Web-assisted tobacco intervention in Portuguese : intentions to make behavioural changes and behavioural changes

ABSTRACT - The problem of how to support ���intentions to make behavioural changes��� (IBC) and ���behaviour changes��� (BC) in smoking cessation when there is a scarcity of resources is a pressing issue in public health terms. The present research focuses on the use of information and communications technologies and their role in smoking cessation. It is developed in Portugal after the ratification of WHO Framework Convention on Tobacco Control (on 8 November 2005). The prevalence of smokers over fifteen years of age within the population stood at 20.9% (30.9% for men and 11.8% for women). While the strategy of helping people to quit smoking has been emphasised at National Health Service (NHS) level, the uptake of cessation assistance has exceeded the capacity of the service. This induced the search of new theoretical and practical venues to offer alternative options to people willing to stop smoking. Among these, the National Health Plan (NHP) of Portugal (2004-2010), identifies the use of information technologies in smoking cessation. eHealth and the importance of health literacy as a means of empowering people to make behavioural changes is recurrently considered an option worth investigating. The overall objective of this research is to understand, in the Portuguese context, the use of the Internet to help people to stop smoking. Research questions consider factors that may contribute to ���intentions to make behavioural changes��� (IBC) and ���behavioural changes��� (BC) while using a Web-Assisted Tobacco Intervention Probe (WATIP). Also consideration is given to the trade-off on the use of the Web as a tool for smoking cessation: can it reach a vast number of people for a small cost (efficiency) demonstrating to work in the domain of smoking cessation (efficacy)���? In addition to the introduction, there is a second chapter in which the use of tobacco is discussed as a public health menace. The health gains achieved by stopping smoking and the means of quitting are also examined, as is the use of the Internet in smoking cessation. Then, several research issues are introduced. These include background theory and the theoretical framework for the Sense of Coherence. The research model is also discussed. A presentation of the methods, materials and of the Web-Assisted Tobacco Intervention Probe (WATIP) follows. In chapter four the results of the use of the Web-Assisted Tobacco Intervention Probe (WATIP) are presented. This study is divided into two sections. The first describes results related to quality control in relation to the Web-Assisted Tobacco Intervention Probe (WATIP) and gives an overview of its users. Of these, 3,150 answered initial eligibility questions. In the end, 1,463 met all eligibility requirements, completed intake, decided on a day to quit smoking (Dday) and declared their ���intentions to make behavioural changes��� (IBC) while a second targeted group of 650 did not decide on a Dday. With two quit attempts made before joining the platform, most of the participants had experienced past failures while wanting to stop. The smoking rate averaged 21 cigarettes per day. With a mean age of 35, of the participants 55% were males. Among several other considerations, gender and the Sense of Coherence (SOC) influenced the success of participants in their IBC and endeavour to set quit dates. The results of comparing males and females showed that, for current smokers, establishing a Dday was related to gender differences, not favouring males (OR=0.76, p<0.005). Belonging to higher Socio-economic strata (SES) was associated with the intention to consider IBC (when compared to lower SES condition) (OR=1.57, p<0.001) and higher number of school years (OR=0.70, p<0.005) favoured the decision to smoking cessation. Those who demonstrated higher confidence in their likelihood of success in stopping in the shortest time had a higher rate of setting a Dday (OR=0.51, p<0.001). There were differences between groups in IBC reflecting the high and low levels of the SOC score (OR=1.43, p=0.006), as those who considered setting a Dday had higher levels of SOC. After adjusting for all variables, stages of readiness to change and SOC were kept in the model. This is the first Arm of this research where the focus is a discussion of the system���s implications for the participants��� ���intentions to make behavioural changes��� (IBC). Moreover, a second section of this study (second Arm) offers input collected from 77 in-depth interviews with the Web-Assisted Tobacco Intervention Probe (WATIP) users. Here, ���Behaviour Change��� (BC) and the usability of the platform are explored a year after IBC was declared. A percentage of 32.9% of self-reported, 12-month quitters in continuous abstinence from smoking from Dday to the 12-month follow- up point of the use of the Web-Assisted Tobacco Intervention Probe (WATIP) has been assessed. Comparing the Sense of Coherence (SOC) scores of participants by their respective means, according to the two groups, there was a significant difference in these scores of non smokers (BC) (M=144,66, SD=22,52) and Sense of Coherence (SOC) of smokers (noBC) (M=131,51, SD=21,43) p=0.014. This WATIP strategy and its contents benefit from the strengthening of the smoker���s sense of coherence (SOC), so that the person���s progress towards a life without tobacco may be experienced as comprehensible, manageable and meaningful. In this sample the sense of coherence (SOC) effect is moderate although it is associated with the day to quit smoking (Dday). Some of the limitations of this research have to do with self-selection bias, sample size (power) and self-reporting (no biochemical validation). The enrolment of participants was therefore not representative of the smoking population. It is not possible to verify the Web-Assisted Tobacco Intervention Probe (WATIP) evaluation of external validity; consequently, the results obtained cannot be applied generalized. No participation bias is provided. Another limitation of this study is the associated limitations of interviews. Interviewees��� perception that fabricating answers could benefit them more than telling the simple truth in response to questions is a risk that is not evaluated (with no external validation like measuring participants��� carbon monoxide levels). What emerges in this analysis is the relevance of the process that leads to the establishment of the quit day (Dday) to stop using tobacco. In addition, technological issues, when tailoring is the focus, are key elements for scrutiny. The high number of dropouts of users of the web platform mandates future research that should concentrate on the matters of the user-centred design of portals. The focus on gains in health through patient-centred care needs more research, so that technology usability be considered within the context of best practices in smoking cessation.

Impairment of tangible fixed assets in the Portuguese listed companies: Disclosures

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

ANA, SA: A risk management approach

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

Food waste valorization through the production of polyhydroxyalkanoates by mixed microbial cultures

Disserta����o para obten����o do Grau de Mestre em Engenharia Qu��mica e Bioqu��mica

Functional and structural studies of two enzymes: membrane bound kinase and Z-DNA/Z-RNA-binding protein

Disserta����o para obten����o do Grau de Doutor em Sistemas de Bioengenharia

Fostering virtual teams: what companies could and should be doing

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

Internationalization strategy of Origama to Brazil

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

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

Opening Pousada da Serra da Estrela in Covilh��: A two-way impact analysis - Interacting with public agents

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

A CMMI-compliant requirements management and development process

Requirements Engineering has been acknowledged an essential discipline for Software Quality. Poorly-defined processes for eliciting, analyzing, specifying and validating requirements can lead to unclear issues or misunderstandings on business needs and project���s scope. These typically result in customers��� non-satisfaction with either the products��� quality or the increase of the project���s budget and duration. Maturity models allow an organization to measure the quality of its processes and improve them according to an evolutionary path based on levels. The Capability Maturity Model Integration (CMMI) addresses the aforementioned Requirements Engineering issues. CMMI defines a set of best practices for process improvement that are divided into several process areas. Requirements Management and Requirements Development are the process areas concerned with Requirements Engineering maturity. Altran Portugal is a consulting company concerned with the quality of its software. In 2012, the Solution Center department has developed and applied successfully a set of processes aligned with CMMI-DEV v1.3, what granted them a Level 2 maturity certification. For 2015, they defined an organizational goal of addressing CMMI-DEV maturity level 3. This MSc dissertation is part of this organization effort. In particular, it is concerned with the required process areas that address the activities of Requirements Engineering. Our main goal is to contribute for the development of Altran���s internal engineering processes to conform to the guidelines of the Requirements Development process area. Throughout this dissertation, we started with an evaluation method based on CMMI and conducted a compliance assessment of Altran���s current processes. This allowed demonstrating their alignment with the CMMI Requirements Management process area and to highlight the improvements needed to conform to the Requirements Development process area. Based on the study of alternative solutions for the gaps found, we proposed a new Requirements Management and Development process that was later validated using three different approaches. The main contribution of this dissertation is the new process developed for Altran Portugal. However, given that studies on these topics are not abundant in the literature, we also expect to contribute with useful evidences to the existing body of knowledge with a survey on CMMI and requirements engineering trends. Most importantly, we hope that the implementation of the proposed processes��� improvements will minimize the risks of mishandled requirements, increasing Altran���s performance and taking them one step further to the desired maturity level.

O contributo da farm��cia comunit��ria no envelhecimento ativo

RESUMO: A popula����o mundial est�� a envelhecer de forma sustentada. O setor das farm��cias em Portugal est�� a passar por um conjunto de altera����es que conduzir�� a uma a����o mais interventiva ao n��vel da presta����o de cuidados de sa��de. Deste modo delineou-se um estudo descritivo, transversal e explorat��rio sem interven����o, de car��cter qualitativo e quantitativo que compara diferentes grupos et��rios com o objectivo de compreender melhor o papel do farmac��utico no ��mbito do envelhecimento das popula����es. Pretendemos assim optimizar pr��ticas e servi��os que podem ser realizados nas farm��cias e alertar os utentes, para gerir melhor a sua condi����o de sa��de, sensibilizando-os para o pr��prio processo de envelhecimento. Como principais resultados destacamos o papel de interven����o crucial da farm��cia, quer pela sua acessibilidade quer pela contribui����o que pode ter para a condi����o de sa��de das popula����es. Pela amostra estudada em 100% das farm��cias s��o feitos despistes e controlo da hipertens��o arterial e hipercolesterolemia, factores fundamentais no controlo da aterosclerose e das doen��as cardiovasculares. Podemos ainda concluir que a farm��cia pode ser o elemento de otimiza����o, revis��o e reconcilia����o das terap��uticas dos resistentes em lares e ao domic��lio, junto da popula����o 65+. Em termos das pessoas idosas, o nosso estudo indicia que, apesar da crise s��cio econ��mica dos ��ltimos anos, continuam a tomar os medicamentos mais essenciais, o que se relaciona com a pol��tica do medicamento implementada. Este trabalho pretende tamb��m, contribuir para o desenvolvimento de uma rede de compet��ncias da farm��cia ao n��vel do envelhecimento ativo, podendo ser uma oportunidade futura.--------------ABSTRACT: World population is getting older in a sustained way. Portuguese community pharmacies are going through a change process, leading to a higher intervention in healthcare delivery. The study designed is descriptive, transversal and exploratory, with no intervention, with a qualitative and quantitative component that compares different age groups. The purpose is to better understand pharmacists��� role in population aging. One of our main goals is to optimize practices and services with potential to be performed in pharmacies and aware patients to better manage their health, becoming more conscious of their aging process. As main results we highlight the intervention of pharmacies, not only by its accessibility but also sustained on the unique contribution pharmacies deliver in the best benefit of populations��� health condition. In the sample studied, 100% of pharmacies perform screening and vigilance of hypertension and hypercholesterolemia, essential for the control of atherosclerosis and cardiovascular diseases. We may also determine the importance of pharmacies intervention over therapeutics optimization, revision and reconciliation in nursing homes and in domicile, mostly focusing patients over 65. In what concerns to elderly population our study indicates that, despite social and economic crises of recent years, the elderly keeps taking its essential medicines, which is related with medicines politics implemented at the present moment. This project intends to pay a relevant contribution to the development of a group of core competencies in pharmacies, related to the promotion of an active and healthy aging process, which represents an important future opportunity for Portuguese Pharmacies.

On an organizational level: How can the emergency department at Rouge Valley Centenary hospital improve their wait times?

The prolonged wait times may arguably put into question the Canadian Health Act of 1984. Statistics show throughput wait times are 5.5 hours and output wait times for admitted patients are 32.4 hours. After probing and analyzing best practices through a qualitative/quantitative Value Stream Mapping and a qualitative SWOT Analysis; Team Triage and an Overcapacity Protocol is suggested to improve non-admitted patients wait times by 1.89 hours and admitted patients wait times by 16 hours by eliminating wasteful steps in the patient process and upon overcapacity, effectively sharing already stabilized and admitted patients with all wards in the hospital.

The economics of Vieira da Silva

This paper investigates the time valuation and the age valuation profile of art-works created by the Portuguese female painter Maria Helena Vieira da Silva. It uses data from records from her paintings auction sales between 1986 and 2014, taken from Artprice.com. The study explores three aspects regarding her artistic career: (1) estimation of Age-valuation profile, defining her creativity pattern and the age at which she produced her most valuable paintings; (2) estimation of time valuation profile, through a creation of an individual hedonic price index for Vieira da Silva; (3) internationalization phenomenon of the artist, investigating whether selling prices are primarily set in euros or in US dollar. The results suggest that Vieira da Silva peaked quite early in her career; her paintings prices are not very sensible to economic cycles and tends to slightly increase afterlife; the empirical results are not suggestive on which currency is the best predictor of her paintings��� price.

Launching platforms for user-generated content

Field lab: Entrepreneurial and innovative ventures

Measuring social impact: A guideline to implement a tableau de bord

Many impact-seeking organisations cannot measure and demonstrate their social impact because they either lack technical expertise or requisite financial and human resources. This report clarifies the process of social impact measurement to help these organisations engage in social impact measurement practices. It presents a simple guideline to create a measurement approach based on the Tableau de Board. The guideline has been developed through a theoretical revision of best practices in social impact measurement, academic research and the author's individual thoughts and ideas. While a first testing of the approach revealed positive feedback, only future broad-scale testing will demonstrate the approach���s validity and feasibility.