Professional and community satisfaction with the Brazilian family health strategy

OBJECTIVE: To analyze the strengths and limitations of the Family Health Strategy from the perspective of health care professionals and the community. METHODS: Between June-August 2009, in the city of Vespasiano, Minas Gerais State, Southeastern Brazil, a questionnaire was used to evaluate the Family Health Strategy (ESF) with 77 healthcare professionals and 293 caregivers of children under five. Health care professional training, community access to health care, communication with patients and delivery of health education and pediatric care were the main points of interest in the evaluation. Logistic regression analysis was used to obtain odds ratios and 95% confidence intervals as well as to assess the statistical significance of the variables studied. RESULTS: The majority of health care professionals reported their program training was insufficient in quantity, content and method of delivery. Caregivers and professionals identified similar weaknesses (services not accessible to the community, lack of healthcare professionals, poor training for professionals) and strengths (community health worker-patient communications, provision of educational information, and pediatric care). Recommendations for improvement included: more doctors and specialists, more and better training, and scheduling improvements. Caregiver satisfaction with the ESF was found to be related to perceived benefits such as community health agent household visits (OR 5.8, 95%CI 2.8;12.1), good professional-patient relationships (OR 4.8, 95%CI 2.5;9.3), and family-focused health (OR 4.1, 95%CI 1.6;10.2); and perceived problems such as lack of personnel (OR 0.3, 95%CI 0.2;0.6), difficulty with access (OR 0.2, 95%CI 0.1;0.4), and poor quality of care (OR 0.3, 95%CI 0.1;0.6). Overall, 62% of caregivers reported being generally satisfied with the ESF services. CONCLUSIONS: Identifying the limitations and strengths of the Family Health Strategy from the healthcare professional and caregiver perspective may serve to advance primary community healthcare in Brazil.

Probability and statistics: selected problems

Probability and Statistics—Selected Problems is a unique book for senior undergraduate and graduate students to fast review basic materials in Probability and Statistics. Descriptive statistics are presented first, and probability is reviewed secondly. Discrete and continuous distributions are presented. Sample and estimation with hypothesis testing are presented in the last two chapters. The solutions for proposed excises are listed for readers to references.

Terminology and knowledge engineering conference. New frontiers in the constructive symbiosis of terminology and knowledge engineering

To meet the increasing demands of the complex inter-organizational processes and the demand for continuous innovation and internationalization, it is evident that new forms of organisation are being adopted, fostering more intensive collaboration processes and sharing of resources, in what can be called collaborative networks (Camarinha-Matos, 2006:03). Information and knowledge are crucial resources in collaborative networks, being their management fundamental processes to optimize. Knowledge organisation and collaboration systems are thus important instruments for the success of collaborative networks of organisations having been researched in the last decade in the areas of computer science, information science, management sciences, terminology and linguistics. Nevertheless, research in this area didn’t give much attention to multilingual contexts of collaboration, which pose specific and challenging problems. It is then clear that access to and representation of knowledge will happen more and more on a multilingual setting which implies the overcoming of difficulties inherent to the presence of multiple languages, through the use of processes like localization of ontologies. Although localization, like other processes that involve multilingualism, is a rather well-developed practice and its methodologies and tools fruitfully employed by the language industry in the development and adaptation of multilingual content, it has not yet been sufficiently explored as an element of support to the development of knowledge representations - in particular ontologies - expressed in more than one language. Multilingual knowledge representation is then an open research area calling for cross-contributions from knowledge engineering, terminology, ontology engineering, cognitive sciences, computational linguistics, natural language processing, and management sciences. This workshop joined researchers interested in multilingual knowledge representation, in a multidisciplinary environment to debate the possibilities of cross-fertilization between knowledge engineering, terminology, ontology engineering, cognitive sciences, computational linguistics, natural language processing, and management sciences applied to contexts where multilingualism continuously creates new and demanding challenges to current knowledge representation methods and techniques. In this workshop six papers dealing with different approaches to multilingual knowledge representation are presented, most of them describing tools, approaches and results obtained in the development of ongoing projects. In the first case, Andrés Domínguez Burgos, Koen Kerremansa and Rita Temmerman present a software module that is part of a workbench for terminological and ontological mining, Termontospider, a wiki crawler that aims at optimally traverse Wikipedia in search of domainspecific texts for extracting terminological and ontological information. The crawler is part of a tool suite for automatically developing multilingual termontological databases, i.e. ontologicallyunderpinned multilingual terminological databases. In this paper the authors describe the basic principles behind the crawler and summarized the research setting in which the tool is currently tested. In the second paper, Fumiko Kano presents a work comparing four feature-based similarity measures derived from cognitive sciences. The purpose of the comparative analysis presented by the author is to verify the potentially most effective model that can be applied for mapping independent ontologies in a culturally influenced domain. For that, datasets based on standardized pre-defined feature dimensions and values, which are obtainable from the UNESCO Institute for Statistics (UIS) have been used for the comparative analysis of the similarity measures. The purpose of the comparison is to verify the similarity measures based on the objectively developed datasets. According to the author the results demonstrate that the Bayesian Model of Generalization provides for the most effective cognitive model for identifying the most similar corresponding concepts existing for a targeted socio-cultural community. In another presentation, Thierry Declerck, Hans-Ulrich Krieger and Dagmar Gromann present an ongoing work and propose an approach to automatic extraction of information from multilingual financial Web resources, to provide candidate terms for building ontology elements or instances of ontology concepts. The authors present a complementary approach to the direct localization/translation of ontology labels, by acquiring terminologies through the access and harvesting of multilingual Web presences of structured information providers in the field of finance, leading to both the detection of candidate terms in various multilingual sources in the financial domain that can be used not only as labels of ontology classes and properties but also for the possible generation of (multilingual) domain ontologies themselves. In the next paper, Manuel Silva, António Lucas Soares and Rute Costa claim that despite the availability of tools, resources and techniques aimed at the construction of ontological artifacts, developing a shared conceptualization of a given reality still raises questions about the principles and methods that support the initial phases of conceptualization. These questions become, according to the authors, more complex when the conceptualization occurs in a multilingual setting. To tackle these issues the authors present a collaborative platform – conceptME - where terminological and knowledge representation processes support domain experts throughout a conceptualization framework, allowing the inclusion of multilingual data as a way to promote knowledge sharing and enhance conceptualization and support a multilingual ontology specification. In another presentation Frieda Steurs and Hendrik J. Kockaert present us TermWise, a large project dealing with legal terminology and phraseology for the Belgian public services, i.e. the translation office of the ministry of justice, a project which aims at developing an advanced tool including expert knowledge in the algorithms that extract specialized language from textual data (legal documents) and whose outcome is a knowledge database including Dutch/French equivalents for legal concepts, enriched with the phraseology related to the terms under discussion. Finally, Deborah Grbac, Luca Losito, Andrea Sada and Paolo Sirito report on the preliminary results of a pilot project currently ongoing at UCSC Central Library, where they propose to adapt to subject librarians, employed in large and multilingual Academic Institutions, the model used by translators working within European Union Institutions. The authors are using User Experience (UX) Analysis in order to provide subject librarians with a visual support, by means of “ontology tables” depicting conceptual linking and connections of words with concepts presented according to their semantic and linguistic meaning. The organizers hope that the selection of papers presented here will be of interest to a broad audience, and will be a starting point for further discussion and cooperation.

Phonological development in relation to native language and literacy: Variations on a theme in six alphabetic orthographies

Phonological development was assessed in six alphabetic orthographies (English, French, Greek, Icelandic, Portuguese and Spanish) at the beginning and end of the first year of reading instruction. The aim was to explore contrasting theoretical views regarding: the question of the availability of phonology at the outset of learning to read (Study 1); the influence of orthographic depth on the pace of phonological development during the transition to literacy (Study 2); and the impact of literacy instruction (Study 3). Results from 242 children did not reveal a consistent sequence of development as performance varied according to task demands and language. Phonics instruction appeared more influential than orthographic depth in the emergence of an early meta-phonological capacity to manipulate phonemes, and preliminary indications were that cross-linguistic variation was associated with speech rhythm more than factors such as syllable complexity. The implications of the outcome for current models of phonological development are discussed.

Epidemiologia e Saúde Públi

RESUMO - Visa-se explicitar a origem, a razão de ser, a natureza e o que se perspectiva da relação entre a Epidemiologia e a Saúde Pública, através de uma leitura histórica. As duas entidades foram-se definindo e fazendo sentido em conjunto, com sucessos e, também, muita polémica, desde há milénios e até meados do século XIX. Nesta época, uma combinação de circunstâncias proporcionou-lhes uma explosão de crescimento e de definição, de par com várias outras áreas disciplinares. Desde o antigo relato bíblico de como boa alimentação explica o bom estado de saúde, até à valorização científica das condicionantes sociais e económicas da saúde por Marmot e Rose, passando por «miasmas» causando doença e pela deslocação do conceito de risco individual de saúde para o de risco populacional — com as implicações inerentes a essa importante inovação —, este percurso permite identificar as fundações de tão notável simbiose, explicar o estado presente, vê-la evoluir e achar nela o significado do património hoje disponível, e o que ele promete. Algumas discrepâncias quanto à designação dos seus métodos, bem como a contínua discussão quanto à sua verdadeira natureza e orientação futura, atestam a juventude da Epidemiologia como disciplina científica. Entretanto, a Saúde Pública esforça-se por manter a sua essência integradora, à medida que outras disciplinas contribuem mais para que concretize os seus objectivos; é desafiada pela exposição das populações, em larga escala, a factores de doença, por vezes de intensidade mínima, e pelo surgimento de novas doenças ou a ampliação do volume de outras na população, muitas vezes não respeitando fronteiras. A história dessa simbiose mostra bem que conhecer o modo como uma doença se origina permite controlá-la na população, ou mesmo evitá-la, e que é grande o número de problemas que, em sinergia, as duas disciplinas podem clarificar e resolver. Assim, a Epidemiologia oferece à Saúde Pública explicações (olhos, inteligência e linguagem) para os problemas de saúde das populações — o que permite à segunda saber sobre o quê agir —, cenários de possível evolução dos problemas — o que permite aos decisores optarem em função de diferentes pressupostos, sobre como agir — e capacidade de juízo sobre os resultados das acções empreendidas, em simultâneo com a elevação do nível de consciência, de compreensão e de intervenção quanto ao que se está a passar, tanto pelos profissionais, como pela população — transferência do conhecimento. Facilmente se antecipa que a relação entre as duas disciplinas irá evoluir para maior complexidade e, também, solicitação e exigência da Saúde Pública sobre a Epidemiologia, que terá que corresponder em utilidade. E esta, continuando a subespecializar-se e a sofisticar-se tanto nos métodos, como nos enfoques sobre categorias específicas de factores, precisará de progredir muito na gestão da sua consistência enquanto corpo de conhecimento integrado e com peculiaridades metodológicas, à semelhança da Saúde Pública.O modo como evoluirá a relação entre ambas depende ainda da evolução dos próprios problemas, conceitos, teorias e soluções relacionados com a saúde das populações, e ainda do desenvolvimento das demais disciplinas chamadas à integração por ambas, para enfrentarem esses desafios. Nomeadamente, a Epidemiologia terá que gerir com perícia dificuldades já identificadas, como: incorporar métodos qualitativos de investigação na sua fortíssima tradição e cultura quantitativa; operacionalizar satisfatoriamente o conceito de «risco atribuível na população», ao serviço da definição de prioridades de acção dirigida às necessidades de saúde; aperfeiçoar modelos de interpretação causal que respeitem a multicausalidade; aproveitar as técnicas estatísticas de análise multivariada, sem se perder na abstracção dos seus modelos; desenvolver a investigação nas dimensões positivas de saúde, além da doença, para contribuir melhor para a realização da Saúde Pública, sua principal cliente e fornecedora de oportunidades.--------------------------ABSTRACT - The aim of the author is to explicit the origin, the rationale, the nature and the prospects of the relationship between Epidemiology and Public health, through an historic approach. The two entities have been defining and making sense together, by achieving successes, but also with much controversy, since millennia ago, until mid XIX century. A combination of circumstances provided them the opportunity for an explosion of growth and definition, then, alongside several other disciplines. From the ancient biblical report on how good food explains good health, up to the scientific appreciation of both social and economical constraints to health by Marmot and Rose, passing through «miasma» causing disease and through displacing from individual health risk to population risk — with the inherent implications of that important innovation —, this route allows the identification of the foundations of such remarkable symbiosis, the explanation of current status, to see its evolution and find in it the meaning of today’s heritage and what it promises. Some discrepancies on the name of its methods, as well as the continuing discussion about its true nature and future orientation, attest Epidemiology’s youth as a scientific discipline. Meanwhile, Public Health strives to keep its integrating essence, while other disciplines increasingly contribute so that it achieves its objectives; it is challenged by large scale population exposure to disease factors, sometimes with a minimum intensity, and by new diseases emerging in the population or by old ones getting amplified, often not respecting regions boundaries. The history of such a symbiosis shows that knowing the way a disease is generated allows to control it in the population, or even to avoid it, and that the number of problems that the two disciplines are able to clarify and solve together in synergy is considerable. Therefore, Epidemiology offers Public Health explanations (eyes, intelligence and language) for populations’s health problems — allowing that the latter knows on what to act —, scenarios on how problems may tend to evolve — allowing decision-makers to make their choices as a function of different assumptions, on how to act — and judgement capabilities on the results of already undertaken actions, accompanied by the raising of conscience level, understanding and intervention of what is going on by both professionals and the population – knowledge transfer. It is easy to anticipate that the relationship between both disciplines will develop towards increasing complexity and demand from Public Health to Epidemiology, and that this one will have to correspond in usefulness. And the latter, while continuing its subspecialisation and sophistication either in its methods, or in its approaches to specific factor categories, will need to progress in managing its consistency as an integrated body of knowledge having methodological peculiarities, similarly to Public Health. Further, the way the relationship between both will evolve depends on the evolution of the problems themselves, of the concepts, theories and solutions related to the health of populations, and on the development of remaining disciplines called to integration by both, in other to face those problems. Namely, Epidemiology will have to manage with expertise some already known difficulties, as: the inclusion of qualitative research methods in its very strong quantitative tradition and culture; to grant satisfactory operation to the «population attributable risk» concept, in support to the definition of action priorities envisaging health needs; to improve causal interpretation models that comply with multicausality; to take advantage of multivariate statistical techniques, without get

Fashion communication: a way to change comsumption behaviour towards ethical fashion

In view of the major social and environmental problems, with which we are faced nowadays, we noticed a certain absence of values in society, where man draws many more resources than nature can replace in the short or medium term. Within the framework of fashion emerges the ethical fashion as a movement in this direction, intending to change this current paradigm. Ethical fashion encompasses different concepts such as fair trade, sustainability, working conditions, raw materials, social responsibility and the protection of animals. This study aims to determine which type of communication are fashion brands using in this context, and if this communication aims at educating the consumer for a more ethical consumer behavior. For this study were selected 44 fashion brands associated with the Ethical Trade Initiative. The method used for the research development was content analysis for which first was made a data collection of the information provided on the websites and social networks of the selected fashion brands. The data was analyzed taking into account the quality and type of information published related to ethical fashion, for which an ordinal scale was created as a way of measuring and comparing results.

Introduction [to "Citizen voices: performing public participation in science and environment communication"]

"ECREA series, ISSN 1742-9420"

Avaliação da comunicação expressiva em crianças dos 6 aos 41 meses de idade na região norte de Portugal: um estudo exploratório com o Early Communication Indicator

Dissertação de mestrado em Educação Especial (área de especialização em Intervenção Precoce)

Environmental management problems, future generations and social decisions

The decisions of many individuals and social groups, taking according to well-defined objectives, are causing serious social and environmental problems, in spite of following the dictates of economic rationality. There are many examples of serious problems for which there are not yet appropriate solutions, such as management of scarce natural resources including aquifer water or the distribution of space among incompatible uses. In order to solve these problems, the paper first characterizes the resources and goods involved from an economic perspective. Then, for each case, the paper notes that there is a serious divergence between individual and collective interests and, where possible, it designs the procedure for solving the conflict of interests. With this procedure, the real opportunities for the application of economic theory are shown, and especially the theory on collective goods and externalities. The limitations of conventional economic analysis are shown and the opportunity to correct the shortfalls is examined. Many environmental problems, such as climate change, have an impact on different generations that do not participate in present decisions. The paper shows that for these cases, the solutions suggested by economic theory are not valid. Furthermore, conventional methods of economic valuation (which usually help decision-makers) are unable to account for the existence of different generations and tend to obviate long-term impacts. The paper analyzes how economic valuation methods could account for the costs and benefits enjoyed by present and future generations. The paper studies an appropriate consideration of preferences for future consumption and the incorporation of sustainability as a requirement in social decisions, which implies not only more efficiency but also a fairer distribution between generations than the one implied by conventional economic analysis.

Inadequate and infrequent are not alike : ERPs to deviant prosodic patterns in spoken sentence comprehension

The current study on German investigates Event-Related brain Potentials (ERPs) for the perception of sentences with intonations which are infrequent (i.e. vocatives) or inadequate in daily conversation. These ERPs are compared to the processing correlates for sentences in which the syntax-to-prosody relations are congruent and used frequently during communication. Results show that perceiving an adequate but infrequent prosodic structure does not result in the same brain responses as encountering an inadequate prosodic pattern. While an early negative-going ERP followed by an N400 were observed for both the infrequent and the inadequate syntax-to-prosody association, only the inadequate intonation also elicits a P600.

Language and syntactic impairment following stroke in late bilingual aphasics.

PURPOSE: Bilingual aphasia generally affects both languages. However, the age of acquisition of the second language (L2) seems to play a role in the anatomo-functional correlation of the syntactical/grammatical processes, thus potentially influencing the L2 syntactic impairment following a stroke. The present study aims to analyze the influence of late age of acquisition of the L2 on syntactic impairment in bilingual aphasic patients. METHODS: Twelve late bilingual participants (speaking French as L2 and either English, German, Italian or Spanish as L1) with stroke-induced aphasia participated in the study. The MAST or BAT aphasia batteries were used to evaluate overall aphasia score. An auditory syntactic judgement task was developed and used to test participants syntactic performance. RESULTS: The overall aphasia scores did not differ between L1 and L2. In a multiple case analysis, only one patient had lower scores in L2. However, four patients presented significantly lower performances in syntactic processing in the late L2 than in their native language (L1). In these four patients the infarct was localized, either exclusively or at least partially, in the pre-rolandic region. CONCLUSION: This pilot study suggests that, in late bilingual aphasics, syntactic judgment abilities may be more severely impaired in L2, and that this syntactic deficit is most likely to occur following anterior lesions.

Inhabitants' and professionals' social representations of health determinants in a disadvantaged urban area in France: a qualitative analysis = représentations sociales des déterminants de santé dans une zone urbaine défavorisée en France : analyse qualitative auprès d'habitants et de professionnels

Background and objective. - Access to care in French disadvantaged urban areas remains an issue despite the implementation of local healthcare structures. To understand this contradiction, we investigated social representations held by inhabitants of such areas, as well as those of social and healthcare professionals, regarding events or behaviours that can impact low-income individuals' health. Method. - In the context of a health diagnosis, 288 inhabitants living in five disadvantaged districts of Aix-les-Bains, as well as 28 professionals working in these districts, completed an open-ended questionnaire. The two groups of respondents were asked to describe what could have an impact on health status from the inhabitants' point of view. The textual responses were analyzed using the Alceste method. Results. - We observed a number of differences in the way the inhabitants and professionals represented determinants of health in disadvantaged urban areas: the former proposed a representation mixing personal responsibility with physiological, social, familial, and professional aspects, whereas the latter associated health issues with marginalization (financial, drug, or alcohol problems) and personal responsibility. Both inhabitants and professionals mentioned control over events and lifestyle as determinants of health. Discussion. - The results are discussed regarding the consequences of these different representations on the beneficiary - healthcare-provider relationship in terms of communication and trust.

Digital inmigrants and digital natives expectation collection in the Andalusian Public Health System Virtual Library: communication with our users

The Andalusian Public Health System Virtual Library (Biblioteca Virtual del Sistema Sanitario Público de Andalucía, BV-SSPA) provides access to health information resources and services to healthcare professionals through its Website. This virtual environment demands higher users’ knowledge in order to satisfy of the need of information of our users, as digital natives as digital immigrants, improving at the same time the communication with all of them. 1. To collect clients' views and expectations according to their nature of digital natives and immigrants. 2. To know our online reputation. A Collecting User Expectation Questionnaire will be built, taking into account the segmentation of the BV-SSPA users’ professional groups of the Andalusian Public Health System. A pilot test will be run to check the survey dimensions and items about practices, attitudes and knowledge of our users. Two Quality Function Deployment (QFD) matrices will enable the BV-SSPA services to be targeted to our digital natives or digital immigrants, according to their nature, finding the best way to satisfy their information needs. We provide feedback on BV-SSPA: users can have the opportunity to post feedback about the site via the 'Contact us' section and comment about their experience. And Web 2.0 is a shop window, providing the opportunity to show the comments; and through time, our online reputation will be built, but the BV-SSPA must manage its own personal branding. Web 2.0 tools are a driver of improvement, because they provide a key source of insight into people's attitudes. Besides, the BV-SSPA digital identity will be analyzed through indicators like major search engine referrals breakdown, top referring sites (non search engines), or top search engine referral phrases, among others. Definition of digital native and digital immigrant profiles of the BV-SSPA, and their difference, will be explained by their expectations. The design of the two QFD matrices will illustrate in just one graph the requirements of both groups for tackling digital abilities and inequalities. The BV-SSPA could deliver information and services through alternative channels. On the other hand, we are developing a strategy to identify, to measure and to manage a digital identity through communication with the user and to find out our online reputation. With the use of different tools from quantitative and qualitative methodology, and the opportunities offered by Web 2.0 tools, the BV-SSPA will know the expectations of their users as a first step to satisfy their necessities. Personalization is pivotal to the success of the Site, delivering tailored content to individuals based on their recorded preferences. The valuable user research can be used during new product development and redesign. Besides positive interaction let us build trust, show authenticity, and foster loyalty: we improve with effort, communication and show.

Repeating with the right hemisphere: reduced interactions between phonological and lexical-semantic systems in crossed aphasia?

Knowledge on the patterns of repetition amongst individuals who develop language deficits in association with right hemisphere lesions (crossed aphasia) is very limited. Available data indicate that repetition in some crossed aphasics experiencing phonological processing deficits is not heavily influenced by lexical-semantic variables (lexicality, imageability, and frequency) as is regularly reported in phonologically-impaired cases with left hemisphere damage. Moreover, in view of the fact that crossed aphasia is rare, information on the role of right cortical areas and white matter tracts underpinning language repetition deficits is scarce. In this study, repetition performance was assessed in two patients with crossed conduction aphasia and striatal/capsular vascular lesions encompassing the right arcuate fasciculus (AF) and inferior frontal-occipital fasciculus (IFOF), the temporal stem and the white matter underneath the supramarginal gyrus. Both patients showed lexicality effects repeating better words than non-words, but manipulation of other lexical-semantic variables exerted less influence on repetition performance. Imageability and frequency effects, production of meaning-based paraphrases during sentence repetition, or better performance on repeating novel sentences than overlearned clichés were hardly ever observed in these two patients. In one patient, diffusion tensor imaging disclosed damage to the right long direct segment of the AF and IFOF with relative sparing of the anterior indirect and posterior segments of the AF, together with fully developed left perisylvian white matter pathways. These findings suggest that striatal/capsular lesions extending into the right AF and IFOF in some individuals with right hemisphere language dominance are associated with atypical repetition patterns which might reflect reduced interactions between phonological and lexical-semantic processes.