The universal newborn hearing screening in Brazil: From identification to intervention

Objective: The objective of the study is to investigate the results of the newborn hearing screening program carried out in a Public Hospital in Brazil, in the first 3 years regarding: (1) the prevalence of hearing impairment; (2) the influence of the universal hearing screening program on the age at which the diagnosis of hearing loss is defined; (3) the cost effectiveness of the program; (4) the outcomes, in terms of the age in which the hearing rehabilitation started. Methods: A descriptive study of the first 3 years after starting the universal newborn hearing screening in a Public Hospital of Bauru, Sao Paulo state, Brazil. The screening method consists of a two-stage screening approach with transient otoacoustic emissions (TOAE), conducted by an audiologist. If the outcome in the second-stage screening is REFER, the infant is submitted to diagnostic follow-up testing and intervention at the Audiology and Speech Pathology Clinic at the University of Sao Paulo, campus of Bauru. The evaluation of the costs of the universal newborn hearing screening program per each screened newborn (around 4000/year) was done based on a proposal by the National Center for Hearing Assessment and Management, of the Utah State University, United States of America. Results: 11,466 newborns were submitted to hearing screening, corresponding to 90.52% of the living newborns. The prevalence of sensorineural hearing loss was 0.96:1000. Of the 11 children with sensorineural hearing loss, eight children received hearing aids and five started the therapeutic process before the age of 1. Currently, four children between the ages of 11 months and 2 years old were submitted to cochlear implant surgery. The cost of hearing screening was US$7.00 and the annual cost of the universal newborn hearing screening program was US$26,940.47. Conclusion: The hospital-based universal newborn hearing screening carried out through the Brazilian National Health System is viable, with promising results. However, in a country such as Brazil, which presents large socio-economic differences, the same type of analyses should be performed in several regions, so as to take into account specific aspects, to implement the newborn hearing screening along with the Public System. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

The future of cognitive and behavioral therapies in the prevention and early management of psychosis: Opportunities and risks

Behavioral and cognitive interventions for people with psychosis have a long and distinguished history, although the evidence for their application to young people remains limited. We anticipate that the next decades will show substantial research into psychological intervention for this population. Important targets will include the management of environmental stressors, reduction of substance misuse, and promotion of early treatment. Psychological management of positive symptoms, depression, and suicidal behavior will continue to be critical objectives. Important secondary prevention goals will be the retention of cognitive functioning, vocational options, social skills, and social network support, including appropriate family support. We expect primary prevention to include both universal programs and interventions for adolescents at particularly high risk. Technical innovations will include increasing use of Internet-based intervention and behavior cueing devices. Pressures for intervention brevity will continue, as will problems with the systematic delivery of effective procedures.

Managing the Brisbane River and Moreton Bay: an integrated research/management program to reduce impacts on an Australian estuary

The Brisbane River and Moreton Bay Study, an interdisciplinary study of Moreton Bay and its major tributaries, was initiated to address water quality issues which link sewage and diffuse loading with environmental degradation. Runoff and deposition of fine-grained sediments into Moreton Bay, followed by resuspension, have been linked with increased turbidity and significant loss of seagrass habitat. Sewage-derived nutrient enrichment, particularly nitrogen (N), has been linked to algal blooms by sewage plume maps. Blooms of a marine cyanobacterium, Lyngbya majuscula, in Moreton Bay have resulted in significant impacts on human health (e.g., contact dermatitis) and ecological health (e.g., seagrass loss), and the availability of dissolved iron from acid sulfate soil runoff has been hypothesised. The impacts of catchment activities resulting in runoff of sediments, nutrients and dissolved iron on the health of the Moreton Bay waterways are addressed. The Study, established by 6 local councils in association with two state departments in 1994, forms a regional component of a national and state program to achieve ecologically sustainable use of the waterways by protecting and enhancing their health, while maintaining economic and social development. The Study framework illustrates a unique integrated approach to water quality management whereby scientific research, community participation and the strategy development were done in parallel with each other. This collaborative effort resulted in a water quality management strategy which focuses on the integration of socioeconomic and ecological values of the waterways. This work has led to significant cost savings in infrastructure by providing a clear focus on initiatives towards achieving healthy waterways. The Study's Stage 2 initiatives form the basis for this paper.

Brief opportunistic intervention: The role of psychologists in initiating self-change amongst problem drinkers

Excessive consumption of alcohol is a serious public health problem. While intensive treatments are suitable for those who are physically dependent on alcohol, they are not cost-effective options for the vast majority of problem drinkers who are not dependent. There is good evidence that brief interventions are effective in reducing overall alcohol consumption, alcohol-related problems, and health-care utilisation among nondependent problem drinkers. Psychologists are in an ideal position to opportunistically detect people who drink excessively and to offer them brief advice to reduce their drinking. In this paper we outline the process involved in providing brief opportunistic screening and intervention for problem drinkers. We also discuss methods that psychologists can employ if a client is not ready to reduce drinking, or is ambivalent about change. Depending on the client's level of motivation to change, psychologists can engage in either an education-clarification approach, a commitment-enhancement approach, or a skills-training approach. Routine engagement in opportunistic intervention is an important public-health approach to reducing alcohol-related harm in the community.

Effectiveness of case management and post-acute services in older people after hospital discharge

Objective: To evaluate the benefits of coordinating community services through the Post-Acute Care (PAC) program in older patients after discharge from hospital. Design: Prospective multicentre, randomised controlled trial with six months of follow-up with blinded outcome measurement. Setting: Four university-affiliated metropolitan general hospitals in Victoria. Participants: All patients aged 65 years and over who were discharged between August 1998 and October 1999 and required community services after discharge. Interventions: Participants were randomly allocated to receive services of a Post-Acute Care (PAC) coordinator (intervention) versus usual discharge planning (control). Main outcome measures: Comparison of quality of life and carer stress at one-month post-discharge, mortality, hospital readmissions, use of community services and community and hospital costs over the six months post-discharge. Results: 654 patients were randomised, and 598 were included in the analysis (311 in the PAC group and 287 in the control group). There was no difference in mortality between the groups (both 6%), but significantly greater overall quality-of-life scores at one-month follow-up in the PAC group. There was no difference in unplanned readmissions, but PAC patients used significantly fewer hospital bed-days in the six months after discharge (mean, 3.0 days; 95% CI, 2.1-3.9) than control patients (5.2 days; 95% CI, 3.8-6.7). Total costs (including hospitalisation, community services and the intervention) were lower in the PAC than the control group (mean difference, $1545; 95% CI, $11-$3078). Conclusions: The PAC program is beneficial in the transition from hospital to the community in older patients.

Analysis of mediation and reciprocal effects of changes in weight, self-esteem, and exercise in a behavioral weight loss treatment

Improving the treatment of obesity remains a critical challenge. Several health behaviour change models, often based on a social-cognitive framework, have been used to design weight management interventions (Baranowski et al., 2003). However, most interventions have only produced modest weight reductions (Wadden et al., 2002) and socialcognitive variables have shown limited power to predict weight outcomes (Palmeira et al., 2007). Other predictors, and possibl alte nati e e planatory models, are needed to better understand the mechanisms by which weight loss and other obesity treatment-outcomes are brought about (Baranowski, 2006). Self-esteem is one of these possible mechanisms, because is commonly reported to change during the treatment, although these changes are not necessarily associated with weight loss (Blaine et al., 2007; Maciejewski et al., 2005). This possibility should be more evident if the program integrates regular exercise, as it promotes improvements in subjective well-being (Biddle & Mutrie, 2001), with possible influences on long-term behavioral adherence (e.g. diet, exercise). Following the reciprocal effects model tenets (Marsh & Craven, 2006), we expect that the influences between changes in weight, selfesteem and exercise to be reciprocal and might present one of the mechanisms by which obesity treatments can be improved.

Meta-heuristics self-configuration for scheduling

Scheduling resolution requires the intervention of highly skilled human problemsolvers. This is a very hard and challenging domain because current systems are becoming more and more complex, distributed, interconnected and subject to rapidly changing. A natural Autonomic Computing evolution in relation to Current Computing is to provide systems with Self-Managing ability with a minimum human interference. This paper addresses the resolution of complex scheduling problems using cooperative negotiation. A Multi-Agent Autonomic and Meta-heuristics based framework with self-configuring capabilities is proposed.

Psychological well-being and perception of disease severity in people with multiple sclerosis, who underwent a program of self-regulation to promote physical activity

Rehabilitation is very important for in the results of treatment in individuals with multiple sclerosis. Rehabilitation processes occur through gradual changes. These changes integrate intrinsic and extrinsic mechanisms of the individual, promoting adaptations to the needs and activities of daily living according to individual goals. Recommendations for exercise in multiple sclerosis: these recommendations apply only to patients with EDSS less than 7; moderate intensity aerobic exercise for a total of 20 to 30 minutes, twice or three times for week; the resistance training with low or moderate intensity is well tolerated by patients with MS; associated with these exercises were recommended flexibility exercises of moderate intensity, as well as strengthening exercises. The aim of this study is to examine the implications of the program of self-regulation in the perception of illness and mental health (psychological well-being domain) in multiple sclerosis patients.

Lean and quality management integration: improvement program implementation in a service company

Lean Thinking is an important pillar in the success of any program of continuous improvement process. Its tools are useful means in the analysis, control and organization of important data for correct decision making in organizations. This project had as main objective the design of a program of quality improvement in Eurico Ferreira, S.A., based on the evaluation of customer satisfaction and the implementation of 5S. Subsequently, we have selected which business area of the company to address. After the selection, there was an initial diagnostic procedure, identifying the various points of improvement to which some tools of Lean Thinking have been applied, in particular Value Stream Mapping and 5S methodology. With the first, we were able to map the current state of the process in which all stakeholders were represented as well as the flow of materials and information throughout the process. The 5S methodology allowed to act on the wastage, identifying and implementing various process improvements.

Enhancing physical activity coaching through personalized motivational strategies and self-adaptive goal-setting: development of self-adaptive processes in a monitoring and coaching smartphone application

Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica

Relatório de estágio realizado na Escola Secundária José Gomes Ferreira

Para a grande maioria dos professores, tornarem-se melhores profissionais passa pelo alcance máximo de sucesso pelos seus alunos (Guskey, 2002), sendo este o principal foco deste relatório. A interligação entre as quatro áreas de intervenção do estágio pedagógico, permite potencializar cada uma. A reflexão sobre o desenvolvimento pessoal e profissional enquanto professora estagiária tendo em conta um sentimento de auto-eficácia positivo (Jardim & Onofre, 2009) e uma inteligência emocial (Mouton, Hansenne, Delcour & Coles, 2013) foi fundamental para contribuir para uma gestão correta da sala de aula através do modelo ecológico (Hastie e Siedentop, 1999) em conjunto com as 4 dimensões de uma intervenção pedagógico de sucesso (Sidentop, 1983; citado por Onofre, 1995). Tornando-se essencial entender a evolução e as diferenças entre os alunos por ser o centro do processo de ensino-aprendizagem. Assim, o trabalho do professor, começa muito antes do espaço de sala de aula (Fentermacher & Soltis, 1986). A comunidade escolar da Escola Secundária José Gomes Ferreira, compreende que a disciplina tem benefícios educacionais, mas nem sempre a consegue suportar. Assim, é necessário promover experiências positivas no 1º ciclo, de forma a desenvolver atitudes positivas face à Educação Física.

Mise en place d'un programme de prévention et de prise en charge du diabète en Suisse: le point de vue des patients et des professionnels de la santé [Implementation of a diabetes disease management program in Switzerland: patients' and healthcare professionals' point of view].

BACKGROUND: A reorganization of healthcare systems is required to meet the challenge of the increasing prevalence of chronic diseases, e.g. diabetes. In North-America and Europe, several countries have thus developed national or regional chronic disease management programs. In Switzerland, such initiatives have only emerged recently. In 2010, the canton of Vaud set up the "Diabetes Cantonal Program", within the framework of which we conducted a study designed to ascertain the opinions of both diabetic patients and healthcare professionals on the elements that could be integrated into this program, the barriers and facilitators to its development, and the incentives that could motivate these actors to participate. METHODS: We organized eight focus-groups: one with diabetic patients and one with healthcare professionals in the four sanitary areas of the canton of Vaud. The discussions were recorded, transcribed and submitted to a thematic content analysis. RESULTS: Patients and healthcare professionals were rather in favour of the implementation of a cantonal program, although patients were more cautious concerning its necessity. All participants envisioned a set of elements that could be integrated to this program. They also considered that the program could be developed more easily if it were adapted to patients' and professionals' needs and if it used existing structures and professionals. The difficulty to motivate both patients and professionals to participate was mentioned as a barrier to the development of this program however. Quality or financial incentives could therefore be created to overcome this potential problem. CONCLUSION: The identification of the elements to consider, barriers, facilitators and incentives to participate to a chronic disease management program, obtained by exploring the opinions of patients and healthcare professionals, should favour its further development and implementation.