L'apport du patient simulé dans l'apprentissage de la relation médecin-malade: résultats d'une évaluation préliminaire

Contexte : Les étudiants de 4° année des études de médecine à la faculté de biologie et de médecine de Lausanne bénéficient d'un enseignement des habiletés à la communication médecin-malade, ayant recours à un patient simulé joué par un comédien. But : Évaluer la pertinence de cette méthode active dans l'optique de renforcer cet enseignement dans le curriculum. Méthodes : Un questionnaire demande aux étudiants d'apprécier leurs apprentissages, ainsi que le dispositif d'enseignement. Un autre questionnaire évalue les compétences de l'étudiant qui mène l'entretien par l'étudiant lui-même (étudiant actif), par les étudiants observateurs, par l'enseignant et par le patient simulé. Résultats : Ce dispositif d'enseignement est apprécié des étudiants et permet aux étudiants qui ont mené l'entretien et aux étudiants observateurs d'en tirer un bénéfice. Les étudiants actifs ont tendance à évaluer leurs compétences d'entretien plus négativement que ne le font l'enseignant, le comédien et les étudiants observateurs .Conclusion : Ce dispositif d'enseignement est perçu comme pertinent par l'ensemble des participants, mais devrait être renforcé pour donner à chaque étudiant l'occasion de participer activement à l'entrevue simulée. -- Context: 4th year medicine students at the Faculty of Biology and Medicine of Lausanne were taught to develop patient-doctor communication skills, using a simulated patient played by an actor. Objective: To assess the relevance of this active method in the perspective of reinforcing this teaching approach in the curriculum. Method: This new form of teaching was assessed by questionnaires filled by all participants, i.e. students involved in the communication (active student), students who were bystanders (observer students), the tutor, as well as the actor. Results: This teaching approach was appreciated from all students, active and observer, allowing them to gain benefit from the interview on communication skills acquirement. The active students assessed their communication skills more negatively than did the teacher, the actor and the observer students. Conclusion: This teaching method seems to be relevant for all participants and should be reinforced to give the opportunity for each student to participate as an active student.

Utilização do target costing na determinação do preço de venda: O caso da Alvo, s.a.

Com a crescente competitividade no mundo empresarial, os preços dos produtos passaram a exercer um papel fundamental na expansão e sobrevivência das empresas. Consequentemente, hoje em dia é o mercado que determina o preço de venda de um produto, devendo a empresa produzir ao menor custo possível para garantir o retorno financeiro desejado. O objectivo do trabalho é verificar se os procedimentos de Target Costing podem ser aplicados nas Pequenas e Médias Empresas industriais, em São Vicente, cuja actividade também se destina à produção de produtos alimentícios. Como produto teste foi selecionado o produto A, confecçionado pela empresa Alvo, SA. Para atingirmos os objectivos foram utilizadas várias técnicas e métodos de pesquisa, tais como: levantamento bibliográfico, entrevista, conversas informais, questionário, levantamento de dados nos documentos financeiros da empresa ALVO, SA. Para entendermos e aplicarmos o processo de Target Costing recorreu-se à literatura do mesmo. Foi aplicado um questionário para ver a percepção dos clientes da empresa objecto de estudo, quanto ao preço que considerariam ideal pagar por cada quilograma do produto A adquirida. A entrevista realizada com o director geral da ALVO, SA acompanhada com os dados obtidos do departamento de contabilidade serviram como um meio de conhecer a empresa e o seu funcionamento, realçando informações sobre a fixação do preço venda dos seus produtos, a gestão de custos, entre outros. Antes de testar, através de um caso prático, a aplicação do Target Costing, verificou-se, primeiramente, sua aplicação em termos teóricos, testando os seus princípios e premissas para o produto A, na Empresa ALVO, SA. Como resultado constactou-se que os procedimentos de Target Costing podem ser aplicados, tanto na teoria como na prática, nas Pequenas e Médias Empresas industriais, em São Vicente, cuja actividade se destina a produção do produto A. With the increasing competition in the business world, the prices of products have come to play a key role in the expansion and survival of businesses. Consequently, today the selling price of a product is determined by the market so companies should produce at the lowest possible cost to ensure the desired financial return. The purpose of this paper work is to verify if the Target Costing’s procedure can be applied in small and medium business enterprises in São Vicente, whose activity is production of food. For that, product A was selected for tests. In order to achieve these objectives, some techniques and research methods like bibliographic analysis, interviews, informal conversations, questionnaires and analysis of the financial documents of ALVO, SA that is the subject of this case study, were utilized. With the intention of understanding and applying the Target Costing process we also resorted to a detailed reading of related bibliography. A questionnaire was applied in order to know the customers’ opinions about the ideal price for each kilogram of product A. The interview with the managing director of ALVO, SA, combined with the data obtained in the accounting department, was also used as a way to know the company, and it ’s functioning, highlight ing items such as: selling price format ion, cost management, among other aspects. Before testing, through a practical case study, the use of the Target Costing, the theoretical application was firstly verified by testing its principles and assumptions. Secondly, the application of the Target Costing’s process was shown step by step concerning product A at ALVO SA company. As a result we came to the conclusion that procedures used with Target Costing can be applied, in theory and in practice, in small or medium-sized industrial enterprises, in São Vicente, where product A is being manufactured.

Prevalence of beryllium sensitization in patients diagnosed with sarcoidosis

Occupational exposure to beryllium (Be) may lead to development of Be-specific CD4+ T-cell immune response and occurrence of a granulomatous disorder called chronic beryllium disease (CBD). Due to similar clinical pictures, CBD may be misdiagnosed as sarcoidosis if Be exposure (BeE) and Be sensitization (BeS) are not looked for. To determine whether some patients diagnosed as sarcoidosis may have undetected CBD, we screened a retrospective cohort of patients with sarcoidosis for BeE and BeS. BeE was assessed through a self-administered questionnaire and a standardized occupational health interview. BeS was assessed using CFSE flow cytometry developed as an alternative to the classical Be lymphocyte proliferation test (BeLPT). 159 patients recorded in a Swiss interstitial lung disease registry with a diagnosis of sarcoidosis were enrolled through their pulmonary physician and received a screening questionnaire. 68 filled questionnaires were returned. 28/68 patients had positive screening. 24/28 underwent an occupational health interview. BeE was considered probable in 6/24 and possible in 18/24. Using CFSE flow cytometry, BeS was detected in 7/24 of these patients (4/6 with probable BeE and 3/18 with possible BeE). BeS testing by CFSE flow cytometry was positive in 5/6 controls with proven CBD and positive BeLPT, and negative in 10 healthy subjects. Conclusions: the minimal rate of BeE and BeS in an unselected population of patients with sarcoidosis was 7/159 (4.4%), suggesting misdiagnosed CBD. A screening questionnaire could help to detect BeE in patients diagnosed with sarcoidosis, and prompt investigations in search of CBD. CFSE flow cytometry may be an alternative to BeLPT to document BeS.

A problemática do risco cambial na importação estudo de caso: Empresas Importadoras de Automóveis em Cabo Verde

A problemática do risco cambial surge a partir do momento em que agentes económicos decidem efectuar as suas transacções internacionais em divisas. Neste contexto, a necessidade de conhecer e compreender o mercado cambial é peremptório. Como forma de se protegerem das exposições de taxas de câmbio, os agentes sentem necessidade de recorrer a instrumentos de protecção cambial, de forma a proporcionar uma maior segurança à negociação. O presente trabalho teve como objectivo identificar e avaliar o risco cambial nas empresas de importação de automóveis em Cabo Verde, bem como estudar o mercado cambial Cabo-verdiano, procurando, simultaneamente identificar os instrumentos de protecção disponíveis na nossa praça. No entanto, observou-se que no mercado nacional não há utilização dos derivados financeiros, embora, já seja prevista a sua implementação. Deste modo, as empresas de importação de automóveis encontram-se totalmente expostas a esse risco de mercado, e sem qualquer experiência em lidar com os instrumentos de protecção cambial. Para a consecução dos objectivos propostos, realizou-se um estudo de caso, com o propósito de estudar a problemática do risco cambial nas empresas de importação de automóveis em Cabo Verde. A colecta de dados foi realizada por meio de questionários aplicados às empresas importadoras de automóveis e foi complementada com uma entrevista não estruturada aplicada a um especialista com know-how na área. Com o estudo foi possível descrever todas as etapas do processo de importação de automóveis e analisar a expressividade dos riscos cambiais nessas empresas. The problem of currency risk arises from the moment when economic agents decide to perform their international transactions in any foreign exchange. In this respect, the need to know and understand the exchange market is peremptory. As a way to protect themselves from the exposure of rates exchange, agents feel the need to resort to cambial instruments of protection, to provide a greater security to negotiations. This present work had as objectives to identify and survey the currency risk in importing cars companies in Cape Verde, as well as studying the Cape Verdean exchange market to, simultaneously, identify the instruments of protection existent. However, it was observed that in the national market there is no use of financial derivatives, although its implementation is decided. Thus, importing cars companies are entirely exposed to this market risk and without any experience in dealing with the hedging risks these transactions imply. To the attainment of the proposed objectives, we performed a case study with the purpose of studying the problem of currency risk in the importing cars companies in Cape Verde. The data collection was held through questionnaires to the cars importing companies and was complemented with an unstructured interview applied to a specialist with expertise in the area. With the study it was possible to describe all the stages of importing cars process and analyze the expressiveness of currency risks in these companies.

The international development of the RGHQoL: a quality of life measure for recurrent genital herpes.

This paper describes the international development and psychometric testing of the Recurrent Genital Herpes Quality of Life Questionnaire (RGHQoL), a condition-specific quality of life (QoL) instrument. The theoretical foundation for the measure is the needs-based model of QoL and the content of the instrument was derived from in-depth qualitative interviews with relevant patients in the UK. Versions of the RGHQoL were required for the UK, USA, Italy, Germany, France and Denmark for use in international clinical trials. The results indicate that the final 20 item measure has good reliability, internal consistency and validity for all language versions. A small responsiveness study in Denmark suggested that the measure is sensitive to changes in QoL associated with the initiation of suppression treatment for recurrent genital herpes (RGH). It is concluded that the RGHQoL is a valuable instrument for inclusion in clinical trials. The psychometric properties of the instrument are such that it may also be used to monitor the progress of individual patients.

O papel da auditoria interna e as suas implicações nas empresas públicas- estudo de caso: TACV

A auditoria interna é uma actividade independente ancorada à administração da empresa, com vista a acrescentar valor à organização nela inserida, observando o funcionamento dos controlos internos existentes. É uma actividade importante para qualquer empresa, por ser a única que tem acesso a todas as outras áreas da empresa. Cada vez ela torna-se mais importante, pois o mundo encontra-se em constante desenvolvimento e as empresas acompanham esse desenvolvimento ampliando as suas actividades, ou dimensão. O objectivo do estudo foi analisar o funcionamento da auditoria interna nas empresas públicas, identificando os seus benefícios e importância. Realizou-se um estudo bibliográfico e estudo de caso nas empresas públicas da cidade da Praia, através de questionários que foram distribuídos aos responsáveis de cada empresa, centralizando na TACV. Resultado: A maioria das empresas inqueridas é de grande dimensão, representando 57,1 %, as pequenas empresas representando 21.4% e as médias também representando 21.4. O ramo de prestação de serviço teve predominância com 64,3 %, comercial com 21,4% e 14,3 % do ramo industrial. Um total de 57 % das empresas inqueridas realizam auditoria interna e os 43 % que não realizam enunciaram como principais motivos o alto custo e a falta de necessidade, 40% enuncia alto custo, 40% diz não ser necessário e 20% tem outros motivos que não foram especificados. Verificou-se também que 25 % das empresas que realizam auditoria interna não tem o departamento de auditoria interna definido no organograma. Internal auditing is an independent activity anchored to the company management, with a view to adding value to the organization it inserted, observing the operation of existing internal controls. It is an important activity for any company, being the only one that has access to all other areas of the company. Each time it becomes more important as the world is constantly evolving and business development that accompany expanding its activities, or size. The aim of the study was to analyze the functioning of the internal audit public companies, identifying the benefits and importance. We conducted a bibliographic study and a case study in the public utilities of the city of Praia, through questionnaires that were distributed to the heads of each company, centering on TACV. Results: The majority of companies surveyed is large, representing 57.1%, small businesses represent 21.4% and averages also representing 21.4. The branch of service predominated with 64.3%, commercial 21.4% and 14.3% of the industrial sector. A total of 57% of companies surveyed conduct internal audit and the 43% who do not perform as main reasons enunciated the high cost and lack of need, high-cost states 40%, 40% say it is not necessary and 20% have reasons other than were specified. It was also found that 25% of companies that perform internal audit does not have the internal audit department defined in the organizational chart.

Auditoria interna e externa – Uma perspetiva de complementaridade

Esta monografia foi elaborada com o intuito do aprofundamento, aperfeiçoamento e o conhecimento académico, pesquisando um tema que contribuísse, de alguma maneira, para a melhoria da área em questão. Também teve a intenção de contribuir na análise da inter-relação entre a auditoria interna e externa numa perspetiva de complementaridade. Procura-se, na presente monografia, proporcionar uma reflexão sobre a relação existente entre a auditoria interna e a auditoria externa. Para tal, realizaram-se pesquisas bibliográficas sobre os principais conceitos, âmbito, métodos, objetivos, funções e procedimentos, normas pertinentes à auditoria interna e externa, relação entre as duas auditorias, complementaridade e cooperação entre elas e auditoria interna e externa na prevenção e deteção de fraudes. Paralelamente foram elaborados dois questionários enviados a 6 empresas que têm departamentos de auditoria interna retiradas do universo das empresas com departamento de auditoria interna e a 2 empresas que fazem auditoria externa nessas empresas, a atuarem no mercado caboverdiano durante o ano de 2013, com o objetivo de verificar a relação entre a auditoria interna e a externa, através da opinião dos auditores internos e cruzamento com a opinião dos auditores externos, a fim de verificar, efetivamente, como estabelecer essa relação. De posse desses elementos, o objetivo geral apresentado pode ser comprovado pela conclusão de que se pode estabelecer uma relação entre auditoria interna e externa e a mesma pode ser de complementaridade. This monograph was developed with the aim of deepening, improvement and academic knowledge, by researching a topic that would contribute in some way to improve the topic in question. It also intended to contribute to the analysis of the inter-relationship existent between the internal and external audit and the notion that both complement each other’s work. This monograph attempts to provide a reflection on the relationship between internal audit and external audit. For this purpose, a library research was conducted on key concepts, scope, methods, purpose, function and procedures, relevant standards for internal and external audit, the relationship between the two audits, complementarity and cooperation between them, and internal and external audit in the prevention and fraud detection. In parallel, we prepared two questionnaires that were sent to 6 companies that have an internal audit department that are part of the universe of companies with internal audit department; and to two companies that make external audits to the companies mentioned above and that operate in the Cape Verdean market during the year 2013. The objective was to verify the relationship between internal audit and external by reviewing the opinion n of internal auditors and to intersect that with the opinion of external auditor in order to verify effectively, how to establish this relationship. With these elements, the overall goal presented can be substantiated by the finding that a relationship establish between internal and external audit and this relationship can be complementary.

Controlo Interno como factor de melhoria empresarial - estudo de caso prático Centro de Emprego e Formação Profissonal Santa Cruz

A problemática do controlo interno como factor de melhoria empresarial, foi a que orientou esta pesquisa realizada no CEFPSC (Centro de Emprego e Formação Profissional de Santa Cruz). É que, segundo Morais & Martins (2007, pág. 27) existe controlo adequado quando a gestão planeou e organizou, isto é, concebeu, de tal modo que foi assegurado uma garantia razoável que os riscos da organização foram adequadamente geridos e de que os objectivos e metas da organização serão alcançados de forma eficiente e económica. Sendo assim, é de notar a importância desta ferramenta em traçar estratégias de gestão no processo decisório, servindo assim de uma mais-valia à entidade com vista a permitir responder à questão: Em que medida o controlo interno tem sido utilizado como método de apoio à gestão do Centro de Emprego e Formação Profissional de Santa Cruz? Este trabalho tem como objectivo compreender a actuação e a contribuição do Controlo Interno na gestão eficiente do CEFPSC. As informações foram recolhidas mediante a aplicação de um questionário de controlo interno e entrevistas ao Responsável do CEFPSC, bem como ao Presidente do IEFP, enquanto órgão central. O tratamento dos dados foi realizado com auxílio informático, utilizando, para tal, o programa Excel.

Perception of the damaging effects of smoking, and brief cessation counselling by doctors.

An open prospective study was conducted among the patients visiting an urban medical policlinic for the first time without an appointment to assess whether the immigrants (who represent more than half of our patients) are aware of the health effects of smoking, whether the level of acculturation influences knowledge, and whether doctors give similar advice to Swiss and foreign smokers. 226 smokers, 105 Swiss (46.5%), and 121 foreign-born (53.5%), participated in the study. 32.2% (95% CI [24.4%; 41.1%]) of migrants and 9.6% [5.3%; 16.8%] of Swiss patients were not aware of negative effects of smoking. After adjustment for age, the multivariate model showed that the estimated odds of "ignorance of health effects of smoking" was higher for people lacking mastery of the local language compared with those mastering it (odds ratio (OR) = 7.5 [3.6; 15.8], p < 0.001), and higher for men (OR = 4.3 [1.9; 10.0], p < 0.001). Advice to stop smoking was given with similar frequency to immigrants (31.9% [24.2%; 40.8%] and Swiss patients (29.0% [21.0%; 38.5%]). Nonintegrated patients did not appear to receive less counselling than integrated patients (OR = 1.1 [0.6; 2.1], p = 0.812). We conclude that the level of knowledge among male immigrants not integrated or unable to speak the local language is lower than among integrated foreign-born and Swiss patients. Smoking cessation counselling by a doctor was only given to a minority of patients, but such counselling seemed irrespective of nationality.

Is confidence in decisions related to feedback? Evidence-and lack of evidence-from random samples of real-world managerial behavior?

Confidence in decision making is an important dimension of managerialbehavior. However, what is the relation between confidence, on the onehand, and the fact of receiving or expecting to receive feedback ondecisions taken, on the other hand? To explore this and related issuesin the context of everyday decision making, use was made of the ESM(Experience Sampling Method) to sample decisions taken by undergraduatesand business executives. For several days, participants received 4 or 5SMS messages daily (on their mobile telephones) at random moments at whichpoint they completed brief questionnaires about their current decisionmaking activities. Issues considered here include differences between thetypes of decisions faced by the two groups, their structure, feedback(received and expected), and confidence in decisions taken as well as inthe validity of feedback. No relation was found between confidence indecisions and whether participants received or expected to receivefeedback on those decisions. In addition, although participants areclearly aware that feedback can provide both confirming and disconfirming evidence, their ability to specify appropriatefeedback is imperfect. Finally, difficulties experienced inusing the ESM are discussed as are possibilities for further researchusing this methodology.

Alfabetização de crianças caboverdianas em língua portuguesa como língua não materna : o ensino da leitura

abstract: Cape Verde is a country of bilingual characteristics, where coexist two languages: the mother tongue – the Creole of Cape Verde (CCV) or the Capeverdian Language (LCV) and the Non Maternal language – the Portuguese that is the official language and, therefore, the language used in the process of education and learning. This situation generates conflicts so much to linguistic level as to cultural level. The two languages presents some lexical resemblances, what drives, many times, to misconceptions and linguistics errors that complicate children in the learning, in particular, of reading that constitute the base for the learning of others knowledge. The learning of reading, in the Non Maternal language, requires a development of the oral language in Portuguese Language, which stimulates the reasoning of the child through playful exercises and cognitivists and construtivists approaches. In this way, the competences of phonological processing in the acquisition of the competences of reading are important for the discrimination of written text and favor the learning and the development of reading. The child, through the discovery, begins to elaborate concepts in the way to obtain a relation with the written language, by functional form. Adopting a methodology of case study and through questionnaires, direct observation and collect of documentary information, this dissertation presents and analyzes connected aspects to the literacy of capeverdian children in the beginning of the schooling and to the learning of reading as basic support for the learning of Non Maternal language. The subsidies collected by the study, presented in this dissertation will contribute for the education progress of reading and, also, for implement successfully the learning of reading of the students, developing to practical of reading and the expectations in uncover the multiplicity of the dimensions of experience in that domain and contribute for a relative comprehension of written and reading modes.

Hyperhomocysteinemia is independently associated with albuminuria in the population-based CoLaus study.

Increased serum levels of homocysteine and uric acid have each been associated with cardiovascular risk. We analyzed whether homocysteine and uric acid were associated with glomerular filtration rate (GFR) and albuminuria independently of each other. We also investigated the association of MTHFR polymorphisms related to homocysteine with albuminuria to get further insight into causality. This was a cross-sectional population-based study in Caucasians (n = 5913). Hyperhomocysteinemia was defined as total serum homocysteine ≥ 15 μmol/L. Albuminuria was defined as urinary albumin-to-creatinine ratio > 30 mg/g. Uric acid was associated positively with homocysteine (r = 0.246 in men and r = 0.287 in women, P < 0.001). The prevalence of albuminuria increased across increasing homocysteine categories (from 6.4% to 17.3% in subjects with normal GFR and from 3.5% to 14.5% in those with reduced GFR, P for trend < 0.005). Hyperhomocysteinemia (OR = 2.22, 95% confidence interval: 1.60-3.08, P < 0.001) and elevated serum uric acid (OR = 1.27, 1.08-1.50, per 100 μmol/L, P = 0.004) were significantly associated with albuminuria, independently of hypertension and type 2 diabetes. The 2-fold higher risk of albuminuria associated with hyperhomocysteinemia was similar to the risk associated with hypertension or diabetes. MTHFR alleles related to higher homocysteine were associated with increased risk of albuminuria. In the general adult population, elevated serum homocysteine and uric acid were associated with albuminuria independently of each other and of renal function.