Determinants of salivary cotinine level: a population-based study in Brazil

OBJECTIVE: A cross-sectional population-based study was conducted to assess, in active smokers, the relationship of number of cigarettes smoked and other characteristics to salivary cotinine concentrations. METHODS: A random sample of active smokers aged 15 years or older was selected using a stepwise cluster sample strategy, in the year 2000 in Rio de Janeiro, Brazil. The study included 401 subjects. Salivary cotinine concentration was determined using gas chromatography with nitrogen-phosphorus detection. A standard questionnaire was used to collect demographic and smoking behavioral data. The relation between the number of cigarettes smoked in the last 24h and cotinine level was examined by means of a nonparametric fitting technique of robust locally weighted regression. RESULTS: Significantly (p<0.05) higher adjusted mean cotinine levels were found in subjects smoking their first cigarette within five minutes after waking up, and in those smoking 1-20 cigarettes in the last 24h who reported inhaling more than ½ the time. In those smoking 1-20 cigarettes, the slope was significantly higher for those subjects waiting for more than five minutes before smoking their first cigarette after waking up, and those smoking "light" cigarettes when compared with their counterparts. These heterogeneities became negligible and non-significant when subjects with cotinine >40 ng/mL per cigarette were excluded. CONCLUSIONS: There was found a positive association between self-reporting smoking five minutes after waking up, and inhaling more than ½ the time are consistent and higher cotinine levels. These can be markers of dependence and higher nicotine intake. Salivary cotinine proved to be a useful biomarker of recent smoking and can be used in epidemiological studies and smoking cessation programs.

Assessment of genotoxicity in oral epithelial cells of health professionals occupationally exposed to ionizing radiations

Dissertação de Mestrado em Ambiente, Saúde e Segurança.

Housing conditions as a social determinant of low birthweight and preterm low birthweight

OBJECTIVE: To assess the relationship between housing conditions and low birthweight and preterm low birthweight among low-income women. METHODS: A case-control study was conducted with post-partum women living in the city of Rio de Janeiro, Southeast Brazil, in 2003-2005. Two groups of cases, low birthweight (n=96) and preterm low birthweight infants (n=68), were compared against normal weight term controls (n=393). Housing conditions were categorized into three levels: adequate, inadequate, and highly inadequate. Covariates included sociodemographic and anthropometric characteristics, risk behaviors, violence, anxiety, satisfaction during pregnancy, obstetric history and prenatal care. RESULTS: Poor housing conditions was independently associated with low birthweight (inadequate - OR 2.3 [1.1;4.6]; highly inadequate - OR 7.6 [2.1;27.6]) and preterm low birthweight (inadequate - OR 2.2 [1.1;4.3]; highly inadequate - OR 7.6 [2.4;23.9]) and factors associated with outcomes were inadequate prenatal care and previous preterm birth. Low income and low maternal body mass index remained associated with low birthweight. CONCLUSIONS: Poor housing conditions were associated with low birthweight and preterm low birthweight.

Ecological footprint as an indicator of sustainability at Lisbon School of Health Technology, Portugal

Higher education institutions, has an active role in the development of a sustainable future and for this reason, it is essential that they became environmentally sustainable institutions, applying methods such as the Ecological Footprint analysis. This study intent is to strengthen the potential of the ecological footprint as an indicator of the sustainability of students of Lisbon School of Health Technology, and identify the relationship between the ecological footprint and the different socio-demographic variables.

Carbon footprint of the academic community of Lisbon School of Health Technology, Portugal

According to the Intergovernmental Panel on Climate Change, the average temperature of the Earth's surface has risen about 1º C in the last 100 years and will increase, depending on the scenario emissions of Greenhouse Gases. The rising temperatures could trigger environmental effects like rising sea levels, floods, droughts, heat waves, hurricanes. With growing concerns about different environmental issues and the need to address climate change, institutions of higher education should create knowledge and integrate sustainability into teaching programs and research programs, as well as promoting environmental issues for society. The aim of this study is to determine the carbon footprint of the academic community of Lisbon School of Health Technology (ESTeSL) in 2013, identifying possible links between the Carbon Footprint and the different socio-demographic variables.

Short Assessment of Health Literacy for Portuguese-speaking Adults

OBJECTIVE: To develop and validate a short health literacy assessment tool for Portuguese-speaking adults. METHODS: The Short Assessment of Health Literacy for Portuguese-speaking Adults is an assessment tool which consists of 50 items that assess an individual's ability to correctly pronounce and understand common medical terms. We evaluated the instrument's psychometric properties in a convenience sample of 226 Brazilian older adults. Construct validity was assessed by correlating the tool scores with years of schooling, self-reported literacy, and global cognitive functioning. Discrimination validity was assessed by testing the tool's accuracy in detecting inadequate health literacy, defined as failure to fully understand standard medical prescriptions. RESULTS: Moderate to high correlations were found in the assessment of construct validity (Spearman's coefficients ranging from 0.63 to 0.76). The instrument showed adequate internal consistency (Cronbach's alpha=0.93) and adequate test-retest reliability (intraclass correlation coefficient=0.95). The area under the receiver operating characteristic curve for detection of inadequate health literacy was 0.82. A version consisting of 18 items was tested and showed similar psychometric properties. CONCLUSIONS: The instrument developed showed good validity and reliability in a sample of Brazilian older adults. It can be used in research and clinical settings for screening inadequate health literacy.

Towards a Unified Theory of Health-Disease: I. Health as a complex model-object

Theory building is one of the most crucial challenges faced by basic, clinical and population research, which form the scientific foundations of health practices in contemporary societies. The objective of the study is to propose a Unified Theory of Health-Disease as a conceptual tool for modeling health-disease-care in the light of complexity approaches. With this aim, the epistemological basis of theoretical work in the health field and concepts related to complexity theory as concerned to health problems are discussed. Secondly, the concepts of model-object, multi-planes of occurrence, modes of health and disease-illness-sickness complex are introduced and integrated into a unified theoretical framework. Finally, in the light of recent epistemological developments, the concept of Health-Disease-Care Integrals is updated as a complex reference object fit for modeling health-related processes and phenomena.

Towards a unified theory of health-disease: II. Holopathogenesis

This article presents a systematic framework for modeling several classes of illness-sickness-disease named as Holopathogenesis. Holopathogenesis is defined as processes of over-determination of diseases and related conditions taken as a whole, comprising selected facets of the complex object Health. First, a conceptual background of Holopathogenesis is presented as a series of significant interfaces (biomolecular-immunological, physiopathological-clinical, epidemiological-ecosocial). Second, propositions derived from Holopathogenesis are introduced in order to allow drawing the disease-illness-sickness complex as a hierarchical network of networks. Third, a formalization of intra- and inter-level correspondences, over-determination processes, effects and links of Holopathogenesis models is proposed. Finally, the Holopathogenesis frame is evaluated as a comprehensive theoretical pathology taken as a preliminary step towards a unified theory of health-disease.

Prevalence of health promotion programs in primary health care units in Brazil

OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil.

Socioeconomic inequalities in the access to and quality of health care services

OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days) for assistance, and waiting time (in hours) in lines. We used Poisson regression for the crude and adjusted analyses. RESULTS The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status. CONCLUSIONS Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.

Relationship of health workers with their organization and work: a cross-cultural study

ABSTRACT We analyzed the differences, by Student’s t-test and ANOVA, between nurses and physicians from Portugal, Poland, Spain, and United Kingdom regarding their relationship with their work and organization. In total, 1,401 professionals answered the HSA-QHPR questionnaire. There are different levels of connection between physicians and nurses. The United Kingdom has the lowest levels of connection with the work while Portugal has the highest levels of relationship with the organization. The results provide guidelines for the development of policies and differential strategies aimed at improving the quality of healthcare service.

The determinants of trade credit: a study of portuguese industrial companies

Despite the relevance of trade credit as a source of business financing, the topic is far from being considered exhausted, especially because there is no general and integrated theory explaining the causes and consequences of trade credit.Our research aims to contribute towards the literature that studies the determinants for granting and receiving trade credit. In this sequence, the present study seeks to empirically test some theories about the reasons why companies grant and receive commercial credit. For this purpose we apply a fixed effect model to a panel of 11 040 Portuguese industrial companies, of which 360 are large companies and the majority 10 680 are Small and Medium Enterprises (SME) for the period between 2003 and 2009. We conclude that large companies (with greater access to credit market) serve as financial intermediaries to their clients with less access to finance. In addition, it was observed that the supplier companies use trade credit as a legal means of price discrimination. Finally, financially constrained enterprises, especially in times of financial crisis, use commercial credit as an alternative source of funding, endorsing the hypothesis of substitution between trade credit and bank credit.

Promotion of gender equality and social inclusion of unemployed groups in Portuguese European Founds Frameworks (1990-2007): overview and critical reflection

Comunicação apresentada no 38º Congresso Mundial do Instituto Internacional de Sociologia, em Budapeste, Hungria, de 26 a 30 de Junho de 2008.

Maximizing the Social Welfare of Virtual Power Players Operation in Case of Excessive Wind Power

The integration of growing amounts of distributed generation in power systems, namely at distribution networks level, has been fostered by energy policies in several countries around the world, including in Europe. This intensive integration of distributed, non-dispatchable, and natural sources based generation (including wind power) has caused several changes in the operation and planning of power systems and of electricity markets. Sometimes the available non-dispatchable generation is higher than the demand. This generation must be used; otherwise it is wasted if not stored or used to supply additional demand. New policies and market rules, as well as new players, are needed in order to competitively integrate all the resources. The methodology proposed in this paper aims at the maximization of the social welfare in a distribution network operated by a virtual power player that aggregates and manages the available energy resources. When facing a situation of excessive non-dispatchable generation, including wind power, real time pricing is applied in order to induce the increase of consumption so that wind curtailment is minimized. This method is especially useful when actual and day-ahead resources forecast differ significantly. The distribution network characteristics and concerns are addressed by including the network constraints in the optimization model. The proposed methodology has been implemented in GAMS optimization tool and its application is illustrated in this paper using a real 937-bus distribution network with 20.310 consumers and 548 distributed generators, some of them non-dispatchable and with must take contracts. The implemented scenario corresponds to a real day in Portuguese power system.