Distribution of hepatitis B infection in Brazil: the epidemiological situation at the beginning of the 21 st century

Abstract Brazil was formerly considered a country with intermediate hepatitis B endemicity, with large heterogeneity between Brazilian regions and areas of high prevalence, especially in the Amazon basin. Systematic vaccination of children was initiated in 1998. Between 2004 and 2009, a large population-based study reported decreased prevalence in all regions of Brazil. This review analyzed the current hepatitis B epidemiological situation in Brazil through a systematic search of the scientific literature in MEDLINE, LILACS, and CAPES thesis database, as well as disease notifications to the Information System for Notifiable Diseases. The search strategy identified 87 articles and 13 theses, resulting in 100 total publications. The most recent results indicate reduced hepatitis B prevalence nationwide, classifying Brazil as having low endemicity. Most studies showed HBV carrier prevalence less than 1%. However, there are still isolated regions with increased prevalence, particularly the Amazon, as well as specific groups, such as homeless people in large cities and isolated Afro-descendant communities in the center of the country. This review alsao detected successful vaccination coverage reported in a few studies around the country. The prevalence of anti-HBs alone ranged from 50% to 90%. However, isolated and distant localities still have low coverage rates. This review reinforces the downward trend of hepatitis B prevalence in Brazil and the need to intensify vaccination strategies for young people and adults in specific regions with persisting higher HBV infection prevalence.

Perception of organizational politics and the effect of authenticity and affective commitment on deviance and task performance in contact centers

This study aimed to understand employees’ reactions to organizational politics in Contact Centers. Drawing from a sample of 187 supervisor-employee dyads, we studied the relationship between employees’ perceptions of organizational politics and supervisor-rated task performance and deviance, and mediation effects by authenticity at work and affective commitment. Results indicate that workers tend to react to workplace politics with deviant behavior and worse task performance. We found that the relationship between perceived politics and task performance was mediated by authenticity. The relationship between perceived politics and supervisor-rated deviance was mediated by affective commitment to the organization. Implications for management are discussed.

Segurança contra incêndios na reabilitação sustentável de edifícios antigos

Dissertação de mestrado em Construção e Reabilitação Sustentáveis

Environment, health and safety policy in small construction sites: an analysis of the situation in Brazil

This paper analyzes the safety, environmental and occupational health of workers in the small construction industry in Brazil. In this sector there are still many unsafe practices, which are very common in small work sites. We used a qualitative approach to understand these problems by long interviews with people who work directly in small construction sites, including occupational physicians, civil engineers, safety engineers, safety technicians, general foremen, construction workers, labor unionists and auditors. This paper aims to demonstrate that the "invisibility" of the small sites workers makes them less safe and therefore more prone to accidents, also weakening their health. The results show that small constructions workers are less visible to society and supervision because of their short periods of work. Therefore, they are also uncovered to the rigorous applicability of principles of safety and accident prevention. Thus, it has been seen in this field of work a precarious application of NR - 18, which was specifically made for the construction sites and it needs simplification to meet normative characteristics of small construction sites. In the State of Rio de Janeiro, some laws on small sites were recently created and implemented. This study concludes that the rules to work are not being taken as seriously as the legislation determinates, remaining practically unknown by many professionals, from the plot command, supervisors, engineers, architects and technicians who work on construction sites. This ignorance creates space for the lack of safety and consequently to accidents, leading to by weakness in the workers health. Therefore, the work process needs to be modified, the safety regulation must be disseminated through safer practices, promoting employee health and ensure that the work of small sites can be visible, especially ensuring the construction workers health and safety.

“It’s a complicated situation”. Harm in everyday experiences with technology. A qualitative study with school-aged children

Tese de Doutoramento em Ciências da Educação (Especialidade de Tecnologia Educativa)

Quality of life assessment of patients with schizophrenic spectrum disorders from Psychosocial Care Centers

OBJECTIVE: Assessing the quality of life and the clinical and social-demographic factors associated in schizophrenic spectrum patients (ICD-10 F20-F29) attending CAPS at the programmatic area 3.0. METHODS: A cross-sectional study was carried out in a sample of schizophrenic spectrum patients who have been enrolled in 2008 in CAPS in programmatic area (AP) 3 at Rio de Janeiro city, using MINIPLUS to assess schizophrenia spectrum disorder and use of psychoactive substances, Positive and Negative Symptoms Scale (PANSS) to assess psychiatric symptoms and Quality of Life Scale (QLS-BR) to assess the quality of life. RESULTS: Seventy nine patients were included, of whom 74 (93.7%) presented some impairment in quality of life. The most frequently affected area was occupational performance. Variables that showed a significant association with severe impairment of quality of life were: marital status, race, occupation, who patients lived with, homelessness, having children, previous psychiatric hospitalization, negative symptoms and symptoms designated as not applicable (being characterized by a lack of typical positive and negative symptoms). CONCLUSION: The knowledge of these factors should be crucial to implement health policies and psychosocial rehabilitation programs focused on improving the quality of life of these patients.

Upgrade of an industrial building: BIM model of the as-built situation and evaluation of modifications

Dissertação de mestrado integrado in Civil Engineering

Plano de revitalização do centro histórico de Braga

Dissertação de mestrado em Políticas Comunitárias e Cooperação Territorial

Current situation on the occurrence of mycotoxins and toxigenic fungi in Portugal

Mycotoxins are secondary metabolites produced by filamentous fungi that are toxic for humans and animals in small amounts and that are found worldwide in a large number of agricultural commodities. They are usually ingested involuntarily, when contaminated plant products are consumed, and represent a great risk for public health. Therefore, governments throughout the world have imposed strict legal limits for their levels in food and feed products in order to reduce potential health risks for consumers. Despite of its ubiquity, the mycotoxin problem is mainly dependent on regional factors, such as the mycotoxigenic characteristics of the local mycoflora, the local climate conditions, and the local agricultural practices. For this reason, a constant vigilance from local governmental food safety agencies and from the local researcher community is needed. This communication will review the current situation on the occurrence of mycotoxigenic fungi in some Portuguese cultures, such as wine grapes, corn and dried fruits. Particular attention will be given to the incidence of mycotoxigenic Aspergillus strains in those cultures and to the levels of ochratoxin A, aflatoxins, cyclopiazonic acid and fumonisin B2 produced. Data will be discussed taking into account the geographical origin of the isolates and the particular climate conditions of each sampling region. An updated review on the levels of the main mycotoxins found in local products and in imported commodities will also be presented.

Micro-empresa y capacidad empresarial en Córdoba: situación actual y perspectivas. Microenterprise and entrepreneurship in Córdoba: present situation and perpectives.

Las transformaciones del mercado laboral, tanto de los países desarrollados como en vías de desarrollo, han sido importantes en las últimas décadas. Una de sus manifestaciones es la creciente expansión del trabajo organizado en torno a los micro-emprendimientos. Las investigaciones existentes a nivel internacional indican que la capacidad empresarial que debe poseer el emprendedor es un factor que resulta crucial para el desarrollo y sostenimiento de estas formas de producción. Por tal razón, el estudio de este aspecto y de su relación con los micro-emprendimientos es un tema que está concitando creciente atención y sobre el que existe un cuerpo teórico de literatura específica que ha comenzado a transferirse a los países en vías de desarrollo, donde la discusión es aún incipiente. Los estudios han observado que los micro-emprendimientos están normalmente muy ligados a la familia, esto hace que su desenvolvimiento y evolución resulten afectados por las características particulares de cada hogar. Se trata de un complejo conjunto de situaciones sociales que se generan a partir de estas nuevas formas de organización del trabajo, donde resulta dificultoso distinguir entre el micro-emprendimiento y la figura del emprendedor, lo cual ha llevado a que muchas veces las políticas públicas, sensibles a la necesidad de apoyar a los grupos poblacionales vulnerables, adquirieran un sesgo pro-pobre, en detrimento de su objetivo principal de incentivar el desarrollo sustentable de pequeñas unidades productivas. El equipo de investigación autor del presente proyecto concluyó recientemente, en el marco de un proyecto PICTOR II, un primer estudio sobre la temática de los micro-emprendimientos en Córdoba, analizando los factores que ayudan a comprender mejor las razones por las que algunos emprendedores alcanzan un mayor éxito que otros, a partir del cual surgieron nuevos interrogantes sobre el rol de la política pública en esta materia, a los que se intentará dar respuesta en esta oportunidad. Más concretamente, en esta investigación se abordarán, ahora con profundidad, diversas cuestiones importantes que analizan el vínculo entre la figura del emprendedor con el micro-emprendimiento que posee y con el efecto general de las políticas públicas en el sector. Uno de los temas es determinar hasta qué punto el comentado sesgo "pro-pobre" estuvo presente en el caso de las políticas públicas aplicadas en Córdoba y qué consecuencias tuvo sobre los micro-emprendimientos y su sustentabilidad. Este aspecto está directamente ligado a la necesidad de discernir acerca de si el fundamento teórico de las políticas públicas diferencia adecuadamente entre el micro-emprendedor y la micro-empresa. Otra importante cuestión a abordar es la de indagar sobre la relación entre capacidad empresarial, capital humano y nivel socio-económico del emprendedor. Resultará de sumo interés identificar los factores que estimulan e inhiben las manifestaciones de capacidad empresarial individual, y establecer su relación con las posibilidades de sustentabilidad del micro-emprendimiento, lo cual debería ser tomado en cuenta por las políticas públicas. El caso de los individuos que se convirtieron en micro-emprendedores como una estrategia para superar la situación de desempleo en que se encontraban, es un tema que será examinado en especial y a la luz de la performance observada del emprendimiento. Serán fuentes primarias de información la Encuesta llevada a cabo en el proyecto PICTOR II arriba mencionado y una re-encuesta a los micro-emprendedores que fueron oportunamente entrevistados. A ello se agregará un estudio de casos de emprendimientos muy exitosos. Los datos de fuentes secundarias surgirán del INDEC, de organismos oficiales y de instituciones no gubernamentales. Los principales métodos y herramientas de análisis a utilizar son los que proporcionan la Estadística, la Econometría y la Micro-economía.

Prevalencia de Trastornos Mentales en consultantes de Centros de Atención Primaria de la Ciudad de Córdoba, Argentina.Prevalence of Mental Disorders among Consultants in Primary Health Care Centers of the City of Córdoba, Argentina

El informe de la Organización Mundial de la Salud (2001), refiere que en un plazo de 20 años los trastornos mentales pasarán a ser la segunda causa dentro de la carga de morbilidad a nivel mundial, y en la actualidad una de cada cuatro personas padece de algún trastorno mental en alguna etapa de su vida. Los estudios realizados en diversos países revelan que una proporción importante de los consultantes de la atención primaria en salud presentan algún tipo de trastornos mentales. Desde esta perspectiva, la atención primaria de la salud ofrece una oportunidad de intervenir en el manejo de los trastornos mentales de forma temprana y eficaz. En Argentina, es limitada la información acerca del registro epidemiológico en salud mental, no contando con estudios abordados desde la Atención Primaria en la provincia de Córdoba. El objetivo general del proyecto es estimar la prevalencia de trastornos mentales entre los consultantes de atención primaria por problemas de salud general. Para ello se propone: Estimar la prevalencia de trastornos mentales en una muestra representativa de consultantes adultos por problemas de salud general, de centros de atención primaria de la ciudad de Córdoba, identificar y describir los tipos de trastornos mentales que presentan estos consultantes adultos de centros de atención primaria y analizar la prevalencia de los trastornos mentales por sexo y edad de la población en estudio. Metodología: el estudio se realizará en consultorios de Atención Primaria de Salud distribuídos en todo el éjido de la ciudad, teniendo en cuenta la representación de las 12 zonas de CPC. La muestra es probabilística, estratificada, polietápica de pacientes que consultan en el primer nivel de atención. Se entrevistarán 1200 pacientes utilizando la versión computorizada del CIDI 3.0, que proporciona diagnóstico de acuerdo a la DSM IV y la CIE-10. La confiabilidad y la validez del instrumento ha sido ampliamente documentada y la traducción de la encuesta al español fue realizada conforme a las recomendaciones de la OMS. El análisis efectuado será de prevalencia de Trastornos Mentales y del Comportamiento (TMC),asociación entre factores sociodemográficos y TCM estimados calculando las razones de disparidad (odds ratio), regresión logística a fin de ajustar los resultados por la posible interacción entre variables, análisis de la asociación de todas las variables con los TMC, análisis univariado de la asociación de cada variable con los TMC, controlando sexo y edad, se construirá un modelo de regresión logística. En todos los casos el nivel de significación será de 0,05. El equipo de trabajo, de cooperación internacional entre profesionales de la UNC y de la Universidad de Chile, y con la participación en colaboración de los profesionales dependientes de la Secretaría de Salud de la municipalidad de Córdoba, representa un avance para trabajar en los centros de salud de esta ciudad, constituyéndose en un avance, cualitativo y cuantitativo de la actividad científica en Atención Primaria en salud mental con abordaje epidemiológico. Se espera contribuir al conocimiento acerca de la prevalencia de los problemas de salud mental de esta población en la ciudad de Córdoba, proporcionando información a los funcionarios y responsables por la gestión de las áreas vinculadas a la salud mental, aportando conocimiento que promueva una temprana identificación de riesgos iniciales en salud mental y conductas de cuidado en la población como potencial de bienestar.Así mismo, se espera sistematizar una experiencia que pueda ser replicada en otros sitios geográficos. Por todo lo anterior, esta propuesta permitirá conocer por primera vez en la ciudad de Córdoba la frecuencia y características de los problemas de salud mental entre consultantes de Atención Primaria, información fundamental para el desarrollo posterior de estrategias que busquen mejorar la detección y el tratamiento de estos problemas. According to the WHO Report (2001), in 20 years, mental health disorders (MHDs) will be the world’s second most frequent cause of morbidity. Primary care offers the opportunity to handle MHDs efficiently at an early stage. In Argentina, the epidemiologic data on mental health (MH) is limited, and there are no records for Córdoba. The aim of this project is to assess the prevalence of MHDs among consultants who resort to primary health centers (PHCCs) in the city of Córdoba for common health problems, by using a representative sample of adult consultants, identifying and describing the types of MHDs evinced, and analysing prevalence by sex and age group under study. Methodology:the study will be carried out in PHCCs located in the municipal area of Córdoba, covering the 12 zones corresponding to the CPCs (municipal branch offices for each zone). A multi-stage stratified random sample of 1200 patients will be interviewed using the program CIDI 3.0 to produce a diagnostic according to DSM IV and CIE-10, a tool with proven reliability and validity.The aspects to be analysed are prevalence of mental and behavior disorders, their association with socio-demographic factors estimated by odds ratios, logistic regression for adjustment of potential interaction among variables, association with all variables, and univariate analysis for association with each variable. Significance level will be 0.05 in all cases. The international teamwork including professionals from the Universities of Córdoba, Chile and the Public Health Department of the Municipality of Córdoba constitutes a qualitative and quantitative step forward in the field of primary health care studies with an epidemiologic approach. This project aims at providing administrators in the MH area with data for the early detection of initial risks in MH and the promotion of prevention habits. This will be the first study conducted in Córdoba, and is aimed at facilitating replication in other geographical areas.

Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

Background:The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe.Objective:To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP).Methods:Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP.Results:Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus.Conclusion:Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery.

Entwicklung kardiovaskulärer Risikofaktoren bei Small for gestational age-Geborenen im jungen Erwachsenenalter und der Vergleich der metabolischen Situation dieser Patienten mit der von normotroph Geborenen

Magdeburg, Univ., Medizin. Fakultät, Diss., 2008

Die Umsetzung des Menschenrechts auf Bildung im Schulsystem der Bundesrepublik Deutschland : Eine kindheitswissenschaftliche Analyse der Situation von Schülern mit (türkischem) Migrationshintergrund

[s.c.]

Efficiency and environmental regulation: a 'complex situation'

Production of desirable outputs is often accompanied by undesirable by products that have damaging effects on the environment, and whose disposal is frequently regulated by public authorities. In this paper, we compute directional technology distance functions under particular assumptions concerning disposability of bads in order to test for the existence of what we call ‘complex situations’, where the biggest producer is not the greatest polluter. Furthermore, we show that how in such situations, environmental regulation could achieve an effective reduction in the aggregate level of bad outputs without reducing the production of good outputs. Finally, we illustrate our methodology with an empirical application to a sample of Spanish tile ceramic producers.