Assessing usual dietary intake in complex sample design surveys: the National Dietary Survey

The National Cancer Institute (NCI) method allows the distributions of usual intake of nutrients and foods to be estimated. This method can be used in complex surveys. However, the user must perform additional calculations, such as balanced repeated replication (BRR), in order to obtain standard errors and confidence intervals for the percentiles and mean from the distribution of usual intake. The objective is to highlight adaptations of the NCI method using data from the National Dietary Survey. The application of the NCI method was exemplified analyzing the total energy (kcal) and fruit (g) intake, comparing estimations of mean and standard deviation that were based on the complex design of the Brazilian survey with those assuming simple random sample. Although means point estimates were similar, estimates of standard error using the complex design increased by up to 60% compared to simple random sample. Thus, for valid estimates of food and energy intake for the population, all of the sampling characteristics of the surveys should be taken into account because when these characteristics are neglected, statistical analysis may produce underestimated standard errors that would compromise the results and the conclusions of the survey.

Avaliação do risco cardiovascular numa população da zona Norte do País

As doenças cardiovasculares lideram as causas de mortalidade no mundo e em Portugal. Alguns dos fatores de risco (FR) associados são sexo masculino, idade avançada, hipertensão arterial, hipercolesteremia, tabagismo, obesidade e sedentarismo, cuja sinergia amplifica o risco cardiovascular. Realizou-se um rastreio em indivíduos da região norte de Portugal, com o objetivo de determinar, pela tabela derivada do projeto SCORE, o Risco Cardiovascular Absoluto e o Risco Cardiovascular Relativo e Risco Cardiovascular Absoluto Projetado aos 60 anos. Verificou-se a presença de vários FR na amostra em estudo. A avaliação do risco permite estimar a interação de FR individuais, fundamentando a definição de estratégias interventivas, com potenciais ganhos em saúde.

Effectiveness of motivational interviewing at improving oral health: a systematic review

OBJECTIVE : To analyze the effectiveness of motivational interviewing (MI) at improving oral health behaviors (oral hygiene habits, sugar consumption, dental services utilization or use of fluoride) and dental clinical outcomes (dental plaque, dental caries and periodontal status). METHODS : A systematic search of PubMed, LILACS, SciELO, PsyINFO, Cochrane and Google Scholar bibliographic databases was conducted looking for intervention studies that investigated MI as the main approach to improving the oral health outcomes investigated. RESULTS : Of the 78 articles found, ten met the inclusion criteria, all based on randomized controlled trials. Most studies (n = 8) assessed multiple outcomes. Five interventions assessed the impact of MI on oral health behaviors and nine on clinical outcomes (three on dental caries, six on dental plaque, four on gingivitis and three on periodontal pockets). Better quality of evidence was provided by studies that investigated dental caries, which also had the largest population samples. The evidence of the effect of MI on improving oral health outcomes is conflicting. Four studies reported positive effects of MI on oral health outcomes whereas another four showed null effect. In two interventions, the actual difference between groups was not reported or able to be recalculated. CONCLUSIONS : We found inconclusive effectiveness for most oral health outcomes. We need more and better designed and reported interventions to fully assess the impact of MI on oral health and understand the appropriate dosage for the counseling interventions.

Inconstância, ausência e paradoxo na política para o livro no Estado Novo português

Neste artigo procura-se entender a dúplice forma como o Estado Novo em Portugal lidou com o livro como objecto de acção política. As tentativas de enquadrar o livro como alvo de promoção no sentido de um apoio efectivo e da adopção de medidas correctivas das disfunções do mercado, próprias de uma matriz contemporânea e aberta de sistemas políticos e sociais desenvolvidos, nunca terão verdadeiramente existido durante o período autocrático. Com efeito, desde o seu começo até meados da década de 1950 o regime hesitou entre fórmulas – isoladas – de suporte à edição e à leitura, que não pôde ou não quis consolidar, e opções tendentes a conseguir arregimentar agentes do livro (sobretudo editores e autores) à nunca concretizada literatura oficial do Estado Novo, e que obedecesse aos seus pressupostos. O caminho trilhado parece ter sido, a partir de dado momento, essencialmente o da repressão ao livro, pautando o poder a sua actuação pela ausência de propostas de fomento do mercado editorial e livreiro como as que se verificaram noutros contextos nacionais, inclusive ditatoriais.

Developing persuasive interfaces

MSCC Dissertation in Computer Engineering

Diabetes burden in Brazil: fraction attributable to overweight, obesity, and excess weight

OBJECTIVE To estimate the burden of type 2 diabetes mellitus and its percentage attributable to overweight and obesity in Brazil.METHODS The burden of diabetes mellitus was described in terms of disability-adjusted life years, which is the sum of two components: years of life lost and years lived with disability. To calculate the fraction of diabetes mellitus attributable to overweight, obesity, and excess weight, we used the prevalence of these risk factors according to sex and age groups (> 20 years) obtained from the 2008 Pesquisa Dimensões Sociais das Desigualdades (Social Dimensions of Inequality Survey) and the relative risks derived from the international literature.RESULTS Diabetes mellitus accounted for 5.4% of Brazilian disability-adjusted life years in 2008, with the largest fraction attributed to the morbidity component (years lived with disability). Women exhibited higher values for disability-adjusted life years. In Brazil, 49.2%, 58.3%, and 70.6% of diabetes mellitus in women was attributable to overweight, obesity, and excess weight, respectively. Among men, these percentages were 40.5%, 45.4%, and 60.3%, respectively. Differences were observed with respect to Brazilian regions and age groups.CONCLUSIONS A large fraction of diabetes mellitus was attributable to preventable individual risk factors and, in about six years, the contribution of these factors significant increased, particularly among men. Policies aimed at promoting healthy lifestyle habits, such as a balanced diet and physical activity, can have a significant impact on reducing the burden of diabetes mellitus in Brazil.

Risk of dependence associated with health, social support, and lifestyle

OBJECTIVE To analyze the prevalence of individuals at risk of dependence and its associated factors.METHODS The study was based on data from the Catalan Health Survey, Spain conducted in 2010 and 2011. Logistic regression models from a random sample of 3,842 individuals aged ≥ 15 years were used to classify individuals according to the state of their personal autonomy. Predictive models were proposed to identify indicators that helped distinguish dependent individuals from those at risk of dependence. Variables on health status, social support, and lifestyles were considered.RESULTS We found that 18.6% of the population presented a risk of dependence, especially after age 65. Compared with this group, individuals who reported dependence (11.0%) had difficulties performing activities of daily living and had to receive support to perform them. Habits such as smoking, excessive alcohol consumption, and being sedentary were associated with a higher probability of dependence, particularly for women.CONCLUSIONS Difficulties in carrying out activities of daily living precede the onset of dependence. Preserving personal autonomy and function without receiving support appear to be a preventive factor. Adopting an active and healthy lifestyle helps reduce the risk of dependence.

Bullying among adolescents in a Brazilian urban center – “Health in Beagá” Study

OBJECTIVE To analyze the prevalence of bullying and its associated factors in Brazilian adolescents.METHODS Data were used from a population-based household survey conducted by the Urban Health Observatory (OSUBH) utilizing probability sampling in three stages: census tracts, residences, and individuals. The survey included 598 adolescents (14-17 years old) who responded questions on bullying, sociodemographic characteristics, health-risk behaviors, educational well-being, family structure, physical activity, markers of nutritional habits, and subjective well-being (body image, personal satisfaction, and satisfaction with their present and future life). Univariate and multivariate analysis was done using robust Poisson regression.RESULTS The prevalence of bullying was 26.2% (28.0% among males, 24.0% among females). The location of most bullying cases was at or on route to school (70.5%), followed by on the streets (28.5%), at home (9.8%), while practicing sports (7.3%), at parties (4.6%), at work (1.7%), and at other locations (1.6%). Reports of bullying were associated with life dissatisfaction, difficulty relating to parents, involvement in fights with peers and insecurity in the neighborhood.CONCLUSIONS A high prevalence of bullying among participating adolescents was found, and the school serves as the main bullying location, although other sites such as home, parties and workplace were also reported. Characteristics regarding self-perception and adolescent perceptions of their environment were also associated with bullying, thus advancing the knowledge of this type of violence, especially in urban centers of developing countries.

Algebraic structure for the crossing of balanced and stair nested designs

Stair nesting allows us to work with fewer observations than the most usual form of nesting, the balanced nesting. In the case of stair nesting the amount of information for the different factors is more evenly distributed. This new design leads to greater economy, because we can work with fewer observations. In this work we present the algebraic structure of the cross of balanced nested and stair nested designs, using binary operations on commutative Jordan algebras. This new cross requires fewer observations than the usual cross balanced nested designs and it is easy to carry out inference.

Severity of malocclusion in adolescents: populational-based study in the north of Minas Gerais, Brazil

ABSTRACT OBJECTIVE To identify the factors associated with severity of malocclusion in a population of adolescents. METHODS In this cross-sectional population-based study, the sample size (n = 761) was calculated considering a prevalence of malocclusion of 50.0%, with a 95% confidence level and a 5.0% precision level. The study adopted correction for the effect of delineation (deff = 2), and a 20.0% increase to offset losses and refusals. Multistage probability cluster sampling was adopted. Trained and calibrated professionals performed the intraoral examinations and interviews in households. The dependent variable (severity of malocclusion) was assessed using the Dental Aesthetic Index (DAI). The independent variables were grouped into five blocks: demographic characteristics, socioeconomic condition, use of dental services, health-related behavior and oral health subjective conditions. The ordinal logistic regression model was used to identify the factors associated with severity of malocclusion. RESULTS We interviewed and examined 736 adolescents (91.5% response rate), 69.9% of whom showed no abnormalities or slight malocclusion. Defined malocclusion was observed in 17.8% of the adolescents, being severe or very severe in 12.6%, with pressing or essential need of orthodontic treatment. The probabilities of greater severity of malocclusion were higher among adolescents who self-reported as black, indigenous, pardo or yellow, with lower per capita income, having harmful oral habits, negative perception of their appearance and perception of social relationship affected by oral health. CONCLUSIONS Severe or very severe malocclusion was more prevalent among socially disadvantaged adolescents, with reported harmful habits and perception of compromised esthetics and social relationships. Given that malocclusion can interfere with the self-esteem of adolescents, it is essential to improve public policy for the inclusion of orthodontic treatment among health care provided to this segment of the population, particularly among those of lower socioeconomic status.

Crossing balanced and stair nested desings

Balanced nesting is the most usual form of nesting and originates, when used singly or with crossing of such sub-models, orthogonal models. In balanced nesting we are forced to divide repeatedly the plots and we have few degrees of freedom for the first levels. If we apply stair nesting we will have plots all of the same size rendering the designs easier to apply. The stair nested designs are a valid alternative for the balanced nested designs because we can work with fewer observations, the amount of information for the different factors is more evenly distributed and we obtain good results. The inference for models with balanced nesting is already well studied. For models with stair nesting it is easy to carry out inference because it is very similar to that for balanced nesting. Furthermore stair nested designs being unbalanced have an orthogonal structure. Other alternative to the balanced nesting is the staggered nesting that is the most popular unbalanced nested design which also has the advantage of requiring fewer observations. However staggered nested designs are not orthogonal, unlike the stair nested designs. In this work we start with the algebraic structure of the balanced, the stair and the staggered nested designs and we finish with the structure of the cross between balanced and stair nested designs.

A clinical epidemiologic study in a schistosomiasis mansoni endemic area (Tuparecê, Minas Gerais)

A population-based clinical epidemiologic study on schistosomiasis mansoni was carried out in Tuparecê, Minas Gerais. The patients were interviewed for symptoms, water contact, past history and examined for spleen and liver enlargement. From the 830 people registered in the census, 777 (93.6%) had their stools examined (Kato-Katz method) and 696 (83.9%) were clinically evaluated. The overall index of Schistosoma mansoni infection was 43.2%. Significant and increased infection risks could be detected in the young age group (2-14 years old) regarding occupation, time of residence in the area and frequency of water contact. Bloody stools were significantly more prevalent among positives, while diarrhea was significantly more prevalent among those negative. The area was shown to have a low morbidity as well as a low intensity of infection measured by the number of S. mansoni eggs per gram of feces. A close correlation was found between water contact pattern and the age prevalence curve. It has emphasized the importance of habits in determining prevalence rates, besides suggesting that schistosomiasis mansoni in the area is manifested as a light and somewhat harmless infection with little consequence for the population as a whole.

Veículo ZEV (sem emissões)

A crescente dependência energética do Petr óleo e o impacto ambiental daí resultante, tanto como as excessivas autonomias e desempenho dos veículos perante as nossas necessidades, leva a que Portugal, a Europa, o Mundo, necessitem de apostar em inovar e alterar costumes, de forma a que o nosso planeta se mantenha sustentável e de maneira a aumentar a qualidade de vida de todos nós. As emissões proveniente dos veículos representam uma excessiva parcela na poluição atmosférica causada pela queima dos derivados do petróleo. Uma das soluções mais viáveis para a redução de emissões, passaria pela implementação de leis que fomentassem a compra dos veículos ZEV. Este trabalho pretende provar a inviabilidade do uso contínuo de combustíveis fósseis, destaca as principais características dos veículos eléctricos e os benefícios destes quando comparados com os veículos convencionais, descreve as características dos veículos eléctricos comercializados em Portugal e apresenta a sugestão, com base no estudo elaborado, de um veículo ZEV que se adapte às necessidades do cidadão europeu.

Gestão de instalações eléctricas para optimização do desempenho, eficiência e qualidade de energia em grandes edifícios com integração de Miniprodução

As alterações climáticas e as emissões de CO2 são questões que suscitam a nível internacional e nacional o desenvolvimento de estratégias que atenuem os seus impactes. A Eficiência Energética (EE) é essencial para que num futuro próximo não haja impactes significativos no meio ambiente devido a elevado e ineficiente consumo energético. A União Europeia (UE) e Portugal têm desenvolvido políticas e programas que estimulam a eficiência energética, bem como a diminuição de gases com efeito de estufa (GEE) e a promoção da utilização de fontes de energia renovável. Por outro lado vivemos numa sociedade que passa cerca de 80% do seu tempo em edifícios e, nestes, é consumida 40% da energia mundial. Com uma dependência energética superior a 80%, Portugal tem vindo a apostar, nos últimos anos, em fontes de energia renovável. Esta aposta serve como substituição de fontes, mas não leva directamente à redução de consumos. A redução da factura de energia só pode ser atingida com uma maior eficiência energética e melhores práticas de gestão de energia em edifícios, transportes e industria. Esta dissertação centra-se especificamente num conjunto de edifícios públicos, património municipal da autarquia de Matosinhos, cujo modelo de fornecimento da energia eléctrica é passível de análise crítica no sentido de uma optimização radical ao nível da concepção da rede e exploração, com consequente redução de custos ao nível da facturação. Esta nova metodologia de exploração e gestão de sistemas eléctricos incidirá na criação de um “campus” energético autárquico resultante do novo layout da rede e respectivo fornecimento de energia a partir da rede de distribuição pública. O estudo permitirá fornecer ferramentas fundamentais para a gestão municipal e empresarial ao nível da sustentabilidade energética nos edifícios públicos com abrangência aos serviços empresariais. De referir que a gestão das instalações eléctricas para optimização do desempenho, eficiência e qualidade de energia é aplicável aos 308 municípios nacionais com relevância para as empresas que apresentam consumos significativos nos seus edifícios. Enquanto funcionário da Câmara Municipal de Matosinhos, este município foi uma escolha natural como referência, na análise da relação existente entre a administração local e a gestão da energia. Para ajudar à análise foi efectuado um benchmarketing a cinco edifícios municipais: Edifício dos Paços do Concelho, Biblioteca Municipal Florbela Espanca, Palacete Visconde Trevões, ex-Edifício dos SMAS e Edifício do ex-Tribunal, visando potenciar a correcta gestão de energia destes edifícios por parte das entidades que os gerem, perante novas oportunidades de melhoria e soluções encontradas. Como contributo às metas impostas pela Directiva 2009/28/CE para 2020, a qual prevê uma redução de 20% no consumo final de energia através da eficiência energética, a incorporação de 20% de energia renovável no consumo energético global e a consequente redução em 20% da emissão de GEE, é apresentado um estudo ao nível de um parque fotovoltaico com a componente técnica e económica.

Problemática associada à utilização de diferentes tipos de mochila para transporte de material escolar

O transporte de cargas é uma tarefa comum para crianças, adolescentes e adultos, pela necessidade de transferência diária de objetos pessoais, livros e artigos de papelaria para os locais de trabalho ou escolas. Diversos autores apontam que o peso carregado durante transporte de material é o principal responsável pelo aparecimento de dor lombar. Deste modo é importante o constante estudo da temática para a definição recomendações e limites. O presente estudo teve como principais objetivos a caraterização da problemática associada à utilização de mochilas e a determinação do Peso Máximo Aceitável (PMA) e do Índice de Esforço Percebido (IEP) para a tarefa de transporte de mochilas, através da abordagem psicofísica. O estudo foi desenvolvido com estudantes do 7º, 8º e 9º ano de escolaridade e, foi dividido em duas fases. Na 1ª fase foram aplicados questionários para a análise da problemática associada à utilização de diferentes tipos de mochilas escolares. Nesta fase, foram incluídos aspetos associados à identificação do tipo de mochila mais utilizada, as rotinas e hábitos dos estudantes e as características da mochila utilizada. Verificou-se que os estudantes utilizam, maioritariamente, a mochila de duas alças para transporte de material escolar. Posteriormente foram efetuadas medições de peso da mochila, altura e peso aos 131 estudantes que constituíram a amostra da 1º fase. O principal objetivo deste ponto foi identificar o tipo de mochila habitualmente utilizada pelos estudantes assim como, o peso transportado nas mochilas. Na 2ª fase foi efetuado um estudo para a determinação do PMA e do IEP, através da abordagem psicofísica, para a tarefa de transporte de mochila, considerando-se uma amostra constituída por 10 estudantes. Para este estudo, apenas foi considerada a mochila mais frequentemente utilizada, identificada na 1º fase. A tarefa consistiu no transporte da mochila nos dois ombros e com as alças devidamente ajustadas ao corpo, num percurso pré-definido, de acordo com o procedimento experimental. Os resultados indicaram que nem todos os estudantes transportam mochilas com pesos dentro das recomendações da Organização Mundial de Saúde. O PMA determinado pelos estudantes foi de 6.8 kg para a mochila de duas alças e a região dos ombros foi identificada durante todo o estudo como sendo a que apresentava maior intensidade de dor durante o transporte da mochila.