Hospital público português: da crise à renovação?

RESUMO - Este artigo descreve a evolução do estatuto jurídico do hospital público português, com o intuito de o caracterizar, em especial do ponto de vista da sua autonomia. Considera-se que, pelo menos em parte, o estatuto jurídico do hospital público português é responsável pela limitada autonomia de que estas instituições gozaram nos últimos sessenta anos, com as consequentes ineficiências na produção e produtividade, fraca equidade no acesso e aumento de custos com a prestação de cuidados, de discutível qualidade. Nessa medida, várias reformas foram implementadas com o intuito de conferir ao hospital maior autonomia: ao nível da gestão, do financiamento e também reformas organizacionais. De um sistema regionalizado, estabelecido em 1946, até ao Serviço Nacional de Saúde e ao hospital dos nossos dias foram adoptados diversos modelos estatutários. A reforma de 2002 pretende estabelecer uma clara fronteira entre o hospital público, administrativo, burocratizado e aquele que assume natureza empresarial, numa clara viragem — demasiado precoce? — com as «experiências inovadoras » subsequentes à Lei de Bases da Saúde, que permitiram concluir que à maior autonomia correspondiam atitudes e resultados pró-activos e positivos. Por outro lado, ultima-se a preparação da construção de dez novos hospitais com recurso a parcerias público-privadas (PPP), sem ainda estarem definidos quais os estatutos, grau de autonomia e forma de gestão destas entidades. Ainda é cedo para avaliar esta última reforma; não deverá, no entanto, perder-se de vista que a implementação de um novo estatuto jurídico para os hospitais terá necessariamente de permitir a sua renovação sem descurar a sua secular missão de solidariedade.

Coronary heart disease and cerebrovascular disease mortality in young adults: recent trends in Europe.

Background: Over the last two decades, mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) declined by about 30% in the European Union (EU). Design: We analyzed trends in CHD (X ICD codes: I20-I25) and CVD (X ICD codes: I60-I69) mortality in young adults (age 35-44 years) in the EU as a whole and in 12 selected European countries, over the period 1980-2007. Methods: Data were derived from the World Health Organization mortality database. With joinpoint regression analysis, we identified significant changes in trends and estimated average annual percent changes (AAPC). Results: CHD mortality rates at ages 35-44 years have decreased in both sexes since the 1980s for most countries, except for Russia (130/100,000 men and 24/100,000 women, in 2005-7). The lowest rates (around 9/100,000 men, 2/100,000 women) were in France, Italy and Sweden. In men, the steepest declines in mortality were in the Czech Republic (AAPC = -6.1%), the Netherlands (-5.2%), Poland (-4.5%), and England and Wales (-4.5%). Patterns were similar in women, though with appreciably lower rates. The AAPC in the EU was -3.3% for men (rate = 16.6/100,000 in 2005-7) and -2.1% for women (rate = 3.5/100,000). For CVD, Russian rates in 2005-7 were 40/100,000 men and 16/100,000 women, 5 to 10-fold higher than in most western European countries. The steepest declines were in the Czech Republic and Italy for men, in Sweden and the Czech Republic for women. The AAPC in the EU was -2.5% in both sexes, with steeper declines after the mid-late 1990s (rates = 6.4/100,000 men and 4.3/100,000 women in 2005-7). Conclusions: CHD and CVD mortality steadily declined in Europe, except in Russia, whose rates were 10 to 15-fold higher than those of France, Italy or Sweden. Hungary and Poland, and also Scotland, where CHD trends were less favourable than in other western European countries, also emerge as priorities for preventive interventions.

Vitamin D deficiency and a CYP27B1-1260 promoter polymorphism are associated with chronic hepatitis C and poor response to interferon-alfa based therapy

BACKGROUND: Vitamin D is an important immune modulator and preliminary data indicated an association between vitamin D deficiency and sustained virologic response (SVR) rates in patients with chronic hepatitis C. We therefore performed a comprehensive analysis on the impact of vitamin D serum levels and of genetic polymorphisms within the vitamin D cascade on chronic hepatitis C and its treatment. METHODS: Vitamin D serum levels, genetic polymorphisms within the vitamin D receptor and the 1α- hydroxylase were determined in a cohort of 468 HCV genotype 1, 2 and 3 infected patients who were treated with interferon-alfa based regimens. RESULTS: Chronic hepatitis C was associated with a high incidence of severe vitamin D deficiency compared to controls (25(OH)D3<10 ng/mL in 25% versus 12%, p<0.00001), which was in part reversible after HCV eradication. 25(OH)D3 deficiency correlated with SVR in HCV genotype 2 and 3 patients (63% and 83% SVR for patients with and without severe vitamin D deficiency, respectively, p<0.001). In addition, the CYPB27-1260 promoter polymorphism rs10877012 had substantial impact on 1-25- dihydroxyvitamin D serum levels and SVR rates in HCV genotype 1, 2 and 3 infected patients. CONCLUSIONS: Chronic hepatitis C virus infection is associated with vitamin D deficiency. Reduced 25- hydroxyvitamin D levels and CYPB27-1260 promoter polymorphism are associated with failure to achieve SVR in HCV genotype 1, 2, 3 infected patients.

Trends in lung cancer among young European women: the rising epidemic in France and Spain.

Lung cancer mortality in young women in the European Union (EU) has steadily increased until the mid 1990 s and has levelled off thereafter, but trends have been heterogeneous in various countries. We analyzed therefore age-standardized trends in lung cancer mortality in young women (20-44) for the 6 major European countries, using joinpoint regression. In the early 1970s the highest lung cancer mortality in young women was in the UK (2.1/100,000). UK rates, however, steadily declined and in 2000-2004 they were the lowest of all 6 major EU countries (1.2/100,000). The second lowest rate in 2000-2002 was in Italy, whose rates remained around 1.1/100,000 between 1970 and 1994, and increased to 1.4 thereafter. In Germany and Poland, lung cancer rates in young women rose from 0.8-1.0/100,000 in the early 1970s to 1.7-1.9 in the mid 1990 s and levelled off during the last decade. Major rises over recent years were observed in France (from 0.8/100,000 in 1985-1989 to 2.2 in 2000-2003) and in Spain (from 0.8 in the 1985-1989 to 1.7 in 2000-2004). Thus, France showed both the highest rate observed over the last 3 decades and the largest rise over the last 2 decades. Since recent trends in the young give relevant information to the likely future trends in middle age, the female lung cancer epidemic is likely to expand in southern Europe from the current rates of 5.0/100,000 in Spain and 7.7 in France to approach 20/100,000 within the next 2-3 decades. Urgent interventions for smoking cessation in women are therefore required.

The United Nations Educational, Scientific and Cultural Organisation: Pawn or Global Player?,

This contribution aims at exploring the significance of the new generation of UNESCO conventions for the recognition of higher education qualifications. It discusses three possible scenarios and links them to the empirical findings of a study that compares the enabling conditions of the first generation of recognition conventions established in the 1970s and 1980s with the ones establishing the second generation today. Taking an interdisciplinary approach, the paper argues that the changes illustrate a more general shift in the architecture of the global order and highlights a new role of UNESCO.

Screening for occupational asthma by using a self-administered questionnaire in a clinical setting

OBJECTIVE: Because of its high prevalence, early screening for occupational asthma (OA) is crucial. We aimed to evaluate the screening performance of the Occupational Asthma Screening Questionnaire-11 items (OASQ-11) in a clinical setting. METHODS: Between January 2009 and December 2011, 169 workers referred for potential OA to our hospital completed the OASQ-11 and underwent workups to determine the final diagnosis. The discriminative abilities of the OASQ-11 as a whole and in relation to demographic and exposure parameters were determined by the area under the receiving operator characteristic curve (AUC). RESULTS: Model 1, consisting of the OASQ's items, showed fair discrimination (AUC, 0.69; 95% confidence interval, 0.58 to 0.80). Addition of age and exposure duration to model 1 improved discrimination (AUC, 0.80; confidence interval, 0.72 to 0.88). CONCLUSION: A simple model consisting of the OASQ-11's items, age, and exposure duration could well discriminate subjects with OA in a clinical setting.

Integrating Financial Perspective to Quality Orientated Management System. Case: ALSTOM Finland Oy

Tutkimuksen päätavoitteena on tutkia taloudellisen näkökulman integroimista laatuajatteluun pohjautuvaan johtamisjärjestelmään esimerkkiyrityksessä. Johtamisjärjestelmän tulee tuottaa tietoa johdon strategiselle päätöksenteolle ja lisäksi täyttää laatujärjestelmän (ISO 9001:2000) asettamat vaatimukset. Tutkimuksen kohteena oleva työkalu on balanced scorecard (tasapainotettu tuloskortti). Työn tarkoituksena on ehdottaa balanced scorecard- talouden tunnuslukuja esimerkkiyritykselle. Tutkimuksen tavoitteisiin päästään empiiristä tutkimusta varten tehdyn teoreettisen viitekehyksen avulla. Empiiristä tutkimustietoa kerätään osallistuvan havainnoinnin, haastattelujen ja keskustelujen avulla. Tutkimusmenetelmänä on laadullinen case -tutkimus. Balanced scorecardin eri näkökulmille ehdotettiin tunnuslukuja empiirisen tutkimuksen pohjalta. Lisäksi talouden näkökulmaa tutkittiin tarkemmin. Tutkimuksen johtopäätöksenä esitettiin, että taloudelliset tunnusluvut mittaavat ensisijaisesti strategiaa eivätkä laatua. Lisäksi huomioitiin, että tuloskorttien tulisi olla koekäytössä ennen bonuspalkkauksen ja balanced scorecardin yhdistämistä.

Litteracitet i fem högstadieungdomars en-till-en-datorpraktiker

The study focuses on five lower secondary school pupils’ daily use of their one-toone computers, the overall aim being to investigate literacy in this form of computing. Theoretically, the study is rooted in the New Literacy tradition with an ecological perspective, in combination with socio-semiotic theory in a multimodal perspective. New Literacy in the ecological perspective focuses on literacy practices and place/space and on the links between them. Literacy is viewed as socially based, in specific situations and in recurring social practices. Socio-semiotic theory embodying the multimodal perspective is used for the text analysis. The methodology is known as socio-semiotic ethnography. The ethnographic methods encompass just over two years of fieldwork with participating observations of the five participants’ computing activities at home, at school and elsewhere. The participants, one boy and two girls from the Blue (Anemone) School and two girls from the White (Anemone) School, were chosen to reflect a broad spectrum in terms of sociocultural and socioeconomic background. The study shows the existence of a both broad and deep variation in the way digital literacy features in the participants’ one-to-one computing. These variations are associated with experience in relation to the home, the living environment, place, personal qualities and school. The more varied computer usage of the Blue School participants is connected with the interests they developed in their homes and living environments and in the computing practices undertaken in school. Their more varied usage of the computer is reflected in their broader digital literacy repertoires and their greater number and variety of digital literacy abilities. The Blue School participants’ text production is more multifaceted, covers a wider range of subjects and displays a broader palette of semiotic resources. It also combines more text types and the texts are generally longer than those of the White School participants. The Blue School girls have developed a text culture that is close to that of the school. In their case, there is clear linkage between school-initiated and self-initiated computing activities, while other participants do not have the same opportunities to link and integrate self-initiated computing activities into the school context. It also becomes clear that the Blue School girls can relate and adapt their texts to different communicative practices and recipients. In addition, the study shows that the Blue School girls have some degree of scope in their school practice as a result of incorporating into it certain communicative practices that they have developed in nonschool contexts. Quite contrary to the hopes expressed that one-to-one computing would reduce digital inequality, it has increased between these participants. Whether the same or similar results apply in a larger perspective, on a more structural level, is a question that this study cannot answer. It can only draw attention to the need to investigate the matter. The study shows in a variety of ways that the White School participants do not have the same opportunity to develop their digital literacy as the Blue School participants. In an equivalence perspective, schools have a compensational task to perform. It is abundantly clear from the study that investing in one-to-one projects is not enough to combat digital inequality and achieve the digitisation goals established for school education. Alongside their investments in technology, schools need to develop a didactic that legitimises and compensates for the different circumstances of different pupils. The compensational role of schools in this connection is important not only for the present participants but also for the community at large, in that it can help to secure a cohesive, open and democratic society.

Anne McPherson family fonds, 1852-2011 [non-inclusive]

Frank C. (Case) McCordick (1873-1946) was the son of William Henry (1849-1930) and Emily D. Howell (1851-1927) McCordick. William H. McCordick was in the coal business. The McCordick family included Frank Case, Mabel Gertrude, Ethel Howell and Arthur Stanley. Frank C. McCordick was educated in St. Catharines, and worked with his father in the coal business and eventually opened up a leather tanning operation. McCordick was active in the Lincoln Regiment and in 1906 was promoted to captain and in command of Company A, 19th Regiment. He was promoted to major and at the outbreak of war he was sent overseas as a commander of the 35th Battalion of the Canadian Expeditionary Forces (CEF). Upon arrival in France he was made officer commanding the 15th Battalion, King’s Own Yorkshire Light Infantry (KOYLI). After the war and his return to Canada he continued to play an active role in the local military units in the area as well as in Hamilton. After his retirement from the military in 1927 McCordick served as alderman and then mayor of St. Catharines from 1930 to 1931. He was a member of a large number of civic clubs, including St. Catharines Chamber of Commerce, Y.M.C.A., Lion’s Club, St. Catharines Golf Club, Detroit Boat Club, the St Catharines Club, as well as a member of several Masonic lodges. He continued to operate McCordick Tannery and other local investments. In 1903 Frank C. McCordick married May Beatrice Simson, daughter of Thomas E. Simson of Thorold. They had three children, E. (Edward) Frank McCordick, Bruce McCordick and (Margaret) Doris McCordick (m. Hubert Grigaut, d. 1977). The McCordick family resided at 82 Yates Street, near Adams Street. May Simson McCordick (b. 1873) was the daughter of Thomas Edward (1836-1908) and Julia Headlam (1844-1887) Simson of Thorold. Her siblings included: Edward, Frances, John, Augusta, Georgia and Gertrude. E. (Edward) Frank McCordick (1904-1980) was born in St. Catharines, Ont., attended Lake Lodge School in Grimsby, Ridley College in St. Catharines, Beechmont Preparatory School in England, Upper Canada College in Toronto and graduated from Royal Military College in Kingston, Ont. in 1925. Upon graduation he was made a lieutenant in the 10th (St. Catharines) Field Battery. In 1929 he married Helen Stanley Smith, daughter of Stanley George and Mary Walker Smith of St. Catharines. Col. McCordick, now promoted to Major, played an active role in the 10th (St. Catharines) Field Battery, being officer commanding the battery. In late 1939 McCordick headed to England for artillery tactical training and on December 6, 1939 the battery began the long trek overseas. McCordick saw action in Italy and in Holland. Upon his return to Canada at the end of the war he was the Liberal candidate in the federal election for Lincoln County. He remained active in the local military serving as honorary lieutenant-colonel of the 56th Field Regiment (ARCA) and in 1976 as the honorary colonel of the regiment. Col. McCordick held the Efficiency Decoration, the Order of the British Empire, granted in 1945 and was made an officer in the Order of St. John in 1978. He continued to serve his community in various capacities, including the Unemployment Insurance Canada Board, Royal Trust Company and the St. John Ambulance Society. He remained an active member of the alumni of Royal Military College, editing and compiling a newsletter and organizing reunion weekends. He kept in close contact with many of his classmates. Helen Stanley Smith McCordick lived in St. Catharines, Ont., attended Robertson School, and graduated from the University of Toronto in 1926 with a Bachelor of Arts degree in Modern Languages. During the war years (1939-1945) Helen was active in the Transport division of the local branch of the Canadian Red Cross and the Women’s Auxiliary of the 10th Field Battery. In 1932 E. Frank and Helen McCordick welcomed their only child, (Catharine) Anne McCordick. Helen continued to play an active role in her community until her passing in 1997. Stanley George Smith (1865-1960) was born in St. Catharines, Ont., the only child of William Smith (d. June 16, 1876) a native of Edinburgh, Scotland and his wife Hannah Louisa Maria Bulkeley a native of Fairfield, Connecticut. Stanley George Smith married Mary Walker of Guelph, Ont.(d. 1956) Mary was the daughter of Hugh and Elizabeth (d. 1924) Walker. Her siblings included Margaret, Agnes, Jessie, Isabella, Lorne, Ada, Alice, Eva, Alexander and George. Hugh Walker was a prominent fruit and vegetable merchant in Guelph. On 1904 their only child, Helen Stanley Smith was born. He was a post office clerk, and the treasurer for the James D. Tait Co. Ltd., a clothing and dry goods retailer in St. Catharines. The family lived at 39 Church Street in St. Catharines, Ont.

Palynology and foraminiferal geochemistry of the Lower Pleistocene Olduvai Subchron (ca. 1.8 Ma) in DSDP Hole 603C, western North Atlantic

Marine palynology and benthic and planktonic foraminiferal geochemistry are combined to reveal long- and short-term (Milankovitch-scale) paleoceanographic changes across the upper half of the Olduvai Subchron (ca. 1.86--1.77 Ma, lower Pleistocene) in DSDP Hole 603C from the lower New Jersey continental rise. Planktonic foraminiferal Mg/Ca ratios reveal annual sea-surface temperatures between 14.5° and 25°C, whereas modern values vary between 16° and 20°e. Despite evidence of downslope transport in much of the studied interval, dinoflagellate cyst and acritarch assemblages appear to reflect fluctuating temperate to subtropical water masses. These assemblages comprise both neritic and oceanic species, and are marked by a transition upsection from warm conditions, dominated by Lingulodinium machaerophorum, Polysphaeridium zoharyi and Cymatiosphaera? invaginata, to cooler conditions dominated by Filisphaera filifera. Combining dinoflagellate cyst proxies with planktonic foraminiferal geochemistry allows downslope transport events to be recognized during glacial episodes, and events dominated by intensified bottom-water circulation during interglacial episodes. Sixtytwo in-situ dinoflagellate cyst and acritarch taxa were recorded including several not previously described.

Morphonotactic and phonotactic processing in German-speaking adults

Based on the theoretical framework of Dressler and Dziubalska-Kołaczyk (2006a,b), the Strong Morphonotactic Hypothesis will be tested. It assumes that phonotactics helps in decomposition of words into morphemes: if a certain sequence occurs only or only by default over a morpheme boundary and is thus a prototypical morphonotactic sequence, it should be processed faster and more accurately than a purely phonotactic sequence. Studies on typical and atypical first language acquisition in English, Lithuanian and Polish have shown significant differences between the acquisition of morphonotactic and phonotactic consonant clusters: Morphonotactic clusters are acquired earlier and faster by typically developing children, but are more problematic for children with Specific Language Impairment. However, results on acquisition are less clear for German. The focus of this contribution is whether and how German-speaking adults differentiate between morphonotactic and phonotactic consonant clusters and vowel-consonant sequences in visual word recognition. It investigates whether sub-lexical letter sequences are found faster when the target sequence is separated from the word stem by a morphological boundary than when it is a part of a morphological root. An additional factor that is addressed concerns the position of the target cluster in the word. Due to the bathtub effect, sequences in peripheral positions in a word are more salient and thus facilitate processing more than word-internal positions. Moreover, for adults the primacy effect most favors word-initial position (whereas for young children the recency effect most favors word- final position). Our study discusses effects of phonotactic vs. morphonotactic cluster status and of position within the word.

Letter to Mr. C. Howard from Mrs. Tolan

Letter (2 typed pages) to Mr. C. Howard of the Dominion Bank of Toronto from Mrs. Tolan of the Lundy’s Lane Historical Society explaining the origin of the name “Suspension Bridge”, Feb. 23, 1948.

Letter to Mr. C. Howard from Mrs. Tolan

Letter (3 typed pages) to Mr. C. Howard of the Dominion Bank of Toronto from Mrs. Tolan of the Lundy’s Lane Historical Society. She encloses 2 articles entitled “Origins of Niagara Falls, Ontario” and “Captain Creighton and Clifton” Samuel Zimmerman is named in the first article. Mrs. Tolan requests that Mr. Band is also allowed to read the articles, April 25, 1948.