtaining follow-up care, 26 said they had made use of the access assistance to do so. The use of access assistance was associated with being Hispanic, not having health insurance or a regular source of care, and speaking Spanish. It was also associated with being worried about blood glucose. ^ Conclusion. Access assistance, as a community enabling characteristic, may be useful in aiding low-income people in obtaining medical care. ^

Análisis empírico del tráfico en las autopistas de peaje radiales 3 y 5 de Madrid

El propósito de la presente investigación es determinar si, a través del estudio y análisis de los estudios de tráfico en autopistas de peaje, se pueden determinar las razones de los incumplimientos en las previsiones de estos estudios. La metodología se basa en un análisis empírico ex- post facto de los estudios de tráfico contenidos en los anteproyectos de las autopistas Radial 3 y Radial 5 y los datos realmente verificados. Tras una introducción para presentar las principales características de las autopistas de peaje, se realiza una revisión de la bibliografía sobre el cumplimiento de las previsiones de tráfico. Lo anterior permite establecer una serie de aspectos que pueden contribuir a estos incumplimientos, así como una serie de medidas encontradas para mejorar las futuras previsiones. Ya en el núcleo fundamental de la investigación, esta se centra en el análisis del cumplimiento de las previsiones de tráfico contenidas en los anteproyectos de la Radial 3 y Radial 5. Se realiza un análisis crítico de la metodología adoptada, así como de las variables e hipótesis realizadas. Tras este primer análisis, se profundiza en la fase de asignación de los estudios. Siempre con base a los tráficos reales y para el año 2006, se cuantifica el efecto en los incumplimientos, por un lado de las variables utilizadas, y por otro, del propio método ó curva de asignación. Finalmente, y con base en los hallazgos anteriores, se determinan una serie de limitaciones en el método de asignación de tráficos entre recorridos alternativos para el caso de entornos urbanos usado. El planteamiento con base a las teorías del agente racional y maximización de la utilidad esperada es criticado desde la perspectiva de la teoría de decisión bajo condiciones de riesgo planteada por Kahneman y Tversky. Para superar las limitaciones anteriores, se propone una nueva curva de asignación semi empírica que relaciona la proporción del tráfico que circula por la autopista de peaje con la velocidad media en la autovía libre alternativa. ABSTRACT The aim of this research is to confirm whether the forensic analysis of the traffic forecast studies for tolled highways may bring to light the reasons behind the lack of accuracy. The methodology used on this research is empirical and is based on the ex –post facto analysis of the real traffic numbers compared to the forecasted for the tolled highways Radial 3 and Radial 5. Firstly the main features of tolled highways are presented as an introductory chapter. Secondly a broad bibliographic search is presented, this is done from a global perspective and from the Spanish perspective too. From this review, a list of the main causes behind the systematic inaccuracy together with measures to improve future traffic forecast exercises are shown. In what we could consider as the core of the research, it focuses on the ratios of actual / forecast traffic for the tolled highways Radial 3 y Radial 5 in Madrid outskirts. From a critical perspective, the methodology and inputs used in the traffic studies are analysed. In a further step, the trip assignment stage is scrutinised to quantify the influence of the inputs and the assignment model itself in the accuracy of the traffic studies. This exercise is bases on the year 2006. Finally, the assignment model used is criticised for its application in tolled urban highways. The assumptions behind the model, rational agent and expected utility maximization theories, are questioned under the theories presented by Kahneman and Tversky (Prospect Theory). To overcome these assignment model limitations, the author presents a semi empiric new diversion curve. This curve links the traffic proportion using the tolled highway and the average speed in the toll free alternative highway.

The Pennsylvania Turnpike Commission's Incident Management Team.

Transportation Department, Washington, D.C.

Equity in access to outpatient rehabilitation services for children with traumatic brain injury and public insurance

Thesis (Master's)--University of Washington, 2016-06

Disease prevalence among dogs and cats in the United States and Australia and proportions of dogs and cats that receive therapeutic diets or dietary supplements

Objective-To estimate disease prevalence among dogs and cats in the United States and Australia and proportions of dogs and cats that receive therapeutic diets or dietary supplements. Design-Telephone survey. Sample Population-Dog and cat owners located in 5 geographic areas. Procedures-A telephone survey was administered to dog and cat owners. Results-Of 18,194 telephone calls that were made, 1,104 (6%) were to individuals who owned at least I dog or cat and agreed to participate. Information was collected for 635 dogs and 469 cats. Only 14 (1%) respondents indicated that their pet was unhealthy, but 176 (16%) indicated that their pets had 1 or more diseases. The most common diseases were musculoskeletal, dental, and gastrointestinal tract or hepatic disease. Many owners (n = 356) reported their pets were overweight or obese, but only 3 reported obesity as a health problem in their pets. Owners of 28 (2.5%) animals reported that they were feeding a therapeutic diet, with the most common being diets for animals with renal disease (n = 5), reduced-calorie diets (5), and reduced-fat diets (4). Owners of 107 of 1,076 (9.9%) animals reported administering dietary supplements to their pets. Multivitamins (n = 53 animals), chondroprotective agents (22), and fatty acids (13) were the most common dietary supplements used. Conclusions and Clinical Relevance-Results suggest that most dogs and cats reported by their owners to have a health problem were not being fed a therapeutic diet. In addition, the rate of dietary supplement use was lower than that reported for people.

A inserção do técnico em saúde bucal na estratégia saúde da família no estado do Rio Grande do Norte

An oral health technician is a profession in odontology whose own functions are defined in FEDERAL LAW NUMBER 11889, which can act for prevention, recovery and promotion of oral health. According to the web site, Of Primary Health Attention Department. Health Ministry Of Brazilian Federal Republic, you can see through historical cover, as regards Health Family Strategy that, in Rio Grande Do Norte, There are nowadays eight TSB equipments in use. Objective: The aim of this study is to find out the reasons of the inclusion of those technicians in public service, no matter the importance of this work. Method: It is about a quantitive study and a kind of exploring type, taking into account that there are not any similar previous ones. We divide it into two parts: as regards the first one, these technicians were registered in a map using the information of the Formation Schools and Class Counsel to know how and where they are. During the moment of this study, an application (or no application) of the mouth health equipments was done. They tried to discover in this process which elements contribute to the efficiency (or not) of this technical work done all together in equipment work. As regards the second part, the coordinators of Municipal Mouth Health answered to a survay that contained open and closed questions through telephone calls. The sample was defined by a raffle taking into account the work contained in municipalities. Results: There are 1053 technicians.94,3% of them are women, devided in all the health regions. As regards interview, 96,9% of oral health coordinators considered that it is very important to have an oral health technician in odontology. 92,2% would reccomend its inclusion in equipments related to mouth health, dealing to familly health . 76% have never talked before to the Health Secretary in this municipality. this spreading out could be related to financial resources and 51,6% mentioned the importance of improving the physical structure to make this spreading out possible. Conclusions: Oral Health technicians in Rio Grande Do Norte are not being adequatly used by public service, because they do not introduce themselves or act as Oral Health auxiliaries. It is important to increase concience about the importance of this category in odontology. we also say it is necesasary to invert money in a reform of the Basic Health Unities and the inclusion of these workers. On the other hand the role of the state and the public health militancy is questioned in the fulfilment of this process

Content and methodology of predoctoral Geriatric Dentistry teaching in Europe

Objectives: To explore the content and methodology of predoctoral Geriatric Dentistry teaching amongst European dental schools.
Methods: The study was conducted by the European College of Gerodontology (ECG) Education Committee. Αn electronic questionnaire has been developed with close and open-ended items, including information on the prevalence and institutional anchorage of Gerodontology programs, the educators, the content and the methodology of teaching. An electronic mail, including a hyperlink to the questionnaire, was sent to 216 dental schools in 39 European countries (Winter/ Spring 2016). The Deans were asked to either answer themselves, or forward the link to faculty members with knowledge on Gerodontology teaching at their respective schools. Repeated reminders or telephone calls were used for non-respondents and personal networks were exploited to identify potential contact persons.
Results: Until August 2016, 121 dental schools from 29 countries responded to the survey (response rate 56%, EU response rate: 60%). Gerodontology was included in the predoctoral curricula of 86% of the respondents and was compulsory in 68%. The course was mainly offered in senior students and was interdisciplinary in 30% of the schools, delivered mainly by dentists (79%), physicians (21%), psychologists (10%), and nurses (5%). It was conducted as an independent lecture series in 40% of the schools and a course director was assigned in 44% of the respondents. When embedded in other disciplines, these were mainly Prosthodontics (31%). The content included a large number of items, such as epidemiology of oral health, medical problems in old age, prosthodontic management, xerostomia, and caries risk assessment. Lectures were the most common teaching format (69%), followed by small group seminars (27%). The most common types of educational material used were scientific articles (48%), printed textbooks (44%), lecture notes (40%) and e-learning material (21%). Clinical training was offered by 64% of the respondents, within the dental school clinics (49%) and/or in outreach locations (40%).
Conclusion: Amongst the respondent European dental schools (66%) there is an increasing number that teach Gerodontology at a pre-doctoral level with significant variations in content and methodology. Official guidelines and the dissemination of the ECG pre-doctoral curriculum guidelines might help to increase the prevalence and improve the status of Gerodontology teaching in Europe.

Removable orthodontic appliances: frequency and cleaning agents used by students and recommended by dentists

Aim: To evaluate the prevalence and hygiene habits of 13-19 years-old adolescent users of removable orthodontic appliances (ROA) and to determine hygiene methods for the appliances prescribed by dentists, in the city of Pelotas. Methods: The study had two stages. The first stage was a telephone interview with dentists. Dentists were interview by telephone calls in order to obtain information regarding the hygiene methods for cleaning acrylic appliances. Second stage was a cross-sectional study performed with schoolchildren. Children from public and private schools with secondary level were included in the sample. A questionnaire was applied to the students using any type of ROA. Questionnaires included demographic information and behavioral characteristics. Data collected were subjected to Chi-square test and logistic regression. Results: The prevalence of children using ROA was 5.4%. Students (89.7%) and dentists (47.2%) reported to prefer mechanical methods to clean their ROA. Cleaning with soup, hydrogen peroxide or effervescent tabs were less used. High frequency of use was associated with higher frequency of hygiene on the ROA. Conclusions: The prevalence of schoolchildren using removable appliances was low. The common cleaning method used by children and prescribed by dentists was mechanical. Hygiene frequency was significantly associated with the routine of use of the appliance and with the type of hygiene method.