National Immunization Program: Computerized System as a tool for new challenges

The scope and coverage of the Brazilian Immunization Program can be compared with those in developed countries because it provides a large number of vaccines and has a considerable coverage. The increasing complexity of the program brings challenges regarding its development, high coverage levels, access equality, and safety. The Immunization Information System, with nominal data, is an innovative tool that can more accurately monitor these indicators and allows the evaluation of the impact of new vaccination strategies. The main difficulties for such a system are in its implementation process, training of professionals, mastering its use, its constant maintenance needs and ensuring the information contained remain confidential. Therefore, encouraging the development of this tool should be part of public health policies and should also be involved in the three spheres of government as well as the public and private vaccination services.

A Qualidade na administra����o p��blica e a CAF ��� Common assessment framework

Apresenta����o no ��mbito da Disserta����o de Mestrado Orientador: Doutora Alcina Dias

Designing market-based instruments for biodiversity conservation: learning with the Australian experience and evaluating Portugal's potential

Disserta����o apresentada na Faculdade de Ci��ncias e Tecnologia da Universidade Nova de Lisboa para a obten����o do grau de Mestre em Engenharia do Ambiente, perfil Gest��o de Sistemas Ambientais

Integrated ecological-economic modelling and assessment aproach for coastal ecosystem management

Thesis submitted to the Faculty of Sciences and Technology, New University of Lisbon, for the degree of Doctor of Philosophy in Environmental Sciences

Development and Assessment of an E-Learning Course on Breast Imaging for Radiographers: A Stratified Randomized Controlled Trial

Background: Mammography is considered the best imaging technique for breast cancer screening, and the radiographer plays an important role in its performance. Therefore, continuing education is critical to improving the performance of these professionals and thus providing better health care services. Objective: Our goal was to develop an e-learning course on breast imaging for radiographers, assessing its efficacy , effectiveness, and user satisfaction. Methods: A stratified randomized controlled trial was performed with radiographers and radiology students who already had mammography training, using pre- and post-knowledge tests, and satisfaction questionnaires. The primary outcome was the improvement in test results (percentage of correct answers), using intention-to-treat and per-protocol analysis. Results: A total of 54 participants were assigned to the intervention (20 students plus 34 radiographers) with 53 controls (19+34). The intervention was completed by 40 participants (11+29), with 4 (2+2) discontinued interventions, and 10 (7+3) lost to follow-up. Differences in the primary outcome were found between intervention and control: 21 versus 4 percentage points (pp), P<.001. Stratified analysis showed effect in radiographers (23 pp vs 4 pp; P=.004) but was unclear in students (18 pp vs 5 pp; P=.098). Nonetheless, differences in students��� posttest results were found (88% vs 63%; P=.003), which were absent in pretest (63% vs 63%; P=.106). The per-protocol analysis showed a higher effect (26 pp vs 2 pp; P<.001), both in students (25 pp vs 3 pp; P=.004) and radiographers (27 pp vs 2 pp; P<.001). Overall, 85% were satisfied with the course, and 88% considered it successful. Conclusions: This e-learning course is effective, especially for radiographers, which highlights the need for continuing education.

Anthropocentric-based robotic and autonomous systems: assessment for new organisational options

Text based on the paper presented at the Conference "Autonomous systems: inter-relations of technical and societal issues" held at Monte de Caparica (Portugal), Universidade Nova de Lisboa, November, 5th and 6th 2009 and organized by IET-Research Centre on Enterprise and Work Innovation

Designing a technology assessment post-graduation programme: experiences, limits and needs

The post-graduation in the field of Technology Assessment (TA) is recent and that are several and different ways to be organised. Most experiences are related with the Masters diplom level (2nd cycle of graduation in high education). Just one in PhD level is explicit in the field of TA, and some other PhD courses include also TA topics in their programme structure. In this chapter we will analyse the problems related with the design of a post-graduation (MA, MSc or PhD) programme in the field of TA using as reference some international experiences. Hereby, the main conclusion seems to address labour market needs in the specialised knowledge of TA, of technology management or technology innovation. In this sense TA should be included as ���minor��� into post-graduation courses which may range from engineering disciplines to social sciences. As a graduation programme it can fill an expertise gap between technicians, engineers, scientists and the strategic decision makers or policy makers.

Designing a technology assessment post-graduation programme: experiences, limits and needs

IET Working Papers Series No. WPS09/2010

ELEVATED ALANINE AMINOTRANSFERASE (ALT) IN BLOOD DONORS: AN ASSESSMENT OF THE MAIN ASSOCIATED CONDITIONS AND ITS RELATIONSHIP TO THE DEVELOPMENT OF HEPATITIS C

The determination of aminotranferases levels is very useful in the diagnosis of hepatopathies. In recent years, an elevated serum ALT level in blood donors has been associated with an increased risk of post-transfusion hepatitis (PTH). The purpose of the study was to research the factors associated with elevated ALT levels in a cohort of voluntary blood donors and to evaluate the relationship between increased ALT levels and the development of hepatitis C (HCV) infection. 166 volunteer blood donors with elevated ALT at the time of their first donation were studied. All of the donors were questioned about previous hepatopathies, exposure to hepatitis, exposure to chemicals, use of medication or drugs, sexual behaviour, contact with blood or secretions and their intake of alcohol. Every three months, the serum levels of AST, ALT, alkaline phosphatase, gamma glutamyl transpeptidase, cholesterol, triglyceride and glycemia are assessed over a two year follow-up. The serum thyroid hormone levels as well as the presence of auto-antibodies were also measured. Abdominal ultrasound was performed in all patients with persistently elevated ALT or AST levels. A needle biopsy of liver was performed in 9 donors without definite diagnostic after medical investigation. The presence of anti-HCV antibodies in 116 donors were assayed again the first clinical evaluation. At the end of follow-up period (2 years later) 71 donors were tested again for the presence of anti-HCV antibodies. None of donors resulted positive for hepatitis B or hepatitis C markers during the follow-up. Of the 116 donors, 101 (87%) had persistently elevated ALT serum levels during the follow-up. Obesity and alcoholism were the principal conditions related to elevated ALT serum levels in 91/101 (90.1%) donors. Hypertriglyceridemia, hypercholesterolemia, hypothyroidism and diabetes mellitus also were associated with increased ALT levels. Only 1/101 (0.9%) had mild chronic active non A-G viral hepatitis and 3/101 (2.9%) had liver biopsy with non-specific reactive hepatitis. The determination of ALT levels was not useful to detect donors infected with HCV at donation in Brazil, including the initial seronegative anti-HCV phase.

An assessment of the social and economic cohesion aspects of the development of the information society in Europe

Neste trabalho pretende consolidar-se a contribui����o portuguesa para o estudo comunit��rio ���Na Assessment of the Social and Economic Cohesion Aspects of the Development of the Information Society in Europe��� elaborado por um cons��rcio europeu liderado pela Nexus Europe e em que interv��m o ISEGI- Instituto Superior de Estat��stica e Gest��o de Informa����o, da Universidade Nova de Lisboa, como parceiro nacional portugu��s.

Program Catapultas: Education for development in Bairro Padre Cruz

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA ��� School of Business and Economics

Development of a fuzzy qualitative risk assessment model applied to construction industry

Disserta����o para obten����o do Grau de Doutor em Engenharia Industrial

Programas de cuidados integrados para pessoas com esquizofrenia ou perturba����o esquizoafetiva : estudo sobre a exequibilidade, implementa����o e resultados de um programa de cuidados integrados para pessoas com esquizofrenia ou perturba����o esquizoafectiva em Portugal

RESUMO: De acordo com o estado da arte, existem interven����es psicofarmacol��gicas, psicol��gicas e psicossocias, com evid��ncia cient��fica dos seus resultados, no tratamento de pessoas com esquizofrenia e perturba����o esquizoafectiva. No entanto, muitos destes doentes, n��o procuram ajuda dos servi��os de sa��de mental, n��o recebem os referidos cuidados ou n��o s��o detectados nem seguidos por estes. Esta realidade levou ao desenvolvimento de programas integrados, interven����es e estudos mais espec��ficos, nomeadamente para tentar ultrapassar os obst��culos na acessibilidade aos cuidados de sa��de e na continuidade de seguimento destes doentes. No conjunto das dificuldades apuradas, as quest��es da exequibilidade (feasibility) e da implementa����o, t��m tido particular relevo na literatura cient��fica recente, bem como a melhor forma de vencer as respectivas barreiras e adaptar essas interven����es ��s varias realidades, culturas e recursos. Objectivos: Objectivos gerais:1) Avaliar a exequibilidade e a implementa����o inicial de um programa de cuidados integrados, para pessoas com esquizofrenia ou perturba����o esquizoafectiva, no contexto cl��nico das equipas de sa��de mental comunit��rias de um departamento de psiquiatria do Servi��o Nacional de Sa��de, em Portugal, com os recursos materiais e humanos existentes; 2) Avaliar o impacto deste programa, nestes doentes e na respectiva presta����o de cuidados de sa��de mental. Metodologia. Elabor��mos um programa de cuidados integrados (Programa Integrar) com base no modelo cl��nico de case management, com seguimento mantido e integrado. Cada doente passou a ter um terapeuta de refer��ncia, um plano individual de cuidados e manteve o seguimento com o seu psiquiatra assistente. Foram seleccionadas interven����es, nomeadamente, psicoeducativas, familiares, estrat��gias para lidar com os sintomas e a doen��a, preven����o de reca��das e interven����es para melhorar o funcionamento social e ocupacional. A estas interven����es foi sempre associado o tratamento psicofarmacol��gico. O estudo delineado incluiu dois componentes: avalia����o da exequibilidade e implementa����o inicial do programa de cuidados integrados (componente A) e avalia����o do impacto deste programa (componente B), atrav��s de um estudo de interven����o, prospectivo, naturalista, n��o aleatorizado e n��o ontrolado. A amostra do estudo resultou das sucessivas referencia����es, para o Programa Integrar, de pessoas com os diagn��sticos de esquizofrenia ou perturba����o esquizoafectiva, seguidas nas cinco equipas de sa��de mental comunit��rias do Departamento de Psiquiatria do Centro Hospitalar de Lisboa Ocidental, com uma ��rea assistencial correspondente a uma popula����o de, aproximadamente, 400 000 pessoas. Definimos etapas, estrat��gias, par��metros e indicadores para o estudo da exequibilidade do programa. Efectu��mos a monitoriza����o e a avalia����o de tarefas, procedimentos e interven����es recomendadas aos terapeutas de refer��ncia. Realiz��mos duas avalia����es, uma no in��cio do programa e outra ap��s um ano de interven����o. Foram avaliadas as seguintes dimens��es (com indica����o do acr��nimo do instrumento de avalia����o utilizado entre par��ntesis): psicopatologia (BPRS), depress��o (MADRS), necessidades (CAN), incapacidade (DAS), actividade social e ocupacional (SOFAS), atitude em rela����o �� medica����o (DAI), insight (SAI), qualidade de vida (WHOQOL-S) e satisfa����o (POCS). Resultados: Dos 146 doentes que foram inclu��dos no estudo, 97 (66%) eram do sexo masculino e 49 (34%) do sexo feminino, com uma idade m��dia de 36 anos. Destes oentes,116 (79,4%)tinham o diagn��stico (ICD10) de esquizofrenia e 30 (20,6%) de perturba����o esquizoafectiva. Os restantes dados sociodemogr��ficos eram t��picos de popula����es afins em servi��os de sa��de mental nacionais. Do total de doentes (146) que iniciaram o estudo, 26 (18%) abandonaram o seguimento neste programa. Para o componente A da investiga����o (estudo de exequibilidade) salientamos: exerceram fun����es a totalidade (15) dos terapeutas de refer��ncia que receberam forma����o, 76 % efectuaram o n��mero m��nimo recomendado de sess��es / ano por doente (���18), 44,9 fizeram o n��mero m��nimo de sess��es familiares pretendido (��� 3). Nas interven����es mais espec��ficas foram atingidos os objectivos em mais de 75% dos doentes, �� excep����o das interven����es domicili��rias (19,4%), preven����o do abuso de subst��ncias (45,4%) e do risco de suic��dio (34,3%). O plano individual de cuidados foi realizado em 98 % dos doentes e em 38,9 % dos casos ocorreu a participa����o da fam��lia. Neste plano, a m��dia de objectivos definidos foi de 5 e a m��dia de objectivos atingidos correspondeu a 3 (p= 0,001). Na primeira avalia����o, estavam a frequentar estruturas de reabilita����o psicossocial 42 doentes (28,8%) e,12 meses ap��s, esse n��mero passou para 80 (74,1%).Tamb��m aumentou o n��mero de doentes com actividade profissional a tempo completo, de 8 (7,4%) para 18 (16,7%). No componente B do estudo (avalia����o do impacto do programa), em termos de psicopatologia, e para as pontua����es m��dias globais do BPRS, ocorreu uma diminui����o entre a primeira e a segunda avalia����o (p=0,001), tal como nas subescalas: sintomas positivos (p=0,003), sintomas negativos (p=0,002), sintomas de mania (p=0,002) e sintomas de depress��o/ansiedade (p=0,001). Na avalia����o da depress��o (p= 0,001) e da incapacidade (p=0,003), as diferen��as foram significativas e favor��veis. O mesmo n��o sucedeu na atitude em rela����o �� medica����o (p=0,690) nem na escala de avalia����o do insight (p=0,079). Em rela����o ao funcionamento social e ocupacional, qualidade de vida e satisfa����o dos doentes, ocorreu uma melhoria significativa da primeira para a segunda avalia����o As necessidades sem resposta mais frequentes, na primeira avalia����o, corresponderam aos itens: actividades di��rias, contactos sociais, rela����es ��ntimas, relacionamento sexual, benef��cios sociais, sintomas psic��ticos, sofrimento psicol��gico, informa����o sobre a doen��a / tratamento e gest��o/problemas de dinheiro. Para todos estes ��ltimos nove itens, verificou-se uma diferen��a estatisticamente significativa, entre a primeira e a segunda avalia����o, com diminui����o destas necessidades, excepto nas rela����es ��ntimas, relacionamento sexual e nos problemas de dinheiro. Na distribui����o dos tr��s estados de necessidades, para todos os itens, diminu��ram as necessidades sem resposta e as necessidades com resposta parcial e aumentaram as situa����es em que deixaram de se verificar necessidades relevantes. Dos resultados obtidos para outros indicadores cl��nicos e de utiliza����o dos cuidados, ser�� importante referir que na compara����o do ano anterior com o ano em que decorreu o programa, o n��mero de doentes da amostra internados diminuiu 64,1%, bem como a m��dia do n��mero de internamentos (p=0,001). Em rela����o �� dura����o dos internamentos, no ano anterior ao programa, os 39 doentes internados, tiveram um total de dias de internamento de 1522, sendo que, no ano do programa, para os 14 doentes internados, o total foi de 523 dias. Em termos absolutos, ocorreu uma redu����o de 999 dias (menos 65,6% dias). Tamb��m se verificou uma diminui����o de 45,6 % de reca��das (p=0,001).Discuss��o e conclus��es A exequibilidade do programa de cuidados integrados permitiu a aplica����o do modelo cl��nico de case management, com seguimento mantido e integrado, atrav��s do qual cada doente passou a ter um terapeuta de refer��ncia assim como, em 98% casos, um plano individual de cuidados. As fam��lias continuaram a ser o principal suporte para os doentes, mas surgiram dificuldades quando se pretendeu uma participa����o mais activa destas no tratamento.A diminui����o do n��mero e da dura����o dos internamentos constitu��ram importantes resultados com implica����es n��o s�� em termos cl��nicos mas tamb��m econ��micos. Os valores obtidos, para as diferentes vari��veis, tamb��m sugerem o impacto favor��vel do Programa Integrar a n��vel da psicopatologia, das necessidades, da incapacidade, do funcionamento social e ocupacional, da qualidade de vida e da satisfa����o dos doentes. O mesmo n��o sucedeu para o insight e para a mudan��a de atitudes dos doentes em rela����o �� medica����o, resultados que devem ser igualmente considerados em futuros reajustamentos deste programa ou no desenvolvimento de novos programas. Como principais conclus��es podemos referir que: 1) Foi poss��vel a exequibilidade de um programa de cuidados integrados inovador e a implementa����o inicial desse programa, para doentes com esquizofrenia ou perturba����o esquizoafectiva, com os recursos humanos e materiais existentes, no contexto cl��nico das equipas de sa��de mental comunit��rias, de um departamento de psiquiatria e sa��de mental, em Portugal; 2) Na avalia����o do impacto do programa, os resultados obtidos indiciam potencialidades de aplica����o, deste programa de cuidados integrados, com vista �� melhoria cl��nica e psicossocial destes doentes. Devem ser realizados estudos de replica����o, ou complementares �� presente investiga����o, no entanto, os dados obtidos s��o encorajadores para o desenvolvimento de programas similares, a n��vel nacional e internacional, que possam beneficiar um grupo mais alargado de doentes.------------ABSTRACT: Although there are psychological and psychosocial interventions well supported by scientific evidence, which show benefit when combined with psychopharmacological treatments, we know that a significant number of people with schizophrenia or schizoaffective disorders, do not seek help from mental health services, do not receive the care mentioned and are not detected or followed-up by them. This reality led to the development of integrated programs, interventions and more specific studies, to try to overcome the obstacles in the accessibility to the health services and on the follow-up of these patients. Amongst the barriers identified, feasibility and implementation of those programs have been of special relevance in recent scientific literature, as well as the best way to overcome such difficulties and adapt the interventions to the various realities, cultures and resources. Objectives: General objectives were defined: 1) Assessment of the feasibility and initial implementation of an integrated care program, for people with schizophrenia or schizoaffective disorder, in the clinical setting of community mental health teams, in a psychiatric department from the national health service in Portugal; 2) Impact evaluation of the integrated care program, for these patients and their mental health care delivery. Methods: We drew up an integrated care program (Program Integrar) based on the clinical case management model, with continuous and integrated follow-up. Each patient got one case manager, an individual care plan and kept the same psychiatrist. Were selected the appropriated interventions, namely: psycho-educative, family-based interventions, strategies for dealing with the symptoms and the disorder, relapse prevention and interventions to improve social and occupational functioning. These interventions were always associated with psychopharmacological treatment. The investigation was outline with two parts: assessment of the feasibility and initial implementation of the Program Integrar (part A of the study) and impact evaluation of the program (part B of the study). We designed a naturalistic, prospective, intervention study, non-randomized and without control group. Our chosen sample was made with successive referrals of patients with the diagnosis of schizophrenia or schizoaffective disorder, followedup in one of the five community mental health teams of the Psychiatric Department of Centro Hospitalar Lisboa Ocidental, with a catchment area for a population of about 400 000 people. Different stages, strategies, criteria and indicators for studying the feasibility of the program and its implementation were set and the tasks, procedures and recommended interventions of the case managers were monitored and evaluated. We did two assessments with an interval of one year and we evaluated the following dimensions (the acronym of the assessment instrument used in brackets): psychopathology (BPRS), depression (MADRS), needs (CAN), disability (DAS), social and occupational functioning (SOFAS), attitude toward medication (DAI), insight (SAI), quality of life (WHOQOL-S) and satisfaction (POCS). Results: Of the 146 patients who started the study, 97 (66%) were male and 49 (34%) females with a mean age of 36 years. Of these, 116 (79,4%) were diagnosed (ICD10) with schizophrenia and 30 (20,6%) with schizoaffective disorder. The other socio-demographic data were typical of populations within Portuguese mental health services. Of all patients (146), who started the program, 26 (18%) of patients left the program (program dropout rate). Of the regarding part A of the study, which focused on feasibility, the following is of note: all professionals who had been trained for this purpose (15) acted as case manager, 76% did the recommended minimum number of sessions / year per patient (���18) and 44,9% did the minimum number of family sessions desired (��� 3). For the more specific interventions the parameters set out were met for more than 75% of patients, with the exception of domiciliar interventions (19.4%), prevention of substance abuse (45.4%) and suicide risk prevention(34.3%). The individual care plan was done for 98% of patients and in 38,9% of cases this involved family participation. For this plan the mean objectives defined were 5 and in average was achieved 3 (p=0,001). On the first assessment, 42 patients (28.8%) were attending psychosocial rehabilitation structures and 12 months later that number rose up to 80 (74,1%). Regarding their employment status, in the first assessment 8 (7,4%) were in full time employment and in the second evaluation the number rise to 18 (16,7%). For part B of the study (impact program evaluation), in terms of psychopathology, global mean scores for the BPRS, decreased (p=0,001), as did the four sub scales: positive symptoms (p=0,003); negative symptoms (p=0,002); manic symptoms (p=0,002) and symptoms of depression/anxiety (p=0,001). Both in the evaluation of depression (p=0,001), as in the assessment of disability (p=0,003), the differences were significant. However, this was not the case with attitudes towards medication (p=0,690) and with insight evaluation (p=0,079). In relation to social and occupational functioning, quality of life and patient satisfaction there was a statistically significant improvement from the first to the second assessment. The most commonly unmet needs in the first assessment were daily activities, social contacts, intimate relationships, sexual relations, social benefits, psychotic symptoms,psychological distress, information about the disorder / treatment and money problems money management. Of these, in the second assessment, all of those nine unmet needs showed significant improvement, excepted intimate relationships, sexual relations and Money problems / money management. In the distribution of the three states of needs for all items, it happened a decreased in unmet needs and partially met needs and increased in the situations where relevant needs were no longer found. For other clinical indicators it is important to note, when we compared the year prior to this program and the year after, there were fewer hospitalizations (reduction of 64,1% of admissions) and in the mean number of admissions (p=0,001). Regarding the length of hospitalization in the year prior to the program, the 39 patients admitted had a total of 1522 hospital days, and in the year of the program for the 14 hospitalized patients, the total was 523 days. In absolute terms, there was a reduction of 999 days (65,6%). There was also a 45,6% reduction of relapses (p = 0,001). Discussion and Conclusions: The feasibility of the integrated care program allowed the application of the clinical case management model, with continuous follow-up. Each patient got a case manager and in 98% of the cases they also got an individual plan of care. Families continued to be the main support for patients but, difficulties occurred when it was claimed a more active participation. The decrease in the number and duration of admissions were important findings with implications not only in clinical terms but also in economic field. The achieved results for the different variables can also indicate the favorable impact of this program, at the level of psychopathology, needs, disability, social and occupationa functioning, quality of life and patient satisfaction. The same did not happen for the evaluation of insight and in the changes of attitudes towards medication. These data should also be considered for future readjustments of this program and for the developing of new programs.Finally, the two-overview conclusions are: 1) It was possible the feasibility of an integrated care program and initial implementation of this innovative program, for patients with schizophrenia or schizoaffective disorder, with the human and material resources available in the clinical context of the community mental health teams, in a psychiatry and mental health department of the national health service in Portugal; 2) In assessing the impact of the program, the results suggest potential application of this integrated care program, to improve clinical state and psychosocial variables for these patients. There should be done studies to replicate these results, however the results obtained are promising for the development of similar programs at nationally and internationally level, that could benefit a wider group of patients.

Transparency in project bond ratings: Assessment of rating methodologies and development of a proven rating simulator

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Finance from the NOVA ��� School of Business and Economics

How training evaluation can be used to potentiate employee development in an organization

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA ��� School of Business and Economics