Is quality of life measurement likely to be a proxy for health needs assessment in patients with coronary artery disease?

BACKGROUND: The identification of patients' health needs is pivotal in optimising the quality of health care, increasing patient satisfaction and directing resource allocation. Health needs are complex and not so easily evaluated as health-related quality of life (HRQL), which is becoming increasingly accepted as a means of providing a more global, patient-orientated assessment of the outcome of health care interventions than the simple medical model. The potential of HRQL as a surrogate measure of healthcare needs has not been evaluated. OBJECTIVES AND METHOD: A generic (Short Form-12; SF-12) and a disease-specific questionnaire (Seattle Angina Questionnaire; SAQ) were tested for their potential to predict health needs in patients with acute coronary disease. A wide range of healthcare needs were determined using a questionnaire specifically developed for this purpose. RESULTS: With the exception of information needs, healthcare needs were highly correlated with health-related quality of life. Patients with limited enjoyment of personal interests, weak financial situation, greater dependency on others to access health services, and dissatisfaction with accommodation reported poorer HRQL (SF-12: p < 0.001; SAQ: p < 0.01). Difficulties with mobility, aids to daily living and activities requiring assistance from someone else were strongly associated with both generic and disease-specific questionnaires (SF-12: r = 0.46-0.55, p < 0.01; SAQ: r = 0.53-0.65, p < 0.001). Variables relating to quality of care and health services were more highly correlated with SAQ components (r = 0.33-0.59) than with SF-12 (r = 0.07-0.33). Overall, the disease-specific Seattle Angina Questionnaire was superior to the generic Short Form-12 in detecting healthcare needs in patients with coronary disease. Receiver-operator curves supported the sensitivity of HRQL tools in detecting health needs. CONCLUSION: Healthcare needs are complex and developing suitable questionnaires to measure these is difficult and time-consuming. Without a satisfactory means of measuring these needs, the extent to which disease impacts on health will continue to be underestimated. Further investigation on larger populations is warranted but HRQL tools appear to be a reasonable proxy for healthcare needs, as they identify the majority of needs in patients with coronary disease, an observation not previously reported in this patient group

Need for redefining needs

Defining needs is difficult due to the inherent complexity of the concept of 'need', so it is not surprising that numerous definitions have been proposed. 'Health' consists of a wide range of characteristics so 'health needs' ought to include personal and social care, health care, accommodation, finance, education, employment and leisure, transport and access.Target-driven standards in areas of health care with a high political profile appear to be replacing the concept of universal provision and clinical need; this major change in clinical care warrants a re-evaluation of health care outcomes. Identifying who might benefit from this new approach to health care is equally important if scarce resources are to be fully and appropriately utilised. If the goal of care is 'optimal health', the key marker of success ought to be to ascertain individual patients' health care needs (HCN) and tailor services accordingly. Wide variation in the description of 'needs' directly affects policies and services intended to meet a population's health care needs. Consequently, the definition of 'needs' has important implications for healthcare provision- the more constrained the definition, the less healthcare will be made available and vice versa. This paper describes some common definitions of needs and discusses their respective benefits and disadvantages in terms of health care provision and their potential impact on health policy

Unmet health needs in patients with coronary heart disease: implications and potential for improvement in caring services

BACKGROUND: Improving the quality of health care services requires tailoring facilities to fulfil patients' needs. Satisfying patients' healthcare needs, listening to patients' opinions and building a closer provider-user partnership are central to the NHS. Few published studies have discussed cardiovascular patients' health needs, but they are not comprehensive and fail to explore the contribution of outcome to needs assessment. METHOD: A comprehensive self-administered health needs assessment (HNA) questionnaire was developed for concomitant use with generic (Short Form-12 and EuroQOL) and specific (Seattle Angina Questionnaire) health-related quality of life (HRQL) instruments on 242 patients admitted to the Acute Cardiac Unit, Nottingham. RESULTS: 38% reported difficulty accessing health facilities, 56% due to transport and 32% required a travelling companion. Mean HRQOL scores were lower in those living alone (P < 0.05) or who reported unsatisfactory accommodation. Dissatisfaction with transport affected patients' ease of access to healthcare facilities (P < 0.001). Younger patients (<65 y) were more likely to be socially isolated (P = 0.01). Women and patients with chronic disease were more likely to be concerned about housework (P < 0.05). Over 65 s (p < 0.05) of higher social classes (p < 0.01) and greater physical needs (p < 0.001) had more social needs, correlating moderately (0.32 < r < 0.63) with all HRQL domains except SAQ-AS. Several HRQL components were highly correlated with the HNA physical score (p < 0.001). CONCLUSIONS: Patients wanted more social (suitable accommodation, companionship, social visits) and physical (help aids, access to healthcare services, house work) support. The construct validity and intra-class reliability of the HNA tool were confirmed. Our results indicate a gap between patients' health needs and available services, highlighting potential areas for improvement in the quality of services

Women at Michigan : the "dangerous experiment," 1870s to the present /

Includes bibliographical references (p. 123-126) and index.

Modelo gerador de questões no reforço da aprendizagem das radiações e conteúdos de física moderna no ensino secundário

Os avanços e a disseminação do uso das Tecnologias de Informação e Comunicação (TIC) descortinam novas perspetivas para a educação com suporte em ambientes digitais de aprendizagem usados via internet (Fiolhais & Trindade, 2003). A plataforma usada no Projeto Matemática Ensino (PmatE) da Universidade de Aveiro (UA) é uma das ferramentas informáticas que suporta esses ambientes através da avaliação baseada no Modelo Gerador de Questões (MGQ), possibilitando a obtenção da imagem do progresso feito pelos alunos (Vieira, Carvalho & Oliveira, 2004). Reconhecendo a importância didática desta ferramenta, já demonstrada noutras investigações (por exemplo, Carvalho, 2011; Pais de Aquino, 2013; Peixoto, 2009), o presente estudo tem como objetivo geral desenvolver material didático digital de Física, no contexto do programa moçambicano de Física da 12ª classe, para alunos e professores sobre radiações e conteúdos da Física Moderna. Pretendeu-se, ainda, propor estratégias de trabalho com recurso às TIC para a melhoria da qualidade das aprendizagens nesta disciplina. O estudo assentou nas três seguintes questões de investigação: (a) Como conceber instrumentos de avaliação das aprendizagens baseadas no modelo gerador de questões para o estudo das radiações e conteúdos da Física Moderna, no contexto do programa moçambicano de Física da 12ª classe? (b) Que potencialidades e constrangimentos apresentam esses instrumentos quando implementados com alunos e professores? (c) De que forma o conhecimento construído pode ser mobilizado para outros temas da Física e para o ensino das ciências em geral? O estudo seguiu uma metodologia de Estudos de Desenvolvimento, de natureza mista, que compreendeu as fases da Análise, Design, Desenvolvimento e Avaliação, seguindo como paradigma um estudo de cariz exploratório, com uma vertente de estudo de caso. Assim, na Análise, foi discutido o contexto da educação em Moçambique e a problemática da abordagem das radiações e conteúdos de Física Moderna no ensino secundário no quadro desafiante que se coloca atualmente à educação científica. No Design foram avaliadas as abordagens dasTIC no ensino e aprendizagem da Física e das ciências em geral e construída a árvore de objetivos nos conteúdos referidos na fase anterior. Na fase do Desenvolvimento foram construídos os instrumentos de recolha de dados, elaborados os protótipos de MGQ e sua posterior programação, validação e testagem em formato impresso no estudo exploratório. Na Avaliação, foi conduzido o estudo principal com a aplicação dos modelos no formato digital e feita sua avaliação, o que incluiu a administração de inquéritos por questionário a alunos e professores. Os resultados indicam que na conceção de MGQ, a definição dos objetivos de aprendizagem em termos comportamentais é fundamental na formulação de questões e na análise dos resultados da avaliação com o objetivo de reajustar as estratégias didáticas. Apontam também que a plataforma do PmatE que suporta os MGQ, embora possua constrangimentos devido a sua dependência da internet e limitações de ordem didática, contribui positivamente na aprendizagem e na identificação das dificuldades e principais erros dos alunos, por um lado. Por outro, estimula através da avaliação os processos de assimilação e acomodação do conhecimento. O estudo recomenda a necessidade de mudanças nas práticas de ensino e de aprendizagem para que seja possível a utilização de conteúdos digitais como complemento à abordagem didática de conteúdos.

Equality of opportunity, cultural diversity and claims for fairness

The present paper examines some of the tensions, problems and challenges associated with claims for equality of opportunity (the fairness argument). The introductory part identifies three separate forms of justification for public education, including the argument associated with equality of opportunity. Part II examines in detail two questions that reveal part of the anatomy of equality of opportunity: (1) what an opportunity is, and (2) when individuals’ opportunities are equal. This is followed by a presentation of the two basic principles of equality of opportunity: (1) the principle of non-discrimination, and (2) the “levelling the playing field” principle. The next part takes up the multiculturalist hypothesis advanced by minority groups for the accommodation and recognition of cultural diversity. This is followed by the identification of a set of claims comprising the “fairness argument”. The last section focuses on the “currency problem” associated with cultural diversity as a form of “unfair disadvantage”. Part V examines two of the major shortcomings associated with the multicultural conception of equality of opportunity, while the concluding part discusses some of the questions that must be answered by any conception of equal opportunities. (DIPF/Orig.)

Um percurso do docente generalista: a complementaridade entre a educação Pré-Escolar e o 1º ciclo do Ensino Básico

Relatório de estágio apresentado à Escola Superior de Educação de Paula Frassinetti para obtenção do grau de Mestre em Educação Pré-Escolar e Ensino do 1º Ciclo do Ensino Básico

La planificación territorial de la política de renovación de las áreas turísticas maduras. Planes de Renovación, Mejora e Incremento de la Competitividad de Canarias

La renovación integral del espacio público y privado de las áreas turísticas maduras se plantea como el elemento de articulación de la política turística. Sin embargo, la experiencia acumulada plantea la necesidad de generar escenarios de buena gobernanza del territorio, en detrimento de la implementación de una estrategia de intervención pública por la vía impositiva de la norma. Para ello, la política pública de las Islas Canarias (España) ha incorporado un singular y novedoso instrumento de ordenación territorial: los “Planes de Modernización, Mejora e Incremento de la Competitividad”. Se trata de planes ad hoc que, con un carácter excepcional, pretenden convertirse en los mecanismos que, vía convenio urbanístico, deben dar cobertura, viabilizar y agilizar la ejecución eficiente de los proyectos de renovación física de los alojamientos turísticos. Sin embargo, la implementación de estos planes no está exenta de complicaciones, las cuales están reduciendo su eficiencia. El principal objetivo de este trabajo es analizar las debilidades y potencialidades de estos instrumentos, susceptibles de ser aplicados a ámbitos turísticos similares.

INFLUÊNCIA DA SAÚDE BUCAL SOBRE A QUALIDADE DE VIDA DE ADOLESCENTES ESCOLARES

Objetivo: Investigar o impacto da saúde bucal em relação à qualidade de vida de adolescentes escolares, associando-o às condições sociodemográficas. Métodos: Estudo de campo transversal e quantitativo desenvolvido em 2012, no município de Sumé-PB, com 184 adolescentes na faixa etária de 15 a 19 anos. Para avaliar o impacto, aplicou-se o questionário Oral Health Impact Profile (OHIP-14) aos participantes, enquanto para a obtenção dos dados referentes às condições sociodemográficas, os pais ou responsáveis responderam a um segundo questionário. Utilizou-se o teste Qui-quadrado para associar o impacto da saúde bucal sobre a qualidade de vida e as variáveis sociodemográficas pesquisadas, sendo considerados significativos com p<0,05. Resultados: Em geral, o impacto foi considerado fraco em 167 pesquisados (90,8%). “Dor física” foi a dimensão na qualidade de vida mais afetada pelas questões bucais entre aquelas que resultaram em impacto médio (22,8%; n=42). Apenas as variáveis “Situação do imóvel” e “Acomodação” associaram-se ao impacto geral (p<0,05). Os reduzidos percentuais de impacto geral forte (1,1%; n=2) relacionaram-se aos adolescentes cujas mães só estudaram até o ensino fundamental, ou às famílias que vivem com um salário mínimo ou menos (1,1%). Conclusão: Observou-se que as condições de saúde bucal apresentaram um impacto negativo fraco na qualidade de vida dos adolescentes investigados. As análises das condições sociodemográficas dos indivíduos relacionadas ao impacto geral da qualidade de vida relacionada à saúde oral associaram-se as variáveis “Situação do imóvel” e “Acomodação”.

Evolution of mylonitic microfabrics (EMM), a computer application for educational purposes

`Evolution of mylonitic microfabrics' (EMM) is an interactive Filemaker Pro 3.0 application that documents a series of see-through deformation experiments on polycrystalline norcamphor. The application comprises computer animations, graphics and text explanations designed to give students and researchers insight into the interaction and dynamic nature of small-scale, mylonitic processes like intracrystalline glide, dynamic recrystallization and strain localization (microshearing). EMM shows how mylonitic steady state is achieved at different strain rates and temperatures. First, rotational mechanisms like glide-induced vorticity, subgrain rotation recrystallization and rigid-body rotation bring grains' crystal lattices into orientations that are favorable for intracrystalline glide. In a second stage, selective elimination of grains whose lattices are poorly oriented for glide involves grain boundary migration. This strengthens the texture. Temperature and strain rate affect both the relative activity of different strain accommodation mechanisms and the rate of microfabric change. Steady-state microfabrics are characterized by stable texture, grain size and shape-preferred orientations of grains and domains. This involves the cyclical generation and elimination of dynamically recrystallized grains and microshear zones.

The development of the accounting professional in a postcolonial context: evidence from Sierra Leone

Despite increasing interest in the development of the accountancy profession and constitutive professional bodies in ex-colonies, little is known about the development of professional accountants as individuals. Similarly, although the continuing influence of the legacies of colonialism and imperialism on the accounting professionalisation trajectory in ex-colonies has been recognised, little attempt has been made to theorise such continuing colonial intervention as a postcolonial condition of accommodation and resistance, with implications for the development of professional accountants. This thesis fills this vacuum by employing four aspects of the critical lens of postcolonial theory – local-global nexus, psycho-existential complex, postcolonial hybridity and diaspora - to gain an insight into the development of accounting professionals in ex-colonies with specific reference to Sierra Leone. Specifically, it examines the current model of accounting professionalisation adopted in Sierra Leone and implications for the development of professional accountants in the country; investigates the historical and ideological legacies of colonialism that shaped and continue to influence the professionalisation trajectory in Sierra Leone; explores the perceptions of Sierra Leonean chartered and aspiring accountants of their professional identity in terms of their professional development within Sierra Leone; and explores the lived experiences of Sierra Leonean chartered and aspiring accountants in the diaspora and the diaspora effect on accountancy in Sierra Leone. The empirical evidence presented here emanated from two sources: a web-based survey and semi-structured interviews with Sierra Leonean chartered and aspiring accountants both within and outside the country at the time of the study. The model for developing professional accountants in Sierra Leone comprises a partnership between the local professional body, ICASL, and the British-based global body, the ACCA. A postcolonial analysis of the empirical evidence reveals that an unintended consequence of this model is that the local is co-opted within the global while the global becomes increasingly localised. The analysis also shows that the presence of a perceived global body ‘inferiorises’ the local body to the point of undesirability among local chartered and aspiring accountants. Thus the partnership has to date done little by way of developing ICASL’s capacity to ensure the development of a localised profession and professionals. Instead, it produces, within the Sierra Leone accountancy space, professional hybrids that at once pose as global as well as local accountants. This has significant implications for the local profession because many of the hybrid professional accountants who could potentially drive the local profession forward end up in the diaspora, which leaves the local profession in a weaker state. Also, given the established link between a robust accountancy profession and sustainable economic development, such professional diasporisation could negatively impact on the country’s economic development. In sum, Sierra Leone has failed to establish an accounting professionalisation model that develops professional accountants (through contextualised professional education and training) that meets the specific accounting needs of its growing economy.

The impact of social housing on health in Glasgow and Baltimore, 1930-1980

This dissertation seeks to discern the impact of social housing on public health in the cities of Glasgow, Scotland and Baltimore, Maryland in the twentieth century. Additionally, this dissertation seeks to compare the impact of social housing policy implementation in both cities, to determine the efficacy of social housing as a tool of public health betterment. This is accomplished through the exposition and evaluation of the housing and health trends of both cities over the course of the latter half of the twentieth century. Both the cities of Glasgow and Baltimore had long struggled with both overcrowded slum districts and relatively unhealthy populations. Early commentators had noticed the connection between insanitary housing and poor health, and sought a solution to both of these problems. Beginning in the 1940s, housing reform advocates (self-dubbed ‘housers') pressed for the development of social housing, or municipally-controlled housing for low-income persons, to alleviate the problems of overcrowded slum dwellings in both cities. The impetus for social housing was twofold: to provide affordable housing to low-income persons and to provide housing that would facilitate healthy lives for tenants. Whether social housing achieved these goals is the crux of this dissertation. In the immediate years following the Second World War, social housing was built en masse in both cities. Social housing provided a reprieve from slum housing for both working-class Glaswegians and Baltimoreans. In Baltimore specifically, social housing provided accommodation for the city’s Black residents, who found it difficult to occupy housing in White neighbourhoods. As the years progressed, social housing developments in both cities faced unexpected problems. In Glasgow, stable tenant flight (including both middle class and skilled artisan workers)+ resulted in a concentration of poverty in the city’s housing schemes, and in Baltimore, a flight of White tenants of all income levels created a new kind of state subsidized segregated housing stock. The implementation of high-rise tower blocks in both cities, once heralded as a symbol of housing modernity, also faced increased scrutiny in the 1960s and 1970s. During the period of 1940-1980, before policy makers in the United States began to eschew social housing for subsidized private housing vouchers and community based housing associations had truly taken off in Britain, public health professionals conducted academic studies of the impact of social housing tenancy on health. Their findings provide the evidence used to assess the second objective of social housing provision, as outlined above. Put simply, while social housing units were undoubtedly better equipped than slum dwellings in both cities, the public health investigations into the impact of rehousing slum dwellers into social housing revealed that social housing was not a panacea for each city’s social and public health problems.

Reading Performance in Children with Visual Function Anomalies

Aims: To compare reading performance in children with and without visual function anomalies and identify the influence of abnormal visual function and other variables in reading ability. Methods: A cross-sectional study was carried in 110 children of school age (6-11 years) with Abnormal Visual Function (AVF) and 562 children with Normal Visual Function (NVF). An orthoptic assessment (visual acuity, ocular alignment, near point of convergence and accommodation, stereopsis and vergences) and autorefraction was carried out. Oral reading was analyzed (list of 34 words). Number of errors, accuracy (percentage of success) and reading speed (words per minute - wpm) were used as reading indicators. Sociodemographic information from parents (n=670) and teachers (n=34) was obtained. Results: Children with AVF had a higher number of errors (AVF=3.00 errors; NVF=1.00 errors; p<0.001), a lower accuracy (AVF=91.18%; NVF=97.06%; p<0.001) and reading speed (AVF=24.71 wpm; NVF=27.39 wpm; p=0.007). Reading speed in the 3rd school grade was not statistically different between the two groups (AVF=31.41 wpm; NVF=32.54 wpm; p=0.113). Children with uncorrected hyperopia (p=0.003) and astigmatism (p=0.019) had worst reading performance. Children in 2nd, 3rd, or 4th grades presented a lower risk of having reading impairment when compared with the 1st grade. Conclusion: Children with AVF had reading impairment in the first school grade. It seems that reading abilities have a wide variation and this disparity lessens in older children. The slow reading characteristics of the children with AVF are similar to dyslexic children, which suggest the need for an eye evaluation before classifying the children as dyslexic.

Fatores de longevidade do programa Central do Cidadão no Rio Grande do Norte

The public management reform in Brazil, since 1995, provoked new experiences in public administration. Among the new models of public service the one-stop shopping has distinguished and was adopted at Rio Grande do Norte with the Citizens Center Program. The one-stop shopping assembles in the same place many public services with appropriate structure, enabled human resources and citizens focus processes. The goal of this research was understand how citizens focus processes help to explain Citizens Center Program s longevity. It was made a case study and the research tools were applied with Citizen Center Programs workers and citizen-users at South Unit of Citizen Center Program placed at Via Direta Mall, Natal. The major contributions for Citizen Center Program s longevity were imputed to Basic Operation Processes. The most spoken features in Citizen Center Program mentioned were quality, efficiency, celerity e personal appearance, what demonstrate concern and care with citizen-users. Worker s personal appearance, accommodation, celerity, politeness and attending capacity planning were high evaluated by citizen-users revealing the wisely choice of use a large quality concept and citizenship concept in public administration. Citizen-users also pointed the necessity of refine and enlarge the communication ways that form an essential mechanism to public citizen focus administration. Not ignoring the policy aspect citizen focus processes were noticed like especial management actions that make easier citizen s activities and public service access, what generate satisfaction to citizen-users. It s possible to conclude that the high level approving evaluation of Citizen Center Program consolidates it an especial public policy that serves citizen s necessities e create appropriate legitimacy conditions of the public policy making harder the choice of ending the policy even in more fragile moments strongly contributing for its longevity

A house, not a home? Examining the use of the private rented sector to resolve homelessness in Scotland

Changes to homelessness legislation in post-devolution Scotland have resulted in an expansion of rights for homeless households seeking formal assistance from local authorities. These changes have led to Scotland’s homelessness arrangements being considered among the most progressive in Europe. In recent years, however, the Scottish Government has increasingly promoted homelessness prevention and Housing Options approaches as a means by which homelessness might be avoided or resolved without recourse to statutory rights. As part of that, they have promoted greater use of the private rented sector (PRS) as a key housing option, with the potential to meet the needs of homeless households. The arguments made to support use of the PRS have much in common with arguments for privatisation in other areas of social policy, notably greater choice for the individual promoting better welfare outcomes, and competition among providers encouraging improvements in quality of service provision. Critics have argued that such benefits may not be realised and that, on the contrary, privatisation may lead to exclusion or act to worsen households’ outcomes. This thesis considers the extent to which the PRS has been utilised in Scotland to accommodate homeless households, and the consequences of this for their welfare. The thesis uses a combination of quantitative and qualitative methods. To examine trends in the use of the PRS, it presents quantitative analysis of the data on the operation of the statutory system and Housing Options arrangements, and of data from a survey of local authority homelessness strategy officers. To examine the consequences of this for homeless households, the thesis uses qualitative research involving face-to-face interviews with 35 homeless households across three local authority areas. This research considers the extent to which households’ experiences of homelessness, housing need and the PRS reflect the arguments presented in the literature, and how settled accommodation has impacted on households’ ability to participate fully in society. The research found an increasing but still limited role for the PRS in resolving statutory homelessness in Scotland, with indications that the PRS is being increasingly used as part of the Housing Options approach and as a means of resolving homelessness outside the statutory system. The PRS is being utilised to varying degrees across different local authority areas, and a variety of methods are being used to do so. While local authorities saw clear advantages to making greater use of the sector, a number of significant barriers including affordability, available stock and landlord preferences - made this difficult in practice. Research with previously homeless households in the PRS similarly found broadly positive experiences and views of the sector, particularly with regard to enabling households to access good quality accommodation in desirable areas of their choosing, with many households highlighting improvements relating to social inclusion and participation. Nevertheless, concerns around the security of tenure offered by the sector, repairs, service standards and unequal power relations between landlord and tenant persisted. As such, homeless households frequently expressed their decision to enter the sector in terms of a trade-off between choice and security.