WorldWideScience

Sample records for kaiser permanente health

  1. Achieving Kaiser Permanente quality.

    Science.gov (United States)

    McHugh, Matthew D; Aiken, Linda H; Eckenhoff, Myra E; Burns, Lawton R

    2016-01-01

    The Kaiser Permanente model of integrated health delivery is highly regarded for high-quality and efficient health care. Efforts to reproduce Kaiser's success have mostly failed. One factor that has received little attention and that could explain Kaiser's advantage is its commitment to and investment in nursing as a key component of organizational culture and patient-centered care. The aim of this study was to investigate the role of Kaiser's nursing organization in promoting quality of care. This was a cross-sectional analysis of linked secondary data from multiple sources, including a detailed survey of nurses, for 564 adult, general acute care hospitals from California, Florida, Pennsylvania, and New Jersey in 2006-2007. We used logistic regression models to examine whether patient (mortality and failure-to-rescue) and nurse (burnout, job satisfaction, and intent-to-leave) outcomes in Kaiser hospitals were better than in non-Kaiser hospitals. We then assessed whether differences in nursing explained outcomes differences between Kaiser and other hospitals. Finally, we examined whether Kaiser hospitals compared favorably with hospitals known for having excellent nurse work environments-Magnet hospitals. Patient and nurse outcomes in Kaiser hospitals were significantly better compared with non-Magnet hospitals. Kaiser hospitals had significantly better nurse work environments, staffing levels, and more nurses with bachelor's degrees. Differences in nursing explained a significant proportion of the Kaiser outcomes advantage. Kaiser hospital outcomes were comparable with Magnet hospitals, where better outcomes have been largely explained by differences in nursing. An important element in Kaiser's success is its investment in professional nursing, which may not be evident to systems seeking to achieve Kaiser's advantage. Our results suggest that a possible strategy for achieving outcomes like Kaiser may be for hospitals to consider Magnet designation, a proven and

  2. A retrospective analysis of health systems in Denmark and Kaiser Permanente

    DEFF Research Database (Denmark)

    Frølich, Anne; Schiøtz, Michaela L; Strandberg-Larsen, Martin

    2008-01-01

    ABSTRACT: BACKGROUND: To inform Danish health care reform efforts, we compared health care system inputs and performance and assessed the usefulness of these comparisons for informing policy. METHODS: Retrospective analysis of secondary data in the Danish Health Care System (DHS) with 5.3 million...... citizens and the Kaiser Permanente integrated delivery system (KP) with 6.1 million members in California. We used secondary data to compare population characteristics, professional staff, delivery structure, utilisation and quality measures, and direct costs. We adjusted the cost data to increase...... comparability. RESULTS: A higher percentage of KP patients had chronic conditions than did patients in the DHS: 6.3% vs. 2.8% (diabetes) and 19% vs. 8.5% (hypertension), respectively. KP had fewer total physicians and staff compared to DHS, with134 physicians/100,000 individuals versus 311 physicians/100...

  3. Kaiser Permanente-Sandia National Health Care Model: Phase 1 prototype final report. Part 2 -- Domain analysis

    Energy Technology Data Exchange (ETDEWEB)

    Edwards, D.; Yoshimura, A.; Butler, D.; Judson, R.; Mason, W.; Napolitano, L.; Mariano, R. [Sandia National Labs., Livermore, CA (United States); Eddy, D.; Schlessinger, L. [Kaiser Permanente, Pasadena, CA (United States)

    1996-11-01

    This report describes the results of a Cooperative Research and Development Agreement between Sandia National Laboratories and Kaiser Permanente Southern California to develop a prototype computer model of Kaiser Permanente`s health care delivery system. As a discrete event simulation, SimHCO models for each of 100,000 patients the progression of disease, individual resource usage, and patient choices in a competitive environment. SimHCO is implemented in the object-oriented programming language C{sup 2}, stressing reusable knowledge and reusable software components. The versioned implementation of SimHCO showed that the object-oriented framework allows the program to grow in complexity in an incremental way. Furthermore, timing calculations showed that SimHCO runs in a reasonable time on typical workstations, and that a second phase model will scale proportionally and run within the system constraints of contemporary computer technology.

  4. Kaiser Permanente/Sandia National health care model. Phase I prototype final report. Part 1 - model overview

    Energy Technology Data Exchange (ETDEWEB)

    Edwards, D.; Yoshimura, A.; Butler, D.; Judson, R. [and others

    1996-11-01

    This report describes the results of a Cooperative Research and Development Agreement between Sandia National Laboratories and Kaiser Permanente Southern California to develop a prototype computer model of Kaiser Permanente`s health care delivery system. As a discrete event simulation, SimHCO models for each of 100,000 patients the progression of disease, individual resource usage, and patient choices in a competitive environment. SimHCO is implemented in the object-oriented programming language C++, stressing reusable knowledge and reusable software components. The versioned implementation of SimHCO showed that the object-oriented framework allows the program to grow in complexity in an incremental way. Furthermore, timing calculations showed that SimHCO runs in a reasonable time on typical workstations, and that a second phase model will scale proportionally and run within the system constraints of contemporary computer technology. This report is published as two documents: Model Overview and Domain Analysis. A separate Kaiser-proprietary report contains the Disease and Health Care Organization Selection Models.

  5. The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

    Science.gov (United States)

    Otte-Trojel, Terese; Rundall, Thomas G; de Bont, Antoinette; van de Klundert, Joris; Reed, Mary E

    2015-12-16

    Patient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited. This paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development? We identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of

  6. Internet infrastructures and health care systems: a qualitative comparative analysis on networks and markets in the British National Health Service and Kaiser Permanente.

    Science.gov (United States)

    Séror, Ann C

    2002-12-01

    The Internet and emergent telecommunications infrastructures are transforming the future of health care management. The costs of health care delivery systems, products, and services continue to rise everywhere, but performance of health care delivery is associated with institutional and ideological considerations as well as availability of financial and technological resources. to identify the effects of ideological differences on health care market infrastructures including the Internet and telecommunications technologies by a comparative case analysis of two large health care organizations: the British National Health Service and the California-based Kaiser Permanente health maintenance organization. A qualitative comparative analysis focusing on the British National Health Service and the Kaiser Permanente health maintenance organization to show how system infrastructures vary according to market dynamics dominated by health care institutions ("push") or by consumer demand ("pull"). System control mechanisms may be technologically embedded, institutional, or behavioral. The analysis suggests that telecommunications technologies and the Internet may contribute significantly to health care system performance in a context of ideological diversity. The study offers evidence to validate alternative models of health care governance: the national constitution model, and the enterprise business contract model. This evidence also suggests important questions for health care policy makers as well as researchers in telecommunications, organizational theory, and health care management.

  7. Investing in Obesity Treatment: Kaiser Permanente's Approach to Chronic Disease Management.

    Science.gov (United States)

    Tsai, Adam G; Histon, Trina; Donahoo, W Troy; Hashmi, Shahid; Murali, Sameer; Latare, Peggy; Oliver, Lajune; Slovis, Jennifer; Grall, Sarah; Fisher, David; Solomon, Loel

    2016-09-01

    Kaiser Permanente, an integrated health care delivery system in the USA, takes a "whole systems" approach to the chronic disease of obesity that begins with efforts to prevent it by modifying the environment in communities and schools. Aggressive case-finding and substantial investment in intensive lifestyle modification programs target individuals at high risk of diabetes and other weight-related conditions. Kaiser Permanente regions are increasingly standardizing their approach when patients with obesity require treatment intensification using medically supervised diets, prescription medication to treat obesity, or weight loss surgery.

  8. Kaiser Permanente's performance improvement system, Part 1: From benchmarking to executing on strategic priorities.

    Science.gov (United States)

    Schilling, Lisa; Chase, Alide; Kehrli, Sommer; Liu, Amy Y; Stiefel, Matt; Brentari, Ruth

    2010-11-01

    By 2004, senior leaders at Kaiser Permanente, the largest not-for-profit health plan in the United States, recognizing variations across service areas in quality, safety, service, and efficiency, began developing a performance improvement (PI) system to realizing best-in-class quality performance across all 35 medical centers. MEASURING SYSTEMWIDE PERFORMANCE: In 2005, a Web-based data dashboard, "Big Q," which tracks the performance of each medical center and service area against external benchmarks and internal goals, was created. PLANNING FOR PI AND BENCHMARKING PERFORMANCE: In 2006, Kaiser Permanente national and regional continued planning the PI system, and in 2007, quality, medical group, operations, and information technology leaders benchmarked five high-performing organizations to identify capabilities required to achieve consistent best-in-class organizational performance. THE PI SYSTEM: The PI system addresses the six capabilities: leadership priority setting, a systems approach to improvement, measurement capability, a learning organization, improvement capacity, and a culture of improvement. PI "deep experts" (mentors) consult with national, regional, and local leaders, and more than 500 improvement advisors are trained to manage portfolios of 90-120 day improvement initiatives at medical centers. Between the second quarter of 2008 and the first quarter of 2009, performance across all Kaiser Permanente medical centers improved on the Big Q metrics. The lessons learned in implementing and sustaining PI as it becomes fully integrated into all levels of Kaiser Permanente can be generalized to other health care systems, hospitals, and other health care organizations.

  9. The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: A qualitative study of Kaiser Permanente

    NARCIS (Netherlands)

    E.T. Otte-Trojel (Eva Terese); T.G. Rundall (Thomas); A.A. de Bont (Antoinette); J.J. van de Klundert (Joris); M.E. Reed (Mary E.)

    2015-01-01

    textabstractBackground: Patient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain

  10. Kaiser Permanente's performance improvement system, Part 4: Creating a learning organization.

    Science.gov (United States)

    Schilling, Lisa; Dearing, James W; Staley, Paul; Harvey, Patti; Fahey, Linda; Kuruppu, Francesca

    2011-12-01

    In 2006, recognizing variations in performance in quality, safety, service, and efficiency, Kaiser Permanente leaders initiated the development of a performance improvement (PI) system. Kaiser Permanente has implemented a strategy for creating the systemic capacity for continuous improvement that characterizes a learning organization. Six "building blocks" were identified to enable Kaiser Permanente to make the transition to becoming a learning organization: real-time sharing of meaningful performance data; formal training in problem-solving methodology; workforce engagement and informal knowledge sharing; leadership structures, beliefs, and behaviors; internal and external benchmarking; and technical knowledge sharing. Putting each building block into place required multiple complex strategies combining top-down and bottom-up approaches. Although the strategies have largely been successful, challenges remain. The demand for real-time meaningful performance data can conflict with prioritized changes to health information systems. It is an ongoing challenge to teach PI, change management, innovation, and project management to all managers and staff without consuming too much training time. Challenges with workforce engagement include low initial use of tools intended to disseminate information through virtual social networking. Uptake of knowledge-sharing technologies is still primarily by innovators and early adopters. Leaders adopt new behaviors at varying speeds and have a range of abilities to foster an environment that is psychologically safe and stimulates inquiry. A learning organization has the capability to improve, and it develops structures and processes that facilitate the acquisition and sharing of knowledge.

  11. The Kaiser Permanente Northwest Cardiovascular Risk Factor Management Program: A Model for All

    Science.gov (United States)

    Joyce, Jodi S; Fetter, Martina M; Klopfenstein, Dean H; Nash, Michael K

    2005-01-01

    Proof of the effectiveness of preventive measures that reduce established risk traits for atherothrombotic disorders has spurred attempts to systematically apply these interventions among susceptible populations. One such attempt is the Cardiovascular Risk Factor Management (CVRFM) Program, launched in 2003 to optimize clinical management and outcomes for 75,000 Kaiser Permanente Northwest Region (KPNW) members with atherosclerotic cardiovascular disease (CVD) or hypertension. The CVRFM Program is a centralized, multidisciplinary, proactive telephone-based clinical management intervention consisting of an “outreach” call, an interview, a mailed individualized care plan and information packet, regular follow-up (including protocolized medication management) and—when “goal status” is achieved—transfer of the patient to a maintenance plan. Quarterly evaluation of effectiveness entailed measurement of a range of clinical, utilization, and member satisfaction outcomes. Results by the fourth quarter were outstanding: For example, >98% of participants with coronary disease or diabetes had LDL cholesterol testing, >90% of coronary patients received aspirin or statin treatment, 99% were “extremely” or “very” satisfied with the program, and reductions were observed in the number of hospitalizations and visits to the emergency department and clinic. Mathematical models predict a decrease in myocardial infarctions and cardiovascular mortality within two years after implementing the program, the underlying principles of which should yield similar improvement in other Kaiser Permanente (KP) Regions and in other health care organizations. PMID:21660155

  12. Breaching the security of the Kaiser Permanente Internet patient portal: the organizational foundations of information security.

    Science.gov (United States)

    Collmann, Jeff; Cooper, Ted

    2007-01-01

    This case study describes and analyzes a breach of the confidentiality and integrity of personally identified health information (e.g. appointment details, answers to patients' questions, medical advice) for over 800 Kaiser Permanente (KP) members through KP Online, a web-enabled health care portal. The authors obtained and analyzed multiple types of qualitative data about this incident including interviews with KP staff, incident reports, root cause analyses, and media reports. Reasons at multiple levels account for the breach, including the architecture of the information system, the motivations of individual staff members, and differences among the subcultures of individual groups within as well as technical and social relations across the Kaiser IT program. None of these reasons could be classified, strictly speaking, as "security violations." This case study, thus, suggests that, to protect sensitive patient information, health care organizations should build safe organizational contexts for complex health information systems in addition to complying with good information security practice and regulations such as the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

  13. The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators.

    NARCIS (Netherlands)

    Lester, H.; Schmittdiel, J.; Selby, J.; Fireman, B.; Campbell, S.M.; Lee, J.; Whippy, A.; Madvig, P.

    2010-01-01

    OBJECTIVE: To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California. DESIGN: Longitudinal analysis. SETTING: 35 medical facilities of Kaiser Permanente Northern California,

  14. Kaiser Permanente's performance improvement system, part 2: developing a value framework.

    Science.gov (United States)

    Schilling, Lisa; Deas, Dennis; Jedlinsky, Maile; Aronoff, Deborah; Fershtman, Juliette; Wali, Abdul

    2010-12-01

    In 2008, Kaiser Permanente began phased implementation of a nationwide performance improvement (PI) system. The aim was to improve performance by providing consistent, highly meaningful performance measurement, increase PI skills in staff at all levels, develop organizational capabilities, and provide support for making improvements in medical centers and across regions. Evaluating the PI System: The intermediate results of the PI system were assessed in the 22 medical centers in four of the eight Kaiser Permanente regions. Implementation for 3 of these medical centers occurred in January 2008 through November 2008, with implementation for the remaining 19 medical centers occurring from September 2008 through September 2009. The 22 medical centers that were evaluated achieved a 61% improvement in selected capabilities, and improvement advisors (IAs) successfully completed 84% of initial PI projects. For each dollar invested, estimates suggested an average return on investment of $2.36. Critical factors include adequate dedicated time for PI activities by staff with necessary expertise, expert support to operations, alignment of projects with regional and national strategic priorities, and close working relationships between PI staff and operational management. Involving finance leaders in improvement planning, prioritization, and oversight is important. These elements can be adapted to smaller systems and single hospitals. The initial evaluation of the Kaiser Permanente PI system indicated that (1) IAs successfully led projects in conjunction with frontline teams, (2) organizational capabilities increased, and (3) the investment in PI infrastructure and staff was sound. Expansion throughout the entire Kaiser Permanente system is under way.

  15. A Community-Level Initiative to Prevent Obesity: Results From Kaiser Permanente's Healthy Eating Active Living Zones Initiative in California.

    Science.gov (United States)

    Cheadle, Allen; Atiedu, Akpene; Rauzon, Suzanne; Schwartz, Pamela M; Keene, Laura; Davoudi, Mehrnaz; Spring, Rebecca; Molina, Michelle; Lee, Lynda; Boyle, Kathryn; Williamson, Dana; Steimberg, Clara; Tinajero, Roberta; Ravel, Jodi; Nudelman, Jean; Azuma, Andrea Misako; Kuo, Elena S; Solomon, Loel

    2018-05-01

    A growing number of health systems are leading health promotion efforts in their wider communities. What impact are these efforts having on health behaviors and ultimately health status? This paper presents evaluation results from the place-based Kaiser Permanente Healthy Eating Active Living Zones obesity prevention initiative, implemented in 2011-2015 in 12 low-income communities in Kaiser Permanente's Northern and Southern California Regions. The Healthy Eating Active Living Zones design targeted places and people through policy, environmental, and programmatic strategies. Each Healthy Eating Active Living Zone is a small, low-income community of 10,000 to 20,000 residents with high obesity rates and other health disparities. Community coalitions planned and implemented strategies in each community. A population-dose approach and pre and post surveys were used to assess impact of policy, program, and environmental change strategies; the analysis was conducted in 2016. Population dose is the product of reach (number of people affected by a strategy divided by target population size) and strength (the effect size or relative change in behavior for each person exposed to the strategy). More than 230 community change strategies were implemented over 3 years, encompassing policy, environmental, and programmatic changes as well as efforts to build community capacity to sustain strategies and make changes in the future. Positive population-level results were seen for higher-dose strategies, particularly those targeting youth physical activity. Higher-dose strategies were more likely to be found in communities with the longest duration of investment. These results demonstrate that strong (high-dose), community-based obesity prevention strategies can lead to improved health behaviors, particularly among youth in school settings. This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is

  16. Making the business case for hospital information systems--a Kaiser Permanente investment decision.

    Science.gov (United States)

    Garrido, Terhilda; Raymond, Brian; Jamieson, Laura; Liang, Louise; Wiesenthal, Andrew

    2004-01-01

    Further evidence in favor of the clinical IT business case is set forth in Kaiser Permanente's cost/benefit analysis for an electronic hospital information system. This article reviews the business case for an inpatient electronic medical record system, including 36 categories of quantifiable benefits that contribute to a positive cumulative net cash flow within an 8.5 year period. However, the business case hinges on several contingent success factors: leadership commitment, timely implementation, partnership with labor, coding compliance, and workflow redesign. The issues and constraints that impact the potential transferability of this business case across delivery systems raise questions that merit further attention.

  17. Is the Kaiser Permanente model superior in terms of clinical integration?: a comparative study of Kaiser Permanente, Northern California and the Danish healthcare system.

    Science.gov (United States)

    Strandberg-Larsen, Martin; Schiøtz, Michaela L; Silver, Jeremy D; Frølich, Anne; Andersen, John S; Graetz, Ilana; Reed, Mary; Bellows, Jim; Krasnik, Allan; Rundall, Thomas; Hsu, John

    2010-04-08

    Integration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in practice. Our objective was to compare primary care clinicians' perceptions of clinical integration and three sub-aspects in two healthcare systems: Kaiser Permanente, Northern California (KPNC) and the Danish healthcare system (DHS). Further, we examined the associations between specific organizational factors and clinical integration within each system. Comparable questionnaires were sent to a random sample of primary care clinicians in KPNC (n = 1103) and general practitioners in DHS (n = 700). Data were analysed using multiple logistic regression models. More clinicians in KPNC perceived to be part of a clinical integrated environment than did general practitioners in the DHS (OR = 3.06, 95% CI: 2.28, 4.12). Further, more KPNC clinicians reported timeliness of information transfer (OR = 2.25, 95% CI: 1.62, 3.13), agreement on roles and responsibilities (OR = 1.79, 95% CI: 1.30, 2.47) and established coordination mechanisms in place to ensure effective handoffs (OR = 6.80, 95% CI: 4.60, 10.06). None of the considered organizational factors in the sub-country analysis explained a substantial proportion of the variation in clinical integration. More primary care clinicians in KPNC reported clinical integration than did general practitioners in the DHS. Focused measures of clinical integration are needed to develop the field of clinical integration and to create the scientific foundation to guide managers searching for evidence based approaches.

  18. Kaiser Permanente Creatinine Safety Program: A Mechanism to Ensure Widespread Detection and Care for Chronic Kidney Disease.

    Science.gov (United States)

    Sim, John J; Rutkowski, Mark P; Selevan, David C; Batech, Michael; Timmins, Royann; Slezak, Jeff M; Jacobsen, Steven J; Kanter, Michael H

    2015-11-01

    Chronic kidney disease is highly prevalent but is challenging to diagnose because of the need to establish chronicity. Within the current healthcare environment, a single abnormal creatinine measurement often can go without a follow-up, which can lead to missed diagnoses or diagnostic errors. The Kaiser Permanente Southern California creatinine safety program (the Creatinine SureNet) was created to help ensure that all single abnormal creatinine results had a follow-up evaluation. In the period February 1, 2010, to March 1, 2014, the electronic health records were used to capture individuals with single abnormal creatinine results that went >90 days without a repeat measurement. A coordinated effort among a centralized regional nurse and providers was used to communicate with patients and order a repeat creatinine measurement. A total of 12,396 individuals were identified (84% ambulatory care encounters). A total of 6981 individuals (52%) followed up with a repeat measurement. Female patients, non-Hispanic whites, and older individuals were more likely to obtain a repeat measurement. Subsequently, 3668 individuals had chronic kidney disease confirmed. Within 6 months, 1550 patients had chart documentation of their chronic kidney disease and 336 patients had a nephrology consultation. The ambulatory care environment, given its high volume and various prioritizations, is an under-recognized area where diagnostic errors are not uncommon and failure to follow up on abnormal test results can occur routinely. The Kaiser Permanente Southern California Creatinine SureNet program leverages the electronic health records and its multidisciplinary resources in an effort to ensure that patients with potential chronic kidney disease are identified and managed properly. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators.

    Science.gov (United States)

    Lester, Helen; Schmittdiel, Julie; Selby, Joe; Fireman, Bruce; Campbell, Stephen; Lee, Janelle; Whippy, Alan; Madvig, Philip

    2010-05-11

    To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California. Longitudinal analysis. 35 medical facilities of Kaiser Permanente Northern California, 1997-2007. 2 523 659 adult members of Kaiser Permanente Northern California. Main outcomes measures Yearly assessment of patient level glycaemic control (HbA(1c) financial incentives were attached to screening for diabetic retinopathy (1999-2003), the rate rose from 84.9% to 88.1%. This was followed by four years without incentives when the rate fell year on year to 80.5%. During the two initial years when financial incentives were attached to cervical cancer screening (1999-2000), the screening rate rose slightly, from 77.4% to 78.0%. During the next five years when financial incentives were removed, screening rates fell year on year to 74.3%. Incentives were then reattached for two years (2006-7) and screening rates began to increase. Across the 35 facilities, the removal of incentives was associated with a decrease in performance of about 3% per year on average for screening for diabetic retinopathy and about 1.6% per year for cervical cancer screening. Policy makers and clinicians should be aware that removing facility directed financial incentives from clinical indicators may mean that performance levels decline.

  20. End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve.

    Science.gov (United States)

    Sim, John J; Batech, Michael; Danforth, Kim N; Rutkowski, Mark P; Jacobsen, Steven J; Kanter, Michael H

    2017-01-01

    The Kaiser Permanente Southern California (KPSC) creatinine safety program (Creatinine SureNet) identifies and outreaches to thousands of people annually who may have had a missed diagnosis for chronic kidney disease (CKD). We sought to determine the value of this outpatient program and evaluate opportunities for improvement. Longitudinal cohort study (February 2010 through December 2015) of KPSC members captured into the creatinine safety program who were characterized using demographics, laboratory results, and different estimations of glomerular filtration rate. Age- and sex-adjusted rates of end-stage renal disease (ESRD) were compared with those in the overall KPSC population. Among 12,394 individuals, 83 (0.7%) reached ESRD. The age- and sex-adjusted relative risk of ESRD was 2.7 times higher compared with the KPSC general population during the same period (94.7 vs 35.4 per 100,000 person-years; p creatinine measurements, only 13% had a urine study performed (32% among patients with confirmed CKD). Our study found a higher incidence of ESRD among individuals captured into the KPSC creatinine safety program. If the Chronic Kidney Disease Epidemiology Collaboration equation were used, fewer people would have been captured while improving the accuracy for diagnosing CKD. Urine testing was low even among patients with confirmed CKD. Our findings demonstrate the importance of a creatinine safety net program in an integrated health system but also suggest opportunities to improve CKD care and screening.

  1. Genetic Ancestry Is not Associated with Breast Cancer Recurrence or Survival in U.S. Latina Women Enrolled in the Kaiser Permanente Pathways Study.

    Science.gov (United States)

    Engmann, Natalie J; Ergas, Isaac J; Yao, Song; Kwan, Marilyn L; Roh, Janise M; Ambrosone, Christine B; Kushi, Lawrence H; Fejerman, Laura

    2017-09-01

    Background: The U.S. Hispanic/Latino population is heterogeneous both socioculturally and by the proportion of European, Indigenous American, and African ancestry of the regions from which individuals originate. A previous study reported that genetic ancestry was associated with breast cancer survival among Latinas, independent of sociodemographic and tumor characteristics, suggesting that a genetic factor associated with ancestry may affect breast cancer survival. Methods: We evaluated the association of genetic ancestry with breast cancer outcomes among 506 Latina women with invasive breast cancer in the Pathways Study, a cohort study within Kaiser Permanente, an integrated health care delivery system. Proportional hazards models were used to assess the effect of ancestry on breast cancer recurrence (53 events), breast cancer-specific mortality (31 events) and all-cause mortality (54 events), with a mean follow-up time of 6 years. Results: Indigenous American ancestry was not associated with breast cancer recurrence [HR = 1.00 per 10% increase; 95% confidence interval (CI), 0.86-1.16], breast cancer mortality (HR = 0.95; 95% CI, 0.77-1.17), or all-cause mortality (HR = 0.93; 95% CI, 0.80-1.08). Adjustment for sociodemographic variables, tumor characteristics, and treatment did not alter the associations. Conclusions: Our results suggest that previously reported differences in breast cancer survival by genetic ancestry may be overcome by improving health care access and/or quality. Impact: Improving health care access and quality may reduce breast cancer disparities among U.S. Latinas. Cancer Epidemiol Biomarkers Prev; 26(9); 1466-9. ©2017 AACR . ©2017 American Association for Cancer Research.

  2. Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE among Kaiser Permanente Member Populations in the United States, 2012-2013.

    Directory of Open Access Journals (Sweden)

    Scott P Grytdal

    Full Text Available Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE. However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0-98 years. Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested. In addition, 22 (2% of specimens were positive for rotavirus; 19 (2% were positive for sapovirus; and 7 (1% were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children 65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per 1,000 person-years. Outpatient incidence rates of rotavirus, sapovirus, and astrovirus were 2.0, 1.6, 0.6 per 1,000 person

  3. Questioning the claims from Kaiser.

    Science.gov (United States)

    Talbot-Smith, Alison; Gnani, Shamini; Pollock, Allyson M; Gray, Denis Pereira

    2004-06-01

    The article by Feachem et al, published in the BMJ in 2002, claimed to show that, compared with the United Kingdom (UK) National Health Service (NHS), the Kaiser Permanente healthcare system in the United States (US) has similar healthcare costs per capita, and performance that is considerably better in certain respects. To assess the accuracy of Feachem et al's comparison and conclusions. Detailed re-examination of the data and methods used and consideration of the 82 letters responding to the article. Analyses revealed four main areas in which Feachem et al's methodology was flawed. Firstly, the populations of patients served by Kaiser Permanente and by the NHS are fundamentally different. Kaiser's patients are mainly employed, significantly younger, and significantly less socially deprived and so are healthier. Feachem et al fail to adjust adequately for these factors. Secondly, Feachem et al have wrongly inflated NHS costs by omitting substantial user charges payable by Kaiser members for care, excluding the costs of marketing and administration, and deducting the surplus from Kaiser's costs while underestimating the capital charge element of the NHS budget and other costs. They also used two methods of converting currency, the currency rate and a health purchasing power parity conversion. This is double counting. Feachem et al reported that NHS costs were 10% less per head than Kaiser. Correcting for the double currency conversion gives the NHS a 40% cost advantage such that per capita costs are 1161 dollars and 1951 dollars for the NHS and Kaiser, respectively. Thirdly, Feachem et al use non-standardised data for NHS bed days from the Organisation for Economic Cooperation and Development, rather than official Department of Health bed availability and activity statistics for England. Leaving aside the non-comparability of the population and lack of standardisation of the data, the result is to inflate NHS acute bed use and underestimate the efficiency of

  4. Kaiser captures spirit of games.

    Science.gov (United States)

    Herreria, J

    1998-01-01

    With a multi-media campaign, Kaiser Permanente blitzed its market area by becoming a sponsor of the Nike World Masters Games. The advertising campaign promoted Kaiser as the exclusive health care sponsor. Company officials are counting on this campaign to leverage the health care institution's commitment to the community. In addition to the advertising, Kaiser searched for local athletes to represent its "play the sports for life" theme. As part of a promotion to award 200 athlete sponsorships to the Games, Kaiser's own master athletes were invited to tell their stories. Some of the members shared stories about such topics as experiencing an accident, receiving assistance from a Kaiser physician and incorporating a lifestyle of sport for rehabilitation. From the hundreds of letters received, two members and one employee were selected for the television spots. The sporting event reinforces Kaiser's philosophy of fitness-oriented lifestyles among its members. The Nike World Masters Games are the largest participatory multi-sport competition in the world, gathering together more than 25,000 men and women from more than 100 countries.

  5. Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE) among Kaiser Permanente Member Populations in the United States, 2012-2013.

    Science.gov (United States)

    Grytdal, Scott P; DeBess, Emilio; Lee, Lore E; Blythe, David; Ryan, Patricia; Biggs, Christianne; Cameron, Miriam; Schmidt, Mark; Parashar, Umesh D; Hall, Aron J

    2016-01-01

    Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE). However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP) health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0-98 years). Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested). In addition, 22 (2%) of specimens were positive for rotavirus; 19 (2%) were positive for sapovirus; and 7 (1%) were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children age (outpatient incidence = 25.6 per 1,000 person-years; community incidence = 152.2 per 1,000 person-years), followed by older adults aged >65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per 1,000 person

  6. Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE) among Kaiser Permanente Member Populations in the United States, 2012–2013

    Science.gov (United States)

    Grytdal, Scott P.; Biggs, Christianne; Cameron, Miriam; Schmidt, Mark; Parashar, Umesh D.; Hall, Aron J.

    2016-01-01

    Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE). However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP) health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0–98 years). Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested). In addition, 22 (2%) of specimens were positive for rotavirus; 19 (2%) were positive for sapovirus; and 7 (1%) were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children incidence = 25.6 per 1,000 person-years; community incidence = 152.2 per 1,000 person-years), followed by older adults aged >65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per 1,000 person

  7. Which is the real Kaiser?

    Science.gov (United States)

    Kertesz, L

    1997-08-25

    Fans of Kaiser Permanente, the nation's oldest and largest HMO, consider the company a cost-effective healthcare delivery system that supports its patients, caregivers and the practice of high-quality medicine. Its detractors see Kaiser as an evil HMO empire that hoards money, mistreats doctors and skimps on care. The dichotomy shows that Kaiser is like a giant mirror, reflecting the struggles and uncertainties of the evolving U.S. healthcare system.

  8. Kaiser Family Foundation - Content Search

    Data.gov (United States)

    U.S. Department of Health & Human Services — Chartpacks, chartbooks, factsheets, reports, and slide presentations bring Kaiser Family Foundation information to life, and can be easily incorporated into your...

  9. Innovative partnerships to advance public health training in community-based academic residency programs

    Directory of Open Access Journals (Sweden)

    Lo JC

    2017-10-01

    Full Text Available Joan C Lo,1–3 Thomas E Baudendistel,2,3 Abhay Dandekar,3,4 Phuoc V Le,5 Stanton Siu,2,3 Bruce Blumberg6 1Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; 2Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 3Graduate Medical Education, Kaiser Permanente East Bay, Oakland, CA, USA; 4Department of Pediatrics, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 5School of Public Health, University of California Berkeley, Berkeley, CA, USA; 6Graduate Medical Education, Kaiser Permanente Northern California, Oakland, CA, USA Abstract: Collaborative partnerships between community-based academic residency ­training programs and schools of public health, represent an innovative approach to training future physician leaders in population management and public health. In Kaiser Permanente Northern California, development of residency-Masters in Public Health (MPH tracks in the Internal Medicine Residency and the Pediatrics Residency programs, with MPH graduate studies completed at the University of California Berkeley School of Public Health, enables physicians to integrate clinical training with formal education in epidemiology, biostatistics, health policy, and disease prevention. These residency-MPH programs draw on more than 50 years of clinical education, public health training, and health services research – creating an environment that sparks inquiry and added value by developing skills in patient-centered care through the lens of population-based outcomes. Keywords: graduate medical education, public health, master’s degree, internal medicine, pediatrics, residency training

  10. The permanental process

    DEFF Research Database (Denmark)

    McCullagh, Peter; Møller, Jesper

    2006-01-01

    We extend the boson process first to a large class of Cox processes and second to an even larger class of infinitely divisible point processes. Density and moment results are studied in detail. These results are obtained in closed form as weighted permanents, so the extension i called a permanental...... process. Temporal extensions and a particularly tractable case of the permanental process are also studied. Extensions of the fermion process along similar lines, leading to so-called determinantal processes, are discussed....

  11. 75 FR 70689 - Kaiser Aluminum Fabricated Products, LLC; Kaiser Aluminum-Greenwood Forge Division; Currently...

    Science.gov (United States)

    2010-11-18

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-70,376] Kaiser Aluminum Fabricated Products, LLC; Kaiser Aluminum- Greenwood Forge Division; Currently Known As Contech Forgings, LLC..., applicable to workers of Kaiser Aluminum Fabricated Products, LLC, Kaiser Aluminum-Greenwood Forge Division...

  12. del establecimiento permanente

    Directory of Open Access Journals (Sweden)

    V. Ma. Antonieta Martin Granados

    2002-01-01

    Full Text Available A pesar de que en México se han realizado adiciones a la legislación en materia civil y mercantil relacionadas con el uso de medios electrónicos como instrumentos para realizar actos jurídicos, éstas resultan insuficientes, pues nada se ha hecho en materia procesal, penal y laboral, entre otras. En este trabajo se presentan, en materia fiscal, algunas consideraciones acerca del concepto de establecimiento permanente tanto en la legislación mexicana como en el Convenio Modelo (CM de la Organización para la Cooperación y Desarrollo Económico (OCDE y se argumenta que a pesar de que la definición de la legislación mexicana es mucho más amplia que la que se encuentra en el mencionado convenio, el comercio electrónico presenta algunos retos para determinar el lugar en donde residen las partes involucradas, el lugar en donde se celebran las operaciones y se pagan o cobran, sobre todo tratándose de servicios o adquisición de bienes intangibles. Por último, se señala que en materia fiscal es necesario que las autoridades mexicanas permitan el uso de la factura electrónica

  13. Movements of permanent health education triggered by the training of facilitators Movimientos de la educación permanente en salud desencadenados a partir de la formación de facilitadores Movimentos da educação permanente em saúde, desencadeados a partir da formação de facilitadores

    Directory of Open Access Journals (Sweden)

    Cinira Magali Fortuna

    2011-04-01

    Full Text Available This study mapped the movements of Permanent Health Education in the region of Araraquara, São Paulo, Brazil, begun by the Permanent Health Education Facilitators program, promoted by the Ministry of Health and the National School of Public Health. This qualitative study was grounded on the theoretical framework of institutional and schizoanalysis. Data were collected from operative groups of individuals who finished the program. The results were grouped into two plans: micropolitics and organization. Micropolitics indicates the production of different concepts concerning permanent education and different ways to establish it. Autonomy and control and also a tenuous relationship between tutorship and autonomy were highlighted, in the plan of organization. In conclusion, the program was an important device that suffered captures/overcoding but also produced changes in practice.Se tuvo por objetivo cartografiar los movimientos de educación permanente en salud, en la región de Araraquara, Sao Paulo, Brasil, iniciados a partir del curso de Facilitadores de Educación Permanente en Salud, del Ministerio de la Salud y Escuela Nacional de Salud Pública. Es un estudio de abordaje cualitativo, sustentado por el referencial teórico del análisis institucional en la línea esquizoanalítica, siendo los datos recolectados mediante grupos operativos con alumnos terminando el referido curso. Los resultados fueron agrupados en dos planos: micropolítica y organización. Con relación a la micropolítica, apuntan que hubo producción de diferentes conceptos sobre educación permanente y diferentes formas de institucionalización de la misma. En el plano de la organización se destacan la autonomía y el control y también la tenue relación entre tutela y autonomía. Concluimos que el curso fue un importante dispositivo que sufrió capturas, pero también produjo cambios en las prácticas.Tem-se, aqui, por objetivo, cartografar os movimentos de educa

  14. Evaluation of a surveillance case definition for anogenital warts, Kaiser Permanente northwest.

    Science.gov (United States)

    Naleway, Allison L; Weinmann, Sheila; Crane, Brad; Gee, Julianne; Markowitz, Lauri E; Dunne, Eileen F

    2014-08-01

    Most studies of anogenital wart (AGW) epidemiology have used large clinical or administrative databases and unconfirmed case definitions based on combinations of diagnosis and procedure codes. We developed and validated an AGW case definition using a combination of diagnosis codes and other information available in the electronic medical record (provider type, laboratory testing). We calculated the positive predictive value (PPV) of this case definition compared with manual medical record review in a random sample of 250 cases. Using this case definition, we calculated the annual age- and sex-stratified prevalence of AGW among individuals 11 through 30 years of age from 2000 through 2005. We identified 2730 individuals who met the case definition. The PPV of the case definition was 82%, and the average annual prevalence was 4.16 per 1000. Prevalence of AGW was higher in females compared with males in every age group, with the exception of the 27- to 30-year-olds. Among females, prevalence peaked in the 19- to 22-year-olds, and among males, the peak was observed in 23- to 26-year-olds. The case definition developed in this study is the first to be validated with medical record review and has a good PPV for the detection of AGW. The prevalence rates observed in this study were higher than other published rates, but the age- and sex-specific patterns observed were consistent with previous reports.

  15. Moving from tacit knowledge to evidence-based practice: the Kaiser Permanente community partners study.

    Science.gov (United States)

    Enguídanos, Susan M; Jamison, Paula M

    2006-01-01

    For several decades both medical and social work practices have failed to consistently include measures to determine the effectiveness of their care and practices. This is especially true of care management practices. With the growth and aging of our population, this is of particular concern when many of our resources for older adults are channeled into services such as geriatric care management. This article describes a randomized controlled trial that tested the effectiveness of four levels of geriatric care management. Results from this study did not support the tacit knowledge of the clinicians in terms of the effectiveness of their practices. This article describes the study methods and results, and how evidence from this study impacted subsequent service provided by geriatric care managers.

  16. Permanent education in health. An instrument to enhance interpersonal relations in nursing work La educación permanente en salud. Instrumento potenciador de las relaciones interpersonales del trabajo en enfermería Educação permanente em saúde. Instrumento potencializador das relações interpessoais no trabalho da enfermagem

    Directory of Open Access Journals (Sweden)

    Juliane Portella Ribeiro

    2012-08-01

    Full Text Available This is a reflexive study about the need to adopt Permanent Education in Health, as an instrument capable of transforming interpersonal relations in nursing work, as it values and respect collective construction with a view to the qualification of care. Privileging specialization programs only, with a focus on work techniques, on educative processes, as a training strategy for health services, ends up reinforcing the fragmentation of care, teams and the work process. In conclusion, Permanent Education in Health serves not only as teaching and learning practice to update and transform practices, but also influences team relations, transforming joint action processes and, at the same time, implying each subject-worker involved in health practices.Se trata de un estudio reflexivo sobre la necesidad de adoptar la Educación Permanente en Salud, como un instrumento capaz de transformar las relaciones interpersonales en el trabajo de la enfermería, ya que valora y respeta la construcción colectiva para la calificación de la atención. Privilegiar sólo la especialización con direccionalidad en la técnica del trabajo en los procesos educativos, como estrategia de capacitación para los servicios de salud, acaba por reforzar la fragmentación del cuidado, de los equipos y del proceso de trabajo. Se concluye que la Educación Permanente en Salud, además de servir como práctica de enseñanza y aprendizaje para la actualización y transformación de las prácticas, actúa en las relaciones del equipo, transformando los procesos de acción conjunta y, al mismo tiempo, implicando cada sujeto-trabajador involucrado en las prácticas de salud.Se trata de um estudo reflexivo sobre a necessidade de adotar a Educação Permanente em Saúde, como um instrumento capaz de transformar as relações interpessoais no trabalho da enfermaria, já que, valoriza e respeita a construção coletiva, para a qualificação do atendimento. Privilegiar só a especializa

  17. Henry J. Kaiser Family Foundation

    Science.gov (United States)

    ... Virginia and in the Maine referendum on Medicaid expansion will still have a practical impact on what ... income, family size and age. Medicaid Extending Federal Funding for CHIP: What is at Stake? Health Reform ...

  18. The Kaiser Wilhelm Society under National Socialism

    CERN Document Server

    Sachse, Carola; Walker, Mark

    2009-01-01

    During the first part of the twentieth century, German science led the world. The most important scientific institution in Germany was the Kaiser Wilhelm Society, including institutes devoted to different fields of scientific research. These researchers were not burdened by teaching obligations and enjoyed excellent financial and material support. When the National Socialists came to power in Germany, all of German society, including science, was affected. The picture that previously dominated our understanding of science under National Socialism from the end of the Second World War to the recent past - a picture of leading Nazis ignorant and unappreciative of modern science and of scientists struggling to resist the Nazis - needs to be revised. This book surveys the history of Kaiser Wilhelm Institutes under Hitler, illustrating definitively the cooperation, if not collaboration, between scientists and National Socialists in order to further the goals of autarky, racial hygiene, war, and genocide.

  19. Gestão participativa na educação permanente em saúde: olhar das enfermeiras Gestión participativa en la educación permanente en salud: visión de las enfermeras Participative management in permanent health education: view of the nurses

    Directory of Open Access Journals (Sweden)

    Adriane Calvetti de Medeiros

    2010-02-01

    Full Text Available Este estudo de abordagem qualitativa teve como objetivo conhecer as estratégias de gestão, com base na Educação Permanente em Saúde (EPS. Os participantes da pesquisa foram seis enfermeiras assistenciais de uma unidade de terapia intensiva de um hospital universitário do Estado do Rio Grande do Sul. Utilizou-se como instrumento de coleta de dados o Método de Círculo de Cultura de Freire. Os dados foram coletados nos meses de junho a agosto/2007. Os resultados apontam para o planejamento participativo e tomada de decisão como estratégias da EPS que promovem a autonomia, a valorização, a competência técnica e a construção do trabalho em equipe, em seu próprio percurso de aprendizagem.Este estudio de abordaje cualitativa tuvo como objetivo conocer las estrategias de gestión, con base en la Educación Permanente en Salud (EPS. Los participantes de la investigación fueron seis enfermeras asistenciales de una unidad de terapia intensiva de un hospital universitario del Estado de Rio Grande do Sul. Se utilizó como instrumento de recollección de datos el Método de Círculo de Cultura de Freire. Los dados fueran recogidos en los meses de junio a agosto/2007. Los resultados apuntan para la planificación participativo y toma de decisión como estrategias de la EPS que promueven la autonomía, la valorización, la competencia técnica y la construcción del trabajo en equipo, en su propio recorrido de aprendizajeThis study is of qualitative approach, and aimed at knowing the management strategies, on the basis of the Permanent Education in Health (PEH. The participants of the research had been six nurses of an intensive care unit from an university hospital in the State of Rio Grande do Sul, Brazil. The Method Circle of Culture of Freire was used like as instrument for collection of data. The data were collected in the period from June to august, 2007. Results point out participative planning and decision making as strategies of the

  20. Control permanente de la gestión sanitaria por monitoreo de costos mediante acontecimientos indicadores Ongoing health management control by cost monitoring through tracer indicators

    Directory of Open Access Journals (Sweden)

    Horacio Villanueva

    2001-12-01

    Full Text Available Objetivos. Determinar el costo operacional de un servicio quirúrgico, comparar los resultados con estándares y determinar la incidencia de costos. Obtener una metodología eficaz para este fin, extrapolable a todo tipo de servicio asistencial y de fácil instrumentación en una herramienta informática convencional (base de datos de alta difusión y bajo costo que pueda usarse en el control permanente de la gestión. Métodos. El estudio se realizó durante 1999 en el Servicio de Ortopedia y Traumatología del Hospital Estatal "Domingo Funes", Córdoba, Argentina. De los 817 pacientes sometidos a procedimientos diagnósticos o terapéuticos en ese servicio a lo largo del año, se seleccionaron los 154 que necesitaron internación y maniobras quirúrgicas o instrumentales. Se utilizó el método de acontecimientos indicadores descrito por Kessner. Dichos acontecimientos, clasificados en función de su complejidad (alta, mediana, escasa o nula, fueron seleccionados y definidos por consenso de expertos: especialistas médicos y economistas. Se valoraron los costos directos e indirectos para estudiar su peso en el costo total, en cuya estimación se utilizaron nueve variables que se aplicaron a los diferentes acontecimientos indicadores. Resultados. El mayor peso del costo total, tanto estándar como real, recayó en ambos casos sobre la variable "día cama". De la variable "día cama" en el total de acontecimientos indicadores, el 51,2% correspondió a la internación social (costo indirecto y el 48,8% a la internación terapéutica (costo directo. Su diferencia con respecto al costo estándar fue un aumento del orden del 117%. Los costos indirectos (internación social e insumos terapéuticos absorbieron casi la mitad del costo real total. El costo real de todos los acontecimientos investigados, sin incluir los costos indirectos, solo superó al costo estándar en un 6,4%. Incluyendo los costos indirectos (internación social e insumos terap

  1. Desvelamento crítico da pessoa estomizada: em ação o programa de educação permanente em saúde Develamiento crítico de la persona ostomizada: programa de educación permanente en salud en acción Critical unveiling of people with stomas: the continuing health education program in action

    Directory of Open Access Journals (Sweden)

    Regina Ribeiro Cunha

    2012-01-01

    Full Text Available OBJETIVO: Apresentar o desvelamento crítico do Itinerário de Pesquisa Freireano na atenção à pessoa estomizada. MÉTODOS: Estudo qualitativo em saúde articulado com o referencial metodológico de Freire, que compreende a obtenção e análise dos dados nos círculos dialógicos, constituído por três momentos dialéticos, interdisciplinarmente entrelaçados: investigação temática, codificação e descodificação e desvelamento crítico. Ocorreu no período de abril de 2009 e fevereiro de 2010, com número irregular de participantes, no auditório da Unidade de Referência Especializada Presidente Vargas, no Município de Belém/PA. RESULTADOS: A deficiente qualificação dos profissionais de saúde foi um dos temas geradores mais relevantes, sendo desvelada a necessidade de implantação de um Programa de Educação Permanente na Atenção à pessoa estomizada. CONCLUSÃO: O desvelamento proposto constituiu uma vivência para que essas pessoas estomizadas habilitem-se a "ler o mundo" e, assim, conheçam e caminhem rumo à transformação de sua realidade.OBJETIVO: Presentar el develamiento crítico del Itinerario de Investigación Freireano en la atención a la persona ostomizada. MÉTODOS: Estudio cualitativo en salud articulado con el referencial metodológico de Freire, que comprende la obtención y análisis de los datos en los círculos dialógicos, constituido por tres momentos dialécticos, interdisciplinariamente entrelazados: investigación temática, codificación y decodificación y develamiento crítico. Se llevó a cabo en el período de abril del 2009 y febrero del 2010, con un número irregular de participantes, en el auditorio de la Unidad de Referencia Especializada Presidente Vargas, en el Municipio de Belém/PA. RESULTADOS: La deficiente calificación de los profesionales de salud fue uno de los temas generadores más relevantes, siendo develada la necesidad de implantación de un Programa de Educación Permanente

  2. Use of Electronic Health Records and Administrative Data for Public Health Surveillance of Eye Health and Vision-Related Conditions

    Science.gov (United States)

    Elliott, Amanda; Davidson, Arthur; Lum, Flora; Chiang, Michael; Saaddine, Jinan B; Zhang, Xinzhi; Crews, John E.; Chou, Chiu-Fang

    2014-01-01

    Purpose To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. Methods We describe three currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. Results Each of the three sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. Conclusions Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented. PMID:23158225

  3. Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

    Science.gov (United States)

    Monroe, C Douglas; Chin, Karen Y

    2013-05-01

    The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

  4. Programa de Capacitação Permanente de Conselheiros Populares de Saúde na cidade de São Paulo São Paulo city: Permanent Skills Improvement Course for elected representatives to the Municipal Health Councils

    Directory of Open Access Journals (Sweden)

    Cláudia Maria Bógus

    2003-12-01

    Full Text Available O Movimento Popular de Saúde do Município de São Paulo vem elegendo Conselhos Populares de Saúde desde 1979. A questão da formação política e capacitação técnica de lideranças sempre foi uma preocupação do movimento de saúde. Durante a gestão municipal de 1993 a 2000 a interlocução entre o governo local e a representação popular foi rompida e disto decorreu um período de refluxo dos movimentos sociais. Porém, no início de 1998, os movimentos organizados de saúde das regiões leste e sudeste conseguiram se articular para eleger conselheiros para os Conselhos Populares de Saúde. Foram eleitos 1.039 conselheiros. Após vários esforços isolados de capacitação de conselheiros optou-se por realizar um Programa de Capacitação Permanente de Conselheiros de Saúde como forma de envolver o conjunto de bairros e regiões. Por meio de um convênio entre o Ministério da Saúde e o Centro de Educação Permanente da Faculdade de Saúde Pública da Universidade de São Paulo foram realizados 52 cursos para 1.011 desses conselheiros eleitos. Neste trabalho, a partir de análise documental, os autores descrevem esse processo de capacitação, caracterizam o perfil sócio econômico dos conselheiros e analisam a avaliação dos participantes nos cursos de capacitação.The popular health movement from São Paulo City has been electing Popular Health Councils since 1979. The issue of political and technical capabilities of its leaders has been an important point for the movement. During the years 1993 to 2000, the communication channels between the municipal government and popular leadership have been broken, leading back the social movement related to public health. However, in the beginningof 1988, the organized health movements located both at the east and southeast parts of São Paulo City, were succeeded in electing 1.039 members for those popular councils. After several scattered efforts to provide capability and skills to the

  5. Searching for the optimal renal prescription. Fresenius, Kaiser Permanente team up to offer new options in dialysis care.

    Science.gov (United States)

    Neumann, M E

    1999-01-01

    The goals are simple: Improve well-being of the dialysis patient and reduce hospitalizations. The tools are diverse: Ultrapure dialysate. On-line blood monitoring. Biocompatible membranes. No reuse. Daily, in-center dialysis and possibly nocturnal dialysis at home. Reimbursement: Full-risk capitation, With Medicare and commercial payor rates varying on a patient-by-patient basis. Create an incubator with approximately 1,000 end-stage renal disease patients, treated at both capitated payment-exclusive dialysis units and mingled in at traditional fee-for-service clinics. Establish a team of nurses and renal care staff to direct the care plan, and put the program in place. After the first year, analyze the data and see if the end--hopefully, improved outcomes and resulting reduced hospitalizations--justifies the means--the higher cost for "optimal technologies."

  6. Use of electronic health records and administrative data for public health surveillance of eye health and vision-related conditions in the United States.

    Science.gov (United States)

    Elliott, Amanda F; Davidson, Arthur; Lum, Flora; Chiang, Michael F; Saaddine, Jinan B; Zhang, Xinzhi; Crews, John E; Chou, Chiu-Fang

    2012-12-01

    To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. Perspective, comparing systems. We describe 3 currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. Each of the 3 sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Using Population Dose to Evaluate Community-level Health Initiatives.

    Science.gov (United States)

    Harner, Lisa T; Kuo, Elena S; Cheadle, Allen; Rauzon, Suzanne; Schwartz, Pamela M; Parnell, Barbara; Kelly, Cheryl; Solomon, Loel

    2018-05-01

    Successful community-level health initiatives require implementing an effective portfolio of strategies and understanding their impact on population health. These factors are complicated by the heterogeneity of overlapping multicomponent strategies and availability of population-level data that align with the initiatives. To address these complexities, the population dose methodology was developed for planning and evaluating multicomponent community initiatives. Building on the population dose methodology previously developed, this paper operationalizes dose estimates of one initiative targeting youth physical activity as part of the Kaiser Permanente Community Health Initiative, a multicomponent community-level obesity prevention initiative. The technical details needed to operationalize the population dose method are explained, and the use of population dose as an interim proxy for population-level survey data is introduced. The alignment of the estimated impact from strategy-level data analysis using the dose methodology and the data from the population-level survey suggest that dose is useful for conducting real-time evaluation of multiple heterogeneous strategies, and as a viable proxy for existing population-level surveys when robust strategy-level evaluation data are collected. This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  8. Association between personal health record enrollment and patient loyalty.

    Science.gov (United States)

    Turley, Marianne; Garrido, Terhilda; Lowenthal, Alex; Zhou, Yi Yvonne

    2012-07-01

    To examine the association between patient loyalty, as measured by member retention in the health plan, and access to My Health Manager (MHM), Kaiser Permanente's PHR, which is linked to its electronic health record, KP HealthConnect. We conducted a retrospective cohort observational quality improvement project from the third quarter of 2005 to the fourth quarter of 2008 for approximately 394,000 Kaiser Permanente Northwest members. To control for self-selection bias, we used propensity scores to perform exact 1-to-1 matching without replacement between MHM users and nonusers. We estimated retention rates of the matched data and assessed the association between MHM use and retention versus voluntary termination. We also estimated odds ratios of significant variables impacting member retention. The probability of remaining a member or being involuntarily terminated versus voluntary termination was 96.7% for users (95% confidence interval [CI], 96.6%-96.7%) and 92.2% for nonusers (95% CI, 92.1%-92.4%; P loyalty, retention is critical to healthcare organizations.

  9. Agenesia en dentición permanente

    OpenAIRE

    Beltrán Morera, Jazmín

    2009-01-01

    Objetivo Determinar la frecuencia de agenesia dental en dentición permanente.Materiales y Métodos Se incluyeron 112 pacientes que acudieron al servicio de imagenología de la Facultad de Odontología, Universidad Nacional Autónoma de México, de enero a julio del 2008, mayores de 13 años, sin extracciones dentales ni síndromes genéticos, a quienes se les tomó ortopantomografía. Se registraron variablessociodemográficas y antecedentes familiares de agenesia dental. Lainformación se procesó en SPS...

  10. Optimized Kaiser-Bessel Window Functions for Computed Tomography.

    Science.gov (United States)

    Nilchian, Masih; Ward, John Paul; Vonesch, Cedric; Unser, Michael

    2015-11-01

    Kaiser-Bessel window functions are frequently used to discretize tomographic problems because they have two desirable properties: 1) their short support leads to a low computational cost and 2) their rotational symmetry makes their imaging transform independent of the direction. In this paper, we aim at optimizing the parameters of these basis functions. We present a formalism based on the theory of approximation and point out the importance of the partition-of-unity condition. While we prove that, for compact-support functions, this condition is incompatible with isotropy, we show that minimizing the deviation from the partition of unity condition is highly beneficial. The numerical results confirm that the proposed tuning of the Kaiser-Bessel window functions yields the best performance.

  11. Educação à Distância como estratégia para a educação permanente em saúde: possibilidades e desafios Educación a la Distancia como estratégia para la educación permanente en salud: posibilidades y desafíos Distance Education as strategy for permanent education in health: possibilities and challenges

    Directory of Open Access Journals (Sweden)

    Marluce Alves Nunes Oliveira

    2007-10-01

    Full Text Available Este estudo objetivou refletir sobre a importância da Educação Permanente em Saúde (EPS na promoção do processo de mudança nos docentes da UEFS; estabelecer estratégias para a promoção da EPS e apontar as possibilidades e os desafios para a operacionalização da EAD como estratégia para a EPS. Estudo de revisão bibliográfica. O resultado aponta que a EPS é uma das estratégias para a formação do profissional através de trabalhos coletivos entre os docentes. Como possibilidade: EAD possibilita construir um novo estilo na formação. Desafios: necessidade de conhecimento para utilizar as novas tecnologias da informação e comunicação; dificuldade de acesso a estas tecnologias; escassez de tempo para desenvolver as atividades do curso. Apreendemos que a EAD apresenta nova perspectiva para EPS.Este estudio buscó reflexionar al respecto de la importancia de la Educación Permanente em Salud (EPS em la promoción del proceso de cambios em los docentes de la Universidad Estatal de Feira de Santana (UEFS; establecer estratégias para la promoción de la EPS y apuntar las posibilidades y los desafíos para la operacionalización de la Educación a la Distancia (EAD como estratégia para la EPS. Estudio de una revización bibliográfica. El resultado apunta a que la EPS és una de las estratégias para la formación del profesional por médio de trabajos colectivos entre los docentes. Como posibilidad: EAD posibilita construir um nuevo estilo em lá formación. Desafíos: necesidad de conocimiento para utilizar las nuevas tecnologíes de la información y comunicación; dificultad de acceso a estas tecnologias; poco tiempo para desarrollar las actividades del curso. Aprendimos que la EAD presenta nueva perspectiva para la EPS.The point of this study is to reflect about how important Permanent Education in Health (PEH is in the promotion of the changes process of professors of UEFS; to establish strategies to promote PEH and show the

  12. Prevalence of Childhood Obesity among Young Multiethnic Children from a Health Maintenance Organization in Hawaii.

    Science.gov (United States)

    Novotny, Rachel; Oshiro, Caryn Etsuko Shima; Wilkens, Lynne Ross

    2013-02-01

    Pacific Islander, Asian, and mixed-ethnicity children are not described in national nutrition and health surveys. Data on BMI values of 4608 5- to 8-year-old children available from Kaiser Permanente Hawaii electronic medical records in 2010 were analyzed for prevalence of overweight and obesity and for ethnic differences in BMI and risk for overweight and obesity, controlling for age, sex, neighborhood education level, and on a subset (n=2169) that further controlled for maternal education and maternal age. Kaiser Permanente data allow for reporting of multiple ethnicities. Data revealed that 33% of this child population was of mixed ethnic ancestry. Prevalence of overweight and obesity was 32.6% (12.9% overweight and 19.7% obese). However, Samoan children and children of Native Hawaiian, Filipino, and mixed ethnic ancestries had higher levels of overweight and obesity than whites or Asians. Higher neighborhood education level, higher maternal education level, and older maternal age were associated with decreased risk of overweight and obesity, except for children whose mothers were between 21 and 30 years old, who had a higher risk for obesity than those whose mothers were under 20 years of age (odds ratio=1.34). Populations of mixed ethnicities in the Pacific region deserve further study related to healthy body size and acculturation to environment and lifestyle.

  13. El establecimiento permanente en un contexto virtual

    Directory of Open Access Journals (Sweden)

    Andrés Mauricio Rengifo

    2002-01-01

    Full Text Available La inmediatez, la informalidad y la total irrelevancia de la localización, la distancia y los límites nacionales son ventajas innegables del comercio en Internet. Al mismo, tiempo, son características que plantean interrogantes para los Estados, quienes, conscientes de la importancia de controlar el volumen y la magnitud de las operaciones realizadas en red (al gravarlas directa o indirectamente pueden conseguir fuentes de ingreso para el mantenimiento de las estructuras y la financiación de gastos gubernamentales se cuestionan cuál debe ser el sujeto pasivo de las obligaciones tributarias en un mercado donde las empresas están deslocalizadas o aún, no existen físicamente. El presente artículo aporta a la resolución del problema tras un completo estudio del concepto de establecimiento Permanente de carácter virtual, elaborado por la Organización para la Cooperación y el Desarrollo Económico.

  14. El establecimiento permanente en un contexto virtual

    Directory of Open Access Journals (Sweden)

    Andrés Mauricio Rengifo

    2002-06-01

    Full Text Available La inmediatez, la informalidad y la total irrelevancia de la localización, la distancia y los límites nacionales son ventajas innegables del comercio en Internet. Al mismo, tiempo, son características que plantean interrogantes para los Estados, quienes, conscientes de la importancia de controlar el volumen y la magnitud de las operaciones realizadas en red (al gravarlas directa o indirectamente pueden conseguir fuentes de ingreso para el mantenimiento de las estructuras y la financiación de gastos gubernamentales se cuestionan cuál debe ser el sujeto pasivo de las obligaciones tributarias en un mercado donde las empresas están deslocalizadas o aún, no existen físicamente. El presente artículo aporta a la resolución del problema tras un completo estudio del concepto de establecimiento Permanente de carácter virtual, elaborado por la Organización para la Cooperación y el Desarrollo Económico.

  15. Educação permanente em saúde: uma estratégia para a formação dos agentes comunitários de saúde Educación continua en materia de salud: una estrategia para la formación de agentes de salud de la comunidad Continuing health educating: a strategy for the training of community health agents

    Directory of Open Access Journals (Sweden)

    Vanessa Baliego de Andrade Barbosa

    2012-03-01

    ñanza, necesitando investimento gerencial en la capacitación de los enfermeros en educación permanente, posibilitándolos en la actuación con los ACS.This article aimed to describe and analyze the training process of Health Community Agents (HCA by Family Health Strategy nurses. It is a qualitative research with 17 individuals. Data collection was performed through semi-structured interviews and the analysis was made through the data analysis technique. A category was established: The organization of the educational process in the Family Health Units, in which the themes selected were: nurses as reference team leaders, permanent education, traditional methodologies and education centered on the HCA needs. Through this study we were able to understand that the nurses have less familiarity with permanent education, performing HCA capacitating activities based on traditional teaching methodologies. Investments for capacitating nurses in permanent education are required to allow them to teach HCAs better.

  16. Type C investigation of electrical fabrication projects in ICF Kaiser shops

    International Nuclear Information System (INIS)

    Huckfeldt, R.A.

    1995-06-01

    A Type C Investigation Board was convened to investigate an electrical miswiring problem found during the operation of the electrical distribution trailer for the TWRS Rotary Mode Core Sampling Truck number-sign 2. The trailer was designed by WHC and fabricated ICF KH on site for use in the Characterization Program. This problem resulted in a serious safety hazard since the support truck frame/chassis became electrically energized. This final report provides results of the ''Type C Investigation, Electrical Fabrication Projects in ICF KH Shops, June, 1995.'' It contains the investigation scope, executive summary, relevant facts, analysis, conclusions and corrective actions. DOE Order 5484.1, ''Environmental Protection, Safety and Health Protection Information Reporting Requirements,'' was followed in preparation of this report. Because the incident was electrical in nature and involved both Westinghouse Hanford Company and ICF Kaiser Hanford organizations, the board included members from both contractors and members with considerable electrical expertise

  17. 75 FR 61246 - Kaiser Federal Financial Group, Inc., Covina, CA; Approval of Conversion Application

    Science.gov (United States)

    2010-10-04

    ... DEPARTMENT OF THE TREASURY Office of Thrift Supervision [AC-51: OTS No. H-4729] Kaiser Federal... September 28, 2010, the Office of Thrift Supervision approved the application of K-Fed Mutual Holding Company and Kaiser Federal Bank, Covina, California, to convert to the stock form of organization. Copies...

  18. Evaluation of Rock Stress Estimation by the Kaiser effect

    International Nuclear Information System (INIS)

    Lehtonen, A.

    2005-11-01

    The knowledge of in situ stress is the key input parameter in many rock mechanics analyses. Information on stress allows the definition of boundary conditions for various modelling and engineering tasks. Presently, the estimation of stresses in bedrock is one of the most difficult, time-consuming and high-priced rock mechanical investigations. In addition, the methods used today have not evolved significantly in many years. This brings out a demand for novel, more economical and practical methods for stress estimation. In this study, one such method, Kaiser effect based on acoustic emission of core samples, has been evaluated. It can be described as a 'memory' in rock that is indicated by a change in acoustic emission emitted during uniaxial loading test. The most tempting feature of this method is the ability to estimate the in situ stress state from core specimens in laboratory conditions. This yields considerable cost savings compared to laborious borehole measurements. Kaiser effect has been studied in order to determine in situ stresses for decades without any major success. However, recent studies in Australia and China have been promising and made the estimation of stress tensor possible from differently oriented core samples. The aim of this work has been to develop a similar estimation method in Finland (including both equipment and data reduction), and to test it on samples obtained from Olkiluoto, Eurajoki. The developed measuring system proved to work well. The quality of obtained data varied, but they were still interpretable. The results obtained from these tests were compared with results of previous overcoring measurements, and they showed quite good correlation. Thus, the results were promising, but the method still needs further development and more testing before the final decision on its feasibility can be made. (orig.)

  19. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne

    2012-01-01

    are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system...... in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear...... which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved....

  20. Properties and simulation of α-permanental random fields

    DEFF Research Database (Denmark)

    Møller, Jesper; Rubak, Ege Holger

    An α-permanental random field is briefly speaking a model for a collection of random variables with positive associations, where α is a positive number and the probability generating function is given in terms of a covariance or more general function so that density and moment expressions are given...... by certain α-permanents. Though such models possess many appealing probabilistic properties, many statisticians seem unaware of  α-permanental random fields and their potential applications. The purpose of this paper is first to summarize useful probabilistic results using the simplest possible setting......, and second to study stochastic constructions and simulation techniques, which should provide a useful basis for discussing the statistical aspects in future work. The paper also discusses some examples of  α-permanental random fields....

  1. Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente

    DEFF Research Database (Denmark)

    Schiøtz, Michaela Louise; Price, Mary; Frølich, Anne

    2011-01-01

    As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison...

  2. Self-Management Support to People with Type 2 Diabetes - A comparative study of Kaiser Permanente and the Danish Healthcare System

    DEFF Research Database (Denmark)

    Schiøtz, Michaela Louise; Strandberg-Larsen, Martin; Frølich, Anne

    2012-01-01

    En væsentlig del af kronikeromsorgen i et sundhedsvæsen er også at understøtte egenomsorgen. Egenomsorg omfatter fx, at patienten kender til, hvad der kan optimere behandlingsindsatsen, herunder ændring af livsstil, kendskab til sundhedsvæsenets tilbud, og at deltage aktivt i at koordinere og sik...

  3. Avaliação continuada da educação permanente na atenção à criança na estratégia saúde da família Continuous evaluation of permanent education concerning child care as part of the family health strategy

    Directory of Open Access Journals (Sweden)

    Katia Virginia de Oliveira Feliciano

    2008-03-01

    Full Text Available Este artigo apresenta a avaliação continuada do trabalho realizado e os resultados que podem ser atribuídos à educação permanente na atenção à criança, desenvolvida junto às equipes de saúde da família, com gerência compartilhada pelo Programa de Extensão Comunitária do Instituto Materno Infantil Prof. Fernando Figueira (IMIP, e Secretarias Municipais de Saúde do Recife e Olinda, em Pernambuco, Brasil. Com apoio de consultores externos, o grupo executor realizou reflexão crítica sistemática, orientada pelas categorias desempenho, efeitos e efetividade, visando aprimorar o trabalho em seu decorrer. As fontes de informação foram os registros diários do grupo e das equipes e as percepções sobre o trabalho. Apesar da dificuldade de transformar em rotina as mudanças alcançadas, a educação permanente tem qualificado a atenção à criança. A satisfação das equipes reforça o sentimento de sua fecundidade e operacionalidade.This article presents a continuous evaluation of work involving permanent education regarding childcare and the results that can be attributed to it, as carried out by family health teams managed jointly by the Community Outreach Program of the Instituto Materno Infantil Prof. Fernando Figueira, IMIP and the Municipal Departments of Health of the city Recife and the city of Olinda, State of Pernambuco, Brazil. With the support of external consultants, the group carried out systematic critical reflection, organized around the categories of performance, effects and effectiveness, with a view to enhancing the work under way. The sources of information used were the daily registers of the group and the teams and their views regarding the work. Despite the difficulty of transforming the changes brought about into routines, continuous education seems to have improved the quality of childcare. The satisfaction the teams feel corroborates this feeling that this work is both feasible and productive.

  4. A new class of weight and WA systems of the Kravchenko-Kaiser functions

    Science.gov (United States)

    Kravchenko, V. F.; Pustovoit, V. I.; Churikov, D. V.

    2014-05-01

    A new class of weight and WA-systems of the Kravchenko-Kaiser functions which showed its efficiency in various physical applications is proposed and substantiated. This publication consists of three parts. In the first the Kravchenko-Kaiser weight functions are constructed on basis of the theory of atomic functions (AFs) and the Kaiser windows for the first time. In the second part new constructions of analytic WA-systems of the Kravchenko-Kaiser functions are costructed. In the third part their applications to problems of weight averaging of the difference frequency signals are considered. The numerical experiment and the physical analysis of the results for concrete physical models confirmed their efficiency. This class of functions can find wide physical applications in problems of digital signal processing, restoration of images, radar, radiometry, radio astronomy, remote sensing, etc.

  5. Gestão de recursos financeiros da educação permanente em saúde: desafio das comissões de integração ensino-serviço Management of financial resources of permament education in health: challenge of the in-service learning integration committees

    Directory of Open Access Journals (Sweden)

    Laura Camargo Macruz Feuerwerker

    2013-06-01

    Full Text Available A utilização dos recursos financeiros da educação permanente em saúde (EPS no Brasil, mesmo seguindo a dinâmica estabelecida no Pacto de Gestão, ainda configura-se como um problema nesse contexto. O objetivo foi analisar como ocorre a gestão dos recursos financeiros da Política Nacional de Educação Permanente em duas Comissões Permanentes de Integração Ensino-Serviço (CIES, em Santa Catarina. Estudo qualitativo, do tipo pesquisa participante, realizado através da adequação da Investigação Temática de Paulo Freire, de maio-dezembro/2009, com 56 membros de duas CIES que, após a formação de círculos de investigação, participaram das etapas: levantamento dos temas geradores, codificação, decodificação e desvelamento crítico da realidade. A observação participante e o diálogo foram as principais técnicas de coleta de informações. Os resultados indicam que as CIES se assemelham nas problemáticas relacionadas à gestão de recursos destinados à política, sendo a burocratização, a indefinição de formas de gestão financeira e a morosidade que permeiam as estruturas regionais responsáveis pela gestão dos recursos são os principais fatores explicitados. Os participantes apresentam como possibilidades de mudança a elaboração de ações de EPS sobre a gestão de recursos financeiros em nível estadual.Despite adhering to the dynamics established in the Management Pact, the use of financial resources of Permanent Education in Health (PEH still features as a problem in Brazil. This study analyzes how the management of these financial resources by two Permanent In-Service Learning Integration Committees (ICLS evolves in the State of Santa Catarina, Brazil. It involves a qualitative, participatory research study adapted from Paulo Freire's Thematic Research conducted with 56 members from two ICLS between May and December 2009. After setting up the research groups, the members participated in the stages of theme

  6. Exposure to Mobile Source Air Pollution in Early-life and Childhood Asthma Incidence: The Kaiser Air Pollution and Pediatric Asthma Study.

    Science.gov (United States)

    Pennington, Audrey Flak; Strickland, Matthew J; Klein, Mitchel; Zhai, Xinxin; Bates, Josephine T; Drews-Botsch, Carolyn; Hansen, Craig; Russell, Armistead G; Tolbert, Paige E; Darrow, Lyndsey A

    2018-01-01

    Early-life exposure to traffic-related air pollution exacerbates childhood asthma, but it is unclear what role it plays in asthma development. The association between exposure to primary mobile source pollutants during pregnancy and during infancy and asthma incidence by ages 2 through 6 was examined in the Kaiser Air Pollution and Pediatric Asthma Study, a racially diverse birth cohort of 24,608 children born between 2000 and 2010 and insured by Kaiser Permanente Georgia. We estimated concentrations of mobile source fine particulate matter (PM2.5, µg/m), nitrogen oxides (NOX, ppb), and carbon monoxide (CO, ppm) at the maternal and child residence using a Research LINE source dispersion model for near-surface releases. Asthma was defined using diagnoses and medication dispensings from medical records. We used binomial generalized linear regression to model the impact of exposure continuously and by quintiles on asthma risk. Controlling for covariates and modeling log-transformed exposure, a 2.7-fold increase in first year of life PM2.5 was associated with an absolute 4.1% (95% confidence interval, 1.6%, 6.6%) increase in risk of asthma by age 5. Quintile analysis showed an increase in risk from the first to second quintile, but similar risk across quintiles 2-5. Risk differences increased with follow-up age. Results were similar for NOX and CO and for exposure during pregnancy and the first year of life owing to high correlation. Results provide limited evidence for an association of early-life mobile source air pollution with childhood asthma incidence with a steeper concentration-response relationship observed at lower levels of exposure.

  7. Frederik Kaiser (1808-1872) and the Modernisation of Dutch Astronomy

    Science.gov (United States)

    van der Heijden, Petra

    Frederik Kaiser was the director of Leiden Observatory from 1837 until his death in 1872. Educated by his German-born uncle Johan Frederik Keyser (1766-1823), who was a proficient amateur astronomer, Kaiser proved to be a real observational talent. Despite the poor conditions in which he worked, his observations soon rivalled with the best in the world. Kaiser's contributions to astronomical practice include the foundation of a new, completely up-to-date observatory building in Leiden, and the introduction of statistics and precision measurements in daily practice at the observatory. Moreover he was the author of several bestselling books on popular astronomy. Kaiser had an extensive correspondence with colleagues all over Europe, mostly in Germany. Correpondents include Airy, Argelander, Von Auwers, Bessel, Encke, John Herschel, LeVerrier, Von Littrow, Schumacher, Otto W. Struve, as well as several geodesists and instrument makers. Preliminary research indicates that Frederik Kaiser played a crucial role in the revival of Dutch astronomy in the second half of the 19th century. This project aims at analysing and explaining Kaiser's activities in science, institutionalisation and popularisation, in the context of national and international developments in 19th-century astronomy and scientific culture.

  8. Educação Permanente em Saúde no Brasil: educação ou gerenciamento permanente?

    Directory of Open Access Journals (Sweden)

    Cristiane Lopes Simão Lemos

    2016-03-01

    Full Text Available Resumo O objetivo do estudo foi analisar a concepção e os fundamentos da Educação Permanente em Saúde (EPS constante da Política Nacional de Educação Permanente em Saúde (PNEPS no Brasil. A metodologia baseou-se na análise de documentos do Ministério da Saúde e de artigos científicos relacionados. Constatou-se que a concepção da EPS na PNEPS transcende um significado pedagógico, respondendo a um processo de reestruturação dos serviços diante das novas demandas do modelo. Justamente no momento em que o trabalho se encontra cada vez mais instável e precarizado, o Ministério da Saúde apresenta um discurso sobre uma gestão inovadora, dando centralidade à questão da EPS. A ideia não é de educação permanente, mas de gerenciamento permanente. Ao contrário de um instrumento de transformação radical, a EPS converte-se em uma ideologia que seduz pela sua aparência de novidade pedagógica.

  9. Personal health record use and association with immunizations and well-child care visits recommendations.

    Science.gov (United States)

    Tom, Jeffrey O; Chen, Chuhe; Zhou, Yi Yvonne

    2014-01-01

    To determine the association of parental use of integrated personal health records (PHRs) with children's adherence to immunization and well-child care (WCC) visit recommendations. For the immunization and WCC visit measures, we retrospectively analyzed, respectively, 766 and 639 matched pairs at Kaiser Permanente (KP) Hawaii and 2795 and 2448 pairs at KP Northwest who were ≤ 31 days old at enrollment and continuously enrolled for 2 years between January 2007 and July 2011. The independent variable (≥ 1 PHR feature used vs none) was matched using propensity scores on parental and children characteristics. The dependent variables were 2 measures from the 2010 Healthcare Effectiveness Data and Information Set: combination 2 immunization (all immunizations vs immunizations only at KP Northwest (KP Hawaii: OR 1.1, 95% CI 0.8-1.4, P > .05; KP Northwest OR 1.2, 95% CI 1.0-1.3, P immunizations in only 1 region. Copyright © 2014 Mosby, Inc. All rights reserved.

  10. Educação permanente com os auxiliares de enfermagem da Estratégia Saúde da Família em Sobral, Ceará Continuing education with nursing assistants from the Family Health Strategy in Sobral, Ceará

    Directory of Open Access Journals (Sweden)

    Aldiania Carlos Balbino

    2010-10-01

    Full Text Available A proposta da Política Nacional de Educação Permanente em Saúde (PNEPS é a formação e o desenvolvimento dos trabalhadores para o Sistema Único de Saúde (SUS. A partir desse pressuposto, o objetivo deste estudo foi analisar a percepção dos auxiliares de enfermagem sobre o processo de Educação Permanente (EP que vem sendo realizado pela Escola de Formação em Saúde da Família Visconde de Sabóia (EFSFVS em Sobral, Ceará, Brasil. Desenvolveu-se um estudo exploratório-descritivo de natureza qualitativa com dez auxiliares de enfermagem que participaram pelo menos uma vez das atividades de EP desenvolvidas pela Coordenação de EP de Sobral. Os dados foram coletados por meio da técnica de grupo focal, e os resultados, analisados a partir do discurso do sujeito coletivo. Os resultados evidenciaram que houve mudanças na prática dos auxiliares de enfermagem após a inserção destes nas atividades de EP através do apoderamento e aperfeiçoamento de competências (habilidades, atitudes e conhecimentos. Destarte, faz-se necessária a permanência desses trabalhadores no processo de EP, assim como de avaliação sistemática nesse processo, para que se alcance uma prática profissional eficiente e transformadora, pelo aprender constante, qualificando a atenção à saúde.The proposal set forth by the National Policy on Continuing Education in Health (PNEPS is to train and develop workers for the Unified Health System (SUS. Based on this assumption, the purpose of this study was to analyze the perceptions nursing assistants have about the Continuing Education (CE process being carried out by the Visconde de Sabóia School for Education in Family Health (EFSFVS, in Sobral, state of Ceará, Brazil. A qualitative descriptive-exploratory study was undertaken involving ten nursing assistants who participated at least once in the CE activities undertaken by the Sobral CE Coordination. Data were collected through focus group techniques, and

  11. Le tecnologie mobili dell’apprendimento permanente, il progetto MOTILL

    Directory of Open Access Journals (Sweden)

    Marco Arrigo

    2013-03-01

    Full Text Available In questo articolo vengono presentati alcuni dei risultati del progetto MOTILL. MOTILL, ovvero «Le Tecnologie Mobili nell’apprendimento permanente: buone pratiche», è un progetto finanziato dalla Comunità Europea, nell’ambito del National Lifelong Learning Strategies (NLLS. Il progetto, durato un anno e terminato a Marzo 2010, si è focalizzato sull’uso delle tecnologie mobili in contesti di lifelong learning (LLL. L’articolo sarà dedicato a una breve introduzione del progetto, dei suoi obiettivi e delle azioni portate avanti, e a un rapido riassunto dei principali risultati ottenuti, i quali sono stati resi disponibili online alla comunità scientifica e diffusi ai policy makers impegnati nei programmi di apprendimento permanente.

  12. A institucionalização da educação permanente no programa de saúde da família: uma experiência municipal inovadora The institutionalization of permanent education in the family health program: an innovative municipal experience

    Directory of Open Access Journals (Sweden)

    Ivana Macedo Cardoso

    2005-09-01

    Full Text Available O Programa de Saúde da Família (PSF, adotado pela Secretaria Municipal de Saúde de Vitória (ES como estratégia de estruturação da atenção primária, tem exigido de seus profissionais conhecimentos e habilidades em geral não valorizados em sua formação acadêmica. Além disso, a oferta constante de novos conceitos e tecnologias e a demanda da população por um serviço de saúde adequado às suas necessidades requerem do profissional da saúde aperfeiçoamento contínuo. A Secretaria de Saúde do município, respondendo a essas necessidades, implantou em 2001 e institucionalizou em 2003 o Programa de Educação Permanente (PEP para os profissionais de nível superior das equipes de saúde da família. Esse programa tem pautado sua atuação em uma nova concepção de educação continuada, envolvendo aprendizagem contextualizada baseada em evidências e realizada através de metodologias inovadoras, como a revisão entre pares e a aprendizagem baseada em problemas.The Family Health Program, which was adopted by the Municipal Health Secretariat of the city of Vitória, in the Brazilian state of Espírito Santo, as a strategy for structuring municipal primary health care, has been requiring its professionals to have knowledge and skills that are generally not stressed in their academic education. Moreover, the constant input of new concepts and technologies and the demand of the population for health services that are appropriate for their specific needs require health professionals to constantly improve. The municipal health secretariat, responding to these needs, has implemented in 2001 (and institutionalized in 2003 the Permanent Education program for graduate professionals of the Family Health Program staff. This program's actions have been guided by a new notion of continued education, which involves evidence-based contextualized learning that uses innovative methodologies such as peer reviewing and problem-based learning.

  13. Intersection local times, loop soups and permanental Wick powers

    CERN Document Server

    Jan, Yves Le; Rosen, Jay

    2017-01-01

    Several stochastic processes related to transient Lévy processes with potential densities u(x,y)=u(y-x), that need not be symmetric nor bounded on the diagonal, are defined and studied. They are real valued processes on a space of measures \\mathcal{V} endowed with a metric d. Sufficient conditions are obtained for the continuity of these processes on (\\mathcal{V},d). The processes include n-fold self-intersection local times of transient Lévy processes and permanental chaoses, which are `loop soup n-fold self-intersection local times' constructed from the loop soup of the Lévy process. Loop soups are also used to define permanental Wick powers, which generalizes standard Wick powers, a class of n-th order Gaussian chaoses. Dynkin type isomorphism theorems are obtained that relate the various processes. Poisson chaos processes are defined and permanental Wick powers are shown to have a Poisson chaos decomposition. Additional properties of Poisson chaos processes are studied and a martingale extension is obt...

  14. Educação permanente de profissionais de saúde em instituições públicas hospitalares Educación en el trabajo de los profisionales de la salud en hospitales públicos Permanent education of health professionals in public hospital organizations

    Directory of Open Access Journals (Sweden)

    Daisy Maria Rizatto Tronchin

    2009-12-01

    Full Text Available Estudo exploratório-descrito cujos objetivos foram identificar, caracterizar e analisar as atividades educativas desenvolvidas com profissionais de saúde, à luz das concepções de integralidade, trabalho em equipe e educação permanente. A coleta de dados ocorreu em três hospitais do Município de São Paulo, através de entrevista dirigida a informantes-chave, representantes de todas as categorias profissionais. As entrevistas foram gravadas e transcritas, as informações sistematizadas em categorias operacionais e armazenadas em banco de dados. Os resultados mostram que predominaram atividades educativas voltadas às ações de recuperação da saúde, com participação de profissionais de áreas específicas, revelando um distanciamento da concepção de integralidade e de trabalho em equipe. Concluiu-se que as ações de educação dos profissionais de saúde reiteram o modelo clínico de assistência individual, com fragmentação das ações. Recomenda-se que elas sejam repensadas como estratégia integradora de saberes, capazes de promover a integralidade na atenção hospitalar.Estudio exploratorio-descriptivo cuyos objetivos fueron identificar, caracterizar y analisar las actividades educativas desarrolladas con profisionales de la salud, a la luz de concepciones de integralidad, trabajo en equipo y educación permanente.La colecta de datos ocurrió en tres hospitales del Municipio de São Paulo, a través de entrevista dirigida a informantes-clave, representantes de todas las categorías profisionales. Las entrevistas fueron grabadas y transcritas, las informaciones sistematizadas en categorías operacionales y almacenadas en banco de datos. Los resultados muestran que predominaron las actividades educativas hacia acciones de recuperación de la salud, con participación de profisionales de áreas específicas, revelando un distanciamiento de la concepción de integralidad y de trabajo en equipo. Concluyóse que las acciones de

  15. Duas questões permanentes em um século de políticas de saúde no Brasil republicano Two permanent issues in a century of health policies in Republican Brazil

    Directory of Open Access Journals (Sweden)

    Madel Therezinha Luz

    2000-01-01

    Full Text Available Este artigo discute o tema da centralização versus descentralização das políticas de saúde do Estado brasileiro no século XX. Desenvolve como hipótese central a idéia de que a questão centralização/descentralização de serviços e funções nas políticas públicas, incluindo a de saúde, exprime no Estado a concentração do poder social na sociedade brasileira. A dicotomia centralização/descentralização seria a transposição institucional da concentração/desconcentração do poder social e sua tradução na ordem política. A centralização no Estado materializa a estrutura de concentração do poder institucional, que as políticas públicas exprimem, durante quase todo o século XX, apesar das interferências de vários movimentos da sociedade civil. Analisando as políticas de saúde em diversas conjunturas, e destacando a progressiva diversificação de atores políticos que nelas intervêm, o artigo conclui pela existência de um processo de efetiva descentralização nas políticas na década de 1990, embora sem uma verdadeira desconcentração do poder político.This article discusses the dilemma centralization versus decentralization in health policies of the republican Brazilian State during the twentieth century. It develops the central hypothesis that the dichotomy centralization/ decentralization of functions, services and activities in Brazilian public policies, mainly in the health policies, expresses the concentration/deconcentration dichotomy of social power in civil society. The centralization/decentralization dichotomy as it appears in health policies since the foundation of Brazilian republic, illustrates the authoritarian character of this republic, as a consequence of the concentration of the social power in the hands of a small elite. Analysis of health policies in different conjunctures seems to demonstrate that decentralization tends to be defined by the state and other political actors in a

  16. Frederik Kaiser (1808-1872, een gekweld man met een missie

    Directory of Open Access Journals (Sweden)

    Huib Zuidervaart

    2011-06-01

    Full Text Available Frederik Kaiser (1808-1872, a tormented man with a missionThe Leiden astronomer Kaiser has been instrumental for the rise of Dutch astronomy in the late nineteenth-century. His career was impressive. In 1826, without any formal university education, he began at the Leiden Astronomical Observatory as an ordinary observer. Through his work in astronomy he obtained an honorary doctorate, which enabled him in 1838 to become director of the observatory. In 1844 he was appointed full professor and in the academic year 1857/1858 he even became Rector Magnificus of Leiden University. In 1860 he even saw the fulfillmentof his life-long dream: the opening of a brand new astronomical observatory. However, in spite of these obvious professional successes, Kaiser's personal life was full of melancholy. This paper investigates Kaiser's personality, using correspondence with his family, as well as testimonies written down by his students and other contemporaries. Among others, we demonstrate the way in which Kaiser used his personal network, as well as his fierce continuous – and often publicly expressed – complaining, as a successful strategy in establishing his new astronomical observatory.

  17. Site support program plan for ICF Kaiser Hanford Company, Revision 1

    International Nuclear Information System (INIS)

    1995-10-01

    This document is the general administrative plan implemented by the Hanford Site contractor, ICF Kaiser Hanford Company. It describes the mission, administrative structure, projected staffing, to be provided by the contractor. The report breaks out the work responsibilities within the different units of the company, a baseline schedule for the different groups, and a cost summary for the different operating units

  18. Site support program plan for ICF Kaiser Hanford Company, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-10-01

    This document is the general administrative plan implemented by the Hanford Site contractor, ICF Kaiser Hanford Company. It describes the mission, administrative structure, projected staffing, to be provided by the contractor. The report breaks out the work responsibilities within the different units of the company, a baseline schedule for the different groups, and a cost summary for the different operating units.

  19. Experimental and numerical study of the Kaiser effect in cyclic Brazilian tests with disk rotation

    CSIR Research Space (South Africa)

    Lavrov, A

    2002-04-01

    Full Text Available Sensitivity of the Kaiser effect to the deviations of the directions of sigma(1)-principal stress experienced by rock in Successive loading cycles has an important impact on the application of this effect for stress measurements in rocks. The paper...

  20. Experimental study on the Kaiser effect of AE under multiaxial loading in granite

    International Nuclear Information System (INIS)

    Watanabe, Hidehiko; Hiroi, Takehiro

    2012-01-01

    Knowledge of the in-situ stresses is essential for underground excavation design, particularly in evaluating stability of excavation. Acoustic Emission method, which utilizes the Kaiser effect, is one of the simple methods for measuring in-situ stresses. Experiments on the Kaiser effect has been carried out under uniaxial compression and triaxial compression (σ 1 > σ 2 = σ 3 ), but has not been carried out under the three different principal stresses (σ 1 > σ 2 > σ 3 ). In this study, we performed two experiments on the Kaiser effect under multiaxial loading, using a hollow cylindrical granite specimen. The rapidly increasing point of cumulative AE event count was determined as the peak point of AE event count rate increment (AERI). The main results are summarized as follows. (1) In the case of the cyclic incremental σ 1 loading under σ 2 ≠σ 3 , the large peak point of AERI appeared just before the pre-stress level. And as more stresses prior to just before the peak point were estimated, the estimated error showed a tendency to increase. (2) In the case of re-loading under the lower σ 2 and σ 3 more than pre-loading, the estimated stresses using the three peak points of AERI corresponded to the pre-differential stresses (σ 1 -σ 2 ), (σ 1 -σ 3 ) and pre-axial stress σ 1 . The magnitudes of the three principal stresses were estimated under multiaxial loading from the Kaiser effect, using only one specimen. (author)

  1. Educação permanente com agentes comunitários de saúde: uma proposta de cuidado com crianças asmáticas Continuing education with community health agents: a proposal for care of asthmatic children

    Directory of Open Access Journals (Sweden)

    Maria Wanderleya de Lavor Coriolano

    2012-06-01

    Full Text Available O uso de metodologias ativas nos processos de formação dos trabalhadores de saúde é uma diretriz recomendada na Política Nacional de Educação Permanente em Saúde (PNEPS para trabalhadores do Sistema Único de Saúde (SUS. Neste estudo, formulou-se uma intervenção educativa para agentes comunitários de saúde (ACS sobre cuidados dirigidos a crianças/famílias com asma. O objetivo é descrever uma ação educativa com agentes comunitários de saúde sobre conhecimentos relacionados à asma, adotando as diretrizes da PNEPS no contexto da atenção primária. Tratase de estudo 'quantiqualitativo', com avaliação préteste e pósteste autopreenchida pelos agentes comunitários de saúde, além de metodologias ativas em três grupos focais vivenciais, que tiveram sua trajetória gravada e transcrita para posterior análise de dados, com uso da técnica análise de conteúdo na modalidade temática proposta por Bardin. Os conhecimentos dos ACS sobre mitos relacionados à asma apontaram acréscimo após a ação educativa. Dos grupos focais emergiram as temáticas: Educação em saúde para prevenção das doenças respiratórias; Significado atribuído à asma; Bombinhas: desmistificando conceitos; Fatores desencadeantes para asma; Adaptando cuidados preventivos; Avaliando os conhecimentos construídos. A utilização de metodologias ativas favoreceu o desenvolvimento de competências por parte dos ACS, despertando motivação na abordagem educativa junto às crianças/famílias com asma.The use of active methods in the health worker training process is a guideline that is recommended under the National Continuing Education in Health Policy (PNEPS for National Health System (SUS employees. In this study, the authors created an educational intervention for community health agents (CHA regarding care aimed at children/families with asthma. The aim is to describe an educational action involving community health workers about asthmarelated

  2. Flexibilidad laboral: ¿fin del trabajo permanente?

    Directory of Open Access Journals (Sweden)

    Carmen Añez Hernández

    2016-05-01

    Full Text Available Los trabajos transitorios o atípicos, siguen posicionándose y funcionando trastocando la protección del sistema de regulación y protección del trabajo permanente. De ahí, la importancia de reflexionar teóricamente sobre el tema. Para su desarrollo se plantean los siguientes objetivos: demostrar que la flexibilización laboral ha incidido en la ruptura de las relaciones laborales, caracterizar como la subcontratación laboral encubre dichas relaciones, analizar el despido laboral y sus consecuencias en los trabajadores. El artículo se desarrolló teóricamente, especialmente tomando como referencia autores como: Bravo (2010, Quintero (2010, González (2012 De La Garza (2007, Ugarte (2007, entre otros, lo cual permitió analizar la temática abordada. Los resultados reflejan que dicha estrategia está impulsando la agudización de las condiciones precarias de los derechos laborales, con lo cual se está ante un capitalismo irracional, que tiene como propósito que los trabajadores sufraguen los efectos de las pretensiones de los capitalistas por conseguir mayores tasas de ganancia y niveles más altos de productividad. En consecuencia, la flexibilización de las relaciones laborales está destinada a ocultar los derechos de los trabajadores, agudizar el despido laboral, y propiciar el fin de un trabajo permanente.

  3. Desdobramentos da educação permanente em saúde no município de Vitória, Espírito santo Ramifications of continuing education in health in Vitória, state of Espírito Santo

    Directory of Open Access Journals (Sweden)

    Elzimar Evangelista Peixoto Pinto

    2010-06-01

    Full Text Available Este artigo tem como objetivo discutir os desdobramentos do processo de formação de facilitadores e o trabalho de efetivação de 'rodas' de Educação Permanente em Saúde (EPS em unidades de serviços de saúde no município de Vitória, Espírito Santo, cenário selecionado a partir de mapeamento dentre várias experiências de EPS em andamento no país. Adota os pressupostos metodológicos sugeridos pela cartografia para produção e análise dos dados, utilizando variadas estratégias, como observação participante, entrevistas individuais e coletivas com os profissionais e usuários. Verifica que o termo EPS admite várias concepções: movimento que coloca o trabalho em análise, visando a definir prioridades locais que promovam a reorganização dos espaços de produção de saúde; estratégia de formação dos profissionais de saúde em um processo constante de subjetivação, como estratégia de gestão, na medida em que possibilita reorganizar a gestão a partir da problematização do trabalho. Verifica a existência de 59 Rodas de EPS distribuídas em 25 serviços de saúde, com a presença de dois facilitadores em cada uma. Conclui que, nesse cenário, as várias concepções disputaram espaço e produziram efeitos, especialmente perceptíveis na mudança da forma como os profissionais compreendem o processo educativo e a sua interação com o cotidiano do trabalho.This article aims to discuss the ramifications of the process of training of facilitators and materializing Permanent Education in Health (PEH 'rounds' in health services units in Vitória, state of Espírito Santo, the scenario which was selected to map several PEH experiments already underway in the country. It adopts the methodological assumptions suggested by mapping to produce and analyze data, using various strategies such as participant observation and individual and collective interviews with professionals and users. It was noted that the PEH expression

  4. The impact of SHS exposure on health status and exacerbations among patients with COPD

    Directory of Open Access Journals (Sweden)

    Mark D Eisner

    2009-05-01

    Full Text Available Mark D Eisner1,3, Carlos Iribarren3, Edward H Yelin2, Stephen Sidney3, Patricia P Katz2, Gabriela Sanchez3, Paul D Blanc11Division of Occupational and Environmental Medicine and Division of Pulmonary and Critical Care Medicine; 2Institute for Health Policy Studies, Department of Medicine, University of California, San Francisco, CA, USA; 3Division of Research, Kaiser Permanente, Oakland, CA, USAAbstract: Secondhand smoke (SHS is a major contributor to indoor air pollution. Because it contains respiratory irritants, it may adversely influence the clinical course of persons with chronic obstructive pulmonary disease (COPD. We used data from nonsmoking members of the FLOW cohort of COPD (n = 809 to elucidate the impact of SHS exposure on health status and exacerbations (requiring emergency department visits or hospitalization. SHS exposure was measured by a validated survey instrument (hours of exposure during the past week. Physical health status was measured by the SF-12 Physical Component Summary Score and disease-specific health-related quality of life (HRQL by the Airways Questionnaire 20-R. Health care utilization for COPD was determined from Kaiser Permanente Northern California computerized databases. Compared to no SHS exposure, higher level SHS exposure was associated with poorer physical health status (mean score decrement −1.78 points; 95% confidence interval [CI] −3.48 to −0.074 points after controlling for potential confounders. Higher level SHS exposure was also related to poorer disease-specific HRQL (mean score increment 0.63; 95% CI 0.016 to 1.25 and less distance walked during the Six-Minute Walk test (mean decrement −50 feet; 95% CI −102 to 1.9. Both lower level and higher level SHS exposure was related to increased risk of emergency department (ED visits (hazard ratio [HR] 1.40; 95% CI 0.96 to 2.05 and HR 1.41; 95% CI 0.94 to 2.13. Lower level and higher level SHS exposure were associated with a greater risk of

  5. Economic burden related to chemotherapy-related adverse events in patients with metastatic breast cancer in an integrated health care system

    Directory of Open Access Journals (Sweden)

    Rashid N

    2016-10-01

    Full Text Available Nazia Rashid,1 Han A Koh,2 Hilda C Baca,3 Kathy J Lin,1 Susan E Malecha,4 Anthony Masaquel5 1Drug Information Services, Kaiser Permanente, Downey, 2Southern California Permanente Medical Group, Kaiser Permanente, Bellflower, 3Pharmacy Analytical Services, Kaiser Permanente, Downey, 4US Medical Affairs, Genetech Inc., San Francisco, 5Health Economics and Outcomes, Genentech Inc., San Francisco, CA, USA Background: Breast cancer is treated with many different modalities, including chemotherapy that can be given as a single agent or in combination. Patients often experience adverse events from chemotherapy during the cycles of treatment which can lead to economic burden.Objective: The objective of this study was to evaluate costs related to chemotherapy-related adverse events in patients with metastatic breast cancer (mBC in an integrated health care delivery system.Methods: Patients with mBC newly initiated on chemotherapy were identified and the first infusion was defined as the index date. Patients were ≥18 years old at time of index date, had at least 6 months of health plan membership and drug eligibility prior to their index date. The chemotherapy adverse events were identified after the index date and during first line of chemotherapy. Episodes of care (EOC were created using healthcare visits. Chart review was conducted to establish whether the adverse events were related to chemotherapy. Costs were calculated for each visit, including medications related to the adverse events, and aggregated to calculate the total EOC cost.Results: A total of 1,682 patients with mBC were identified after applying study criteria; 54% of these patients had one or more adverse events related to chemotherapy. After applying the EOC method, there were a total of 5,475 episodes (4,185 single episodes [76.4%] and 1,290 multiple episodes [23.6%] related to chemotherapy-related adverse events. Within single episodes, hematological (1,387 EOC, 33

  6. La formación permanente del profesorado en entornos virtuales de aprendizaje

    OpenAIRE

    Sonia Mª SANTOVEÑA CASAL

    2012-01-01

    La educación permanente nos permite adaptarnos a las exigencias sociales y a las demandas de la sociedad del conocimiento. En este contexto se hace imprescindible una formación permanente con apoyo de entornos virtuales de aprendizaje de calidad. El objetivo principal de esta investigación es el estudio de la calidad de los cursos virtuales destinados a la formación del profesorado desde diferentes instituciones públicas. La muestra está formada por cuatro cursos de formación permanente desti...

  7. Cohort profile: Study of Transition, Outcomes and Gender (STRONG) to assess health status of transgender people.

    Science.gov (United States)

    Quinn, Virginia P; Nash, Rebecca; Hunkeler, Enid; Contreras, Richard; Cromwell, Lee; Becerra-Culqui, Tracy A; Getahun, Darios; Giammattei, Shawn; Lash, Timothy L; Millman, Andrea; Robinson, Brandi; Roblin, Douglas; Silverberg, Michael J; Slovis, Jennifer; Tangpricha, Vin; Tolsma, Dennis; Valentine, Cadence; Ward, Kevin; Winter, Savannah; Goodman, Michael

    2017-12-27

    The Study of Transition, Outcomes and Gender (STRONG) was initiated to assess the health status of transgender people in general and following gender-affirming treatments at Kaiser Permanente health plans in Georgia, Northern California and Southern California. The objectives of this communication are to describe methods of cohort ascertainment and data collection and to characterise the study population. A stepwise methodology involving computerised searches of electronic medical records and free-text validation of eligibility and gender identity was used to identify a cohort of 6456 members with first evidence of transgender status (index date) between 2006 and 2014. The cohort included 3475 (54%) transfeminine (TF), 2892 (45%) transmasculine (TM) and 89 (1%) members whose natal sex and gender identity remained undetermined from the records. The cohort was matched to 127 608 enrollees with no transgender evidence (63 825 women and 63 783 men) on year of birth, race/ethnicity, study site and membership year of the index date. Cohort follow-up extends through the end of 2016. About 58% of TF and 52% of TM cohort members received hormonal therapy at Kaiser Permanente. Chest surgery was more common among TM participants (12% vs 0.3%). The proportions of transgender participants who underwent genital reconstruction surgeries were similar (4%-5%) in the two transgender groups. Results indicate that there are sufficient numbers of events in the TF and TM cohorts to further examine mental health status, cardiovascular events, diabetes, HIV and most common cancers. STRONG is well positioned to fill existing knowledge gaps through comparisons of transgender and reference populations and through analyses of health status before and after gender affirmation treatment. Analyses will include incidence of cardiovascular disease, mental health, HIV and diabetes, as well as changes in laboratory-based endpoints (eg, polycythemia and bone density), overall and in relation to

  8. Synthesis of nanodiamond derivatives carrying amino functions and quantification by a modified Kaiser test

    Directory of Open Access Journals (Sweden)

    Gerald Jarre

    2014-11-01

    Full Text Available Nanodiamonds functionalized with different organic moieties carrying terminal amino groups have been synthesized. These include conjugates generated by Diels–Alder reactions of ortho-quinodimethanes formed in situ from pyrazine and 5,6-dihydrocyclobuta[d]pyrimidine derivatives. For the quantification of primary amino groups a modified photometric assay based on the Kaiser test has been developed and validated for different types of aminated nanodiamond. The results correspond well to values obtained by thermogravimetry. The method represents an alternative wet-chemical quantification method in cases where other techniques like elemental analysis fail due to unfavourable combustion behaviour of the analyte or other impediments.

  9. Preceptoria de território, novas práticas e saberes na estratégia de educação permanente em saúde da família: o estudo do caso de Sobral, CE Preceptorship of territory, new practices and knowledge in the strategy of continuing education in family health strategy: the case study of Sobral, Ceara, Brazil

    Directory of Open Access Journals (Sweden)

    Rosani Pagani

    2012-05-01

    Full Text Available O presente trabalho pretende apresentar um novo ator no Sistema Único de Saúde - o preceptor de território - bem como discutir sua atuação. Com a implantação da Estratégia Saúde da Família, bastante se tem discutido sobre o desafio de formar profissionais para atuarem neste modelo através de educação permanente em saúde. Nesse processo, o município de Sobral, CE, criou em 1999 a residência multiprofissional e a preceptoria de território; em 2001, a Escola de Formação em Saúde da Família Visconde de Sabóia. Este estudo teve como objetivos analisar a implantação e a atuação da preceptoria de território, descrevendo o processo de trabalho dos preceptores e identificando suas competências; além disso, descreveu-se o processo de educação permanente desenvolvido na Estratégia de Saúde da Família em Sobral. Utilizou-se uma abordagem qualitativa do tipo estudo de caso, com os seguintes instrumentos: entrevistas, questionários e grupo focal. Para a organização os dados foram analisados através da técnica do Discurso do Sujeito Coletivo (DSC. Entre os achados do estudo, identifica-se o preceptor de território como um profissional que atua diretamente com os residentes nos territórios das equipes da estratégia de saúde da família, destacando-se por suas amplas competências. Entre estas, podem ser mencionados conhecimentos conceituais nos campos da saúde coletiva e das relações humanas, bem como conhecimento e desenvoltura na utilização de métodos de ensino (problematização, educação permanente em saúde e educação popular. Deve também ser capaz de desenvolver relações harmônicas e de participação. O debate vem auxiliando o preceptor de território de Sobral a estabelecer seu papel e consolidar sua função de educador na construção do SUS.This paper aims to present a new actor in the Health's Unique System of Brazil (SUS, the preceptor of territory, and discuss his performance. The

  10. Armouring facility? Nuclear-weapon and reactor reseach at the Kaiser-Wilhelm Institute for Physics; Eine Waffenschmiede? Kernwaffen- und Reaktorforschung am Kaiser-Wilhelm-Institut fuer Physik

    Energy Technology Data Exchange (ETDEWEB)

    Hachtmann, R. (ed.); Walker, M.

    2005-07-01

    The Kaiser Wilhelm Institute for Physics is best known as the place where Werner Heisenberg worked on nuclear weapons for Hitler. Although this is essentially true, there is more to the story. At the start of World War II this institute was taken over by the German Army Ordnance to be the central, but not exclusive site for a research project into the economic and military applications of nuclear fission. The Army physicist Kurt Diebner was installed in the institute as its commissarial director. Heisenberg was affiliated with the institute as an advisor at first, and became the director in 1942. Heisenberg and his colleagues, including in particular Karl-Heinz Hoecker, Carl Friedrich von Weizsaecker, and Karl Wirtz, worked on nuclear reactors and isotope separation with the clear knowledge that these were two different paths to atomic bombs [Atombomben]. However, they were clearly ambivalent about what they were doing. New documents recently returned from Russian archives shed new light on this work and the scientists' motivations. (orig.)

  11. Safe Routes to School Local School Project: A health evaluation at 10 low-income schools

    OpenAIRE

    Cooper, Jill F MSW; McMillan, Tracy MPH, PHD

    2010-01-01

    fe Routes to School National Partnership (Partnership) founded the Local School Project (Project) in 2008 to assist ten schools in lowincome communities to: 1) develop and evaluate a school-based SRTS program, 2) build local capacity to apply for state or federal SRTS funding, and 3) increase safe walking and bicycling to and from the school and in the community. The Centers for Disease Control and Prevention, Kaiser Permanente, and the Robert Wood Johnson Foundation provided funding for the ...

  12. Um teste direto da teoria de renda permanente: o caso brasileiro

    Directory of Open Access Journals (Sweden)

    Fábio Augusto Reis Gomes

    2012-01-01

    Full Text Available O presente artigo busca averiguar se a teoria da renda permanente (TRP é capaz de explicar a evolução do consumo no Brasil através de um teste direto com base em revisões de consumo induzidas por inovações na renda. De acordo com a TRP, o consumo reage às mudanças na renda na medida em que a renda corrente contem informação sobre a renda permanente. Para mensurar esta relação, foi estimado um modelo ARIMA (p,1,q para a renda corrente e, como resultado, foi possível verificar se as revisões de consumo e renda permanente se assemelham. Por fim, a TRP foi rejeitada.

  13. Las enfermedades neoplásicas como causa de la incapacidad permanente

    OpenAIRE

    Ares Camerino, A.; Sainz Vera, B.; Marchena Aparicio, J.C.; Soto Pino, M.L.

    2008-01-01

    El cáncer es la primera causa de mortalidad en hombres y la segunda en mujeres, tras las enfermedades cardiovasculares. Desde el punto de vista económico, los costes atribuibles a las enfermedades neoplásicas son principalmente indirectos (pérdida de productividad asociada a la mortalidad o a la incapacidad permanente). Analizando las incapacidades permanentes producidas en la Diputación Provincial de Cádiz en el período 1990-2005, que fueron un total de 208, se concluye, por orden de frecuen...

  14. Educação permanente em enfermagem em um hospital universitário

    OpenAIRE

    Jesus,Maria Cristina Pinto de; Figueiredo,Mariangela Aparecida Gonçalves; Santos,Sueli Maria dos Reis; Amaral,Arlete Maria Moreira do; Rocha,Letícia de Oliveira; Thiollent,Michel Jean Marie

    2011-01-01

    A educação permanente enfatiza a interdisciplinaridade da equipe de saúde, focaliza a prática como fonte do conhecimento e coloca o profissional para atuar ativamente no processo educativo. Este estudo objetivou identificar demandas e expectativas, fatores que interferem na qualificação de trabalhadores de enfermagem de um hospital universitário e propor práticas de capacitação na perspectiva da educação permanente. O processo investigativo fundamentado nos princípios da pesquisa-ação foi rea...

  15. Creativity and Innovation in Health Care: Tapping Into Organizational Enablers Through Human-Centered Design.

    Science.gov (United States)

    Zuber, Christi Dining; Moody, Louise

    There is an increasing drive in health care for creativity and innovation to tackle key health challenges, improve quality and access, and reduce harm and costs. Human-centered design (HCD) is a potential approach to achieving organizational innovation. However, research suggests the nursing workforce feels unsupported to take the risks needed for innovation, and leaders may not understand the conditions required to fully support them. The aim of this study was to identify enabling conditions that support frontline nurses in their attempts to behave as champions of innovation and change. An HCD workshop was undertaken with 125 nurses employed in clinical practice at Kaiser Permanente. The workshop included empathy mapping and semistructured questions that probed participant experiences with innovation and change. The data were collated and thematic analysis undertaken through a Grounded Theory approach. The data were analyzed to identify key enabling conditions. Seven enablers emerged: personal need for a solution; challenges that have meaningful purpose; clarity of goal and control of resources; active experimentation; experiences indicating progress; positive encouragement and confidence; and provision of psychological safety. These enablers were then translated into pragmatic guidelines for leaders on how the tools of HCD may be leveraged for innovation and change in health care.

  16. Clinical pharmacy cardiac risk service for managing patients with coronary artery disease in a health maintenance organization.

    Science.gov (United States)

    Sandhoff, Brian G; Nies, Leslie K; Olson, Kari L; Nash, James D; Rasmussen, Jon R; Merenich, John A

    2007-01-01

    A clinical pharmacy service for managing the treatment of coronary artery disease in a health maintenance organization is described. Despite the proven benefits of aggressive risk factor modification for patients with coronary artery disease (CAD), there remains a treatment gap between consensus- and evidence-based recommendations and their application in patient care. In 1998, Kaiser Permanente of Colorado developed the Clinical Pharmacy Cardiac Risk Service (CPCRS) to focus on the long-term management of patients with CAD to improve clinical outcomes. The primary goals of the CPCRS are to increase the number of CAD patients on lipid-lowering therapy, manage medications shown to decrease the risk of future CAD-related events, assist in the monitoring and control of other diseases that increase cardiovascular risk, provide patient education and recommendations for nonpharmacologic therapy, and act as a CAD information resource for physicians and other health care providers. Using an electronic medical record and tracking database, the service works in close collaboration with primary care physicians, cardiologists, cardiac rehabilitation nurses, and other health care providers to reduce cardiac risk in the CAD population. Particular attention is given to dyslipidemia, blood pressure, diabetes mellitus, and tobacco cessation. Treatment with evidence-based regimens is initiated and adjusted as necessary. Over 11,000 patients are currently being followed by the CPCRS. A clinical pharmacy service in a large health maintenance organization provides cardiac risk reduction for patients with CAD and helps close treatment gaps that may exist for these patients.

  17. Prevalence of migraine in a diverse community--electronic methods for migraine ascertainment in a large integrated health plan.

    Science.gov (United States)

    Pressman, Alice; Jacobson, Alice; Eguilos, Roderick; Gelfand, Amy; Huynh, Cynthia; Hamilton, Luisa; Avins, Andrew; Bakshi, Nandini; Merikangas, Kathleen

    2016-04-01

    The growing availability of electronic health data provides an opportunity to ascertain diagnosis-specific cases via systematic methods for sample recruitment for clinical research and health services evaluation. We developed and implemented a migraine probability algorithm (MPA) to identify migraine from electronic health records (EHR) in an integrated health plan. We identified all migraine outpatient diagnoses and all migraine-specific prescriptions for a five-year period (April 2008-March 2013) from the Kaiser Permanente, Northern California (KPNC) EHR. We developed and evaluated the MPA in two independent samples, and derived prevalence estimates of medically-ascertained migraine in KPNC by age, sex, and race. The period prevalence of medically-ascertained migraine among KPNC adults during April 2008-March 2013 was 10.3% (women: 15.5%, men: 4.5%). Estimates peaked with age in women but remained flat for men. Prevalence among Asians was half that of whites. We demonstrate the feasibility of an EHR-based algorithm to identify cases of diagnosed migraine and determine that prevalence patterns by our methods yield results comparable to aggregate estimates of treated migraine based on direct interviews in population-based samples. This inexpensive, easily applied EHR-based algorithm provides a new opportunity for monitoring changes in migraine prevalence and identifying potential participants for research studies. © International Headache Society 2015.

  18. Prevalence of migraine in a diverse community—electronic methods for migraine ascertainment in a large integrated health plan

    Science.gov (United States)

    Pressman, Alice; Jacobson, Alice; Eguilos, Roderick; Gelfand, Amy; Huynh, Cynthia; Hamilton, Luisa; Avins, Andrew; Bakshi, Nandini; Merikangas, Kathleen

    2016-01-01

    Introduction The growing availability of electronic health data provides an opportunity to ascertain diagnosis-specific cases via systematic methods for sample recruitment for clinical research and health services evaluation. We developed and implemented a migraine probability algorithm (MPA) to identify migraine from electronic health records (EHR) in an integrated health plan. Methods We identified all migraine outpatient diagnoses and all migraine-specific prescriptions for a five-year period (April 2008–March 2013) from the Kaiser Permanente, Northern California (KPNC) EHR. We developed and evaluated the MPA in two independent samples, and derived prevalence estimates of medically-ascertained migraine in KPNC by age, sex, and race. Results The period prevalence of medically-ascertained migraine among KPNC adults during April 2008–March 2013 was 10.3% (women: 15.5%, men: 4.5%). Estimates peaked with age in women but remained flat for men. Prevalence among Asians was half that of whites. Conclusions We demonstrate the feasibility of an EHR-based algorithm to identify cases of diagnosed migraine and determine that prevalence patterns by our methods yield results comparable to aggregate estimates of treated migraine based on direct interviews in population-based samples. This inexpensive, easily applied EHR-based algorithm provides a new opportunity for monitoring changes in migraine prevalence and identifying potential participants for research studies. PMID:26069243

  19. La educación permanente y las plataformas web en España

    Directory of Open Access Journals (Sweden)

    Medina, Beatriz

    2014-04-01

    Full Text Available La Educación Permanente en España, actualmente disfrutando de una etapa de consolidación, está haciéndose eco de las novedades educativas relacionadas con las Tecnologías de la Información y la Comunicación. En este sentido, realizamos un estudio con el objetivo de conocer la presencia de la Educación Permanente en internet y su oferta formativa, para lograrlo utilizamos la metodología comparada. Las distintas administraciones competentes ofrecen una variada oferta de recursos en plataformas web para hacer más accesible la Educación Permanente. Entre los principales hallazgos tenemos que todas las comunidades y ciudades autónomas del país poseen páginas o portales web dirigidos a las personas adultas que se encuentran en esta etapa del sistema educativo español, excepto Baleares; solo la comunidad autónoma Andalucía tiene un portal exclusivo para la Educación Permanente.

  20. EDUCACIÓN PERMANENTE EN SERVICIO DE FORMACIÓN DE PROFESIONALES DE ENFERMERÍA

    Directory of Open Access Journals (Sweden)

    Rosa Gomes Ferreira

    2015-12-01

    Full Text Available A formação é um processo contínuo e deve estar presente no cotidiano de trabalho e para tal, surge a educação permanente, como pactuação teoria-prática. Nossos objetivos são o de descrever as práticas educativas em saúde, enfatizando a educação permanente e analisar os contrapontos e intersecções à efetividade da assistência, mediante a prática de educação permanente. Estudo qualitativo, descritivo, exploratório. O estudo aponta que a educação permanente emerge como ferramenta capaz de despertar desejo, no trabalhador, em discutir e refletir acerca da prática. No entanto, todas as práticas educativas, tal como a educação continuada, tem valor e penetrância no campo do trabalho.  DOI: http://dx.doi.org/10.12957/sustinere.2015.18127

  1. Food Insecurity in Older Adults in an Integrated Health Care System.

    Science.gov (United States)

    Steiner, John F; Stenmark, Sandra H; Sterrett, Andrew T; Paolino, Andrea R; Stiefel, Matthew; Gozansky, Wendolyn S; Zeng, Chan

    2018-05-01

    To estimate food insecurity prevalence and develop a statistical prediction model for food insecurity. Retrospective cohort study. Kaiser Permanente Colorado. Adult members who completed a pre-Medicare Annual Wellness Visit survey. Food insecurity was assessed using a single screening question. Sociodemographic and clinical characteristics from electronic health records and self-reported characteristics from the survey were used to develop the prediction model. Of 130,208 older adult members between January 2012 and December 2015, 50,097 (38.5%) completed food insecurity screening, 2,859 of whom (5.7% of respondents) reported food insecurity. The prevalence of food insecurity was 10.0% or greater among individuals who were black or Hispanic, had less than high school education, had Medicaid insurance, were extremely obese, had poor health status or quality of life, had depression or anxiety, had impairments in specific activities of daily living, had other nutritional risk factors, or were socially isolated (all pinsecurity and those without and 14.3% of individuals in the highest quintile of risk reported food insecurity. Food insecurity is prevalent even in older adults with private-sector healthcare coverage. Specific individual characteristics, and a model based on those characteristics, can identify older adults at higher risk of food insecurity. System-level interventions will be necessary to connect older adults with community-based food resources. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

  2. Social organization of self-management support of persons with diabetes: a health systems comparison.

    Science.gov (United States)

    Schiøtz, Michaela; Frølich, Anne; Krasnik, Allan; Taylor, Warren; Hsu, John

    2012-09-01

    Identify important organizational elements for providing self-management support (SMS). Semi-structured qualitative interviews conducted in two healthcare systems. Kaiser Permanente Northern California and the Danish Health Care System. 36 managers and healthcare professionals in the two healthcare systems. Elements important to providing self-management support to persons with diabetes. Healthcare professionals' provision of SMS was influenced by healthcare system organization and their perceptions of SMS, the capability and responsibility of healthcare systems, and their roles in the healthcare organization. Enabling factors for providing SMS included: strong leadership; aligned incentives; use of an integrated health information technology (HIT) system; multidisciplinary healthcare provider teams; ongoing training for healthcare professionals; outreach; and quality goals. Barriers to providing SMS included lack of collaboration between providers and skeptical attitudes towards prevention and outreach. Implementation of SMS can be improved by an understanding of the elements that enhance its provision: (1) initiatives seeking to improve collaboration and integration between providers; (2) implementation of an integrated HIT system; and (3) ongoing training of healthcare professionals.

  3. La incapacidad permanente y su impacto en el sistema español de Seguridad Social

    Directory of Open Access Journals (Sweden)

    César Luis Gómez Garcillán

    Full Text Available Se analizan datos de incapacidad permanente de los últimos años en la seguridad social. Conclusiones: El desglose provincial muestra grandes diferencias a nivel territorial cuyo origen o motivación no se puede determinar actualmente en tanto no se dispone de dos parámetros básicos, el código de diagnóstico de la patología principal determinante de la incapacidad permanente y el código identificativo de la actividad laboral (profesión habitual del interesado que permitirían realizar un análisis fiable de la situación. Entre los factores que podrían incidir de alguna manera en la mayor o menor incidencia de la incapacidad permanente, podemos analizar dos grandes componentes, la población protegida y su composición a nivel de regímenes y la iniciativa en la incoación de los procedimientos. El grupo de provincias con una incidencia más elevada en incapacidad permanente acusa tasas de paro también más elevadas que el grupo con incidencia menor. La tendencia en el número de procedimientos de IP incoados resulta claramente a la baja con una caída de más del 9% en cinco años. El INSS desestima un porcentaje creciente de los mismos, la razón de ese comportamiento no reside en una valoración restrictiva o más exigente por parte de la gestora, sino porque se instruyen menos procesos de incapacidad permanente y porque va tomando mayor protagonismo en la iniciativa de incoación el procedimiento a instancia de parte, cuyo porcentaje de desestimación es el más elevado.

  4. La incapacidad permanente en una empresa pública en el periodo 1995-2009 Permanent incapacity in a public company from 1995-2009

    Directory of Open Access Journals (Sweden)

    José Carlos Marchena Aparicio

    2011-09-01

    Full Text Available Objetivos: La cuantificación de las relaciones entre salud, medio laboral y capacidad para el trabajo nos permite descifrar aspectos importantes de la incapacidad permanente. Este trabajo tiene como objetivo describir las características de la población trabajadora de la Diputación Provincial de Cádiz a la que se le concedió una incapacidad permanente en el periodo 1995-2009. Métodos: Se llevó a cabo un estudio descriptivo retrospectivo sobre el total de trabajadores/as con incapacidad permanente en el periodo descrito que considera las siguientes variables: sexo, edad, antigüedad, tipo de ocupación, causa de la incapacidad permanente, días de incapacidad temporal y número de incapacidades temporales concedidas en los 5 años previos, recogidas a través de archivos documentales. Resultados: El número de incapacidades permanentes concedidas ascendió a 192. Un 53,1% fueron mujeres; funcionarios el 59,9%; la edad de concesión fue de 54,06 años de media con 24,98 años de antigüedad en la empresa; el tipo de trabajo en el que más incapacidad permanente se concedieron es el manual, 44,8%; El tipo de patología más frecuente de incapacidad permanente fueron las enfermedades músculo-esqueléticas (29,7%, neoplasias (23,4% y trastornos mentales (18,8%, asociándose significativamente dicha variable con el sexo (p=0,006, el tipo de trabajo desempeñado (p=0,007, la edad de concesión (pObjectives: The quantifying relationship between health, working environment and work capacity allows us to unravel important aspects of permanent incapacity (PI. One of the objectives of this study is to describe working population characteristics of the Provincial Council of Cadiz who were granted permanent incapacity from 1995 to 2009. Method: A retrospective descriptive study was carried out amongst all the workers with PI in the period described with the following variables taken into account: gender, age, time working for the company, type of

  5. Armouring facility? Nuclear-weapon and reactor reseach at the Kaiser-Wilhelm Institute for Physics

    International Nuclear Information System (INIS)

    Hachtmann, R.; Walker, M.

    2005-01-01

    The Kaiser Wilhelm Institute for Physics is best known as the place where Werner Heisenberg worked on nuclear weapons for Hitler. Although this is essentially true, there is more to the story. At the start of World War II this institute was taken over by the German Army Ordnance to be the central, but not exclusive site for a research project into the economic and military applications of nuclear fission. The Army physicist Kurt Diebner was installed in the institute as its commissarial director. Heisenberg was affiliated with the institute as an advisor at first, and became the director in 1942. Heisenberg and his colleagues, including in particular Karl-Heinz Hoecker, Carl Friedrich von Weizsaecker, and Karl Wirtz, worked on nuclear reactors and isotope separation with the clear knowledge that these were two different paths to atomic bombs [Atombomben]. However, they were clearly ambivalent about what they were doing. New documents recently returned from Russian archives shed new light on this work and the scientists' motivations. (orig.)

  6. Multidimensional digital image representations using generalized Kaiser-Bessel window functions.

    Science.gov (United States)

    Lewitt, R M

    1990-10-01

    Inverse problems that require the solution of integral equations are inherent in a number of indirect imaging applications, such as computerized tomography. Numerical solutions based on discretization of the mathematical model of the imaging process, or on discretization of analytic formulas for iterative inversion of the integral equations, require a discrete representation of an underlying continuous image. This paper describes discrete image representations, in n-dimensional space, that are constructed by the superposition of shifted copies of a rotationally symmetric basis function. The basis function is constructed using a generalization of the Kaiser-Bessel window function of digital signal processing. The generalization of the window function involves going from one dimension to a rotationally symmetric function in n dimensions and going from the zero-order modified Bessel function of the standard window to a function involving the modified Bessel function of order m. Three methods are given for the construction, in n-dimensional space, of basis functions having a specified (finite) number of continuous derivatives, and formulas are derived for the Fourier transform, the x-ray transform, the gradient, and the Laplacian of these basis functions. Properties of the new image representations using these basis functions are discussed, primarily in the context of two-dimensional and three-dimensional image reconstruction from line-integral data by iterative inversion of the x-ray transform. Potential applications to three-dimensional image display are also mentioned.

  7. Heart rate calculation from ensemble brain wave using wavelet and Teager-Kaiser energy operator.

    Science.gov (United States)

    Srinivasan, Jayaraman; Adithya, V

    2015-01-01

    Electroencephalogram (EEG) signal artifacts are caused by various factors, such as, Electro-oculogram (EOG), Electromyogram (EMG), Electrocardiogram (ECG), movement artifact and line interference. The relatively high electrical energy cardiac activity causes EEG artifacts. In EEG signal processing the general approach is to remove the ECG signal. In this paper, we introduce an automated method to extract the ECG signal from EEG using wavelet and Teager-Kaiser energy operator for R-peak enhancement and detection. From the detected R-peaks the heart rate (HR) is calculated for clinical diagnosis. To check the efficiency of our method, we compare the HR calculated from ECG signal recorded in synchronous with EEG. The proposed method yields a mean error of 1.4% for the heart rate and 1.7% for mean R-R interval. The result illustrates that, proposed method can be used for ECG extraction from single channel EEG and used in clinical diagnosis like estimation for stress analysis, fatigue, and sleep stages classification studies as a multi-model system. In addition, this method eliminates the dependence of additional synchronous ECG in extraction of ECG from EEG signal process.

  8. Environmental aspects of Kaiser S2 harvester utilization in mountain terrains

    Directory of Open Access Journals (Sweden)

    Jozef Slugeň

    2012-01-01

    Full Text Available This paper deals with evaluating the ecological impacts of Kaiser S2 harvester utilization in mountain terrains. The harvester was used in bark beetle calamity and secondary felling in mixed forest (spruce, fir, beech stand with average incline of 70%. Assisting its movement in these extreme conditions were two supporting bases, which were used to stabilize it in the stand. Our aim was to determine the damage to the trees, underwood and stand soil. The resulting damage of remaining stand was 6.19%, which is, considering the demanding terrain conditions and in comparison with the outcomes of other research, a relatively acceptable value. Damage to the underwood was not found, due to its insufficient height and low representation. Measurements of damage to the soil by its compression indicated that the heaviest damage was under the supporting bases, where a heavy surface damage was found by creation of holes up to 15 cm deep. This type of damage is not dangerous, because it does not create a continuous track dangerous in storm rainfall and subsequent soil erosion. Soil compression in the track and on unimpaired soil reached lower levels. All of the measurements of compression by static penetration were carried out only to the depth of 15 cm due to high soil skeleton. This also negatively affected the measurements, which had to be repeated in many cases.

  9. Genetics as a modernization program: biological research at the Kaiser Wilhelm Institutes and the political economy of the Nazi State.

    Science.gov (United States)

    Gausemeier, Bernd

    2010-01-01

    During the Third Reich, the biological institutes of the Kaiser Wilhelm Society (KWG, Kaiser-Wilhelm-Gesellschaft) underwent a substantial reorganization and modernization. This paper discusses the development of projects in the fields of biochemical genetics, virus research, radiation genetics, and plant genetics that were initiated in those years. These cases exemplify, on the one hand, the political conditions for biological research in the Nazi state. They highlight how leading scientists advanced their projects by building close ties with politicians and science-funding organizations and companies. On the other hand, the study examines how the contents of research were shaped by, and how they contributed to, the aims and needs of the political economy of the Nazi system. This paper therefore aims not only to highlight basic aspects of scientific development under Nazism, but also to provide general insights into the structure of the Third Reich and the dynamics of its war economy.

  10. Mineralogical control on thermal damage and the presence of a thermal Kaiser effect during temperature-cycling experiments

    Science.gov (United States)

    Browning, J.; Daoud, A.; Meredith, P. G.; Mitchell, T. M.

    2017-12-01

    Volcanic and geothermal systems are in part controlled by the mechanical and thermal stresses acting on them and so it is important to understand the response of volcanic rocks to thermo-mechanical loading. One such response is the well-known `Kaiser stress-memory' effect observed under cyclic mechanical loading. By contrast, the presence of an analogous `Kaiser temperature-memory effect' during cyclic thermal loading has received little attention. We have therefore explored the possibility of a Kaiser temperature-memory effect using three igneous rocks of different composition, grain size and origin; Slaufrudalur Granophyre (SGP), Nea Kameni Andesite (NKA) and Seljadalur Basalt (SB). We present results from a series of thermal stressing experiments in which acoustic emissions (AE) were recorded contemporaneously with changing temperature. Samples of each rock were subjected to both a single heating and cooling cycle to a maximum temperature of 900 °C and multiple heating/cooling cycles to peak temperatures of 350°C, 500°C, 700°C and 900 °C (all at a constant rate of 1°C/min on heating and a natural cooling rate of memory effect in SGP, but not in either NKA and SB. We further find that the vast majority of thermal crack damage is generated upon cooling in the finer grained materials (NKA and SB), but that substantial thermal crack damage is generated during heating in the coarser grained SGP. The total amount of crack damage generated due to heating or cooling is dependent on the mineral composition and, most importantly, the grain size and arrangement, as well as the maximum temperature to which the rock is exposed. Knowledge of thermal stress history and the presence of a Kaiser temperature-memory effect is potentially important in understanding magma chamber dynamics, where the cyclic nature of mechanical and thermal inflation and deflation can lead to sequential accumulation of damage, potentially leading to critical rupture.

  11. Diagnosing the Kaiser: Psychiatry, Wilhelm II and the Question of German War Guilt The William Bynum Prize Essay 2016.

    Science.gov (United States)

    Freis, David

    2018-07-01

    After his abdication in November 1918, the German emperor Wilhelm II continued to haunt the minds of his people. With the abolition of the lese-majesty laws in the new republic, many topics that were only discussed privately or obliquely before could now be broached openly. One of these topics was the mental state of the exiled Kaiser. Numerous psychiatrists, physicians and laypeople published their diagnoses of Wilhelm in high-circulation newspaper articles, pamphlets, and books shortly after the end of the war. Whether these diagnoses were accurate and whether the Kaiser really was mentally ill became the issue of a heated debate.This article situates these diagnoses of Wilhelm II in their political context. The authors of these diagnoses - none of whom had met or examined Wilhelm II in person - came from all political camps and they wrote with very different motives in mind. Diagnosing the exiled Kaiser as mentally ill was a kind of exorcism of the Hohenzollern rule, opening the way for either a socialist republic or the hoped-for rule of a new leader. But more importantly, it was a way to discuss and allocate political responsibility and culpability. Psychiatric diagnoses were used to exonerate both the Emperor (for whom the treaty of Versailles provided a tribunal as war criminal) and the German nation. They were also used to blame the Kaiser's entourage and groups that had allegedly manipulated the weak-willed monarch. Medical concepts became a vehicle for a debate on the key political questions in interwar Germany.

  12. Crack Identification in CFRP Laminated Beams Using Multi-Resolution Modal Teager–Kaiser Energy under Noisy Environments

    Science.gov (United States)

    Xu, Wei; Cao, Maosen; Ding, Keqin; Radzieński, Maciej; Ostachowicz, Wiesław

    2017-01-01

    Carbon fiber reinforced polymer laminates are increasingly used in the aerospace and civil engineering fields. Identifying cracks in carbon fiber reinforced polymer laminated beam components is of considerable significance for ensuring the integrity and safety of the whole structures. With the development of high-resolution measurement technologies, mode-shape-based crack identification in such laminated beam components has become an active research focus. Despite its sensitivity to cracks, however, this method is susceptible to noise. To address this deficiency, this study proposes a new concept of multi-resolution modal Teager–Kaiser energy, which is the Teager–Kaiser energy of a mode shape represented in multi-resolution, for identifying cracks in carbon fiber reinforced polymer laminated beams. The efficacy of this concept is analytically demonstrated by identifying cracks in Timoshenko beams with general boundary conditions; and its applicability is validated by diagnosing cracks in a carbon fiber reinforced polymer laminated beam, whose mode shapes are precisely acquired via non-contact measurement using a scanning laser vibrometer. The analytical and experimental results show that multi-resolution modal Teager–Kaiser energy is capable of designating the presence and location of cracks in these beams under noisy environments. This proposed method holds promise for developing crack identification systems for carbon fiber reinforced polymer laminates. PMID:28773016

  13. EDUCAÇÃO PERMANENTE EM SAÚDE: Reflexões e desafios

    OpenAIRE

    Palhares Guimarães,Eliane Marina; Haueisen Martin,Sandra; Paolinelli Rabelo,Flávia Cristina

    2010-01-01

    Este trabalho é resultado de uma reflexão sobre o processo de educação permanente em saúde e na enfermagem. Tem como objetivo apresentar algumas perspectivas e tendências da educação em saúde e na enfermagem, com ênfase em educação permanente. Analisa a importância dos avanços tecnológicos e sua incorporação no processo de ensinar e de aprender. O texto é dividido em três partes, abordando inicialmente as mudanças organizacionais e, conseqüentemente, na educação, decorrentes da incorporação t...

  14. Los entornos personales de aprendizaje en el marco de la educación permanente

    Directory of Open Access Journals (Sweden)

    Elvira E. Navas

    2013-01-01

    Full Text Available En este trabajo se presenta un estudio documental sobre el surgimiento, evolución y estado actual de la utilización y desarrollo de los Entornos Personales de Aprendizaje (Personal Learning Environment, PLE en el marco de la Educación Permanente o Aprendizaje para Toda la vida (Lifelong Learning. En primer lugar, se hace una revisión del concepto de Educación Permanente desde la literatura de inicios de siglo XX. A continuación, se procede a estudiar el término PLE, desde sus orígenes hasta la interpretación actual. Se presentan experiencias tanto nacionales como internacionales donde se ejemplifica de forma práctica la utilización de PLE en la educación universitaria. Finalmente, se hace una reflexión de cierre sobre las proyecciones de futuro del uso de los PLE en el marco de la educación permanente.

  15. Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care

    Science.gov (United States)

    Lake, James; Turner, Mason Spain

    2017-01-01

    Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally. This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics. PMID:28898197

  16. Racial/ethnic and socioeconomic differences in short-term breast cancer survival among women in an integrated health system.

    Science.gov (United States)

    Keegan, Theresa H M; Kurian, Allison W; Gali, Kathleen; Tao, Li; Lichtensztajn, Daphne Y; Hershman, Dawn L; Habel, Laurel A; Caan, Bette J; Gomez, Scarlett L

    2015-05-01

    We examined the combined influence of race/ethnicity and neighborhood socioeconomic status (SES) on short-term survival among women with uniform access to health care and treatment. Using electronic medical records data from Kaiser Permanente Northern California linked to data from the California Cancer Registry, we included 6262 women newly diagnosed with invasive breast cancer. We analyzed survival using multivariable Cox proportional hazards regression with follow-up through 2010. After consideration of tumor stage, subtype, comorbidity, and type of treatment received, non-Hispanic White women living in low-SES neighborhoods (hazard ratio [HR] = 1.28; 95% confidence interval [CI] = 1.07, 1.52) and African Americans regardless of neighborhood SES (high SES: HR = 1.44; 95% CI = 1.01, 2.07; low SES: HR = 1.88; 95% CI = 1.42, 2.50) had worse overall survival than did non-Hispanic White women living in high-SES neighborhoods. Results were similar for breast cancer-specific survival, except that African Americans and non-Hispanic Whites living in high-SES neighborhoods had similar survival. Strategies to address the underlying factors that may influence treatment intensity and adherence, such as comorbidities and logistical barriers, should be targeted at low-SES non-Hispanic White and all African American patients.

  17. "Presumed fair: Ironic effects of organizational diversity structures": Correction to Kaiser et al. (2013).

    Science.gov (United States)

    2016-06-01

    Reports an error in "Presumed fair: Ironic effects of organizational diversity structures" by Cheryl R. Kaiser, Brenda Major, Ines Jurcevic, Tessa L. Dover, Laura M. Brady and Jenessa R. Shapiro (Journal of Personality and Social Psychology, 2013[Mar], Vol 104[3], 504-519). In the article, a raw data merging error in one racial discrimination claim condition from Experiment 6 inadvertently resulted in data analyses on an inaccurate data set. When the error was discovered by the authors and corrected, all analyses reported in Experiment 6 for claim validity, seriousness of the claim, and support for the claimant were inaccurate and none were statistically significant. The conclusions should be altered to indicate that participants with management experience who reflected on their own workplace diversity policies did not show the predicted effects. The literature review, remaining five studies, and remaining conclusions in the article are unaffected by this error. Experiment 6 should also report that 26.4% (not 26.4.7%) of participants had a graduate degree and eight participants (not 8%) did not provide educational data. Experiment 5 should have referred to the claim validity measure as a six-item measure ( .92) rather than a five-item measure; analyses on claim validity are accurate in text. Table 2's note should have said standard errors, not standard deviations. (The following abstract of the original article appeared in record 2012-31077-001.) This research tests the hypothesis that the presence (vs. absence) of organizational diversity structures causes high-status group members (Whites, men) to perceive organizations with diversity structures as procedurally fairer environments for underrepresented groups (racial minorities, women), even when it is clear that underrepresented groups have been unfairly disadvantaged within these organizations. Furthermore, this illusory sense of fairness derived from the mere presence of diversity structures causes high

  18. A three-dimensional `Kaiser damage-memory' effect through true-triaxial loading

    Science.gov (United States)

    Meredith, P. G.; Browning, J.; Harland, S. R.; Healy, D.; Stuart, C.; Mitchell, T. M.

    2017-12-01

    Microcrack damage leading to failure in rocks evolves in response to differential loading. The vast majority of experimental studies investigate damage evolution, the `Kaiser damage-memory' effect, and rock failure using conventional triaxial stress states (σ1 > σ2 = σ3). Such stress states develop a crack population that displays cylindrical transverse isotropy. However, in nature the stress state is in general truly triaxial (σ1 > σ2 > σ3) and experiments that utilise such loading conditions can generate crack populations that display planar transverse isotropy which in turn influences properties such as permeability and strength. We investigate the evolution of crack damage under both conventional and true triaxial stress conditions using results from measurements made on cubic samples of sandstone deformed in three orthogonal directions with independently controlled stress paths. We have measured, simultaneously with stress and strain, the changes in ultrasonic compressional and shear wave velocities in the three principal directions, together with the bulk acoustic emission (AE) output. Changes in acoustic wave velocities are associated with both elastic closure and opening of pre-existing cracks, and the inelastic formation of new cracks. By contrast, AE is only associated with the inelastic growth of new crack damage and as such, we use the onset of AE to determine the initiation of new crack damage. By mapping these damage onsets under both conventional triaxial and true triaxial sequential cyclic loading, we have shown that `damage envelopes' evolve dynamically and can be pushed closer to the failure envelope. Whether a stress state has been `visited' before is key to determining and understanding damage states. Crack damage populations can be generated with multiple orientations depending on the arrangement of loading directions and hence principal stress directions. The sequential cyclic loading tests show that further damage in any one population

  19. Teager-Kaiser Energy and Higher-Order Operators in White-Light Interference Microscopy for Surface Shape Measurement

    Directory of Open Access Journals (Sweden)

    Abdel-Ouahab Boudraa

    2005-10-01

    Full Text Available In white-light interference microscopy, measurement of surface shape generally requires peak extraction of the fringe function envelope. In this paper the Teager-Kaiser energy and higher-order energy operators are proposed for efficient extraction of the fringe envelope. These energy operators are compared in terms of precision, robustness to noise, and subsampling. Flexible energy operators, depending on order and lag parameters, can be obtained. Results show that smoothing and interpolation of envelope approximation using spline model performs better than Gaussian-based approach.

  20. Otra aproximación a Carl Gangolf Kaiser (1837-1895), arquitecto de la corte del emperador Maximiliano

    OpenAIRE

    Drewes, Michael

    2000-01-01

    Michael Drewes ha estudiado el ambiente artístico que rodeó al que fuera segundo emperador de México, Maximiliano de Austria. En por lo menos dos artículos anteriores publicados en Anales del Instituto de Investigaciones Estéticas (números 59 y 63), se ocupó ya del arquitecto Carl Gangolf Kaiser, un artista que presentó diversos proyectos de construcción y remodelación para Maximiliano. Quizás por su juventud, los proyectos que entonces realizó este arquitecto para remodelar edificios tan imp...

  1. LA FORMACIÓN AMBIENTAL PERMANENTE DEL DIRECTIVO EDUCACIONAL DEL SIGLO XXI

    Directory of Open Access Journals (Sweden)

    Mavel Moré Estupiñán

    2013-12-01

    Full Text Available La situación ambiental actual impone nuevos retos a los sistemas educativos, entre ellos el de incorporar la educación ambiental para el desarrollo sostenible al proceso pedagógico en los diferentes subsistemas de educación. Para lograr este propósito, es decisivo el rol del directivo educacional, desde la implementación del sistema de dirección institucional. Por ello, la formación ambiental de este profesional constituye un imperativo y se declara como problema científico de la presente investigación, que se sustenta teórica y metodológicamente en los fundamentos de la formación ambiental permanente del directivo educacional y delimita como objetivo: proponer un Modelo para orientar hacia el desarrollo sostenible este proceso. Garantizan el cumplimiento del objetivo, el empleo de métodos teóricos, estadísticos y/o de procesamiento matemático y empíricos, de corte cuantitativo y cualitativo, que se articulan a partir de las técnicas de la investigación-acción-participativa. El Modelo constituye la contribución a la teoría pedagógica y son aportes de significación práctica los programas de las formas organizativas de la formación permanente. El criterio de la práctica, como resultado de la sistematización de una secuencia de ciclos, y las valoraciones de diferentes evaluadores confirman la pertinencia, relevancia y efectividad del Modelo de formación ambiental permanente del directivo educacional.

  2. Bone health history in breast cancer patients on aromatase inhibitors.

    Directory of Open Access Journals (Sweden)

    Marilyn L Kwan

    Full Text Available A cross-sectional study was performed to assess bone health history among aromatase inhibitor (AI users before breast cancer (BC diagnosis, which may impact fracture risk after AI therapy and choice of initial hormonal therapy. A total of 2,157 invasive BC patients initially treated with an AI were identified from a prospective cohort study at Kaiser Permanente Northern California (KPNC. Data on demographic and lifestyle factors were obtained from in-person interviews, and bone health history and clinical data from KPNC clinical databases. The prevalence of osteoporosis and fractures in postmenopausal AI users was assessed, compared with 325 postmenopausal TAM users. The associations of bone health history with demographic and lifestyle factors in AI users were also examined. Among all initial AI users, 11.2% had a prior history of osteoporosis, 16.3% had a prior history of any fracture, and 4.6% had a prior history of major fracture. Postmenopausal women who were taking TAM as their initial hormonal therapy had significantly higher prevalence of prior osteoporosis than postmenopausal AI users (21.5% vs. 11.8%, p<0.0001. Among initial AI users, the associations of history of osteoporosis and fracture in BC patients with demographic and lifestyle factors were, in general, consistent with those known in healthy older women. This study is one of the first to characterize AI users and risk factors for bone morbidity before BC diagnosis. In the future, this study will examine lifestyle, molecular, and genetic risk factors for AI-induced fractures.

  3. From diagnosis through survivorship: health-care experiences of colorectal cancer survivors with ostomies

    Science.gov (United States)

    Grant, Marcia; McMullen, Carmit K.; Altschuler, Andrea; Mohler, M. Jane; Hornbrook, Mark C.; Herrinton, Lisa J.; Krouse, Robert S.

    2014-01-01

    Purpose The journey from diagnosis through treatment to survivorship can be challenging for colorectal cancer (CRC) survivors with permanent ostomies. Memories of both the positive and negative health-care interactions can persist years after the initial diagnosis and treatment. The purpose of this paper is to describe the health-care experiences of long-term (>5 years) CRC survivors with ostomies. Methods Thirty-three CRC survivors with ostomies who were members of Kaiser Permanente, an integrated care organization, in Oregon, southwestern Washington and northern California participated in eight focus groups. Discussions from the focus groups were recorded, transcribed, and analyzed for potential categories and themes. Results Health-care-related themes described CRC survivors’ experiences with diagnosis, treatment decision-making, initial experiences with ostomy, and survivorship. Participants discussed both positive and negative health-care-related experiences, including the need for continued access to trained nurses for ostomy self-care, access to peer support, and resources related to managing persistent, debilitating symptoms. Conclusions Long-term CRC survivors with ostomies have both positive and negative health-care experiences, regardless of health-related quality of life (HRQOL) and gender. Long-term support mechanisms and quality survivorship care that CRC survivors with ostomies can access are needed to promote positive adjustments and improved HRQOL. Structured abstract The current literature in CRC survivor-ship suggests that HRQOL concerns can persist years after treatment completion. The coordination of care to manage persistent late- and long-term effects are still lacking for CRC survivors living with an ostomy. Findings from this qualitative analysis will aid in the development of support strategies that foster more positive adjustments for CRC survivors living with an ostomy and support their ongoing ostomy-related needs. PMID:24442998

  4. La normativa de atribución de rentas a establecimientos permanentes en Colombia

    OpenAIRE

    Navarro Ibarrola, Aitor

    2016-01-01

    En el presente trabajo se analizan las reglas para la determinación de la renta de establecimientos permanentes situados en Colombia. A tal efecto, el autor lleva a cabo un estudio sobre la base de las pautas que la OCDE establece en la materia, ya que el sistema de conceptos propuesto por este organismo internacional se adoptó como referencia por parte del legislador colombiano a partir de 2012. En concreto, en el marco del concepto de entidad funcionalmente separada, se analiza el contenido...

  5. Análisis de series temporales en estaciones permanentes GPS

    OpenAIRE

    García Cañada, Laura

    2016-01-01

    En los ultimos años el número de estaciones permanentes GPS ha aumentado considerablemente para diferentes aplicaciones geodésicas y se comienza a disponer de series de coordenadas suficientemente largas como para poder aplicar ánalisis de series temporales. El principal objetivo de esta tesis es estudiar la influencia de la red de estaciones utilizada, marco de referencia y/o estrategia de procesado en las series temporales de coordenadas de estaciones CGPS y todos aquellos parámetros que se...

  6. Análisis de series temporales en estaciones permanentes GPS

    OpenAIRE

    García Cañada, Laura

    2015-01-01

    En los ultimos años el número de estaciones permanentes GPS ha aumentado considerablemente para diferentes aplicaciones geodésicas y se comienza a disponer de series de coordenadas suficientemente largas como para poder aplicar ánalisis de series temporales. El principal objetivo de esta tesis es estudiar la influencia de la red de estaciones utilizada, marco de referencia y/o estrategia de procesado en las series temporales de coordenadas de estaciones CGPS y todos aquellos parámetros que s...

  7. Older adults' readiness to engage with eHealth patient education and self-care resources: a cross-sectional survey.

    Science.gov (United States)

    Gordon, Nancy P; Hornbrook, Mark C

    2018-03-27

    This study examined access to digital technologies, skills and experience, and preferences for using web-based and other digital technologies to obtain health information and advice among older adults in a large health plan. A primary aim was to assess the extent to which digital divides by race/ethnicity and age group might affect the ability of a large percentage of seniors, and especially those in vulnerable groups, to engage with online health information and advice modalities (eHIA) and mobile health (mHealth) monitoring tools. A mailed survey was conducted with age-sex stratified random samples of English-speaking non-Hispanic white, African-American/black (black), Hispanic/Latino (Latino), Filipino-American (Filipino), and Chinese-American (Chinese) Kaiser Permanente Northern California members who were aged 65-79 years. Respondent data were weighted to the study population for the cross-sectional analyses. Older seniors and black, Latino, and Filipino seniors have less access to digital tools, less experience performing a variety of online tasks, and are less likely to believe that they would be capable of going online for health information and advice compared to younger and white Non-Hispanic seniors. Consequently, they are also less likely to be interested in using eHIA modalities. The same subgroups of seniors that have previously been shown to have higher prevalence of chronic conditions and greater difficulties with healthcare access are also less likely to adopt use of eHIA and mHealth monitoring technologies. At the patient population level, this digital divide is important to take into account when planning health information and chronic disease management programs. At the individual patient level, to provide good patient-centered care, it is important for providers to assess rather than assume digital access, eHealth skills, and preferences prior to recommending use of web-based resources and mHealth tools.

  8. Estimation of spacial geo-stress components in rock samples by using the Kaiser effect of acoustic emission

    International Nuclear Information System (INIS)

    Kanagawa, Tadashi; Hayashi, Masao; Nakasa, Hiroyasu.

    1976-01-01

    The spacial remaining stress component of the rock core sample is experimentally obtained by using Kaiser effect of acoustic emission (AE), and the estimated ground pressure is compared with the natural ground pressure measured by the conventional over-coring method, in order to see the feasiblity of AE method. In this experiments of AE, 111 specimens were cut out in all directions of the rock cores (tuff) sampled from the place where the ground pressure was measured by the over-coring method, and the generation of AE caused by the load was measured. Whereby, the stress components in three directions are determined. As a result of comparison, t the AE method is proved to be effective enough to estimate the ground pressure of rock geo-dynamically. In the application of the Kaiser effect to the estimation of the geo-stress in rock samples, one of the most difficult problems is how to eliminate the obstruction of erroneous AE signals caused by the strong stress concentration at the end corners of the rock specimen. As the result of comparison, the values obtained by the AE method have a tendency of greater than the values obtained by the over-coring method. It is conceived that the AE method can easily detect the maximum stress value for geo historical long time, and that the stress concentration is apt to mix in AE method by boring. (Iwakiri, K.)

  9. Reply to Nicholson's comment on "Consistent calculation of aquatic gross production from oxygen triple isotope measurements" by Kaiser (2011

    Directory of Open Access Journals (Sweden)

    J. Kaiser

    2012-08-01

    Full Text Available The comment by Nicholson (2011a questions the "consistency" of the "definition" of the "biological end-member" used by Kaiser (2011a in the calculation of oxygen gross production. "Biological end-member" refers to the relative oxygen isotope ratio difference between photosynthetic oxygen and Air-O2 (abbreviated 17δP and 18δP for 17O/16O and 18O/16O, respectively. The comment claims that this leads to an overestimate of the discrepancy between previous studies and that the resulting gross production rates are "30% too high". Nicholson recognises the improved accuracy of Kaiser's direct calculation ("dual-delta" method compared to previous approximate approaches based on 17O excess (17Δ and its simplicity compared to previous iterative calculation methods. Although he correctly points out that differences in the normalised gross production rate (g are largely due to different input parameters used in Kaiser's "base case" and previous studies, he does not acknowledge Kaiser's observation that iterative and dual-delta calculation methods give exactly the same g for the same input parameters (disregarding kinetic isotope fractionation during air-sea exchange. The comment is based on misunderstandings with respect to the "base case" 17δP and 18δP values. Since direct measurements of 17δP and 18δPdo not exist or have been lost, Kaiser constructed the "base case" in a way that was consistent and compatible with literature data. Nicholson showed that an alternative reconstruction of 17δP gives g values closer to previous studies. However, unlike Nicholson, we refrain from interpreting either reconstruction as a benchmark for the accuracy of g. A number of publications over the last 12 months

  10. [The PROPRESE trial: results of a new health care organizational model in primary care for patients with chronic coronary heart disease based on a multifactorial intervention].

    Science.gov (United States)

    Ruescas-Escolano, Esther; Orozco-Beltran, Domingo; Gaubert-Tortosa, María; Navarro-Palazón, Ana; Cordero-Fort, Alberto; Navarro-Pérez, Jorge; Carratalá-Munuera, Concepción; Pertusa-Martínez, Salvador; Soler-Bahilo, Enrique; Brotons-Muntó, Francisco; Bort-Cubero, Jose; Núñez-Martínez, Miguel A; Bertomeu-Martínez, Vicente; López-Pineda, Adriana; Gil-Guillén, Vicente F

    2014-06-01

    Comparison of the results from the EUROASPIRE I to the EUROASPIRE III, in patients with coronary heart disease, shows that the prevalence of uncontrolled risk factors remains high. The aim of the study was to evaluate the effectiveness of a new multifactorial intervention in order to improve health care for chronic coronary heart disease patients in primary care. In this randomized clinical trial with a 1-year follow-up period, we recruited patients with a diagnosis of coronary heart disease (145 for the intervention group and 1461 for the control group). An organizational intervention on the patient-professional relationship (centered on the Chronic Care Model, the Stanford Expert Patient Programme and the Kaiser Permanente model) and formative strategy for professionals were carried out. The main outcomes were smoking control, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP). A multivariate analysis was performed. The characteristics of patients were: age (68.4±11.8 years), male (71.6%), having diabetes mellitus (51.3%), dyslipidemia (68.5%), arterial hypertension (76.7%), non-smokers (76.1%); LDL-C cardiovascular risk factors control (smoking, LDL-C and SBP). Chronic care strategies may be an efficacy tool to help clinicians to involve the patients with a diagnosis of CHD to reach better outcomes. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  11. Mothers of children diagnosed with attention-deficit/hyperactivity disorder: health conditions and medical care utilization in periods before and after birth of the child.

    Science.gov (United States)

    Ray, G Thomas; Croen, Lisa A; Habel, Laurel A

    2009-01-01

    Analyzing health conditions and medical utilization of mothers of children with attention-deficit/hyperactivity disorder (ADHD) can shed light on biologic, environmental, and psychosocial factors relating to ADHD. To examine health conditions, health care utilization, and costs of mothers of children with ADHD in periods before the child was diagnosed. Using automated data from Northern California Kaiser Permanente we identified mothers of children with ADHD, mothers of children without ADHD, and mothers of children with asthma. Mothers' diagnostic clusters, health care utilization, and costs were compared. Mothers of children with ADHD were compared with mothers of children without ADHD and, separately, to mothers of children with asthma. Compared with mothers of children without ADHD, mothers of children with ADHD were more likely to be diagnosed with numerous medical and mental health problems in the 2 years after birth of their child, including depression [odds ratio (OR): 1.88], anxiety neuroses (OR: 1.64), obesity (OR: 1.70), and musculoskeletal symptoms (OR: 1.51). Results were similar for the year before delivery. Mothers of children with ADHD also had higher total health care costs per person in the year before ($1,003) and the 2 years after ($953) the birth of their child. Mothers of children with ADHD also were diagnosed with more health conditions and had higher health care costs than mothers of children with asthma. Our findings suggest that the likelihood of being diagnosed with ADHD is related to maternal conditions and use of health services that precede the child's diagnosis. Future studies are needed to clarify whether this is due to biologic, psychosocial, or environmental factors, or a combination.

  12. Educación permanente y continua en una perspectiva de integridad del ser

    Directory of Open Access Journals (Sweden)

    Izabel Cristina Feijó de Andrade

    2014-12-01

    Full Text Available Este artículo buscó discutir las articulaciones y distinciones entre los conceptos de educación permanente y educación continua de modo que favorezca la perspectiva de integridad del ser, vínculo que requiere saberes hasta entonces poco privilegiados en las Universidades y que demandan el rescate de dimensiones basadas en la experiencia, la didáctica y la existencia del educador, tanto individual, comportamental, cultural, social y espiritual. Consideramos que las nociones de educación permanente y educación continua poseen elementos entrelazables que nos permiten desarrollar la capacidad de reaccionar críticamente por medio de una relación autoformativa. Las revisiones teóricas implementadas permitieron algunas consideraciones sobre los procesos formativos actuales y las prácticas de profesores rumbo a una Educación para la Integridad. Concluimos provisoriamente que las aproximaciones y distinciones entre EP y EC pueden proporcionar a los profesores la toma de conciencia de su vinculación todo/parte y del sentido de la vida.

  13. Alcoholic beverage intake and risk of lung cancer: the California Men's Health Study.

    Science.gov (United States)

    Chao, Chun; Slezak, Jeff M; Caan, Bette J; Quinn, Virginia P

    2008-10-01

    We investigated the effect of alcoholic beverage consumption on the risk of lung cancer using the California Men's Health Study. The California Men's Health Study is a multiethnic cohort of 84,170 men ages 45 to 69 years who are members of the Kaiser Permanente California health plans. Demographics and detailed lifestyle characteristics were collected from surveys mailed between 2000 and 2003. Incident lung cancer cases were identified by health plan cancer registries through December 2006 (n=210). Multivariable Cox's regression was used to examine the effects of beer, red wine, white wine (including rosé), and liquor consumption on risk of lung cancer adjusting for age, race/ethnicity, education, income, body mass index, history of chronic obstructive pulmonary disease/emphysema, and smoking history. There was a significant linear decrease in risk of lung cancer associated with consumption of red wine among ever-smokers: hazard ratio (HR), 0.98; 95% confidence interval (95% CI), 0.96-1.00 for increase of 1 drink per month. This relationship was slightly stronger among heavy smokers (>or=20 pack-years): HR, 0.96; 95% CI, 0.93-1.00. When alcoholic beverage consumption was examined by frequency of intake, consumption of >or=1 drink of red wine per day was associated with an approximately 60% reduced lung cancer risk in ever-smokers: HR, 0.39; 95% CI, 0.14-1.08. No clear associations with lung cancer were seen for intake of white wine, beer, or liquor. Moderate red wine consumption was inversely associated with lung cancer risk after adjusting for confounders. Our results should not be extrapolated to heavy alcohol consumption.

  14. A novel power harmonic analysis method based on Nuttall-Kaiser combination window double spectrum interpolated FFT algorithm

    Science.gov (United States)

    Jin, Tao; Chen, Yiyang; Flesch, Rodolfo C. C.

    2017-11-01

    Harmonics pose a great threat to safe and economical operation of power grids. Therefore, it is critical to detect harmonic parameters accurately to design harmonic compensation equipment. The fast Fourier transform (FFT) is widely used for electrical popular power harmonics analysis. However, the barrier effect produced by the algorithm itself and spectrum leakage caused by asynchronous sampling often affects the harmonic analysis accuracy. This paper examines a new approach for harmonic analysis based on deducing the modifier formulas of frequency, phase angle, and amplitude, utilizing the Nuttall-Kaiser window double spectrum line interpolation method, which overcomes the shortcomings in traditional FFT harmonic calculations. The proposed approach is verified numerically and experimentally to be accurate and reliable.

  15. ‘God is groot en wij begrijpen Hem niet’: Kaisers populaire sterrenkunde en het einde van de fysiko-theologie

    Directory of Open Access Journals (Sweden)

    Frans van Lunteren

    2011-06-01

    Full Text Available Frederik Kaiser, popular astronomy, and the decline of natural theologyThroughout his remarkable career the Leiden astronomer Frederik Kaiser (1808-1872 struggled to revive Dutch astronomy, which at the time was rather moribund. His efforts comprised mobilizing public support through popularization. In spite of a lack of illustrations, his popular Starry Sky (1844 proved immensely successful with the general public. This work differed in many respects from earlier Dutch popular writings, and helped to establish the new genre of popular science. Kaiser enunciated his idiosyncratic views on popularization in a lecture which he later published as a brochure. Whereas his research reflects the shift from the dilettante to the professional scientist in being focussed on precision measurement, his popular work likewise testified to the transition from natural philosophy to modern science. Charged with the task of composing a natural theological work on astronomy, the deeply religious Kaiser, wriggled his way through the text. Feeling unable to advance the usual arguments, he finally found refuge in the book of Job: 'Behold, God is great and we know him not'. Arguably, the rise of popular science and the decline of natural theology were intimately connected.

  16. Formación permanente del profesorado en Jalisco: evaluación y propuesta

    OpenAIRE

    Camacho Buenrostro, Benita

    2016-01-01

    Este trabajo tiene como objetivo realizar una evaluación del modelo de formación permanente para docentes de Educación Básica implementado en Jalisco durante el período 2007-2012. La investigación se ubica en el paradigma naturalista o interpretativo y busca lograr el objetivo a través del enfoque de la evaluación comprensiva. También utiliza métodos cualitativo y cuantitativo y se apoya en distintas técnicas: análisis de documentos, observación directa de este fenómeno, entrevistas a funcion...

  17. Educação permanente no contexto da enfermagem e na saúde

    OpenAIRE

    Mancia,Joel Rolim; Cabral,Leila Chaves; Koerich,Magda Santos

    2004-01-01

    Neste trabalho os autores discutem a proposta atual de educação permanente do Ministério da Saúde, voltada para a formação de recursos humanos para o Sistema Único de Saúde. Traz um resgate da educação em geral e especificamente da educação de adultos, questão que afeta diretamente a enfermagem, visto que esta contribui com o maior contingente de trabalhadoras na área da saúde, constituindo-se em foco central das políticas públicas. Assim apresentam as principais controvérsias e apontam para ...

  18. Tratamiento de un molar permanente inmaduro necrótico mediante pulpotomía

    OpenAIRE

    Boj Quesada, Juan Ramón; Cortés Lillo, Olga; Canalda Sahli, Carlos

    1995-01-01

    Se describe un caso que afecta al primer molar permanente inferior derecho, con tumefacción, fluctuación y fístula , con ápices no cerrados. El tratamiento de elección hubiese sido una técnica clásica de apicoformación con hidróxido de calcio. Pero por motivos de colaboración, se realizó una pulpotomía con hidróxido de calcio. Tras los controles radiológicos a los 3 meses, al año y al año y medio se comprobó que continuaba el desarrollo radicular y finalizaba el cierre apical.

  19. Probabilidad de retención de segundos molares permanentes mandibulares (Estudio piloto

    Directory of Open Access Journals (Sweden)

    Paulo Sandoval Vidal

    Full Text Available Objetivos: Determinar la frecuencia del segundo molar mandibular permanente (MM2 con probabilidad de impactación, en un grupo de pacientes de Ortodoncia de Temuco, Chile. Método: Estudio de corte transversal, con muestra por conveniencia. Se revisaron 2095 fichas de individuos de ambos sexos, con ausencia de patología sindrómica. Los datos recolectados se obtuvieron de radiografías panorámicas. Se midió el ángulo del segundo molar con respecto al plano oclusal, la invasión distal del primer molar y la distancia entre distal del primer molar y el borde anterior de la rama mandibular. Resultados: El promedio de edad de los pacientes relevados fue de 10 años. Se observó un 1,43% de probabilidad de retención de MM2 (n=30; en promedio y el plano el ángulo MM2 resultó de 27° el izquierdo y 26° el derecho; la invasión de MM2 en distal del primer molar resultó de 1,5 mm; el ángulo entre MM2 y el planos oclusal es de 123°; la distancia entre la cara distal del primer molar y el borde anterior de la rama mandibular fue 13 mm. Conclusiones: Existe una baja prevalencia de segundos molares mandibulares permanentes con probabilidad de impactación. La invasión a la cara distal del primer molar fue mayor en pacientes con riesgo de impactación

  20. Evaluation Techniques of Creating Coherence in Poems of Kaiser Aminpour Relying on the Theory of Halliday’s Linguistics

    Directory of Open Access Journals (Sweden)

    Reza Sattari

    2016-05-01

    Full Text Available AbstractOne of the linguistics theories that are utilized in present age in the analysis of literary texts is the theory of Halliday’s linguistics which is called theory of systemic - functional linguistics. Halliday’s theory in the second half of the twentieth century, in contrast to the "generative linguistics" approach, which is based on formal language like a mental and individual phenomenon.    Hallidayan called the semantic, literal, syntax and logical relationship of words as coherence of a text and believes that the coherence of the text, includes all the semantic relations by which, every piece of speech or writing can serve as text. Hence, cohesion, referred to relations that relates all elements of a sentence to the elements of other sentences. From Hallidayan's  point of view, elements of coherence of a text are divided into two parts: grammatical and lexical. Grammatical cohesion includes factors such as referrals, replacements, removals and relevancy, and lexical coherence includes repetition and collocation in literary language.   Kaiser is one of the contemporary famous poets that have composed many poets in different molds of poetry. Kaiser Manipur's poems benefit the integration due to the poet's fluency in Persian and his familiarity with the vocabulary and grammatical and lexical capacities of Persian literature. In this research, we have studied the cohesion in Kaiser Manipur's poems from two views of lexical and grammatical by using Holidaying theory of coherence as well as the techniques that the poet has applied to reach the cohesion in his poems.    The method of research in the present paper is descriptive-analytical and all the information and data has been collected from the sources of library and electronic. In this paper, we first briefly discussed the Holidaying coherence theory, and then, with a special approach to this theory, the most important techniques that Kaiser Manipur has

  1. Prevalencia preoperatoria de la fibrilación auricular permanente en cirugía cardíaca

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    Fernando Hornero

    2005-07-01

    Conclusiones: La FA permanente se presenta en nuestro medio quirúrgico preoperatorio en el 13,6%, preferentemente asociada a enfermedad mitral. Los factores de riesgo cardiovasculares están presentes con similar prevalencia en los pacientes con FA que en el resto, excepto el tamaño auricular.

  2. Telephone-Based Coaching: A Comparison of Tobacco Cessation Programs in an Integrated Health Care System

    Science.gov (United States)

    Boccio, Mindy; Sanna, Rashel S.; Adams, Sara R.; Goler, Nancy C.; Brown, Susan D.; Neugebauer, Romain S.; Ferrara, Assiamira; Wiley, Deanne M.; Bellamy, David J.; Schmittdiel, Julie A.

    2016-01-01

    Purpose Many Americans continue to smoke, increasing their risk of disease and premature death. Both telephone-based counseling and in-person tobacco cessation classes may improve access for smokers seeking convenient support to quit. Little research has assessed whether such programs are effective in real-world clinical populations. Design Retrospective cohort study comparing wellness coaching participants with two groups of controls. Setting Kaiser Permanente, Northern California (KPNC), a large integrated health care delivery system. Subjects 241 patients who participated in telephonic tobacco cessation coaching from 1/1/2011–3/31/2012, and two control groups: propensity-score matched controls, and controls who participated in a tobacco cessation class during the same period. Wellness coaching participants received an average of two motivational interviewing based coaching sessions that engage the patient, evoke their reason to consider quitting and help them establish a quit plan. Measures Self-reported quitting of tobacco and fills of tobacco cessation medications within 12 months of follow-up. Analysis Logistic regressions adjusting for age, gender, race/ethnicity, and primary language. Results After adjusting for confounders, tobacco quit rates were higher among coaching participants vs. matched controls (31% vs. 23%, PCoaching participants and class attendees filled tobacco-cessation prescriptions at a higher rate (47% for both) than matched controls (6%, Pcoaching was as effective as in-person classes and was associated with higher rates of quitting compared to no treatment. The telephonic modality may increase convenience and scalability for health care systems looking to reduce tobacco use and improve health. PMID:26559720

  3. Red wine consumption and risk of prostate cancer: the California men's health study.

    Science.gov (United States)

    Chao, Chun; Haque, Reina; Van Den Eeden, Stephen K; Caan, Bette J; Poon, Kwun-Yee T; Quinn, Virginia P

    2010-01-01

    Red wine contains polyphenol antioxidants that inhibit prostate cancer development in animal studies. We investigated the effect of red wine intake on the risk of prostate cancer using data prospectively collected in the California Men's Health Study (CMHS). CMHS is a multiethnic cohort of 84,170 men aged 45-69 years who were members of the Kaiser Permanente Southern and Northern California Health Plans. Information on demographic and lifestyle factors was collected using mailed questionnaires between 2002 and 2003. We used Cox models to estimate the effect of red wine on prostate cancer risk, adjusting for potential confounders. A total of 1,340 incident prostate cancer cases identified from Surveillance, Epidemiology and End Result-affiliated cancer registries were included in the analyses. We did not find a clear association between red wine intake and risk of prostate cancer. Hazard ratio (HR) estimates for consuming or =1 drink/week but or =1 drink/day were 0.89, 95% confidence interval (0.74-1.07), 0.99 (0.83-1.17) and 0.88 (0.70-1.12), respectively. Further, we observed no linear dose response. The lack of association for red wine intake was consistently observed when we restricted the analyses to those with and without a history of PSA screening. In addition, we also did not observe any association with prostate cancer for beer, white wine, liquor or combined alcoholic beverage intake (HR for combined alcoholic beverage intake of > or =5 drinks/day = 1.16 (0.83-1.63). Neither red wine nor total alcohol consumption were associated with prostate cancer risk in this population of moderate drinkers.

  4. Characteristics of Resistant Hypertension in a Large Ethnically Diverse Hypertension Population of an Integrated Health System

    Science.gov (United States)

    Sim, John J.; Bhandari, Simran K.; Shi, Jiaxiao; In Liu, Lu A.; Calhoun, David A.; McGlynn, Elizabeth A.; Kalantar-Zadeh, Kamyar; Jacobsen, Steven J.

    2013-01-01

    Objective To evaluate the prevalence and characterize resistant hypertension from a large representative population with successful hypertension management and reliable health information. Patient and Methods We performed a cross sectional study using clinical encounter, laboratory, and administrative information from the Kaiser Permanente Southern California health system during 1/1/2006–12/31/2007. From individuals age >17 years with hypertension, resistant hypertension was identified and prevalence determined. Multivariable logistic regression was used to calculate odds ratios (OR) with adjustments for demographics, clinical variables, and medication use. Results Among 470,386 hypertensive individuals, 12.8% were identified as resistant representing15.3% of those on medications. Overall, 37,061 (7.9%) had uncontrolled hypertension while on ≥ 3 medicines. OR (95% confidence interval) for resistant hypertension were greater for black race (1.68, 1.62–1.75), older age (1.11, 1.10–1.11 for every 5 year increase), males (1.06, 1.03–1.10), and obesity (1.46, 1.42–1.51). Medication adherence rates were higher in resistant hypertension (93 vs 90%, phypertension. Conclusion Within a more standardized hypertension treatment environment, we observed a rate of resistant hypertension comparable to past studies using more fragmented data sources. Past observations have been limited due to non-representative populations, reliability of the data, heterogeneity of the treatment environments, and less than ideal control rates. This cohort which was established with an electronic medical record based approach has the potential to provide a better understanding of resistant hypertension and outcomes. PMID:24079679

  5. Cannabinoid Hyperemesis Syndrome: Public Health Implications and a Novel Model Treatment Guideline

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    Seth Meyer

    2017-11-01

    Full Text Available Introduction: Cannabinoid hyperemesis syndrome (CHS is an entity associated with cannabinoid overuse. CHS typically presents with cyclical vomiting, diffuse abdominal pain, and relief with hot showers. Patients often present to the emergency department (ED repeatedly and undergo extensive evaluations including laboratory examination, advanced imaging, and in some cases unnecessary procedures. They are exposed to an array of pharmacologic interventions including opioids that not only lack evidence, but may also be harmful. This paper presents a novel treatment guideline that highlights the identification and diagnosis of CHS and summarizes treatment strategies aimed at resolution of symptoms, avoidance of unnecessary opioids, and ensuring patient safety. Methods: The San Diego Emergency Medicine Oversight Commission in collaboration with the County of San Diego Health and Human Services Agency and San Diego Kaiser Permanente Division of Medical Toxicology created an expert consensus panel to establish a guideline to unite the ED community in the treatment of CHS. Results: Per the consensus guideline, treatment should focus on symptom relief and education on the need for cannabis cessation. Capsaicin is a readily available topical preparation that is reasonable to use as first-line treatment. Antipsychotics including haloperidol and olanzapine have been reported to provide complete symptom relief in limited case studies. Conventional antiemetics including antihistamines, serotonin antagonists, dopamine antagonists and benzodiazepines may have limited effectiveness. Emergency physicians should avoid opioids if the diagnosis of CHS is certain and educate patients that cannabis cessation is the only intervention that will provide complete symptom relief. Conclusion: An expert consensus treatment guideline is provided to assist with diagnosis and appropriate treatment of CHS. Clinicians and public health officials should identity and treat CHS

  6. Demonstration of shield-type longwall supports at York Canyon Mine of Kaiser Steel Corporation. Final technical report A

    Energy Technology Data Exchange (ETDEWEB)

    Lawrence, R.G.; King, R.

    1980-04-01

    This report represents work on a program that was originated by the USBM of the Department of the Interior and was transferred to the Department of Energy on October 1, 1977. A demonstration with the Government funded Hemscheidt 320 HSL caliper type shield supports was conducted at three longwall panels of Kaiser Steel Corporation's York Canyon Mine. The purpose of this longwall demonstration was to provide the US coal industry with information on all aspects of shield longwall mining in high seams. The demonstration provided a working model for the coal industry and during the project, 350 people from the industry, schools, and government agencies visited the demonstration. They were provided with a first hand knowledge of a working shield longwall. The demonstration showed that the control of large coal lumps may be a problem in the mining of coal seam thicker than 8 feet. Mining with shield type supports provided good working conditions and a safe working environment. The shield requires very little maintenance and has a high mechanical availability.

  7. EDUCAÇÃO PERMANENTE EM ENFERMAGEM E A INTERFACE COM A OUVIDORIA HOSPITALAR

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    Raquel Costa Rodrigues de Souza

    2010-01-01

    Full Text Available Se trata de un estudio descriptivo-exploratorio, con enfoque cualitativo, cuyo objetivo fue investigar las demandas de los usuarios del servicio de Defensoría del Pueblo relacionadas con la asistencia de enfermería y discutir su contribución para la educación permanente. La investigación se desarrolló en hospital público federal, con notoriedad en realización de procedimientos diagnósticos y terapéuticos de alta complejidad en Ortopedia. La recolección de datos se basó en la técnica de análisis documental, incluyendo la gestión de informaciones y materiales, de las demandas de los usuarios que figuran en los registros de la Oficina de Defensoría del Pueblo, relativos al año 2009, (total de 3.895 declaraciones. Hemos clasificado las declaraciones recibidas- en este estudio- según la naturaleza de la comunicación: elogio, pedido de información, queja, sugerencia y denuncia. Hemos considerado la importancia del Servicio de Defensoría del Pueblo para mejorar la actuación de enfermería, teniendo en cuenta las contribuciones extraídas del contexto de las demandas y que la relación interdisciplinar permite percibir y evaluar las necesidades evidenciadas.

  8. CONTROL DE GESTIÓN: DIMENSIONES Y DIAGNÓSTICO PERMANENTE

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    Maritza Hernández Torres

    2003-04-01

    Full Text Available

    Los actuales entornos competitivos en los que se desarrolla la actividad empresarial, junto a la necesidad de responder de forma adecuada a los continuos cambios y constante incertidumbre a los que las organizaciones han de enfrentarse, conllevan una significativa modificación en lo que a la gestión empresarial se refiere, resultando esencial en este sentido, el papel del control de gestión, que como elemento del proceso de dirección, es el que más contribuye a mejorar las actuaciones de cualquier sistema. Las empresas deben tomar decisiones estratégicas adecuadas que permitan alcanzar alguna ventaja competitiva en la búsqueda de la excelencia empresarial a través de un proceso flexible de mejora continua. Para contribuir a tal propósito, en el presente trabajo se realizan algunas reflexiones acerca del control de gestión, abarcando desde el enfoque clásico hasta el moderno, su evolución y situación en las organizaciones cubanas; así como, el análisis de sus dimensiones soportado en un procedimiento para su permanente diagnóstico en correspondencia con las particularidades en que las diferentes empresas desarrollan su actividad.

  9. Las Lesson Study en Andalucía: un modelo de formación permanente

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    Rosa M.ª Caparrós Vida

    2015-01-01

    Full Text Available El presente artículo ofrece los resultados de un estudio de casos desarrollado en el marco de un proyecto de investigación I+D de la Universidad de Málaga a través de una de las modalidades de formación permanente ofertadas por un Centro de Formación del Profesorado, bajo la demanda de un grupo de docentes de una escuela de la comarca de la Axarquía en Málaga. Las Lesson Study se convierten en el eje del estudio de los procesos de comprensión y reconstrucción del conocimiento práctico de una maestra de 1º de primaria sobre la enseñanza y el aprendizaje de la lectura y escritura, encontrando evidencias significativas sobre cómo esta estrategia metodológica y de investigación contribuye a la reconstrucción del mismo.

  10. Biopoder e UPPs: alteridade na experiência do policiamento permanente em comunidades cariocas

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    Thiago Benedito Livramento Melicio

    2012-12-01

    Full Text Available O artigo visa refletir sobre a experiência do efetivo policial permanente em dois conjuntos de comunidades cariocas, inserido no escopo das Unidades de Polícia Pacificadora (UPP. Foram realizados dois estudos exploratórios, em agosto e dezembro de 2010. Na esteira do conceito foucaultiano de biopoder, discute-se a UPP como rede de relações de poder que a compõe e a legitima, pensando-se o local em que se instala, a política de Estado a que responde, os atores com que opera e as produções históricas das relações entre Estado e territórios populares. O campo de análise constitui-se, assim, nas práticas e saberes localizados no cotidiano e nos efeitos produzidos com a presença do policial na paisagem da favela. Se novas regras são trazidas com as UPPs, novas identificações são mobilizadas e as modulações de conjunto abrem lacunas, o governo de si não se produz sozinho, mas combina-se com diversidades na gestão da vida.

  11. La cátedra abierta y permanente de Ética

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    Ana María Caballero

    2015-06-01

    Full Text Available La Cátedra Abierta y Permanente de Ética se propuso como un espacio de discusión y reflexión ético-política para debatir las diferentes corrientes del pensamiento axiológico y político, que propicie la resignificación de las representaciones culturales y sociales de sentido que permitan desarrollar una mirada socio histórica sobre las relaciones entre educación, ética y cultura colombiana, de tal manera que los estudiantes de la Universidad Pedagógica Nacional asuman una conciencia clara de su función como actores sociales en la construcción de la sociedad civil, la democracia, la promoción y la defensa de los derechos humanos, el crecimiento económico y el desarrollo social. La formación de valores morales que fundamenten una ética cívica parte del conocimiento de la realidad nacional y global, de la autoconciencia de cada individuo que aspira a constituirse en un ser autónomo usando su pensamiento crítico y participando en la construcción de la democracia, como modelo de gobierno que garantiza las libertades individuales, propiciando espacios para la conquista de los ideales de libertad, equidad, solidaridad y tolerancia, que permitan la convivencia ciudadana y la construcción de la nacionalidad colombiana.

  12. Estrategias del Teatro del Oprimido para la formación permanente del profesorado

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    Tomás Motos-Teruel

    2012-01-01

    Full Text Available Este artículo relata una experiencia y su valoración de formación permanente del profesorado basada en el aprendizaje vivencial utilizando como estrategia metodológica el Teatro del Oprimido (TO para estimular y favorecer la reflexión sobre la práctica educativa. Sus objetivos básicos fueron dar a conocer la formulación teórica y la metodología del TO y hacer la transferencia de las estrategias metodológicas vivenciadas a la práctica docente. El estudio se ha planteado desde una óptica cualitativa con el estudio de caso único. Y como resultados más destacables hay que reseñar el interés y la percepción de la utilidad personal y profesional del TO como instrumento de reflexión sobre la acción y generador de clima positivo. El Teatro del Oprimido es una formulación teórica y un método estético cuya teoría y praxis están inspiradas en la Pedagogía del Oprimido de Paulo Freire, utiliza las técnicas dramáticas como un instrumento eficaz para la comprensión y la búsqueda de alternativas a problemas sociales, interpersonales e individuales.

  13. Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex.

    Science.gov (United States)

    Krouse, Robert S; Herrinton, Lisa J; Grant, Marcia; Wendel, Christopher S; Green, Sylvan B; Mohler, M Jane; Baldwin, Carol M; McMullen, Carmit K; Rawl, Susan M; Matayoshi, Eric; Coons, Stephen Joel; Hornbrook, Mark C

    2009-10-01

    Intestinal stomas can pose significant challenges for long-term (> or = 5 years) rectal cancer (RC) survivors. Specifying common challenges and sociodemographic or clinical differences will further the development of tailored interventions to improve health-related quality of life (HRQOL). This was a matched cross-sectional study of long-term RC survivors conducted in three Kaiser Permanente regions. The mailed questionnaire included the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-Ostomy) and Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2). Groups surveyed were permanent ostomates (cases) and those who did not require an ostomy (controls). RC survivors were matched on sex, age, and time since diagnosis. Comparisons between groups used regression analysis with adjustment for age, comorbidity score, history of radiation therapy, income, and work status. Response rate was 54% (491 of 909). Cases and controls had similar demographic characteristics. On the basis of the mCOH-QOL-Ostomy, both male and female cases had significantly worse social well-being compared with controls, while only female cases reported significantly worse overall HRQOL and psychological well-being. For younger females (ostomy had a greater impact on physical well-being compared with older females. Based on the SF-36v2, statistically significant and meaningful differences between female cases and controls were observed for seven of the eight scales and on the physical and mental component summary scores. Men and women report a different profile of challenges, suggesting the need for targeted or sex-specific interventions to improve HRQOL in this population. This may include focus on physical HRQOL for female ostomy survivors younger than age 75.

  14. Geographic Clusters of Basal Cell Carcinoma in a Northern California Health Plan Population.

    Science.gov (United States)

    Ray, G Thomas; Kulldorff, Martin; Asgari, Maryam M

    2016-11-01

    Rates of skin cancer, including basal cell carcinoma (BCC), the most common cancer, have been increasing over the past 3 decades. A better understanding of geographic clustering of BCCs can help target screening and prevention efforts. Present a methodology to identify spatial clusters of BCC and identify such clusters in a northern California population. This retrospective study used a BCC registry to determine rates of BCC by census block group, and used spatial scan statistics to identify statistically significant geographic clusters of BCCs, adjusting for age, sex, and socioeconomic status. The study population consisted of white, non-Hispanic members of Kaiser Permanente Northern California during years 2011 and 2012. Statistically significant geographic clusters of BCC as determined by spatial scan statistics. Spatial analysis of 28 408 individuals who received a diagnosis of at least 1 BCC in 2011 or 2012 revealed distinct geographic areas with elevated BCC rates. Among the 14 counties studied, BCC incidence ranged from 661 to 1598 per 100 000 person-years. After adjustment for age, sex, and neighborhood socioeconomic status, a pattern of 5 discrete geographic clusters emerged, with a relative risk ranging from 1.12 (95% CI, 1.03-1.21; P = .006) for a cluster in eastern Sonoma and northern Napa Counties to 1.40 (95% CI, 1.15-1.71; P Costa and west San Joaquin Counties, compared with persons residing outside that cluster. In this study of a northern California population, we identified several geographic clusters with modestly elevated incidence of BCC. Knowledge of geographic clusters can help inform future research on the underlying etiology of the clustering including factors related to the environment, health care access, or other characteristics of the resident population, and can help target screening efforts to areas of highest yield.

  15. Reproductive health outcomes of insured adolescent and adult women who access oral levonorgestrel emergency contraception.

    Science.gov (United States)

    Raine-Bennett, Tina; Merchant, Maqdooda; Sinclair, Fiona; Lee, Justine W; Goler, Nancy

    2015-04-01

    To assess the level of risk for adolescents and women who seek emergency contraception through various clinical routes and the opportunities for improved care provision. This study looked at a retrospective cohort to assess contraception and other reproductive health outcomes among adolescents and women aged 15-44 years who accessed oral levonorgestrel emergency contraception through an office visit or the call center at Kaiser Permanente Northern California from 2010 to 2011. Of 21,421 prescriptions, 14,531 (67.8%) were accessed through the call center. In the subsequent 12 months, 12,127 (56.6%) adolescents and women had short-acting contraception (pills, patches, rings, depot medroxyprogesterone) dispensed and 2,264 (10.6%) initiated very effective contraception (intrauterine contraception, implants, sterilization). Initiation of very effective contraception was similar for adolescents and women who accessed it through the call center-1,569 (10.8%) and office visits-695 (10.1%) (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 0.93-1.13). In the subsequent 6 months, 2,056 (9.6%) adolescents and women became pregnant. Adolescents and women who accessed emergency contraception through the call center were less likely to become pregnant within 3 months of accessing emergency contraception than woman who accessed it through office visits (adjusted OR 0.82, 95% CI 0.72-0.94); however, they were more likely to become pregnant within 4-6 months (adjusted OR 1.37, 95% CI 1.16-1.60). Among adolescents and women who were tested for chlamydia and gonorrhea, 689 (7.8%) and 928 (7.9%) were positive in the 12 months before and after accessing emergency contraception, respectively. Protocols to routinely address unmet needs for contraception at every call for emergency contraception and all office visits, including visits with primary care providers, should be investigated.

  16. Reproductive Health Outcomes of Insured Women Who Access Oral Levonorgestrel Emergency Contraception

    Science.gov (United States)

    Raine-Bennett, Tina; Merchant, Maqdooda; Sinclair, Fiona; Lee, Justine W.; Goler, Nancy

    2015-01-01

    Objectives To assess the level of risk for women who seek emergency contraception through various clinical routes and the opportunities for improved care provision. Methods This study looked at a retrospective cohort to assess contraception and other reproductive health outcomes among women aged 15-44 who accessed oral levonorgestrel emergency contraception through an office visit or the call center at Kaiser Permanente Northern California from 2010 to 2011. Results Of 21,421 prescriptions, 14,531(67.8%) were accessed through the call center. In the subsequent 12 months, 12,127(56.6%) women had short-acting contraception (pills, patches, rings, depot medroxyprogesterone) dispensed and 2,264(10.6%) initiated very effective contraception (intrauterine contraception, implants, sterilization). Initiation of very effective contraception was similar for women who accessed it through the call center -1,569(10.8%) and office visits – 695(10.1%) (adjusted OR 1.02 95% confidence interval (CI) 0.93-1.13). In the subsequent 6 months, 2,056(9.6%) women became pregnant. Women who accessed emergency contraception through the call center were less likely to become pregnant within 3 months of accessing emergency contraception than woman who accessed it through office visits (adjusted OR 0.82 95% CI 0.72-0.94); however they were more likely to become pregnant within 4-6 months (adjusted OR 1.37 95%CI 1.16-1.60). Among women who were tested for chlamydia and gonorrhea, 689(7.8%) and 928(7.9%) were positive in the 12 months before and after accessing emergency contraception, respectively. Conclusions Protocols to routinely address unmet need for contraception at every call for emergency contraception and all office visits including visits with primary care providers should be investigated. PMID:25751211

  17. Educação permanente: reflexão na prática da enfermagem hospitalar.

    Directory of Open Access Journals (Sweden)

    José Reginaldo PINTO

    2015-08-01

    Full Text Available Na prática hospitalar, a Educação Permanente é indispensável à formação dos trabalhadores, os quais necessitam ter conhecimentos renovados em sua prática profissional. Nesta perspectiva, buscou-se analisar por meio dessa pesquisa a percepção dos enfermeiros de um hospital de ensino acerca da educação permanente no ambiente hospitalar. Trata-se de uma pesquisa descritiva com abordagem qualitativa, realizada com nove enfermeiros coordenadores de setores, utilizando-se três grupos focais, constituído por três enfermeiros em cada grupo. A investigação ocorreu no Hospital do Coração do município de Sobral, Ceará. Utilizaram-se entrevistas que foram gravadas nas reuniões dos grupos. A análise de conteúdo de Bardin estruturou os achados encontrados. Esses resultados foram separados por unidades temáticas. Foram respeitados os princípios éticos de acordo com a resolução 466/12. A primeira unidade temática investigou o conhecimento dos sujeitos acerca da Educação Permanente, Continuada e em Serviço. Os primeiros achados identificaram divergências de opiniões dos participantes quando conceituaram a diferenciação entre as modalidades de educação em saúde. A segunda unidade resgatou a opinião dos sujeitos sobre as estratégias para implantar uma comissão de educação permanente no hospital. As falas dos participantes revelaram que a comissão deveria motivar os profissionais a continuarem se qualificando no serviço. Ainda indagaram que essas comissões deveria ter caráter multidisciplinar. A última unidade analisada referiu-se a forma de atuar das comissões de educação permanente. Os investigados assinalaram que elas deveriam proporcionar a melhoria do ensino aos profissionais aplicando as metodologias ativas.

  18. Mixture models for undiagnosed prevalent disease and interval-censored incident disease: applications to a cohort assembled from electronic health records.

    Science.gov (United States)

    Cheung, Li C; Pan, Qing; Hyun, Noorie; Schiffman, Mark; Fetterman, Barbara; Castle, Philip E; Lorey, Thomas; Katki, Hormuzd A

    2017-09-30

    For cost-effectiveness and efficiency, many large-scale general-purpose cohort studies are being assembled within large health-care providers who use electronic health records. Two key features of such data are that incident disease is interval-censored between irregular visits and there can be pre-existing (prevalent) disease. Because prevalent disease is not always immediately diagnosed, some disease diagnosed at later visits are actually undiagnosed prevalent disease. We consider prevalent disease as a point mass at time zero for clinical applications where there is no interest in time of prevalent disease onset. We demonstrate that the naive Kaplan-Meier cumulative risk estimator underestimates risks at early time points and overestimates later risks. We propose a general family of mixture models for undiagnosed prevalent disease and interval-censored incident disease that we call prevalence-incidence models. Parameters for parametric prevalence-incidence models, such as the logistic regression and Weibull survival (logistic-Weibull) model, are estimated by direct likelihood maximization or by EM algorithm. Non-parametric methods are proposed to calculate cumulative risks for cases without covariates. We compare naive Kaplan-Meier, logistic-Weibull, and non-parametric estimates of cumulative risk in the cervical cancer screening program at Kaiser Permanente Northern California. Kaplan-Meier provided poor estimates while the logistic-Weibull model was a close fit to the non-parametric. Our findings support our use of logistic-Weibull models to develop the risk estimates that underlie current US risk-based cervical cancer screening guidelines. Published 2017. This article has been contributed to by US Government employees and their work is in the public domain in the USA. Published 2017. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

  19. Methods for assessing fracture risk prediction models: experience with FRAX in a large integrated health care delivery system.

    Science.gov (United States)

    Pressman, Alice R; Lo, Joan C; Chandra, Malini; Ettinger, Bruce

    2011-01-01

    Area under the receiver operating characteristics (AUROC) curve is often used to evaluate risk models. However, reclassification tests provide an alternative assessment of model performance. We performed both evaluations on results from FRAX (World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK), a fracture risk tool, using Kaiser Permanente Northern California women older than 50yr with bone mineral density (BMD) measured during 1997-2003. We compared FRAX performance with and without BMD in the model. Among 94,489 women with mean follow-up of 6.6yr, 1579 (1.7%) sustained a hip fracture. Overall, AUROCs were 0.83 and 0.84 for FRAX without and with BMD, suggesting that BMD did not contribute to model performance. AUROC decreased with increasing age, and BMD contributed significantly to higher AUROC among those aged 70yr and older. Using an 81% sensitivity threshold (optimum level from receiver operating characteristic curve, corresponding to 1.2% cutoff), 35% of those categorized above were reassigned below when BMD was added. In contrast, only 10% of those categorized below were reassigned to the higher risk category when BMD was added. The net reclassification improvement was 5.5% (p<0.01). Two versions of this risk tool have similar AUROCs, but alternative assessments indicate that addition of BMD improves performance. Multiple methods should be used to evaluate risk tool performance with less reliance on AUROC alone. Copyright © 2011 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  20. Integrated Personal Health Records: Transformative Tools for Consumer-Centric Care

    Directory of Open Access Journals (Sweden)

    Raymond Brian

    2008-10-01

    Full Text Available Abstract Background Integrated personal health records (PHRs offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable. Discussion While there is a spectrum of dominant PHR models, (standalone, tethered, integrated, the authors state that only the integrated model has true transformative potential to strengthen consumers' ability to manage their own health care. Integrated PHRs improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders. Summary Integrated PHRs

  1. TENDENCIATEMPORALDE LAINCAPACIDAD LABORAL PERMANENTE EN ESPAÑA (1992-2010

    Directory of Open Access Journals (Sweden)

    Xavier Duran

    2012-01-01

    Full Text Available Fundamentos: La incapacidad permanente (IP es un problema de salud laboral en el que intervienen factores laborales, sanitarios o legales, los cuales han variado en España a lo largo de los últimos años. El objetivo del presente estudio es describir la tendencia temporal de la IP en España desde 1992 a 2010 por gravedad de la incapacidad y diferentes variables sociodemográficas y de afiliación a la seguridad social. Métodos: A partir de los datos de la Seguridad Social sobre afiliación y altas de IP en España se describió la tendencia temporal de la incidencia anual de la IP en el periodo comprendido entre 1992 y 2010. Para valorar las tendencias se estimó el porcentaje de cambio anual (PCA y el intervalo de confianza al 95% mediante un modelo de regresión binomial negativa. Resultados: La tendencia de la incidencia de IP se subdividió en tres periodos. El primero (1992 a 1997 presentó una incidencia aproximadamente constante de 75 casos por 10.000 trabajadores (PCA1= -0,1; IC 95%:-1,6 a 1,4. Seguidamente las tasas descendieron durante un período de tres años (PCA2:-12,1%; IC 95%:-13,9 a -10,4, situándose alrededor de 50 nuevos casos por 10.000 trabajadores en el año 2000. A partir de este año la incidencia de IP se mantuvo aproximadamente constante hasta el año 2010 (PCA3=0,4; IC 95%:-0,2 a 1,0. Conclusiones: Apesar del incremento de trabajadores afiliados a la seguridad social en el periodo estudiado, la incidencia de IP se mantiene bastante estable, con un descenso entre 1997 y 2000 que se podría atribuir a las medidas de evaluación y seguimiento de las IP adoptados en 1995.

  2. Are the different gully morphologies due to different formation processes on the Kaiser dune field on Mars?

    Science.gov (United States)

    Pasquon, K.; Gargani, J.; Nachon, M.; Conway, S. J.; Massé, M.; Jouannic, G.; Balme, M. R.; Costard, F.; Vincendon, M.

    2017-12-01

    Diverse gully morphologies are seen on Mars and differences are often neglected for simplification. Here we describe in detail the morphology and present-day activity of two gully-systems on the Kaiser dune field in the southern hemisphere of Mars. We then compare their activity with that of the morphologically distinct linear dune gullies present on the same dunes. The studied gully-systems have large depositional aprons (named "large apron gullies") and occur on dune faces oriented westward. They are active from mid-autumn to late winter (i.e. from Ls 50° to Ls 180°) coinciding with CO2 ice condensation/sublimation cycles. Sandy material collapses from the alcove flanks onto the alcove floor sporadically throughout this period. This accumulated sand is remobilized by punctuated mass flows which we estimate to be up to 7100 m3 in volume. These flows run out on to the apron and occur between Ls 120° and Ls 160°. These mass flow events occur when the number of "digitate flows" is at its seasonal maximum. Digitate flows are characterized by long-narrow zig-zagging low-albedo tracks and do not seem to transport appreciable sediment, and they can number in the hundreds. Small pits appear at their termini or midway along and sometimes these pits are re-deepened by subsequent flows. These events repeat every year and using volume balance calculations we find that the whole system could be built on a timescale of hundreds of martian ears. These large apron gullies differ in morphology and timing from the linear dune gullies. The linear dune gullies are active in late winter, or beginning of spring when the CO2 frost finally sublimates, which occurs after the activity of the large apron gullies. Due to the difference of orientation between large apron gullies and linear dune as well as timing, we infer that insolation, which may influence (i) the depth to ground ice, (ii) the amount of volatiles deposits, is the main cause their differences. Sediment transport by CO2

  3. EDUCAÇÃO PERMANENTE NO CONTEXTO HOSPITALAR: A EXPERIÊNCIA QUE RESSIGNIFICA O CUIDADO EM ENFERMAGEM

    OpenAIRE

    Flores,Giovana Ely; Oliveira,Dora Lúcia Leidens de; Zocche,Denise Antunes de Azambuja

    2016-01-01

    Resumo O artigo aborda o processo de formação vivenciado por enfermeiras educadoras no contexto hospitalar, na perspectiva da educação permanente em saúde, com destaques para as experiências que constituíram esse processo, os sentidos dessa formação e as mudanças decorridas no desenvolvimento do cuidado de enfermagem com base nas aprendizagens significativas. Tratou-se de estudo qualitativo exploratório-descritivo, desenvolvido por meio de grupos focais com sete enfermeiras que atuavam no Pro...

  4. Ätiologie und Prävalenz permanenter kindlicher Hörstörungen in Deutschland

    OpenAIRE

    Spormann-Lagodzinski, ME; Nubel, K; König, O; Gross, M; Gross, M

    2003-01-01

    Permanente Hörstörungen bei Kindern haben in den letzten Jahren bezüglich Ätiologie und Prävalenz einen deutlichen Wandel erlebt. In den westlichen Industrienationen ist sie auf 1 bis 3 pro 1.000 Neugeborene gesunken. Nach Ergebnissen des Deutschen Zentralregisters für kindliche Hörstörungen (DZH) liegt die Prävalenz in Deutschland bei ca. 1,2:1.000. Von 6.200 ausgewerteten Datensätzen des DZH haben 36% aller permanenten Hörstörungen eine (vermutlich oder gesichert) genetische Ursache, 18% si...

  5. Minería de datos en la encuesta permanente de hogares 2009, universidad nacional del litoral, argentina

    OpenAIRE

    Denis Lizazo Torres; Roberto Delfor Meyer; Verena Torres Cárdenas

    2011-01-01

    En este trabajo se aplicó por primera vez la Minería de Datos a la información generada por la Encuesta Permanente de Hogares del año 2009, del Observatorio Social de la Universi-dad del Litoral en Santa Fe, Argentina. El objetivo fue utilizar algoritmos de clasificación que poseen enfoques descriptivos, y es una de las tareas más utilizada en Minería de Datos para obtener nuevos conocimientos sobre la familia santafecina. La base de datos fue confeccio-nada con la información en el relevamie...

  6. Las ciencias naturales me generan... emociones vinculadas a las ciencias en la formación docente permanente

    OpenAIRE

    Mengascini, Adriana

    2017-01-01

    Presentamos y discutimos resultados de una indagación realizada en el contexto de una propuesta de formación docente permanente, respecto de las emociones asociadas a las ciencias naturales, a su enseñanza y a la realización de trabajos experimentales entre docentes de primaria y secundaria de Argentina. Las emociones manifestadas hacia las ciencias fueron positivas (interés, atracción, motivación), aunque respecto de su enseñanza y la realización de actividades experimentales se expresaron a...

  7. Evaluación de la formación permanente del profesorado: enfoque de resultados || Evaluation of permanent teacher training: approach of results

    Directory of Open Access Journals (Sweden)

    José Domínguez

    2015-07-01

    Full Text Available La evolución del sistema educativo ha provocado cambios significativos en la formación permanente del profesorado, por tanto, es necesario un diagnóstico de necesidades utilizando instrumentos y metodologías que informen de las demandas formativas profesionales. En este sentido, el objetivo principal del estudio se centra en aportar luz sobre las percepciones y expectativas del profesorado acerca de la formación permanente en la Comunidad Autónoma de Galicia. Para ello, se utilizó una metodología evaluativa centrada en el contexto, entrada, proceso y producto (diseño CIPP. Los resultados confirman que la evolución de la formación se viene incrementando en su oferta pero disminuyendo su eficacia. Además, se ha comprobado la necesidad de reestructurar la formación permanente, apostando por un modelo más global, con cobertura en todas las necesidades formativas del profesorado. El gran reto de la formación permanente del profesorado es la transferibilidad de la misma al contexto del aula, una cuestión sencilla pero muy difícil de evaluar. Mejorar la calidad educativa depende directamente de la eficiencia y excelencia en la formación docente, la cual debería someterse a un proceso de revisión y actualización permanente.

  8. Asian & Pacific Islander American Health Forum

    Science.gov (United States)

    ... Report.pdf [1.2MB] Obesity and Overweight Among Asian American Children and Adolescents 2016.04.28-OBESITY AND ... Month Stay Connected! Receive the latest APIAHF updates Asian & Pacific Islander American Health Forum. All rights reserved. One Kaiser Plaza, ...

  9. Control permanente de la gestión sanitaria por monitoreo de costos mediante acontecimientos indicadores

    Directory of Open Access Journals (Sweden)

    Horacio Villanueva

    2001-12-01

    Full Text Available Objetivos. Determinar el costo operacional de un servicio quirúrgico, comparar los resultados con estándares y determinar la incidencia de costos. Obtener una metodología eficaz para este fin, extrapolable a todo tipo de servicio asistencial y de fácil instrumentación en una herramienta informática convencional (base de datos de alta difusión y bajo costo que pueda usarse en el control permanente de la gestión. Métodos. El estudio se realizó durante 1999 en el Servicio de Ortopedia y Traumatología del Hospital Estatal "Domingo Funes", Córdoba, Argentina. De los 817 pacientes sometidos a procedimientos diagnósticos o terapéuticos en ese servicio a lo largo del año, se seleccionaron los 154 que necesitaron internación y maniobras quirúrgicas o instrumentales. Se utilizó el método de acontecimientos indicadores descrito por Kessner. Dichos acontecimientos, clasificados en función de su complejidad (alta, mediana, escasa o nula, fueron seleccionados y definidos por consenso de expertos: especialistas médicos y economistas. Se valoraron los costos directos e indirectos para estudiar su peso en el costo total, en cuya estimación se utilizaron nueve variables que se aplicaron a los diferentes acontecimientos indicadores. Resultados. El mayor peso del costo total, tanto estándar como real, recayó en ambos casos sobre la variable "día cama". De la variable "día cama" en el total de acontecimientos indicadores, el 51,2% correspondió a la internación social (costo indirecto y el 48,8% a la internación terapéutica (costo directo. Su diferencia con respecto al costo estándar fue un aumento del orden del 117%. Los costos indirectos (internación social e insumos terapéuticos absorbieron casi la mitad del costo real total. El costo real de todos los acontecimientos investigados, sin incluir los costos indirectos, solo superó al costo estándar en un 6,4%. Incluyendo los costos indirectos (internación social e insumos terap

  10. Characterizing Race/Ethnicity and Genetic Ancestry for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort

    Science.gov (United States)

    Banda, Yambazi; Kvale, Mark N.; Hoffmann, Thomas J.; Hesselson, Stephanie E.; Ranatunga, Dilrini; Tang, Hua; Sabatti, Chiara; Croen, Lisa A.; Dispensa, Brad P.; Henderson, Mary; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H.; Ludwig, Dana; Olberg, Diane; Quesenberry, Charles P.; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C.; Sciortino, Stanley; Shen, Ling; Smethurst, David; Somkin, Carol P.; Van Den Eeden, Stephen K.; Walter, Lawrence; Whitmer, Rachel A.; Kwok, Pui-Yan; Schaefer, Catherine; Risch, Neil

    2015-01-01

    Using genome-wide genotypes, we characterized the genetic structure of 103,006 participants in the Kaiser Permanente Northern California multi-ethnic Genetic Epidemiology Research on Adult Health and Aging Cohort and analyzed the relationship to self-reported race/ethnicity. Participants endorsed any of 23 race/ethnicity/nationality categories, which were collapsed into seven major race/ethnicity groups. By self-report the cohort is 80.8% white and 19.2% minority; 93.8% endorsed a single race/ethnicity group, while 6.2% endorsed two or more. Principal component (PC) and admixture analyses were generally consistent with prior studies. Approximately 17% of subjects had genetic ancestry from more than one continent, and 12% were genetically admixed, considering only nonadjacent geographical origins. Self-reported whites were spread on a continuum along the first two PCs, indicating extensive mixing among European nationalities. Self-identified East Asian nationalities correlated with genetic clustering, consistent with extensive endogamy. Individuals of mixed East Asian–European genetic ancestry were easily identified; we also observed a modest amount of European genetic ancestry in individuals self-identified as Filipinos. Self-reported African Americans and Latinos showed extensive European and African genetic ancestry, and Native American genetic ancestry for the latter. Among 3741 genetically identified parent–child pairs, 93% were concordant for self-reported race/ethnicity; among 2018 genetically identified full-sib pairs, 96% were concordant; the lower rate for parent–child pairs was largely due to intermarriage. The parent–child pairs revealed a trend toward increasing exogamy over time; the presence in the cohort of individuals endorsing multiple race/ethnicity categories creates interesting challenges and future opportunities for genetic epidemiologic studies. PMID:26092716

  11. Characterizing Race/Ethnicity and Genetic Ancestry for 100,000 Subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort.

    Science.gov (United States)

    Banda, Yambazi; Kvale, Mark N; Hoffmann, Thomas J; Hesselson, Stephanie E; Ranatunga, Dilrini; Tang, Hua; Sabatti, Chiara; Croen, Lisa A; Dispensa, Brad P; Henderson, Mary; Iribarren, Carlos; Jorgenson, Eric; Kushi, Lawrence H; Ludwig, Dana; Olberg, Diane; Quesenberry, Charles P; Rowell, Sarah; Sadler, Marianne; Sakoda, Lori C; Sciortino, Stanley; Shen, Ling; Smethurst, David; Somkin, Carol P; Van Den Eeden, Stephen K; Walter, Lawrence; Whitmer, Rachel A; Kwok, Pui-Yan; Schaefer, Catherine; Risch, Neil

    2015-08-01

    Using genome-wide genotypes, we characterized the genetic structure of 103,006 participants in the Kaiser Permanente Northern California multi-ethnic Genetic Epidemiology Research on Adult Health and Aging Cohort and analyzed the relationship to self-reported race/ethnicity. Participants endorsed any of 23 race/ethnicity/nationality categories, which were collapsed into seven major race/ethnicity groups. By self-report the cohort is 80.8% white and 19.2% minority; 93.8% endorsed a single race/ethnicity group, while 6.2% endorsed two or more. Principal component (PC) and admixture analyses were generally consistent with prior studies. Approximately 17% of subjects had genetic ancestry from more than one continent, and 12% were genetically admixed, considering only nonadjacent geographical origins. Self-reported whites were spread on a continuum along the first two PCs, indicating extensive mixing among European nationalities. Self-identified East Asian nationalities correlated with genetic clustering, consistent with extensive endogamy. Individuals of mixed East Asian-European genetic ancestry were easily identified; we also observed a modest amount of European genetic ancestry in individuals self-identified as Filipinos. Self-reported African Americans and Latinos showed extensive European and African genetic ancestry, and Native American genetic ancestry for the latter. Among 3741 genetically identified parent-child pairs, 93% were concordant for self-reported race/ethnicity; among 2018 genetically identified full-sib pairs, 96% were concordant; the lower rate for parent-child pairs was largely due to intermarriage. The parent-child pairs revealed a trend toward increasing exogamy over time; the presence in the cohort of individuals endorsing multiple race/ethnicity categories creates interesting challenges and future opportunities for genetic epidemiologic studies. Copyright © 2015 by the Genetics Society of America.

  12. Challenges in risk estimation using routinely collected clinical data: The example of estimating cervical cancer risks from electronic health-records.

    Science.gov (United States)

    Landy, Rebecca; Cheung, Li C; Schiffman, Mark; Gage, Julia C; Hyun, Noorie; Wentzensen, Nicolas; Kinney, Walter K; Castle, Philip E; Fetterman, Barbara; Poitras, Nancy E; Lorey, Thomas; Sasieni, Peter D; Katki, Hormuzd A

    2018-06-01

    Electronic health-records (EHR) are increasingly used by epidemiologists studying disease following surveillance testing to provide evidence for screening intervals and referral guidelines. Although cost-effective, undiagnosed prevalent disease and interval censoring (in which asymptomatic disease is only observed at the time of testing) raise substantial analytic issues when estimating risk that cannot be addressed using Kaplan-Meier methods. Based on our experience analysing EHR from cervical cancer screening, we previously proposed the logistic-Weibull model to address these issues. Here we demonstrate how the choice of statistical method can impact risk estimates. We use observed data on 41,067 women in the cervical cancer screening program at Kaiser Permanente Northern California, 2003-2013, as well as simulations to evaluate the ability of different methods (Kaplan-Meier, Turnbull, Weibull and logistic-Weibull) to accurately estimate risk within a screening program. Cumulative risk estimates from the statistical methods varied considerably, with the largest differences occurring for prevalent disease risk when baseline disease ascertainment was random but incomplete. Kaplan-Meier underestimated risk at earlier times and overestimated risk at later times in the presence of interval censoring or undiagnosed prevalent disease. Turnbull performed well, though was inefficient and not smooth. The logistic-Weibull model performed well, except when event times didn't follow a Weibull distribution. We have demonstrated that methods for right-censored data, such as Kaplan-Meier, result in biased estimates of disease risks when applied to interval-censored data, such as screening programs using EHR data. The logistic-Weibull model is attractive, but the model fit must be checked against Turnbull non-parametric risk estimates. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  13. Restorative Integral Support (RIS) for Older Adults Experiencing Co-Occurring Disorders

    Science.gov (United States)

    Larkin, Heather; MacFarland, Nicole S.

    2012-01-01

    The Restorative Integral Support (RIS) model is a whole person response that assists people to overcome adversity. The Adverse Childhood Experiences (ACE) Study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention shows the association between stressors in childhood and multiple later-life health and social problems.…

  14. A educação permanente da equipe de enfermagem para o cuidado nos serviços de saúde mental

    OpenAIRE

    Tavares,Cláudia Mara de Melo

    2006-01-01

    Estudio exploratório, cuyo objetivo fue analizar la necesidad de la educación permanente del equipo de enfermera para cuidar en los servicios de la salud mental. Fueron estudiadas treinta siete profesionales de enfermería mental. Como resultados, se verificó que él equipe de la enfermería demanda calificación de vasto espectro. Se concluye que la educación permanente del equipo del oficio de enfermera de la salud mental exige más allá de programas educativos establecidos en la def...

  15. Formación permanente y distribución del profesorado de Educación Secundaria por comarcas y departamentos. El caso de Asturias

    OpenAIRE

    Paula GONZÁLEZ-VALLINAS; José Luis SAN FABIÁN MAROTO

    2009-01-01

    Este estudio se centra en la formación del profesorado y explora las relaciones existentes entre la formación permanente y diversas características del profesorado, las comarcas y departamentos de los IES en Asturias. Como resultado de una investigación basada en el análisis de datos secundarios cuantitativos del profesorado y municipios de Asturias se obtiene una radiografía de la formación permanente de su profesorado (modalidad y materia de formación). Se realizan análisis a nivel de depar...

  16. Un estudio de las concepciones docentes acerca de la formación permanente Um estudo das concepções docentes sobre a formação permanente A Survey of Teachers' Thoughts on Continuing Education

    Directory of Open Access Journals (Sweden)

    Irene Marina Macera

    2012-12-01

    Full Text Available Este trabajo presenta las concepciones docentes acerca de su formación permanente. Se identificaron distintos puntos de análisis relacionados con la antigüedad en la profesión, intereses metodológicos, intereses de actualización de conocimientos, intereses de incorporación de nuevos saberes y, por último, el lugar que ocupa la formación en la subjetividad docente. En los inicios de la docencia, la formación permanente funciona y se concibe como un modo de mantenerse activos mientras se insertan en el mercado laboral. En cambio, para los docentes que ya tienen una trayectoria, esta se concibe como una fuga del trabajo, un recurso que en ocasiones le otorga sentido al trabajo, asumiendo de este modo un lugar subjetivo importante en el quehacer docente. Pero, cualquiera que sea la motivación, la adquisición de nuevos saberes es la razón más antigua que los docentes asumen para formarse.Este trabalho apresenta as concepções docentes sobre sua formação permanente. Identificaram-se diferentes pontos de análise relacionados com a antiguidade na profissão, interesses metodológicos, interesses de atualização de conhecimentos, interesses de incorporação de novos saberes e, por último, o lugar que a formação ocupa na subjetividade docente. No início da docência, a formação permanente funciona e se concebe como um modo de se manterem ativos enquanto se inserem no mercado de trabalho. Em compensação, para os docentes que já têm uma trajetória, esta se concebe como uma fuga do trabalho, um recurso que em ocasiões outorga sentido ao trabalho e assume, desse modo, um lugar subjetivo importante no fazer docente. Contudo, qualquer que seja a motivação, a aquisição de novos saberes é a razão mais antiga que os docentes assumem para se formar.This study delves into what teachers think about their own continuing education. Different points of analysis are identified with respect to seniority in the profession

  17. Are symbols useful and culturally acceptable in health-state valuation studies? An exploratory study in a multi-ethnic Asian population

    Directory of Open Access Journals (Sweden)

    Hwee-Lin

    2008-10-01

    Full Text Available Hwee-Lin, Wee1, Shu-Chuen Li2, Xu-Hao Zhang1, Feng Xie3, David Feeny4, Nan Luo5, Yin-Bun Cheung6, David Machin7, Kok-Yong Fong8, Julian Thumboo81Department of Pharmacy, National University of Singapore (NUS, Singapore; 2Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia; 3McMaster University, Hamilton, Ontario, Canada; 4Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA; 5Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, NUS, Singapore; 6Clinical Trials and Epidemiology Research Unit, Singapore; 7School of Health and Related Research, University of Sheffield, Sheffield, UK; 8Department of Rheumatology and Immunology, Singapore General Hospital, SingaporeBackground: Symbols have been used in health state valuation studies to help subjects distinguish the severity of various characteristics of a given health state. Symbols used in such studies need to be evaluated for their cross-cultural appropriateness because a given symbol may have different meanings or acceptability in different cultures, which may affect results of such studies.Objectives: To evaluate if using symbols to differentiate health states of different severity is useful and culturally acceptable in a multi-ethnic, urban Asian population.Methods: Using in-depth interviews with adult Chinese, Malay, and Indian Singaporeans conducted in English/mother-tongue, subjects were shown a health state with 6 levels (Health Utilities Index 3 vision, each displayed with a symbol, and asked (1a if symbols were useful in differentiating severity of each level (measured using dichotomous and 0–10 visual analog scale [VAS] scales or (1b offensive and (2 to assess 7 alternative sets of symbols.Results: Of 63 subjects (91% response rate, 18 (29% felt symbols were useful in differentiating severity of each level. Reported usefulness

  18. Gestión de la formación permanente del docente: reflexión y propuesta

    Directory of Open Access Journals (Sweden)

    MSc. Silvia M. Sarmiento-Berrezueta

    2015-11-01

    Full Text Available La práctica educativa actual exige implementar un nuevo Modelode Gestión de la formación permanente de los docentes basado en los estándares de calidad. Este artículo se centra en cómo alcanzar la calidad de la gestión formativa profesional mediante una propuesta de autoformación y co-formación basada sobre la reflexión, valoración y motivación, normada desde el Código de Convivencia, que conlleva a aprender y desaprender en los colectivos de docentes de educación básica superior en el Ecuador.

  19. Inmunización y militarización del cuerpo social en Colombia: el Estado en emergencia permanente

    Directory of Open Access Journals (Sweden)

    Juan Pablo Aranguren Romero

    2015-12-01

    Full Text Available En este artículo analizo cómo las estrategias de guerra contrainsurgente emprendidas en Colombia durante las décadas de los sesenta y los setenta recrean un dispositivo inmunitario en donde la nación es entendida como un cuerpo social amenazado e infectado por ideologías comunistas y en donde su seguridad y protección contra los actos violentos, suponen la administración de la violencia. Sostengo que este dispositivo inmunitario, opera bajo una lógica autodestructiva y una noción de amenaza deslocalizada que incentivó la militarización de la sociedad, la gestión del miedo y el sostenimiento de un Estado en emergencia permanente. Hechos que, a su vez, permitieron la apelación a la excepcionalidad constitucional como forma de gobierno normalizada.

  20. MERCOSUR ambiental. El aporte del Laudo 1/2012 del Tribunal Permanente de Revisión

    Directory of Open Access Journals (Sweden)

    Alberto Cesar Moreira

    2014-03-01

    Full Text Available El trabajo reflexiona acerca de la dimensión ambiental del MERCOSUR, identificando los desarrollos institucionales y normativos más significativos e intentando desentrañar algunas de las causas que dificultan su consolidación. En ese orden de ideas, destaca la escasa utilización que los Estados han hecho del sistema de solución de controversias de este esquema y pone de resalto el aporte del laudo 1/2012 del Tribunal Permanente de Revisión, ya que al resolver sobre su competencia en razón de la materia, reconoce y acompaña a las distintas dimensiones que el MERCOSUR ha ido desarrollado, entre ellas la ambiental.

  1. COMPETENCIAS EMPRENDEDORAS DEL ALUMNADO DE EDUCACIÓN PERMANENTE DE ADULTOS EN ANDALUCÍA. PERCEPCIÓN DEL PROFESORADO

    Directory of Open Access Journals (Sweden)

    José Ma. Fernández Batanero

    2017-01-01

    Full Text Available En el presente trabajo analizamos la percepción que tiene el profesorado de Educación Permanente de Personas Adultas en Andalucía (España acerca del grado de presencia de competencias emprendedoras en su alumnado. Para dar respuesta al objetivo planteado adoptamos un diseño de investigación de tipo descriptivo, donde el enfoque de recolección y análisis de datos se ha definido como mixto, en el que se integran técnicas cualitativas (entrevistas en profundidad y cuantitativas (cuestionario. Para la validación del cuestionario, se utilizó la técnica de juicio de expertos, seleccionados mediante el procedimiento de «Coeficiente de competencia experta» o «Coeficiente K». El análisis de la fiabilidad del cuestionario a través de la prueba de Cronbach fue de 0,957. El cuestionario ha sido respondido por 549 profesores y profesoras de Centros de Educación Permanente de Andalucía y se han realizado 23 entrevistas en profundidad a informantes claves (directores de centros y coordinadores de sección. Los resultados muestran con claridad la percepción, tanto del profesorado como de aquellos que ejercen el ejercicio de la dirección, que el alumnado de estos centros educativos no están lo suficientemente preparados para iniciar por su cuenta un proyecto empresarial, a pesar de cursar contenidos curriculares de cultura emprendedora. Consideran que aún no poseen las competencias emprendedoras necesarias para crear y gestionar eficazmente un proyecto empresarial, constituyendo la falta de creatividad uno de los mayores obstáculos para dicho fin. Así mismo, se desprende del estudio la escasa incidencia que ejercen los programas de cultura emprendedora que se desarrollan en este tipo de centros.

  2. [The history of the Kaiser Wilhelm Society during the Third Reich. Interim reports of the president's commission of the Max Planck Society].

    Science.gov (United States)

    Weber, M M

    2002-11-01

    In 1997 the Max Planck Society set up a presidential commission to do research on the historical development of its precursor organization, the Kaiser Wilhelm Society (KWG), during the Third Reich. This paper presents some of the important results given in the interim reports of this commission that are relevant to psychiatry. It focuses on brain research, anthropology, psychiatric genetics, and the role of the well-known biochemist Adolf Butenandt. In general, the interim reports reflect the numerous links between the biomedical research of the KWG and the institutions of the National Socialist (Nazi) state. However, they do not yet allow a final historical assessment as to the complex situation of this field of research during National Socialism.

  3. Anomalías dentomaxilofaciales en dientes permanentes y su relación con traumas en la primera infancia Dental-maxillary-facial anomalies in permanent teeth and their relation to traumas in early childhood

    Directory of Open Access Journals (Sweden)

    Arlene Liset Corrales León

    2009-03-01

    Full Text Available Se realizó un estudio descriptivo, longitudinal y retrospectivo que incluyó niños de 7 a 14 años de edad, pertenecientes al área de salud de la "Clínica Estomatológica Docente Guama" del municipio Pinar del Río, en el período comprendido entre febrero del 2003 a marzo de 2005, con el objetivo de determinar la presencia de anomalías dentomaxilofaciales en dentición permanente y su relación con traumas en la primera infancia. El universo de estudio estuvo constituido por 250 niños, y de ellos, se seleccionó una muestra de 60 niños y se les confeccionó una planilla recolectora de datos para la investigación. Los resultados obtenidos fueron procesados estadísticamente mediante el sistema automatizado STATISTIC y la prueba de CHI CUADRADO, en su aplicación de bondad de ajuste, y el paquete SPSS, para la prueba de comparación de proporciones. En todos los casos se prefija un nivel de significación de 0,05. Entre los resultados globales más significativos encontramos que fueron los traumas ocurridos en las edades de 5-6 años los que más anomalías dentomaxilofaciales causaron en la dentición permanente. Resultó el sexo masculino el más afectado por estas alteraciones, fueron los traumas recibidos directamente sobre los dientes, los mayores causantes de anomalías en la dentición permanente. Resultaron las hipoplasias del esmalte, como otras anomalías no ortodóncicas las más frecuentes; se comprobó que el sexo femenino tuvo mayor implicación psicosocial por estas alteraciones y se divulgaron a estomatólogos, padres y maestros orientaciones sobre la relación entre los traumas en la primera infancia y las anomalías dentomaxilofaciales en la dentición permanente.A descriptive, longitudinal and retrospective research was carried out including children from 7 to 14 years old belonging to the health area of "Guama" Dental University Clinic in Pinar del Rio Municipality, from February 2003 to March 2005 aimed at determining

  4. Caries dental aguda del primer molar permanente en niños de 12 años

    Directory of Open Access Journals (Sweden)

    Daniel Enrique Reyes Romagosa

    Full Text Available Introducción: el primer molar permanente es considerado la llave de la oclusión dentaria, la presencia de caries en éste es elevada, lo que dificulta el logro de las metas trazadas por organizaciones de salud a nivel mundial en este grupo de edad. Objetivo: determinar el comportamiento de la caries dental aguda en primer molar permanente en una población de 12 años de edad atendida en la Clínica Estomatológica Santa Cruz de la Parroquia Goaigoaza. Métodos: se realizó un estudio descriptivo transversal en la Clínica Estomatológica Santa Cruz. Parroquia Goaigoaza, municipio Puerto Cabello, estado Carabobo, en el período comprendido entre abril del 2009 a abril 2010. Se seleccionaron 97 pacientes de 12 años de edad los que constituyeron el universo y la muestra. Acudieron a la consulta por dolor debido a la presencia de caries dental aguda. Se registraron las variables: edad, sexo, grado clínico de la caries dental, estímulos externos que provocaron dolor, la cara dental y la arcada dentaria más afectadas. La información fue recogida mediante interrogatorio y examen clínico. Resultados: el sexo masculino representó el 63,9 %. La caries dental de 3er grado estuvo presente en un 68 %. Los estímulos externos que provocaron dolor fueron: el frío presente en 75,2 % y los alimentos dulces en 69,1 % en ambos sexos. El primer molar inferior derecho resultó más afectado (46,4 % que el izquierdo (36,1 %, así como la arcada dentaria inferior (25,8 % y la cara oclusal (64,9 %. Conclusiones: predominaron el sexo masculino y la caries dental aguda de 3er grado. El frío y los alimentos dulces fueron los estímulos externos más frecuentes. Los más afectados resultaron el primer molar inferior derecho, la cara oclusal y la arcada dentaria inferior.

  5. Minería de datos en la encuesta permanente de hogares 2009, universidad nacional del litoral, argentina

    Directory of Open Access Journals (Sweden)

    Denis Lizazo Torres

    2011-04-01

    Full Text Available En este trabajo se aplicó por primera vez la Minería de Datos a la información generada por la Encuesta Permanente de Hogares del año 2009, del Observatorio Social de la Universi-dad del Litoral en Santa Fe, Argentina. El objetivo fue utilizar algoritmos de clasificación que poseen enfoques descriptivos, y es una de las tareas más utilizada en Minería de Datos para obtener nuevos conocimientos sobre la familia santafecina. La base de datos fue confeccio-nada con la información en el relevamiento de 2009, denominado Onda 2009, y se procesó con el software de minería de datos Weka 3.6.2. Los algoritmos de clasificación que mejores resultados aportaron fueron: ZeroR, Ridor y J48, pertenecientes a los grupos de Reglas y Árboles de Decisión, siendo el algoritmo de clasificación J48 el que mejor clasifica a la En-cuesta Permanente de Hogares 2009 del Observatorio Social de la Universidad Nacional del Litoral. In this work it was applied the Data Mining for the first time, to the information generated by the Permanent Survey of Homes of the year 2009, of the Social Observatory of the University of the Litoral in Santa Fe, Argentina. The objective was to use classification algorithms that possess descriptive focuses and it is one of the tasks more used in Data Mining, to obtain new knowledge on the family of Santa Fe. The database was made with the information of the Permanent Survey of Homes of the year 2009 and it was processed with the software of data mining Weka 3.6.2. The classification algorithms that better results contributed were: ZeroR, Ridor and J48, belonging to the groups of Rules and Trees of Decision, being the classifica-tion algorithm J48 the one that better it classifies to the Permanent Survey of Homes 2009, of the Social Observatory of the National University of the Litoral.

  6. Effect of Somatic Experiencing Resiliency-Based Trauma Treatment Training on Quality of Life and Psychological Health as Potential Markers of Resilience in Treating Professionals

    Directory of Open Access Journals (Sweden)

    Neal E. Winblad

    2018-02-01

    Full Text Available Background: Individuals who treat trauma are at significant risk of vicarious traumatization and burnout. Somatic Experiencing® (SE® is a resiliency-focused trauma treatment modality designed to address autonomic nervous system (ANS dysregulation and its impacted physical health and mental health symptoms e.g., anxiety, depression, post-traumatic stress disorder, migraines, fibromyalgia, and chronic fatigue, etc. The SE® training supports the development of clinical skills to reduce physical health/mental health symptoms as well as increase clinician resilience. Individuals who display resilience often have increased experiences of well-being (quality of life and decreased levels of self-reported psychological symptoms. Greater resilience could mitigate the risks to providers and the clients they treat.Materials and Methods: This within-groups, longitudinal study assessed students (N = 18 over the course of a 3-year SE® practitioner training. This training focuses on increased ANS, physical, and emotional regulation skills. The convenience of a web-based survey allowed for: measures of a general quality of life (WHOQOL-BREF, psychological symptoms, somatic, anxiety, and depressive symptoms (PHQ-SADS, as well as a measure of early life exposure to adversity (CDC/Kaiser Permanente ACE Score Calculator Questionnaire. The clinician survey was conducted yearly for 3 years. Future studies would do well to also include laboratory-based objective measures of ANS functioning.Results: ANOVA with repeated measures showed that there were significant reductions in anxiety symptoms (GAD7, p < 0.001 and somatization symptoms (PHQ15, p < 0.001. Health-related quality of life (a measure of physical well-being and social quality of life (a measure of interpersonal well-being both increased significantly (Health QoL p = 0.028; Social QoL p = 0.046.Conclusions: Results suggest that professionals attending the 3-year SE® training course experience a significant

  7. Valoración "in vitro" de las fuerzas de adhesión de un sistema adhesivo convencional y otro autograbante en esmalte de dientes temporales y permanentes

    OpenAIRE

    Herrera Martínez, Gilberto de Jesús

    2012-01-01

    El presente trabajo trata de aportar más información sobre un nuevo adhesivo autograbante a esmalte de dientes temporales y permanentes. El objetivo es valorar las fuerzas de adhesión en MPa de los sistemas adhesivos (convencional y autograbante),en el esmalte de dientes temporales y permanentes. Métodos: utilizando una muestra de 160 dientes (temporales y permanentes)a nivel de la estructura del esmalte, divididos en cuatro grupos, no tomándose en cuenta para el criterio de selección la p...

  8. Historias de vida de mujeres afincadas de forma permanente en situación de exclusión social

    Directory of Open Access Journals (Sweden)

    Gabriela Moriana Mateo

    2016-07-01

    Full Text Available Este artículo presenta parte de los resultados de un trabajo de campo etnográfico realizado en distintos centros de Servicios Sociales Especializados para mujeres de la Generalitat Valenciana. Su objetivo es conocer los tipos de violencia y los factores de exclusión social que subyacen en las historias de vida de las mujeres institucionalizadas. La metodología de investigación utilizada ha sido de índole cualitativa. Se ha realizado observación participante y entrevistas tanto informales como biográficas que, junto con documentos personales e informes sociales, han permitido elaborar 15 historias de vida. Aunque en esta aproximación tan sólo se analizan las cuatro afincadas en la situación de exclusión social de forma permanente. Respecto a los resultados, cabe señalar que en las trayectorias vitales analizadas subyacen distintos factores de exclusión social que afectan tanto a los hombres como a las mujeres, pero también importantes factores específicos de género, como la violencia contra las mujeres intrafamiliar y de género.

  9. Educação permanente: uma ferramenta para o desenvolvimento docente na graduação

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Lazarini

    Full Text Available OBJETIVO: Descrever a percepção dos docentes tutores e dos docentes da Unidade de Prática Profissional (UPP da primeira série dos cursos de Medicina e Enfermagem da Famema quanto à relevância de participar do programa de Educação Permanente (EP. MÉTODOS: Estudo exploratório com questionário semiestruturado. Empregou-se a técnica de análise temática do Discurso do Sujeito Coletivo. RESULTADOS: A quase totalidade dos sujeitos considerou a atividade de EP como relevante. Os docentes da UPP apontaram ótimo espaço para aprendizagem, troca de experiências e reflexão sobre a prática. As ideias centrais dos tutores foram bom espaço de discussão e reflexão, porém um momento mal aproveitado. CONSIDERAÇÕES: Para os docentes da UPP, a proposta da EP (reflexão sobre a prática vem sendo atingida, mas não tem respondido às expectativas e ao entendimento dos tutores. Dada a importância do desenvolvimento docente para a sustentação de um currículo inovador, é necessário problematizar os sentidos implícitos nesta fala em busca de uma EP mais responsiva aos tutores

  10. Educação permanente em saúde e no trabalho de enfermagem: perspectiva de uma práxis transformadora.

    OpenAIRE

    da Silva, Luiz Anildo Anacleto; Centro de Educação Superior Norte da Universidade Federal de Santa Maria; Ferraz, Fabiane; Universidade Federal de Santa Catarina; Lino, Mônica Motta; Universidade Federal de Santa Catarina; Backes, Vânia Marli Schubert; Universidade Federal de Santa Catarina; Schmidt, Sandra Marcia Soares; Universidade Federal de Santa Maria

    2011-01-01

    Trata-se de uma reflexão teórica que tem por objetivo estimular os leitores a repensar o papel da educação permanente dos sujeitos-trabalhadores da saúde e de enfermagem na perspectiva do desenvolvimento individual e coletivo, por meio da práxis transformadora. Procurou-se fazer uma articulação reflexiva dos princípios da práxis transformadora apresentada pelo filósofo Adolfo Sánchez Vázquez com os preceitos de educação permanente em saúde e no trabalho de enfermagem. Tal articulação apresent...

  11. A proposta da educação permanente em saúde na atualização da equipe de saúde em diabetes mellitus

    OpenAIRE

    Rodrigues,Andreia Cristinha Seabra; Vieira,Gisele de Lacerda Chaves; Torres,Heloisa de Carvalho

    2010-01-01

    O objetivo do estudo foi relatar a experiência da Educação Permanente em Saúde na atualização da equipe de saúde de uma Unidade Básica de Saúde para a atenção integral e humanizada às pessoas com diabetes tipo 2. A metodologia de escolha para a capacitação das equipes de saúde foi a Educação em Permanente em Saúde, por meio de oficinas educativas em diabetes com enfoque na problematização do processo educativo e profissional. Buscou-se, assim, construir um programa de educação em diabetes vis...

  12. La aspiración de Brasil al asiento permanente en el Consejo de Seguridad de la Organización de las Naciones Unidas: un breve panorama

    Directory of Open Access Journals (Sweden)

    Renata de Melo Rosa

    2009-12-01

    Full Text Available Este artículo analiza la posición de Brasil frente a la aspiración de un asiento permanente al Consejo de Seguridad de las Naciones Unidas. Los esfuerzos entabulados por Brasil en el escenario internacional, los discursos del primer rango del gobierno, así como un protagonismo más acelerado frente a los vecinos latino-americanos confirman esta aspiración. Pero, Brasil aún enfrenta serios problemas internos de seguridad nacional y tendrá que enfrentar otros compañeros regionales también, aspirantes a un assiento de miembro permanente en el Consejo de Seguridad de la ONU, como Canadá, por ejemplo. La ocupación del assiento temporario en el bienio de 2010-2011 también es uno de los factores analizados en este trabajo.

  13. Educação Permanente no cotidiano da Atenção Básica no Mato Grosso do Sul

    Directory of Open Access Journals (Sweden)

    Jacinta de Fátima Franco Pereira Machado

    Full Text Available O artigo analisou as ações de Educação Permanente em Saúde na Atenção Básica em Mato Grosso do Sul, Brasil, na perspectiva de 184 equipes participantes da primeira fase do Programa de Melhoria do Acesso e da Qualidade (PMAQ, de junho de 2012 a fevereiro de 2013. Entre as ações de Educação Permanente, os cursos presenciais foram mais prevalentes, seguidos por troca de experiência, teleducação, ensino à distância e tutoria/preceptoria, tanto na capital quanto no interior. As ações de planejamento e apoio à gestão foram mais prevalentes na capital. As ações de apoio da gestão estavam diretamente relacionadas com o planejamento e a organização do processo de trabalho.

  14. Effect of Somatic Experiencing Resiliency-Based Trauma Treatment Training on Quality of Life and Psychological Health as Potential Markers of Resilience in Treating Professionals

    Science.gov (United States)

    Winblad, Neal E.; Changaris, Michael; Stein, Phyllis K.

    2018-01-01

    Background: Individuals who treat trauma are at significant risk of vicarious traumatization and burnout. Somatic Experiencing® (SE®) is a resiliency-focused trauma treatment modality designed to address autonomic nervous system (ANS) dysregulation and its impacted physical health and mental health symptoms e.g., anxiety, depression, post-traumatic stress disorder, migraines, fibromyalgia, and chronic fatigue, etc. The SE® training supports the development of clinical skills to reduce physical health/mental health symptoms as well as increase clinician resilience. Individuals who display resilience often have increased experiences of well-being (quality of life) and decreased levels of self-reported psychological symptoms. Greater resilience could mitigate the risks to providers and the clients they treat. Materials and Methods: This within-groups, longitudinal study assessed students (N = 18) over the course of a 3-year SE® practitioner training. This training focuses on increased ANS, physical, and emotional regulation skills. The convenience of a web-based survey allowed for: measures of a general quality of life (WHOQOL-BREF), psychological symptoms, somatic, anxiety, and depressive symptoms (PHQ-SADS), as well as a measure of early life exposure to adversity (CDC/Kaiser Permanente ACE Score Calculator Questionnaire). The clinician survey was conducted yearly for 3 years. Future studies would do well to also include laboratory-based objective measures of ANS functioning. Results: ANOVA with repeated measures showed that there were significant reductions in anxiety symptoms (GAD7, p interpersonal well-being) both increased significantly (Health QoL p = 0.028; Social QoL p = 0.046). Conclusions: Results suggest that professionals attending the 3-year SE® training course experience a significant improvement in self-reported measures associated with resiliency including: quality of life (well-being) and psychological symptoms (anxiety and somatization). Our

  15. EL DESARROLLO PROFESIONAL MEDIANTE LA FORMACION PERMANENTE DE LOS PROFESORES CUBANOS DE MATEMÁTICA Y CIENCIAS PARA TRABAJAR EN PAISES DE HABLA INGLESA

    Directory of Open Access Journals (Sweden)

    Noelio Vázquez Vargas

    2014-12-01

    Full Text Available Este artículo trata sobre el desarrollo profesional. Se presenta un estudio histórico sobre la enseñanza del inglés con fines específicos (IFE durante la formación permanente de los profesores cubanos de Matemática y Ciencias, además, se presentan las competencias básicas de los profesores de estas asignaturas, teniendo en cuenta el criterio de diferentes autores.

  16. Necesidades y motivaciones de los estudiantes de educación permanente en España. El caso del Centro de Educación Permanente Valle del Guadiato en Córdoba

    Directory of Open Access Journals (Sweden)

    Beatriz del V. Medina F

    2013-05-01

    Full Text Available El objetivo de la investigación en la que está basado el artículo fue identificar las necesidades y las motivaciones de los estudiantes del Centro de Educación Permanente (CEPER Valle del Guadiato de Córdoba, España. Se parte de diferentes teorías para su fundamentación, como las aportadas por Maslow (2005, McClelland (1989, García Aretio (1988, Paz (1984, Palladino (1981, entre otros. Se utilizó la metodología comparada cuyas unidades de comparación se corresponden con las unidades espaciales, que en este estudio son los municipios: Belmez, Espiel, Fuente Obejuna, Peñarroya-Pueblonuevo, Villanueva del Rey y Villaviciosa de Córdoba. Para la recogida de datos se utiliza el estudio documental, el cuestionario escrito y la observación cualitativa. El universo poblacional del CEPER Valle del Guadiato lo conformaron 606 personas adultas del período escolar 2011-2012 (592 estudiantes, 14 maestros, siendo la muestra de 265 personas (251 estudiantes, 14 maestros. Entre las principales conclusiones destacan que las necesidades sociales, laborales y personales de los estudiantes del Centro objeto de estudio se derivan básicamente del deseo de aprender, del deseo de superación personal, y del interés por el tema. Las motivaciones giran en torno a la oportunidad de ocupar sus tiempos libres, a la posibilidad de tener mejores oportunidades de encontrar trabajo, y al apoyo de la familia.

  17. Necesidades y motivaciones de los estudiantes de educación permanente en España. El caso del Centro de Educación Permanente Valle del Guadiato en Córdoba

    Directory of Open Access Journals (Sweden)

    Beatriz del V. Medina F

    2013-01-01

    Full Text Available El objetivo de la investigación en la que está basado el artículo fue identifi-car las necesidades y las motivaciones de los estudiantes del Centro de Educación Permanente (CEPER Valle del Guadiato de Córdoba, España. Se parte de dife-rentes teorías para su fundamentación, como las aportadas por Maslow (2005,McClelland (1989, García Aretio (1988, Paz (1984, Palladino (1981, entre otros. Se utilizó la metodología comparada cuyas unidades de comparación se co-rresponden con las unidades espaciales, que en este estudio son los municipios: Belmez, Espiel, Fuente Obejuna, Peñarroya-Pueblo nuevo, Villanueva del Rey y Villaviciosa de Córdoba. Para la recogida de datos se utiliza el estudio documental, el cuestionario escrito y la observación cualitativa. El universo poblacional del “CEPER Valle del Guadiato” lo conformaron 606 personas adultas del período escolar 2011-2012 (592 estudiantes, 14 maestros, siendo la muestra de 265 personas (251 estudiantes, 14 maestros. Entre las principales conclusiones destacan que las necesidades sociales, laborales y personales de los estudiantes del Centro objeto de estudio se derivan básicamente del deseo de aprender, del deseo de superación personal, y del interés por el tema. Las motivaciones giran en torno a la oportunidad de ocupar sus tiempos libres, a la posibilidad de tener mejores oportunidades de encontrar trabajo, y al apoyo de la familia.

  18. ["A decision meaning a new foundation...": from the Kaiser Wilhelm Institute for Anthropology, Human Genetics and Eugenics to the Max Planck Institute for Molecular Genetics].

    Science.gov (United States)

    Sachse, Carola

    2011-01-01

    The Max Planck Institute for Molecular Genetics (MPIMG) in Berlin-Dahlem dates its establishment to 1964. Its homepage makes no mention of its predecessor institutes, the Kaiser Wilhelm Institute for Anthropology, Human Genetics and Eugenics (KWIA) and the subsequent MPI for Comparative Genetics and Hereditary Pathology (MPIVEE). This article traces the two critical phases of transition regarding the constellations of academic staff, institutional and epistemic ruptures and continuities specific to the era. Only one of the five department heads from the final war years, Hans Nachtsheim, remained a researcher within the Max Planck Society (MPG); he nevertheless continued to advocate the pre-war and wartime eugenic agenda in the life sciences and social policy. The generational change of 1959/60 became a massive struggle within the institute, in which microbial genetics (with Fritz Kaudewitz) was pitted against human genetics (with Friedrich Vogel) and managed to establish itself after a fresh change in personnel in 1964/65. For the Dahlem institute, this involved a far-reaching reorientation of its research, but for the genetically oriented life sciences in the Max Planck Society as a whole it only meant that molecular biology, which was already being pursued in the West German institutes, gained an additional facility. With this realignment of research traditions, the Society was able to draw a line under the Nazi past without having to address it head-on.

  19. Effect of electrode contact area on the information content of the recorded electrogastrograms: An analysis based on Rényi entropy and Teager-Kaiser Energy

    Science.gov (United States)

    Alagumariappan, Paramasivam; Krishnamurthy, Kamalanand; Kandiah, Sundravadivelu; Ponnuswamy, Mannar Jawahar

    2017-06-01

    Electrogastrograms (EGG) are electrical signals originating from the digestive system, which are closely correlated with its mechanical activity. Electrogastrography is an efficient non-invasive method for examining the physiological and pathological states of the human digestive system. There are several factors such as fat conductivity, abdominal thickness, change in electrode surface area etc, which affects the quality of the recorded EGG signals. In this work, the effect of variations in the contact area of surface electrodes on the information content of the measured electrogastrograms is analyzed using Rényi entropy and Teager-Kaiser Energy (TKE). Two different circular cutaneous electrodes with approximate contact areas of 201.14 mm2 and 283.64 mm2, have been adopted and EGG signals were acquired using the standard three electrode protocol. Further, the information content of the measured EGG signals were analyzed using the computed values of entropy and energy. Results demonstrate that the information content of the measured EGG signals increases by 6.72% for an increase in the contact area of the surface electrode by 29.09%. Further, it was observed that the average energy increases with increase in the contact surface area. This work appears to be of high clinical significance since the accurate measurement of EGG signals without loss in its information content, is highly useful for the design of diagnostic assistance tools for automated diagnosis and mass screening of digestive disorders.

  20. The historical development of modern virus research in Germany, especially in the Kaiser-Wilhelm-/Max-Planck-Society, 1936--1954.

    Science.gov (United States)

    Butenandt, A

    1977-01-01

    This is lecture on the historical development of modern virus research in Germany to introduce a symposium dedicated to Prof. Werner Schäfer, Tübingen, on the occasion of his 65th birthday. The author was set the task of relating from his memories the beginning of modern virus research in Germany. This research has, since 1936, essentially taken place in the Kaiser-Wilhelm/Max-Planck-Society and in 1954 led to the founding of the Max-Planck-Institute for Virus Research in Tübingen, an institute which to the present day owes its scientific reputation in considerable part to the activity of Werner Schäfer. Since the author personally experienced and participated in the Institute's development from 1936-1954, his remarks are predominantly influenced by personal recollections, which have been sharpended by a renewed study of old records in the 'Library and Archive of the History of the Max-Planck-Gesellschaft', Berlin-Dahlem.

  1. Personal reminiscences of the Kaiser Wilhelm Institute, Berlin, 1937/38 and of the nuclear project in Canada, 1944/56

    International Nuclear Information System (INIS)

    Cook, L.G.

    1989-01-01

    Part 1 of this talk deals with reminiscences from the Kaiser Wilhelm Institute in Berlin during the period 1937-1938. Topics include the course of experimental events and the continuing search for interpretations that would stand up, the guiding influence of the work of Irene Curie and Pvale Savic on the experimental work of Hahn and Strassmann, the influence and effects of Nazi political pressures within the Institute, the shadows of war, and how uranium fission finally got itself discovered. Part 2 gives reminiscences from the Nuclear Project in Canada from 1944 to 1956 as an extension of the pre-war work in Paris - both in concept and in personnel - created by British effort, the powerful changing US influences, the shift to British direction and a goal, the world's first high power heavy water moderated reactor for the production of massive quantities of synthetic radioactive materials, extraction processes including those for plutonium, the shift to Canadian direction and goals, a heavy water moderated electricity production system, and a postscript

  2. Medline Plus

    Full Text Available ... Merriam, KS, 05/04/2012) Colorectal Cancer Laparoscopic Right Colectomy ... Incontinence Advanced Procedures in Male Incontinence: The Male Sling (Kaiser Permanente San Diego ...

  3. Obtención del Valor Genético Predicho en Animales Incluyendo el Efecto del Medio Ambiente Permanente Obtención del Valor Genético Predicho en Animales Incluyendo el Efecto del Medio Ambiente Permanente

    Directory of Open Access Journals (Sweden)

    Mauricio Valencia Posadas

    2012-02-01

    Full Text Available The genetic improvement of the animals based in productive records and genealogical information, is a fundamental mechanism to increase the economic income of the commercial farms, through the estimation of the predicted breeding values (VGP’s. The VGP’s allows the identification of animals genetically superior to be used as parents of the next generation. In many parts of the world the best linear unbiased predictor procedure (MPLI is used as an animal model, for its appropriate properties, to obtain the VGP’s. In these models the permanent environment effect is usually included in order to increase the accuracy of the VGP’s. In this work a developed example is presented using supposed data to obtain VGP’s with the MPLI procedure and an animal model where the methodology, interpretation and use of the VGP’s are shown.El mejoramiento genético de los animales, con base en los registros de rendimiento e información genealógica, es un mecanismo fundamental para incrementar los rendimientos económicos de las explotaciones comerciales, a partir de la estimación de valores genéticos predichos (VGP’s. Los VGP permiten identificar a los animales genéticamente superiores de una forma objetiva, para que sean utilizados como padres de la siguiente generación. En muchas partes del mundo se utiliza el procedimiento del mejor predictor lineal insesgado (MPLI con un modelo animal por sus adecuadas propiedades para obtenerlos VGP’s. En dichos modelos se suele incluir el efecto del medio ambiente permanente con el objeto de incrementar la precisión de los VGP’s. En este trabajos e presenta un ejemplo desarrollado utilizando datos supuestos para obtener VGP’s con el procedimiento MPLI y un modelo animal, donde se muestra la metodología, interpretación y uso que tienen los VGP’s.

  4. Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Fellows Jeffrey L

    2012-08-01

    Full Text Available Abstract Background Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of ‘forced abstinence’ for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231. Methods/Design The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW and at Oregon Health & Science University (OHSU hospitals in Portland, Oregon. The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR + IVR follow-up calls, compared to usual care inpatient counseling (UC. In November 2011, we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days, willing to remain abstinent postdischarge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR + IVR or UC using a 2:1 assignment strategy. Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications, and four IVR follow-up calls over seven weeks postdischarge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported thirty-day smoking abstinence at six months postrandomization for AR + IVR participants compared to usual care. Additional outcomes include self-reported and biochemically confirmed

  5. Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Fellows, Jeffrey L; Mularski, Richard; Waiwaiole, Lisa; Funkhouser, Kim; Mitchell, Julie; Arnold, Kathleen; Luke, Sabrina

    2012-08-01

    Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of 'forced abstinence' for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231). The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW) and at Oregon Health & Science University (OHSU) hospitals in Portland, Oregon. The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR + IVR) follow-up calls, compared to usual care inpatient counseling (UC). In November 2011, we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days, willing to remain abstinent postdischarge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR + IVR or UC using a 2:1 assignment strategy. Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications, and four IVR follow-up calls over seven weeks postdischarge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported thirty-day smoking abstinence at six months postrandomization for AR + IVR participants compared to usual care. Additional outcomes include self-reported and biochemically confirmed seven-day abstinence at six months, self-reported seven

  6. Construção de descritores para o processo de educação permanente em atenção básica Building descriptors for the permanent basic care education process

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    Rosita Saupe

    2007-11-01

    Full Text Available Educação permanente e atenção básica fazem parte do sistema de saúde brasileiro desde suas origens. Recentemente estas políticas públicas foram atualizadas, gerando um movimento inovador de construção de conhecimento visando apoiar sua implementação e consolidação. Este estudo, através de uma metodologia quantitativa, procurou evidenciar os principais descritores que devem orientar os processos de educação permanente em atenção básica. O método é originário da Universidade da Carolina do Norte. É desenvolvido em duas etapas. Os dados apresentados neste artigo dizem respeito à primeira etapa, que inclui as seguintes fases: elaboração de um diagrama com todos os componentes a serem avaliados; sua análise por um grupo de especialistas, indicando o que deve ser mantido, retirado ou incluído; avaliação por juízes, utilizando escala Likert de 1 a 5; verificação da concordância entre os juízes. O diagrama foi decomposto em quatro dimensões, procurando responder as seguintes questões: para quem? - audiências ou população alvo; o quê? - módulos de conteúdos e experiências de aprendizagem; para quê? - competências a serem desenvolvidas; e como? - metodologia a ser priorizada. Os resultados evidenciaram a procedência dos descritores propostos e avaliados, constituindo em material que pode contribuir para a tomada de decisão sobre educação permanente em atenção básica.Permanent education and basic care have been part of the Brazilian health system from the beginning. These public policies were recently updated, leading to an innovative knowledge construction movement to support their implementation and consolidation. This study, which used a quantitative approach, attempted to single-out the main descriptors that must guide the permanent basic care education processes. The method originated at the University of North Carolina and is carried out in two stages. The data shown in this article concern the

  7. A nova gestão pública na Inglaterra: a permanente instabilidade da reforma neoliberal

    Directory of Open Access Journals (Sweden)

    David Hall

    2015-09-01

    Full Text Available RESUMO: A reforma da educação na Inglaterra tem sido intimamente associada a um programa mais amplo da nova gestão pública, centrado na reforma dos serviços públicos. Este artigo analisa as características deste programa de reformas inspirado na NGP, tendo em vista que o sistema educacional inglês se deslocou de uma forma cívica e de proteção social ("cívico-welfarista" para um modo em que o neoliberalismo despontou em ascendência. Atenção particular é dada tanto aos aspectos centralizadores da reforma, em que tem havido um acentuado aumento na intervenção do governo central na educação, quanto aos aspectos descentralizadores da reforma, incluindo a criação de escolas como unidades de negócios e a mercantilização da educação em termos mais gerais. As origens das reformas estão situadas em uma construção discursiva de uma crise educacional, inspirada na Nova Direita, que encontrou posterior expressão em uma série de alterações na legislação que emergiram de e cimentaram um consenso educacional trans-político-partidário que já perdura por mais de trinta anos neste contexto. Este artigo examina os efeitos dessas reformas da NGP na educação na Inglaterra, e as continuidades e descontinuidades entre as diferentes administrações políticas, considerando que a Inglaterra passou por sucessivas ondas de reformas até chegarmos a um período pós-NGP. Concluímos que a permanente instabilidade do sistema educacional inglês pode ser identificado nas tensões que atingem o próprio âmago do processo da NGP, de formas que, antecipamos, continuarão a perturbar um setor rapidamente privatizador.

  8. Evaluación de la formación permanente del profesorado en la República Dominicana : el caso del Infocam

    OpenAIRE

    Ayala de la Cruz, María Esperanza

    2016-01-01

    El presente estudio estuvo orientado a describir y valorar la calidad del sistema de formación, relacionándolo con la aplicación de las políticas educativas y de formación permanente o continua del profesorado en la República Dominicana. Su conexión con las necesidades e intereses de los docentes, su incidencia en el desarrollo personal, profesional, y de desempeño. Teniendo como intención estratégica generar y aportar líneas para avanzar hacia un sistema de evaluación de la formación...

  9. Ações de educação permanente dos enfermeiros facilitadores de um núcleo de educação em enfermagem

    OpenAIRE

    Lavich, Claudia Rosane Perico; Gomes Terra, Marlene; Lemos Mello, Amanda; Raddatz, Michele; Arnemann, Cristiane Trivisiol

    2017-01-01

    Objetivo: Identificar ações desenvolvidas por enfermeiros facilitadores de um Núcleo de Educação Permanente de um Hospital de Ensino.Método: Estudo de caso único com abordagem qualitativa, realizado com oito enfermeiros de um hospital no Estado do Rio Grande do Sul. A produção dos dados foi por meio de análise documental, observação sistemática e grupo focal, realizada de abril a setembro de 2013.Resultados: O estudo aponta para as seguintes categorias: estratégias potentes para promover açõe...

  10. La aspiración de Brasil al asiento permanente en el Consejo de Seguridad de la Organización de las Naciones Unidas: un breve panorama

    OpenAIRE

    Renata de Melo Rosa; Ana Carolina Gomes Lira Linhares

    2009-01-01

    Este artículo analiza la posición de Brasil frente a la aspiración de un asiento permanente al Consejo de Seguridad de las Naciones Unidas. Los esfuerzos entabulados por Brasil en el escenario internacional, los discursos del primer rango del gobierno, así como un protagonismo más acelerado frente a los vecinos latino-americanos confirman esta aspiración. Pero, Brasil aún enfrenta serios problemas internos de seguridad nacional y tendrá que enfrentar otros compañeros regionales también, aspir...

  11. Parálisis facial permanente: corrección quirúrgica con la técnica de Labbé

    Directory of Open Access Journals (Sweden)

    Rubén Yangali

    2008-12-01

    Full Text Available La parálisis facial genera un gran déficit estético y funcional. Las diversas técnicas quirúrgicas han ido evolucionando, a fin de corregir este defecto de la forma más estructural y fisiológica posible. Consideramos que la mioplastia de alargamiento del temporal constituye actualmente la técnica de elección para corregir los casos de parálisis facial permanente.

  12. Enhanced Recovery After Surgery Program Implementation in 2 Surgical Populations in an Integrated Health Care Delivery System.

    Science.gov (United States)

    Liu, Vincent X; Rosas, Efren; Hwang, Judith; Cain, Eric; Foss-Durant, Anne; Clopp, Molly; Huang, Mengfei; Lee, Derrick C; Mustille, Alex; Kipnis, Patricia; Parodi, Stephen

    2017-07-19

    Novel approaches to perioperative surgical care focus on optimizing nutrition, mobility, and pain management to minimize adverse events after surgical procedures. To evaluate the outcomes of an enhanced recovery after surgery (ERAS) program among 2 target populations: patients undergoing elective colorectal resection and patients undergoing emergency hip fracture repair. A pre-post difference-in-differences study before and after ERAS implementation in the target populations compared with contemporaneous surgical comparator groups (patients undergoing elective gastrointestinal surgery and emergency orthopedic surgery). Implementation began in February and March 2014 and concluded by the end of 2014 at 20 medical centers within the Kaiser Permanente Northern California integrated health care delivery system. A multifaceted ERAS program designed with a particular focus on perioperative pain management, mobility, nutrition, and patient engagement. The primary outcome was hospital length of stay. Secondary outcomes included hospital mortality, home discharge, 30-day readmission rates, and complication rates. The study included a total of 3768 patients undergoing elective colorectal resection (mean [SD] age, 62.7 [14.1] years; 1812 [48.1%] male) and 5002 patients undergoing emergency hip fracture repair (mean [SD] age, 79.5 [11.8] years; 1586 [31.7%] male). Comparator surgical patients included 5556 patients undergoing elective gastrointestinal surgery and 1523 patients undergoing emergency orthopedic surgery. Most process metrics had significantly greater changes in the ERAS target populations after implementation compared with comparator surgical populations, including those for ambulation, nutrition, and opioid use. Hospital length of stay and postoperative complication rates were also significantly lower among ERAS target populations after implementation. The rate ratios for postoperative complications were 0.68 (95% CI, 0.46-0.99; P = .04) for patients

  13. Differences in Access to and Preferences for Using Patient Portals and Other eHealth Technologies Based on Race, Ethnicity, and Age: A Database and Survey Study of Seniors in a Large Health Plan.

    Science.gov (United States)

    Gordon, Nancy P; Hornbrook, Mark C

    2016-03-04

    Patients are being encouraged to go online to obtain health information and interact with their health care systems. However, a 2014 survey found that less than 60% of American adults aged 65 and older use the Internet, with much lower usage among black and Latino seniors compared with non-Hispanic white seniors, and among older versus younger seniors. Our aims were to (1) identify race/ethnic and age cohort disparities among seniors in use of the health plan's patient portal, (2) determine whether race/ethnic and age cohort disparities exist in access to digital devices and preferences for using email- and Web-based modalities to interact with the health care system, (3) assess whether observed disparities in preferences and patient portal use are due simply to barriers to access and inability to use the Internet, and (4) learn whether older adults not currently using the health plan's patient portal or website have a potential interest in doing so in the future and what kind of support might be best suited to help them. We conducted two studies of seniors aged 65-79 years. First, we used administrative data about patient portal account status and utilization in 2013 for a large cohort of English-speaking non-Hispanic white (n=183,565), black (n=16,898), Latino (n=12,409), Filipino (n=11,896), and Chinese (n=6314) members of the Kaiser Permanente Northern California health plan. Second, we used data from a mailed survey conducted in 2013-2014 with a stratified random sample of this population (final sample: 849 non-Hispanic white, 567 black, 653 Latino, 219 Filipino, and 314 Chinese). These data were used to examine race/ethnic and age disparities in patient portal use and readiness and preferences for using digital communication for health-related purposes. Adults aged 70-74 and 75-79 were significantly less likely than 65-69 year olds to be registered to use the patient portal, and among those registered, to have used the portal to send messages, view lab test

  14. Differences in Access to and Preferences for Using Patient Portals and Other eHealth Technologies Based on Race, Ethnicity, and Age: A Database and Survey Study of Seniors in a Large Health Plan

    Science.gov (United States)

    Hornbrook, Mark C

    2016-01-01

    Background Patients are being encouraged to go online to obtain health information and interact with their health care systems. However, a 2014 survey found that less than 60% of American adults aged 65 and older use the Internet, with much lower usage among black and Latino seniors compared with non-Hispanic white seniors, and among older versus younger seniors. Objective Our aims were to (1) identify race/ethnic and age cohort disparities among seniors in use of the health plan’s patient portal, (2) determine whether race/ethnic and age cohort disparities exist in access to digital devices and preferences for using email- and Web-based modalities to interact with the health care system, (3) assess whether observed disparities in preferences and patient portal use are due simply to barriers to access and inability to use the Internet, and (4) learn whether older adults not currently using the health plan’s patient portal or website have a potential interest in doing so in the future and what kind of support might be best suited to help them. Methods We conducted two studies of seniors aged 65-79 years. First, we used administrative data about patient portal account status and utilization in 2013 for a large cohort of English-speaking non-Hispanic white (n=183,565), black (n=16,898), Latino (n=12,409), Filipino (n=11,896), and Chinese (n=6314) members of the Kaiser Permanente Northern California health plan. Second, we used data from a mailed survey conducted in 2013-2014 with a stratified random sample of this population (final sample: 849 non-Hispanic white, 567 black, 653 Latino, 219 Filipino, and 314 Chinese). These data were used to examine race/ethnic and age disparities in patient portal use and readiness and preferences for using digital communication for health-related purposes. Results Adults aged 70-74 and 75-79 were significantly less likely than 65-69 year olds to be registered to use the patient portal, and among those registered, to have used the

  15. Health benefits in 2013: moderate premium increases in employer-sponsored plans.

    Science.gov (United States)

    Claxton, Gary; Rae, Matthew; Panchal, Nirmita; Damico, Anthony; Whitmore, Heidi; Bostick, Nathan; Kenward, Kevin

    2013-09-01

    Employer-sponsored health insurance premiums rose moderately in 2013, the annual Kaiser Family Foundation/Health Research and Educational Trust (Kaiser/HRET) Employer Health Benefits Survey found. In 2013 single coverage premiums rose 5 percent to $5,884, and family coverage premiums rose 4 percent to $16,351. The percentage of firms offering health benefits (57 percent) was similar to that in 2012, as was the percentage of workers at offering firms who were covered by their firm's health benefits (62 percent). The share of workers with a deductible for single coverage increased significantly from 2012, as did the share of workers in small firms with annual deductibles of $1,000 or more. Most firms (77 percent), including nearly all large employers, continued to offer wellness programs, but relatively few used incentives to encourage employees to participate. More than half of large employers offering health risk appraisals to workers offered financial incentives for completing the appraisal.

  16. Antecedentes históricos del proceso de formación permanente del maestro tutor y su sistematización

    Directory of Open Access Journals (Sweden)

    MSc. Nirma Pérez-Pelipiche

    2016-02-01

    Full Text Available El estudio histórico realizado permitió evidenciar que la formación permanente de los maestros tutores de los estudiantes de Licenciatura en Educación Primaria ha transitado desde de una concepción espontánea, ocasional y a veces improvisada, hacia una más organizada en la que se han asumido posiciones de constantes cambios a favor del proceso formativo universitario pedagógico. Sin embargo, aún persisten restricciones epistemológicas y praxiológicas que limitan su efectividad, siendo notorio en el contexto de la microuniversidad durante la práctica laboral de los estudiantes en formación. Los estudios revelan que si bien el maestro tutor se erige en una figura esencial del proceso formativo pedagógico, no siempre su preparación ha sido efectiva, por lo que se requiere de una dinámica contextualizada de formación permanente que propicie nuevos sistemas de relaciones, vías y actitudes que actualicen y renueven las formas de ejercer sus funciones formativas en correspondencia con la realidad educativa contemporánea.

  17. La formación del profesorado de Historia en Chile. La formación inicial y permanente de los educadores de la V región en el marco de la reforma educacional

    OpenAIRE

    Vásquez Lara, Nelson Lorenzo

    2004-01-01

    [spa] Objetivos Generales:A. Conocer las principales características que ha tenido la formación inicial de los Profesores de Historia, Geografía y Ciencias Sociales chilenos.B. Conocer las principales características que ha tenido la formación permanente de los profesores de Historia, Geografía y Ciencias Sociales chilenos.C. Averiguar la percepción que los profesores de historia chilenos tienen sobre el grado de utilidad de la formación inicial y permanente.D. Averiguar la percepción que lo...

  18. Formación del profesorado de Historia en Chile. La formación inicial y permanente de los educadores de la V región en el marco de la reforma educacional, La

    OpenAIRE

    Vásquez Lara, Nelson Lorenzo

    2004-01-01

    Objetivos Generales:A. Conocer las principales características que ha tenido la formación inicial de los Profesores de Historia, Geografía y Ciencias Sociales chilenos.B. Conocer las principales características que ha tenido la formación permanente de los profesores de Historia, Geografía y Ciencias Sociales chilenos.C. Averiguar la percepción que los profesores de historia chilenos tienen sobre el grado de utilidad de la formación inicial y permanente.D. Averiguar la percepción que los prof...

  19. Educação permanente e qualidade da assistência à saúde: aprendizagem significativa no trabalho da enfermagem

    Directory of Open Access Journals (Sweden)

    Fernanda Maria do Carmo da Silveira Neves de Oliveira

    2011-01-01

    Full Text Available El objetivo de este artículo es analizar la educación permanente en la práctica de la enfermería. En la actualidad, existe preocupación por los cambios introducidos en la estructura de enseñanza y la aplicación de metodologías activas para capacitar profesionales de salud. En el artículo se reflexiona sobre aspectos cotidianos de la enfermería y la manera actual de suministrar o proporcionar información tecnocientífica al enfermero durante la práctica en el hospital, tratando de enriquecer la asistencia de enfermería mediante la educación permanente. Se describen las prácticas trasformadoras aplicadas por el enfermero asistencial como elemento facilitador del proceso enseñanza-aprendizaje. Se lleva a cabo una revisión amplia de las bases de datos informáticas. En consecuencia, la selección de los textos se basa en los criterios de inclusión y exclusión, y dio origen a 50 artículos científicos. En años recientes, la educación permanente se introdujo como un método en el área de la salud, convirtiéndose en un aspecto indispensable en las prácticas de formación, atención, gestión, formulación de políticas públicas y control social. Así se estableció la idea de cuidado total y se trasformaron e integraron los saberes y las prácticas en el ámbito real del público al que va dirigido. Se concluye que la motivación para actualizar permanentemente la práctica profesional del equipo de enfermería prevé la aplicación de un instrumento interdisciplinario de solubilidad que promueva la visibilidad de las acciones por los clientes y sus familias.

  20. La Educación Permanente en Bibliotecología y Archivología: relato de una experiencia universitaria en Uruguay (1994-2001

    Directory of Open Access Journals (Sweden)

    Edelweiss Zahn

    2013-12-01

    Full Text Available Se indica cómo han variado los roles de la información y la situación relativa de las unindades de información, la producción tecnológica de vías alternativas del almacenamiento documental, tales como las bilbiotecas virtuales o digitales, los archivos y museos electrónicos. El avance de la investigación y del conocimiento en cualquier disciplina, el crecimiento de expectativas y necesidades de formación y actualización por parte de los profesionales, nuevos requerimientos y desafíos en el ámbito laboral y social, y la implantación generalizada de nuevas tecnologías, se han conjugado para obligar a una reflexión profunda de las instituciones responsables de formación especializada. En las Universidades se plantean al menos tres niveles educativos: el grado, los posgrados, y la educación continua o permanente que involucre conocimientos teórico-prácticos y metodológicos, que contribuya a mejorar el desempeño y la jerarquía profesional en la línea de conocimientos "just in time", y que habilite a niveles superiores de conocimiento y a la investigación disciplinaria. Se define y caracteriza la eduación permanente como fenómeno educativo. Se relata el proceso de institucionalización de la Educación Permanente en la Universidad de la República y en la Escuela Universitaria de Bibliotecología y Ciencias Afines en particular. Se desarrollar criterios y políticas académicos, formas de financiación del programa, su evaluación y su proección a futuro. Se presentan datos estadísticos sobre cursos, profesores, y participantes en el período 1994-2001 en la EUBCA     

  1. Mediación de la cultura docente en los proyectos de formación permanente (Mediation of culture teaching in lifelong learning projects (Médiation de la culture de l'enseignant dans les projets de formation continue (Mediação da cultura docente nos projectos de formação permanente

    Directory of Open Access Journals (Sweden)

    Rosa Amaya-de Rebolledo

    2010-12-01

    Full Text Available ResumenLa formación permanente del docente juega un papel clave en el cambio educativo; sin embargo, su con- creción práctica representa un reto epistemológico y metodológico. La problemática ha sido abordada des- de diferentes ángulos, en los cuales la relación entre cultura docente y formación permanente no ha sido claramente desvelada. En este artículo, que constituye un avance en la investigación de tesis doctoral de la Facultad de Ciencias de la Educación de la Universidad de Carabobo, se analiza por qué la cultura docente necesita ser reconocida como una realidad dinámica, dialéctica y relacional que afecta la calidad de la for- mación permanente del docente venezolano.AbstractThe continuous training of the teacher plays a key role in educational change; however, to take it to the practice rep- resents an epistemological and meth- odological challenge. The problem has been approached from different angles, where the relation between culture of the teacher and continuous training has not been clearly discussed. In this article, which constitutes an advance in the investigation of doctoral thesis of the Faculty of Sciences of the Education of Carabobo's University, it is analyzed why the culture of the teacher needs to be recognized as a dynamic reality, dialectic and relational that affects the quality of the continuous training in Venezuelan.RésuméLa formation continue des enseignants joue un rôle essentiel dans le changement éducatif, cependant, sa concrétion prati- que représente un défi épistémologique et méthodologique. La problématique a été envisagée dès perspectives différen- tes, dans lesquelles la relation entre la culture de l'enseignant et la formation continue n'a pas encore été nettement dévoilée. Dans cet article, qui constitue une avance dans la recherche de thèse doctorale de la Faculté de Sciences de l'Éducation de l'Université de Carabobo, on

  2. Educação permanente: instrumento de trabalho do enfermeiro na instituição de longa permanência

    OpenAIRE

    Silva, Bárbara Tarouco da; Barlem, Edison Luiz Devos; Lunardi, Valeria Lerch; Santos, Silvana Sidney Costa

    2008-01-01

    A questão educacional na enfermagem é ampla, podendo referir-se à educação formal em cursos técnicos, de graduação e de pós-graduação, ou à educação em saúde voltada aos treinamentos em serviço. Ante a problemática do envelhecimento populacional, as características da sociedade moderna e o uso crescente de Instituições de Longa Permanência (ILPs) como residência dos idosos, a proposta deste texto reflexivo é enfatizar a relevância e necessidade da educação permanente para os trabalhadores que...

  3. REFORMAS EDUCATIVAS Y FORMACIÓN PERMANENTE DEL PROFESORADO EN LA ÚLTIMA OBRA DE JULIA VARELA: MEMORIA Y OLVIDO

    Directory of Open Access Journals (Sweden)

    Alberto Luís Gómez

    2009-01-01

    Full Text Available En este artículo se analizan la complejidad del proceso de construcción de los Centros de Profesores y el papel desempeñado por una diversidad de instancias y personas que, desde distintos puntos de vista, defendieron su articulación dentro del más amplio campo de la formación permanente del profesorado español entre 1983 y 1990. Habiendo tomado como punto de partida de nuestras reflexiones el último libro de Julia Varela ¿Las reformas educativas a debate (1982-2006¿ defendemos tanto su interés como la asimetría existente entre la relevancia política de esta obra y su debilidad historiográfica.

  4. Políticas y prácticas en la formación permanente del profesorado en TIC en Cataluña

    OpenAIRE

    Adriana Ornellas; Joan\\u2010Anton Sánchez; Leticia Fraga Colman; Laura Domingo

    2015-01-01

    En este artículo presentamos los resultados que emergen de una de las dimensiones investigadas en el proyecto “Políticas y prácticas en torno a las TIC en la enseñanza obligatoria: Implicaciones para la innovación y la mejora” (Ministerio de Ciencia e Innovación. SEJ2007-­‐67562). Nos centramos aquí en uno de los factores determinantes del éxito o fracaso de las políticas destinadas a transformar las prácticas educativas a partir de la integración de las TIC: la formación inicial y permanente...

  5. Estudo comparativo entre ensino presencial e a distância para educação permanente de profissionais auxiliares e técnicos de enfermagem

    OpenAIRE

    Silva, Adriane das Neves

    2014-01-01

    As mudanças ocorridas no mundo do trabalho têm exigido do profissional atualização constante de saberes que possibilitem o desenvolvimento de atitude crítico-reflexiva. Este estudo buscou analisar a aplicabilidade das tecnologias da informação e da comunicação na Educação Permanente dos profissionais auxiliares e técnicos de Enfermagem em um hospital público municipal. É um estudo do tipo ensaio clínico, que lançou mão de técnicas quantitativas e qualitativas através de um experimento que oco...

  6. Educação Permanente em Saúde e Manoel de Barros: uma Aproximação Desformadora

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    Eluana Borges Leitão de Figueiredo

    Full Text Available RESUMO Trata-se de uma reflexão que promove diálogo entre pressupostos da Educação Permanente em Saúde (EPS e proposições desformadoras do poeta Manoel de Barros, com o objetivo de contribuir para a transvisão da formação e do trabalho em saúde. Optou-se por desvelar tal aproximação com base nos versos do poema “As lições de RQ”, que funcionaram como plataforma para os saltos reflexivos. A discussão encontrou respaldo principal em Paulo Freire e Adolfo Sanchez Vázquez, uma vez que caminhou na perspectiva de uma práxis revolucionária, transformadora e libertadora.

  7. Políticas y prácticas en la formación permanente del profesorado en TIC en Cataluña

    Directory of Open Access Journals (Sweden)

    Adriana Ornellas

    2015-01-01

    Full Text Available En este artículo presentamos los resultados que emergen de una de las dimensiones investigadas en el proyecto “Políticas y prácticas en torno a las TIC en la enseñanza obligatoria: Implicaciones para la innovación y la mejora” (Ministerio de Ciencia e Innovación. SEJ2007-­‐67562. Nos centramos aquí en uno de los factores determinantes del éxito o fracaso de las políticas destinadas a transformar las prácticas educativas a partir de la integración de las TIC: la formación inicial y permanente del profesorado.

  8. Deformación permanente de materiales granulares en pavimentos flexibles: estado del conocimiento Permanent strain of granular materials in flexible pavements: state of the art

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    Hugo Alexánder Rondón

    2009-01-01

    Full Text Available Diversos estudios han sido desarrollados en el área de los pavimentos para comprender el comportamiento elastoplástico que experimentan materiales granulares bajo carga cíclica. Este es el segundo de dos artículos que presentan el estado del conocimiento de investigaciones desarrolladas en esta área. Basado en una amplia revisión bibliográfica, este artículo da cuenta de la forma como ha sido estudiado el fenómeno de deformación permanente en materiales granulares empleados para conformar capas de base y sub-base de estructuras de pavimentos flexibles. Además, se exponen y se discuten los factores que afectan la resistencia a la deformación permanente y la evolución de las ecuaciones matemáticas desarrolladas para predecir la deformación que experimentan estos materiales bajo carga cíclica. Un estado del conocimiento sobre el comportamiento resiliente de estos materiales es presentado en el primer artículo (Rondón y Reyes, 2007.Several studies have been conducted in pavement field for trying to understand the elastoplastic behavior experienced by granular materials under a cyclic load. This is the second out of two articles which show state-of-the-art of researches conducted in this field. Based on a wide literature review, this article accounts for the way how permanent strain phenomenon has been studied in granular materials used for creating base and sub-base layers of flexible pavement structures. Besides, this article displays and discusses factors which affect resistance to permanent strain and evolution of mathematical equations developed for predicting that strain experienced by these materials under a cyclic load. A state-of-the-art about resilient behavior of these materials has been presented in the first article (Rondón and Reyes, 2007.

  9. Fórum Permanente da Agenda 21 Paraná: seus vínculos com o processo de mobilização social

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    Myrian Del Vecchio De Lima

    2016-12-01

    Full Text Available Este artigo utiliza a construção dos vínculos entre públicos envolvidos, proposta por Márcio Simeone Henriques (2004, para analisar a ocorrência de um processo de mobilização social, conforme entendimento teórico do sociólogo Bernardo Toro. O trabalho realiza esta proposta especificamente em relação às ações desenvolvidas pelo Fórum Permanente da Agenda 21 no Paraná. O objetivo é observar, por meio dos critérios dos vínculos, as ações de caráter mobilizador com relação a questões socioambientais empreendidas por esse coletivo, a partir do entendimento dos dois autores citados. Para tanto, o texto reflete sobre a compreensão do conceito central em questão, a mobilização social, e o papel da comunicação nesse processo. Após uma breve apresentação do Fórum Permanente da Agenda 21, verifica-se por meio de análise de conteúdo se há, no interior deste coletivo, vínculos que permitam atos de comunicação propícios à mobilização social em torno das diretrizes socioambientais propostas pela Agenda para orientar as políticas públicas.DOI: http://dx.doi.org/10.21882/ruc.v4i7.655 Recebido: 19/09/2016 Publicado: 07/12/2016

  10. Política de Educação Permanente em Saúde: análise de sua implementação

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    Katerine Gonçalves Moraes

    2015-12-01

    Full Text Available Introdução: A política nacional de educação permanente em saúde define novas diretrizes para a gestão democrática na área da educação na saúde, tais como: a gestão participativa, o protagonismo dos trabalhadores e usuários e o fortalecimento do controle social. Objetivo: Analisar o processo de implementação da Política de Educação Permanente em Saúde no Distrito Federal, Brasil. Métodos: Estudo de caso utilizando a teoria da política pública foi realizado no Distrito Federal, envolvendo 24 participantes chave responsáveis pela gestão e implementação dessa política. Resultados: Os achados apontam para um modelo centralizado de gestão com pouca participação de outros segmentos da sociedade civil, obstáculos de financiamento devido a questões burocráticas e desvalorização dos espaços de execução da política. Conclusão: Pode-se concluir que as mudanças políticas e de gestão não têm sido realizadas com a amplitude necessária para a construção coletiva do conhecimento nos serviços de saúde.

  11. TPMG Northern California appointments and advice call center.

    Science.gov (United States)

    Conolly, Patricia; Levine, Leslie; Amaral, Debra J; Fireman, Bruce H; Driscoll, Tom

    2005-08-01

    Kaiser Permanente (KP) has been developing its use of call centers as a way to provide an expansive set of healthcare services to KP members efficiently and cost effectively. Since 1995, when The Permanente Medical Group (TPMG) began to consolidate primary care phone services into three physical call centers, the TPMG Appointments and Advice Call Center (AACC) has become the "front office" for primary care services across approximately 89% of Northern California. The AACC provides primary care phone service for approximately 3 million Kaiser Foundation Health Plan members in Northern California and responds to approximately 1 million calls per month across the three AACC sites. A database records each caller's identity as well as the day, time, and duration of each call; reason for calling; services provided to callers as a result of calls; and clinical outcomes of calls. We here summarize this information for the period 2000 through 2003.

  12. Nuevos retos para el profesorado de secundaria obligatoria: formación permanente para la atención a la diversidad en las aulas (New challenges for teachers of compulsory secondary: lifelong learning for attention to diversity in the classrooms (Nouveaux défis pour le professorat de secondaire obligatoire :formation permanente pour l’attention à la diversité dans la salle de classe (Novos desafios para os professores do ensino médio obrigatório: formação permanente para a atenção à diversidade na sala de aula

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    Mar Prats

    2009-12-01

    Full Text Available La llegada reciente de alumnos inmigrantes a los centros educativos en España ha enfrentado al profesorado a nuevos retos. El presente artículo pone de manifiesto cuáles son estos nuevos retos que afrontan los docentes de la etapa de Educación Secundaria Obligatoria, ESO, a partir de sus propias voces, para conocer las necesidades formativas derivadas de esta situación educativa, con el fin de hacer propuestas de formación permanente para los docentes, como apoyo institucional en la atención de la diversidad de alumnado que coexiste en las aulas. Utilizando como método el estudio de casos múltiples hemos analizado e interpretado la información que conduce a conclusiones prácticas, con muchas posibilidades de ser tenidas en cuenta para la formación permanente de los implicados.

  13. Neuropathological research at the "Deutsche Forschungsanstalt fuer Psychiatrie" (German Institute for Psychiatric Research) in Munich (Kaiser-Wilhelm-Institute). Scientific utilization of children's organs from the "Kinderfachabteilungen" (Children's Special Departments) at Bavarian State Hospitals.

    Science.gov (United States)

    Steger, Florian

    2006-09-01

    During National Socialism, the politically motivated interest in psychiatric genetic research lead to the founding of research departments specialized in pathological-anatomical brain research, the two Kaiser Wilhelm-Institutes (KWI) in Berlin and Munich. The latter was indirectly provided with brain material by Bavarian State Hospitals, to three of which "Kinderfachabteilungen" (Special Pediatric Units) were affiliated. As children became victims of the systematically conducted child "euthanasia" in these Special Pediatric Units, this paper will address the question whether and to which extent the organs from victims of child "euthanasia" were used for (neuro-) pathological research at the KWI in Munich. By means of case studies and medical histories (with focus on the situation in Kaufbeuren-Irsee), I will argue that pediatric departments on a regular base delivered slide preparations, that the child "euthanasia" conduced in these departments systematically contributed to neuropathological research and that slide preparations from victims of child "euthanasia" were used in scientific publications after 1945.

  14. Resultados da correção cirúrgica da exotropia permanente em pacientes amblíopes e não-amblíopes

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    Adriana Valim Portes

    2011-08-01

    Full Text Available A exotropia permanente (XT acomete cerca de 1 a 2% da população. Seu tratamento é clínico: antiambliogênico e correção dos erros refrativos, e cirúrgico. O objetivo do tratamento cirúrgico é alinhar os olhos na posição primária do olhar, proporcionando melhor resultado estético. Há muito tempo diversos autores estudam os fatores pré, per e pós-operatórios relacionados ao resultado cirúrgico, uma vez que a taxa de sucesso varia de 60 a 80%. Ainda são poucos os estudos que comparam a presença de ambliopia como fator de influência no resultado final. OBJETIVO: Comparar o resultado cirúrgico dos pacientes amblíopes e não-amblíopes submetidos à cirurgia de correção de XT. MÉTODOS: Análise retrospectiva de 37 prontuários de pacientes amblíopes (Grupo A e não-amblíopes (Grupo B submetidos à correção cirúrgica de XT por retrocessoressecção monocular, sendo avaliados os registros pós-operatórios imediatos e tardios. Idade: grupo A 24,7 ± 14,2 anos, grupo B 22,6 ±18,6 anos; Desvio pré-operatório: grupo A 29,1± 7,2Δ, grupo B 28,4 ± 6,8Δ. RESULTADOS: A taxa de sucesso foi de 60% e 100% (p<0,05, no pós-operatório imediato e 50% e 82,3% (p=0,082, no pós-operatório final, nos grupos A e B, respectivamente. Não houve diferença significante quanto aos desvios pós-operatórios imediatos, tardios e variação do desvio. CONCLUSÃO: Pode-se concluir que o grupo B mostrou melhor resultado no pós-operatório imediato; porém não houve diferença no resultado cirúrgico de correção de exotropia permanente entre pacientes amblíopes e não-amblíopes no período pós-operatório de seis meses.

  15. Prevalência de cárie em dentes permanentes de escolares do Município de São Paulo, SP, 1970-1996 Dental caries prevalence in permanent teeth of schoolchildren in Brazil, 1970-1996

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    Paulo C Narvai

    2000-04-01

    Full Text Available OBJETIVO: Estudar a evolução da prevalência de cárie em dentes permanentes da população infantil do Município de São Paulo, SP, no período 1970-1996, com base em levantamento epidemiológico em escolares das redes pública e privada de ensino. MÉTODOS: Utilizando metodologia recomendada pela Organização Mundial da Saúde, foram examinados 2.491 escolares de 103 unidades das redes de ensino público e privado. Foi obtida amostra probabilística, com base no cadastro das escolas do município. Os elementos amostrais foram identificados ao acaso. RESULTADOS: Observou-se que de uma situação de prevalência "muito alta" de cárie dentária nos anos 60 e 70, a população de referência evoluiu positivamente, na idade-índice de 12 anos, para um quadro de "baixa" prevalência. CONCLUSÃO: Entre 1986 e 1996 o declínio na cárie dentária, aos 12 anos de idade, foi da ordem de 68,2% entre escolares do Município de São Paulo.OBJECTIVE: To assess the evolution of dental caries in permanent teeth of schoolchildren in S. Paulo City, Brazil, during the period of 1970-1996. METHODS: The World Health Organization methodology for oral health surveys was applied in 2,491 shoolchildren, both male and female from 103 public and private schools. A probabilistic sample stratified by age, school category, and city zones was obtained by the Education State Service data system. Computational resources were used. RESULTS: Data from the 1996 S.Paulo survey were compared with others data provided by studies such as the one conducted in the same city and the reference-population in the second half of the 20th century. In the 60s and 70s the DMF-T Index among 12-year-old schoolchildren was around 7.0. In 1986 it was 6.5 and in 1996 it was registered 2.1, a decline of 68%. CONCLUSION: Dental caries in permanent teeth among S. Paulo City 12-year-old schoolchildren changed from a "very high" to "low" prevalence.

  16. Academic formation and permanent education: influences on leadership styles of nurses Formação acadêmica e educação permanente: influências nos estilos de liderança de enfermeiros

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    Karen Cristina Kades Andrigue

    2017-10-01

    Full Text Available Objetivo: conhecer as influências da formação acadêmica e da Educação Permanente em Saúde (EPS nos estilos de liderança adotados pelos enfermeiros no âmbito hospitalar. Método: pesquisa qualitativa do tipo descritiva, apoiada no referencial de Hersey e Blanchard. Participaram do estudo seis enfermeiros da rede hospitalar de Chapecó (SC, que tipificavam diferentes estilos de liderança. Os dados foram coletados por meio de entrevistas semiestruturadas e analisados conforme Análise Temática. Resultados: os participantes sentiram-se pouco influenciados para liderar diante da formação obtida na graduação e ressaltaram dificuldades de integração ensino-serviço, que interferiram no exercício da liderança. Quanto à EPS, sinalizaram a falta de investimentos na qualificação. Conclusão: destaca-se a importância de o ensino na graduação fortalecer as práticas de aprendizagem da liderança e entende-se que a liderança é aperfeiçoada ao longo da vida profissional.    Objective: to know the influences of academic training and Continuing Health Education (EPS on the leadership styles adopted by nurses in the hospital environment. Method: it is qualitative descriptive-type research supported in the references of Hersey and Blanchard. Six nurses from the hospital network of Chapecó, Santa Catarina, participated in this study and typified different leadership styles. The data were collected through semi-structured interviews and analyzed according to Thematic Analysis. Results: the participants felt only slightly influenced to lead during the training obtained in their graduation course and highlighted difficulties in integrating education service, which interfered in exercising leadership. As for the Continuing Health Education (EPS, it indicated a lack of investment in qualification. Conclusion: standing it was highlighted the importance of education in graduation studies to strengthen leadership learning practices and it is

  17. A Origem Histórica do Conceito de Área de Preservação Permanente no Brasil

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    Glaucus Vinicius Biasetto Ribeiro

    2011-01-01

    Full Text Available A nossa atualidade vem sendo marcada por uma crescente preocupação com as questões ligadas ao meio ambiente e com a preservação do nosso planeta. De uma maneira geral o aquecimento global, a influência antrópica, a degradação de ambientes naturais, os processos ecológicos, a biodiversidade, a sustentabilidade, bem como a cidadania ambiental tem se tornado temas de discussão nas diversas esferas de convívio social.Dentro da história brasileira podemos identificar uma série de regramentos de caráter ambiental considerando-se como marco a Lei 4.771 de 15 de setembro de 1965, que instituiu o novo Código Florestal Brasileiro. Ao longo do presente artigo procuraremos investigar a origem da conceituação das áreas de preservação permanentes, tema alvo de grandes discussões na atualidade, tal qual surgiu e foi inserida na legislação brasileira, procurando recuperar esse aspecto específico da história do Brasil.

  18. Técnica para identificar faltas transitorias y permanentes en líneas de transmisión, utilizando la transformada Wavelet

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    Miguel Martínez

    2009-01-01

    Full Text Available En el presente documento, se presenta un algoritmo que permite distinguir de forma clara y precisa, las faltas transitorias de las permanentes. Adicionalmente se determina el instante de extinción del arco secundario, para así evitar o controlar de forma efectiva y segura la operación de reconexión monofásica en sistemas de transporte de energía. El método de identificación se basa en la determinación de las características de alta frecuencia que posee la señal de tensión de la fase en falta antes del despeje y de la corriente en una fase sana y las relaciona de forma independiente mediante una auto-correlación cruzada. Para el análisis de la señal y extracción de los componentes de alta frecuencia, se ha utilizado la transformada Wavelet. El algoritmo propuesto se probó en un sistema base de 380 kV, funcionando de forma correcta en todos los escenarios planteados y logrando una identificación precisa en los primeros 25 ms de la falta.

  19. Propuesta de un plan permanente de relaciones públicas para educar adolescentes sobre los riesgos que existen en las redes sociales

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    Gina Gilbert Toral

    2014-06-01

    redes sociales, utilizadas como un medio de comunicación altamente efectivo; hoy en día existe un notorio cambio en la manera en que los adolescentes se relacionan e interactúan entre sí, se evidencia que los niños a temprana edad adquieren dominio sobre las redes sociales y el internet en general, por lo que están expuestos a peligros de tipo psicológico, tales como: ciberbullying, sexting, grooming y morphing. Por lo antes expuesto, y con el fin de incidir de manera positiva en los adolescentes, el presente trabajo de investigación propone la creación de un plan permanente de relaciones públicas, que entre otras actividades conlleva: charlas de psicología, talleres de concientización, la elaboración de un código de conducta online que minimice los riesgos, y finalmente el desarrollo de campañas en internet y medios tradicionales.

  20. Perspectivas de las Tecnologías de la Información y las Comunicaciones en la formación permanente del profesorado universitario

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    Dr. C. Oscar Antonio Martínez Molina

    2018-02-01

    Full Text Available El acelerado avance científico y tecnológico pasa por el ámbito educativo haciendo que asuma nuevos retos de elevación del nivel educativo. Las Tecnologías de la Información y las Comunicaciones en la educación proporcionan potencia, fortalecimiento y transformación en el quehacer educativo, al momento que incrementa, en la práctica docente, la calidad del servicio. En el presente artículo se exponen las herramientas tecnológicas en el uso de las TIC en la formación permanente del profesorado universitario, haciéndose una adecuada utilización de las Tecnologías de la Información y las Comunicaciones lo que marcará gran impacto en la organización, desarrollo y productos en el proceso de enseñanza-aprendizaje si se tiene en cuenta que las nuevas tecnologías de la información y de la comunicación han evolucionado espectacularmente en los últimos años, debido especialmente a su capacidad de interconexión a través de la Red. Esta nueva fase de desarrollo va a tener gran impacto en la organización de la enseñanza y el proceso de aprendizaje

  1. Usos da terra e Áreas de Preservação Permanente (APP na Bacia do Rio da Prata, Castelo-ES

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    Luciano Melo Coutinho

    Full Text Available Este trabalho avaliou o uso da terra e identificou Áreas de Preservação Permanente (APPs na Bacia Hidrográfica do Rio da Prata (BRP, município de Castelo-ES, via técnicas de geoprocessamento. A BRP é marcada pela supressão de vegetação nativa, para expansão da fronteira agropecuária. As classes de uso da terra foram vetorizadas por fotointerpretação de aerofotos ortorretificadas. A delimitação das APPs foi realizada a partir de dados de hidrografia e altimetria de cartas topográficas digitais, com respeito às determinações do Código Florestal Brasileiro. A principal forma de uso da terra é a agropecuária (60,84% da área total, composta pela agricultura (30,21% e pela pecuária (30,63%, sendo que a área preservada com floresta nativa é de 36,85%. As APPs representam 55,48% da área total e sua maior parte (50,40% é utilizada para fins socioeconômicos, enquanto a cobertura florestal representa apenas 49,60%.

  2. La formación inicial y permanente del profesorado de Educación Física a través del practicum

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    Herminia María García Ruso

    2013-05-01

    Full Text Available En este artículo se muestran los aspectos más importantes del desarrollo de un proyecto de innovación educativa realizado durante las prácticas de enseñanza. En el proyecto intervinieron cuatro alumnos, futuros maestros especialistas de Educación Física, cuatro tutoras y dos supervisoras. Trataremos de exponer, con cierto matiz descriptivo, las fases seguidas en la realización de un proyecto de investigación-acción, los objetivos formulados, la metodología empleada, la elaboración de una unidad didáctica de expresión corporal y el análisis e interpretación de la información. Finalmente, explicaremos las conclusiones que giran alrededor de tres ejes: la relación de la Universidad y los Centros Educativos, la relación del supervisor y el tutor, y la valoración del propio seminario de investigación-acción como herramienta para la investigación y la formación inicial y permanente del profesorado.

  3. As equações dos estados quase-permanentes e uma visão alternativa da indução eletromagnética

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    Ferreira G. F. Leal

    2001-01-01

    Full Text Available Apresenta-se o sistema de equações que descreve consistentemente os estados quase-permanentes, campos e potenciais, abrangendo a eletrostática, a magnetostática e a lei de indução de Faraday. Mostra-se que ele é correto até a ordem de v² = c² e de wr = c² em que v e w são a velocidade e a aceleração tópicas das cargas, c a velocidade da luz e r a distância ao ponto considerado. Pode-se então obter o campo elétrico de uma carga em movimento nessa aproximação, o qual corrige o campo de Coulomb por termos dependentes da velocidade e da aceleração da carga. Mostra-se assim, como feito anteriormente por Ritz e O'Rahilly, que a indução eletromagnética pode ser atribuída à aceleração das cargas do circuito indutor, propiciando uma visão alternativa dessa interação, usualmente atribuída à variação do fluxo no interior do circuito.

  4. A vivência no processo formativo do projeto Educanvisa: relato de uma experiência de formação permanente | The Experience in Process Formation Project Educanvisa: Report of a Permanent Training Experience

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    Ivanilde Alves Borba Rigo

    2015-02-01

    Full Text Available Este relato tem como objetivo apresentar a vivência no processo formativo dos educadores no Projeto Educanvisa, desenvolvido no Município de Lucas do Rio Verde/MT no ano de 2012, tendo como público os educadores da rede Municipal de Ensino das unidades de Educação Infantil e da Educação Básica. O relato foi focado na educação permanente de educadores, com a finalidade de capacitá-los para que se tornassem multiplicadores e mediadores do assunto em salas de aula. Neste processo de educação permanente, os educadores foram submetidos a palestras orientativas com profissionais da saúde como: nutricionista, farmacêutico, enfermeiros, médico bioquímico e representante da vigilância sanitária. Após adquirido o conhecimento, os educadores tornaram-se multiplicadores e mediadores nas escolas, fazendo o repasse para outros profissionais da educação, os quais tiveram a responsabilidade de efetivar o conhecimento nas salas de aula. O repasses aos educandos se deu por meio de palestras com profissionais da saúde, atividades didático-pedagógicas sobre temas como: A Saúde e a Promoção da Saúde; A Vigilância Sanitária; Os Medicamentos/Alimentos; A Propaganda de Medicamentos e de Alimentos e orientações a comunidade escolar. Nesta perspectiva teve-se, no ano de 2012, um envolvimento de 7.601 alunos, 407 educadores, 15 instituições de ensino mais a comunidade escolar, sendo estes contribuintes de uma reflexão sobre as práticas indevidas do uso de medicamentos e produtos sujeitos à vigilância sanitária. Neste contexto foi possível observar o aprendizado de forma integrada entres os vários atores sociais envolvidos no processo, o que possibilitou a construção de novos valores e experiências no coletivo, aspectos estes que só foram possíveis devido à formação e à multiplicação de conteúdos e experiências integralizadas na prática coletiva

  5. Avaliação quantitativa do efeito do jato de bicarbonato de sódio no esmalte de dentes permanentes jovens Quantitative analysis of the effect of sodium bicarbonate on the enamel surface of young permanent teeth

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    Sara Nader MARTA

    1999-01-01

    Full Text Available Avaliou-se clinicamente o efeito do jato de bicarbonato de sódio sob pressão, empregado na profilaxia da superfície de esmalte sadio de dentes permanentes jovens. Trabalhou-se com réplicas positivas, o que permitiu a análise antes e após a realização de tal procedimento. Foram feitas sessenta moldagens da superfície vestibular de incisivos centrais superiores, as quais sofreram um preparo para a análise quantitativa da rugosidade das superfícies de esmalte. A análise quantitativa foi efetuada utilizando-se o programa para computador Diracom-3, que mensura as sombras e penumbras das imagens dos espécimes. Estabeleceram-se três grupos experimentais com vinte crianças que nunca haviam sido submetidas à profilaxia com Profident, as quais foram moldadas em três momentos. Antes do procedimento ou controle (Grupo 1; imediatamente após (Grupo 2; e um mês após o tratamento (Grupo 3. A análise quantitativa dos dados mostrou não haver diferença estatisticamente significante entre os grupos analisados.The effect of sodium bicarbonate under pressure used in the prophylaxis of the healthful enamel surface of young permanent teeth was clinically evaluated. Positive reproductions were used, which permitted the analysis before and after the realization of such procedure. The moldings of the vestibular surface of central superior incisives made totalized sixty, which went trough a preparation for the quantitative rugosity analysis of the enamel surfaces. The computer program DIRACOM - 3, that measures the shades and half - shadows of the sample images was used for quantitative analysis for which the scanning electron microscopy was employed. Three experimental groups with twenty children each, who had never been submitted to that technique of prophylaxis were established and molds taken in three moments: Group 1 - before the procedure or control ; Group 2 - immediately after and Group 3 - one month after the treatment ( subgroup 2c . The

  6. Estrategias del Teatro del Oprimido para la formación permanente del profesorado (Strategies from the Theatre of the Oppressed for Permanent Training of Teaching Staff (Stratégies du théâtre de l'opprimé pour la formation permanente du corps d'enseignants (Estratégias do teatro do oprimido para a formação permanente do professorado

    Directory of Open Access Journals (Sweden)

    Tomás Motos-Teruel

    2012-06-01

    Full Text Available ResumenEste artículo relata una experiencia y su valoración de forma- ción permanente del profesorado basada en el aprendizaje vi- vencial utilizando como estrategia metodológica el Teatro del Oprimido (TO para estimular y favorecer la reflexión sobre la práctica educativa. Sus objetivos básicos fueron dar a conocer la formulación teórica y la metodología del TO y hacer la trans- ferencia de las estrategias metodológicas vivenciadas a la práctica docente. El estudio se ha planteado desde una óptica cualitativa con el estudio de caso único. Y como resultados más destacables hay que reseñar el interés y la percepción de la utili- dad personal y profesional del TO como instrumento de reflexión sobre la acción y generador de clima positivo. El Teatro del Opri- mido es una formulación teórica y un método estético cuya teo- ría y praxis están inspiradas en la Pedagogía del Oprimido de Paulo Freire, utiliza las técnicas dramáticas como un instrumen- to eficaz para la comprensión y la búsqueda de alternativas a problemas sociales, interpersonales e individuales.AbstractThis paper describes an experience and its as- sessment for application in permanent training of teaching staff, based on experiential learning and using the Theatre of the Oppressed (TO to stimu- late the thought about educational practice. The principal aims were to bring to the attention the theory and methodology of TO and to transfer its experiential methodological strategies to educa- tion practice. The study was designed as a quali- tative analysis of a single case study. The principal results include the interest and perception of use- fulness both at personal and professional levels, of TO as an instrument of thought and a generator of positive environments. The Theatre of the Oppres- sed is a theoretic concept and aesthetic method, the theory and praxis of which are inspired by Paulo Freire's Pedagogy of the Oppressed. It uses dra- ma techniques as

  7. Caracterização das atividades educativas de trabalhadores de enfermagem na ótica da educação permanente

    Directory of Open Access Journals (Sweden)

    Adriana Marques da Silva

    2009-09-01

    Full Text Available Este estudo discute a reciprocidade entre práticas de saúde e educativas e objetiva caracterizar os trabalhadores deenfermagem e suas atividades educativas em região do município de São Paulo. Estudo exploratório-descritivoquantitativo, realizado em 18 serviços de saúde entre 2005/2006, cuja coleta de dados foi feita por meio de entrevistae aplicação de dois formulários. Identificou-se que 84,8% dos trabalhadores de enfermagem atuam nos hospitais epronto socorro (PS; 22,5% são enfermeiros, 15,2%, técnicos de enfermagem (TE e 62,3%, auxiliares deenfermagem (AE. Das 245 ações educativas mapeadas, 78,4% são realizadas nos hospitais e PS,predominantemente, focadas na recuperação da saúde; 46,9% estão direcionadas aos enfermeiros, 39,6% aosenfermeiros, TE e AE e 13,5%, aos TE e AE; 21,2% ações utilizam estratégias tradicionais de ensino e 15,1%, asparticipativas; 69% têm duração de 01-20h; 55,5% são realizadas fora do serviço. Apesar de predominar atividadeseducativas voltadas aos enfermeiros, orientadas para recuperação da saúde, com utilização de estratégias de ensinotradicionais, a presença de ações ancoradas no cotidiano de trabalho, remete à concepção de educação permanente eassinala possibilidades de mudança da abordagem das práticas educativas de trabalhadores na perspectiva daintegralidade da saúde e do cuidado integral de enfermagem.

  8. Contação de história: tecnologia cuidativa na educação permanente para o envelhecimento ativo

    Directory of Open Access Journals (Sweden)

    Nadia Pinheiro da Costa

    Full Text Available RESUMO Objetivo: avaliar pertinência e efetividade da tecnologia cuidativo-educacional "contação de histórias" como estratégia no cultivo do envelhecimento ativo (EA para usuários idosos de uma Unidade Básica de Saúde (UBS, da Amazônia. Método: Pesquisa Convergente Assistencial (PCA, realizada em UBS de Belém, estado do Pará, com oito idosas para testagem da tecnologia. Aplicou-se questionário de avaliação do EA e WHOQOL - breve, avaliação de qualidade de vida. Após capacitação com vistas à educação permanente, idosas contaram histórias para uma plateia que se manifestou respondendo à pergunta: "O que você tirou dela para a sua vida?" Resultados: histórias populares contadas provocaram reações das quais emergiram as categorias: Solidariedade; Respeito ao outro; Imaginação, sonhos, esperança e Cultura do imaginário amazônida. Tal prática resultou positiva, com mudança na qualidade de vida das idosas, no domínio psicológico. Conclusão: "contação de histórias" revelou-se uma tecnologia inovadora, recurso pertinente e efetivo à educação em saúde, especialmente para o envelhecimento ativo.

  9. Diversidad y carbono almacenado en el área forestal permanente de Álvaro Obregón, Calakmul, Campeche

    Directory of Open Access Journals (Sweden)

    Ligia Guadalupe Esparza Olguín

    2018-01-01

    Full Text Available El Área Forestal Permanente (AFP del ejido Álvaro Obregón en Calakmul resguarda selvas subperennifolias que han estado expuestas al manejo forestal. Dada su importancia como reservorios de carbono y biodiversidad, el objetivo de este estudio fue analizar la diversidad arbórea, la acumulación de biomasa y la captura de carbono en diferentes comunidades de dicho tipo de vegetación (selva mediana – SMSP y selva inundable - SI presentes en el AFP, las cuales están en periodo de recuperación desde hace más de 20 años. El trabajo se realizó en parcelas circulares de 1 000 m2, en donde se etiquetaron, midieron (altura y diámetro a la altura de 1.30 m, e identificaron los taxa arbóreos presentes. En las SMSP se determinó una riqueza de 90 especies, con densidades de 5 170 y 3 720 ind ha-1, con una diversidad (H intermedia (2.8 a 2.65. En las SI se identificaron 75 especies, con una densidad (5 920 a 8 630 ind ha-1, y una diversidad (H alta (3.02 a 3.06. La diversidad estructural promedio (Hsdh fue baja para SMSP y SI, con valores de carbono de 16.6 a 37.17 Mg C ha-1, en SMSP; y 36.44 a 44.58 en SI. Se concluye que las selvas subperennifolias analizadas están en recuperación, con procesos de regeneración y captura de carbono importantes para la conservación de la diversidad.

  10. Estimación de la carga de enfermedad por incapacidad laboral permanente en España durante el período 2009-2012

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    María Andrée López

    2014-01-01

    Full Text Available Fundamentos: La incapacidad laboral permanente (IP supone una importante carga social y económica. El objetivo de este estudio fue estimar la carga de enfermedad debida a la IP en España. Métodos: A partir de la Muestra Continua de Vidas Laborales (MCVL se imputó como diagnóstico de la IP (2009-2012 el de la incapacidad temporal (IT iniciada en 2009 en los individuos que cumplieron dos criterios: larga duración de la IT y corta duración del período entre la IT y la IP. Para los casos con diagnóstico imputado se calculó la carga de enfermedad por IP a partir de los años potenciales de vida laboral perdidos (APVLP, definidos como la diferencia entre la edad de jubilación (65 años y la edad de inicio de la IP. Resultados: Según la MCVL, 163.135 (13,6% personas sufrieron de IT en 2009, de las cuáles a 4.738 (0,39% se le reconoció una IP entre 2009-2012. Se pudo establecer el diagnóstico de IP en 3.073 (64,9% casos. Las causas más frecuentes de IP fueron los trastornos musculo-esqueléticos (27,4% y mentales (11,6% que, asimismo, produjeron mayor cantidad de APVLP por IP: 11.086 (26,5% y 7.052 (16,9%, respectivamente. Los trastornos mentales destacaron por producir IP a edades más jóvenes (mediana=49 años. Conclusiones: Los trastornos mentales y los musculo-esqueléticos representaron la mayor carga de enfermedad en individuos en situación de IP.

  11. Custo-efetividade da escovação dental supervisionada convencional e modificada na prevenção da cárie em molares permanentes de crianças de 5 anos de idade Cost-effectiveness of conventional and modified supervised toothbrushing in preventing caries in permanent molars among 5-year-old children

    Directory of Open Access Journals (Sweden)

    Paulo Frazão

    2012-02-01

    Full Text Available O custo-efetividade de um programa modificado de escovação dental supervisionada foi comparado ao programa convencional. Participaram 284 crianças de 5 anos com, pelo menos, um molar permanente com a superfície oclusal irrompida/hígida. Nas unidades de controle, o programa convencional composto de atividade educativa com distribuição de escova e creme dental fluorado foi desenvolvido quatro vezes por ano. Nas unidades de teste, as crianças receberam também escovação profissional nas superfícies oclusais desses dentes, realizada por auxiliar de saúde bucal, empregando-se a técnica de escovação vestíbulo-lingual cinco vezes por ano. Cárie de esmalte/dentina foi registrada nas superfícies vestibular, oclusal e lingual dos molares permanentes durante 18 meses. A razão da densidade de incidência (RDI foi estimada usando o modelo de regressão de Poisson, sendo 50% menor entre os meninos no grupo de teste (p = 0,016. O programa modificado custou R$ 3,04 por criança. A razão de custo-efetividade marginal foi de R$ 10,71 por lesão evitada entre os meninos. O programa modificado foi custo-efetivo nos meninos.The cost-effectiveness of a modified supervised toothbrushing program was compared to a conventional program. A total of 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In the control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice was carried outfour times per year. With the test group, children also underwent professional cross-brushing on surfaces of first permanent molar rendered by a dental assistant five times per year. Enamel/dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars for a period of18 months. The incidence density (ID ratio was estimated using Poisson's regression model. The ID was 50% lower among boys in the test group (p = 0.016. The cost of the

  12. Warfarin Management and Outcomes in Patients with Nonvalvular Atrial Fibrillation Within an Integrated Health Care System.

    Science.gov (United States)

    An, JaeJin; Niu, Fang; Zheng, Chengyi; Rashid, Nazia; Mendes, Robert A; Dills, Diana; Vo, Lien; Singh, Prianka; Bruno, Amanda; Lang, Daniel T; Le, Paul T; Jazdzewski, Kristin P; Aranda, Gustavus

    2017-06-01

    Warfarin is a common treatment option to manage patients with nonvalvular atrial fibrillation (NVAF) in clinical practice. Understanding current pharmacist-led anticoagulation clinic management patterns and associated outcomes is important for quality improvement; however, currently little evidence associating outcomes with management patterns exists. To (a) describe warfarin management patterns and (b) evaluate associations between warfarin treatment and clinical outcomes for patients with NVAF in an integrated health care system. A retrospective cohort study was conducted among NVAF patients with warfarin therapy between January 1, 2006, and December 31, 2011, using Kaiser Permanente Southern California data, and followed until December 31, 2013. Management patterns related to international normalized ratio (INR) monitoring, anticoagulation clinic pharmacist intervention (consultation), and warfarin dose adjustments were investigated along with yearly attrition rates, time-in-therapeutic ranges (TTRs), and clinical outcomes (stroke or systemic embolism and major bleeding). Descriptive statistics and multivariable Cox proportional hazard models were used to determine associations between TTR and clinical outcomes. A total of 32,074 NVAF patients on warfarin treatment were identified and followed for a median of 3.8 years. About half (49%) of the patients were newly initiating warfarin therapy. INR monitoring and pharmacist interventions were conducted roughly every 3 weeks after 6 months of warfarin treatment. Sixty-three percent of the study population had ≥ 1 warfarin dose adjustments with a mean (SD) of 6.7 (6.3) annual dose adjustments. Warfarin dose adjustments occurred at a median of 1 day (interquartile ranges [IQR] 1-3) after the INR measurement. Yearly attrition rate was from 3.3% to 6.3% during the follow-up, and median (IQR) TTR was 61% (46%-73%). Patients who received frequent INR monitoring (≥ 27 times per year), pharmacist interventions (≥ 24

  13. Cenários ambientais para o ordenamento territorial de áreas de preservação permanente no município de Sorocaba, SP

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    Kaline de Mello

    2014-04-01

    Full Text Available Este estudo objetivou analisar a importância das Áreas de Preservação Permanente (APP para a manutenção dos remanescentes florestais no município de Sorocaba, SP. O mapa desses remanescentes foi elaborado com base em fotografias aéreas de 2006, e mapas de hidrografia e de declividade foram usados para determinação das APP. Compararam-se dois cenários: real (mata atual e ideal (mata atual acrescida da restauração das APP, com base em métricas da paisagem. Os resultados indicaram que 19% do município se enquadra como APP e, dessa área, apenas 45% possui cobertura florestal. As APP preservadas representam 50% do total de cobertura florestal da paisagem. A restauração das APP representaria aumento de 16,68% para 28% de cobertura florestal da paisagem e possibilitaria o surgimento de fragmentos maiores que 3.000 ha, enquanto no cenário real os maiores fragmentos atingem 300 ha. Os remanescentes florestais se apresentaram intimamente ligados às APP: margens de rios, áreas alagáveis e encostas, onde a ocupação urbana foi dificultada e existe o instrumento legal de proteção. Esse quadro evidencia que as APP possuem papel fundamental na conservação florestal em um município bastante urbanizado, onde as áreas naturais sofrem muita pressão. A avaliação dos cenários mostrou que a incorporação dos dispositivos legais no planejamento e ordenamento territorial subsidia as estratégias voltadas para a manutenção de hábitats naturais e, consequentemente, a diminuição dos efeitos negativos sobre a biodiversidade. Entretanto, as mudanças recentes no Código Florestal podem representar um retrocesso no cenário ambiental nacional diante da crescente urbanização.

  14. Educação permanente de docentes: análise crítica de experiências não sistematizadas

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    Henriqueta Galvanin Guidio de Almeida

    Full Text Available Quando alterações curriculares abrangentes são propostas para os cursos de Medicina, como no caso da implantação de um currículo integrado, exige-se do professor a modificação de seu papel central de transmissor de conhecimentos para um papel mais cooperativo efacilitador do processo de ensino-aprendizagem, o que pode gerar insegurança, sensação de perda de poder e resistência. A capacitação formal dos docentes para suas novas funções é imperiosa para o sucesso nas mudanças. Além das ações educativas sistematizadas, atividades alternativas podem contribuir para aperfeiçoar a função docente. Este artigo analisa a experiência de docentes do curso de Medicina da Universidade Estadual de Londrina (UEL, membros das comissões de apoio ao colegiado, que desenvolveram, nos primeiros anos da implantação do currículo integrado, atividades não sistematizadas de educação permanente junto a docentes do curso. São comentadas informações a respeito: da reunião semanal realizada com os tutores; da pesquisação sobre a inserção e o desenvolvimento docente no currículo integrado; da revisão dos conteúdos dos módulos temáticos; da pesquisação com os coordenadores dos módulos temáticos; e do inquérito realizado com os preceptores de áreas do internato médico. As atividades analisadas forneceram respostas a demandas locais e contribuíram com a dinâmica de um processo de implantação que deve permanecer em contínua renovação.

  15. Prevalencia de defectos del desarrollo del esmalte en los incisivos permanentes de escolares: un estudio fotográfico en el Sur de Brasil

    Directory of Open Access Journals (Sweden)

    Renata Barbieri Bogo

    2011-01-01

    presencia de DDE en los incisivos permanentes de los escolares en el sur de Brasil fue alta, es importante que el cirujano dentista sea capaz de diagnosticar e identificar los posibles factores etiológicos.

  16. Consumo no Brasil: teoria da renda permanente, formação de hábito e restrição à liquidez

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    Fábio Augusto Reis Gomes

    2004-09-01

    Full Text Available Este artigo analisa a série de consumo agregado do Brasil. Como usual, investiga-se, primeiramente, a aplicabilidade da hipótese do passeio aleatório do consumo, derivada teoricamente a partir das hipóteses de ciclo de vida/renda permanente e expectativas racionais (TRP. Utilizando a decomposição de Beveridge e Nelson (1981 verificamos que o consumo apresenta, além de uma tendência estocástica, uma parte cíclica estacionaria, o que não é compatível com a TRP. Este resultado está em conformidade com o resultado de Reis et alii (1998 de que grande parte da população brasileira está restrita a consumir sua renda corrente, existindo um ciclo comum entre consumo e renda. Em uma tentativa de gerar um processo estocástico para o consumo compatível com a evidência empírica introduzimos formação de hábito nas preferências de um consumidor representativo. No entanto, o processo daí derivado não se mostrou significativo diante da possibilidade dos consumidores serem restritos à liquidez.This article analyzes the behavior of aggregate consumption series in Brazil. As usual, the random walk hypothesis of consumption, derived theoretically from the life cycle/permanent income and rational expectations hypothesis (PIH, is tested. The Beveridge e Nelson (1981 decomposition indicates that the consumption series has a stochastic trend and a cyclical stationary component, incompatible with the PIH. This result is in line with Reis et alii (1998, who concluded that a large fraction of Brazilian people is credit constrained, which generates a common cycle between consumption and income. Following, we introduce habit formation in the preference of a representative consumer in order to attempt to produce a process of consumption compatible with the empirical evidence. However, such a process does not prove itself statistically significant amidst the possibility of credit constraint consumers.

  17. Suspended sediment entrainment estimation in unsteady turbulent flows by means of a stochastic meted; Computo de la incorporacion de sedimento en suspension en flujos turbulentos no permanentes utilizando un enfoque estocastico

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, Jose Fernando; Garcia, Marcelo Horacio [Universidad de Illinois (United States); Admiraal, David Mark [Universidad de Nebraska en Lincoln (United States)

    2001-06-01

    bibliografia, pero todas ellas han sido derivadas para condiciones de flujo permanente y uniforme. La bondad de estas relaciones para predecir tasas de incorporacion en flujos no permanentes no ha sido demostrada y tampoco se ha intentado desarrollar una formulacion general que sea aplicable tanto en condiciones permanentes como no permanentes. El enfoque tradicional relacionada la incorporacion de sedimento con el esfuerzo de corte asociado con la friccion de grano en una forma deterministica, proveyendo solo una relacion entre valores medios. Una alternativa es considerar el esfuerzo de corte y la incorporacion como magnitudes estocasticas turbulentas y expresarlas en terminos de sus funciones de densidad de probabilidad (PDF). De esta manera se pueden obtener estadisticos de la incorporacion a partir de las PDF del esfuerzo de corte tanto en situaciones de flujos permanentes como no permanentes, dado que el efecto de la impermanencia esta implicito en el PDF. Esta nueva metodologia fue usada para estimar la incorporacion de sedimento debido al paso de embarcaciones en los rios Mississippi e Illinois. Al usar una expansion en cumulantes de bajo orden para describir la PDF del esfuerzo de corte y una version generalizada de la relacion de incorporacion de Garcia y Parker, se obtuvo una expresion para el promedio de la incorporacion, en funcion del promedio, varianza, asimetria y kurtosis del esfuerzo de corte. Los resultados se comparan satisfactoriamente con valores mencionados en la literatura.

  18. Defectos del esmalte, caries en dentición primaria, fuentes de fluoruro y su relación con caries en dientes permanentes Enamel defects, caries in primary dentition and fluoride sources: relationship with caries in permanent teeth

    Directory of Open Access Journals (Sweden)

    Ana Alicia Vallejos-Sánchez

    2007-06-01

    Full Text Available Objetivo: Explorar la relación entre la presencia de defectos del esmalte (DE, la experiencia de caries en la dentición temporal, y la exposición a diversas fuentes de fluoruros, con la presencia de caries en la dentición permanente de niños con dentición mixta. Material y métodos: Se realizó un estudio transversal en 713 sujetos de 6-9 años de edad de 4 escuelas de Campeche, México, mediante un cuestionario dirigido a las madres, y un examen clínico bucal a los niños. La variable dependiente fue la prevalencia de caries en la dentición permanente. Resultados: El promedio de dientes temporales cariados, extraídos y obturados (ceod y dientes permanentes cariados, perdidos y obturados (CPOD fue de 2,48 (2,82 (ceod > 0 = 58,9% y 0,40 (0,98 (CPOD > 0 = 18,2%, respectivamente. El índice SiC (índice de caries significativa, calculado en la dentición temporal fue de 5,85 para los niños de 6 años de edad. En el análisis de regresión logística multivariado permanecieron significativas, después de ajustar por variables de exposición a fluoruros, la mayor edad (odds ratio [OR] = 2,99, el ceod > 0 (OR = 5,46, la menor escolaridad de la madre (OR = 1,57 y una interacción entre sexo y defectos del esmalte. Conclusiones: Las caries en la dentición temporal y permanente fueron relativamente menores que las observaciones publicadas por otros estudios en México. Los resultados confirmaron que la caries en la dentición temporal se asoció fuertemente con la caries en la dentición permanente. No hubo una relación significativa entre las fuentes de fluoruro y la caries dental en la dentición permanente.Objective: To examine the relationship between the presence of enamel defects, dental caries in primary teeth, and exposure to various fluoride technologies and the presence of dental caries in permanent teeth in children with mixed dentition. Materials and methods: A cross-sectional study was conducted in 713 children aged 6-9 years old

  19. Hacia un espacio europeo de aprendizaje para toda la vida. Evolución y desarrollo de la Educación Permanente en la Unión Europea.

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    Fernando López Noguero

    2008-01-01

    Full Text Available En sus inicios, la Unión Europea (UE concedió una mínima importancia a la educación en el marco de los derechos y las políticas sociales europeas, aumentando su peso paulatinamente, como comprobaremos en la propia evolución de la Educación Permanente en la UE, desarrollo que hemos dividido en cuatro etapas fundamentales. Así, desde la proclamación del Año Europeo de la Educación y la Formación Permanentes en 1996, en el que se fomentó en el seno de la UE el concepto de aprendizaje durante toda la vida, la Educación Permanente ha cambiado radicalmente en Europa hacia una nueva realidad que se ha dado en llamar “Espacio Europeo de Aprendizaje para toda la vida”, que analizamos en profundidad a través del análisis de la legislación y programas educativos existentes en la UE. ------------------------------------------------------------------------ In its early years, the European Union (EU granted a minimal importance to education in the framework of rights and social policies in Europe, increasing its weight gradually, as we Hill check on the evolution of Continuing Education in EU development which we have divided into tour Basic stages. So we will check how, since the proclamation of the European Year of Education and Training Standing in 1996, which fostered within the EU the concept of lifelong learning, Continuing Education has changed dramatically in Europe towards a new reality that has been termed a “European Area Learning for Life” which analyzed in depth through the analysis of legislation and educational programs existing in the EU.

  20. Las redes sociales en los procesos de adaptación a cambios permanentes de hábitat* Un estudio con habitantes de la Depresión Momposina (Norte de Colombia)

    OpenAIRE

    Gabriel Garrido Escudero; Camilo Madariaga

    2001-01-01

    En este artículo se describen las redes sociales durante los procesos de adaptación a los permanentes cambios que viven los pobladores de la Depresión Momposina en La Travesía, corregimiento de Mompox (Colombia). La información se recogió en una muestra de 262 personas, mediante la triangulación se compararon los resultados cuantitativos y los cuantitativos y se contrastó la información desde diversas estrategias para describir de mejor forma los fenómenos estudiados. Con ba...

  1. "Estudo in vitro do potencial cariostático dos selantes resinosos, dos cimentos ionoméricos, do diamino fluoreto de prata e do verniz fluoretado, aplicados em superfície oclusal de molares permanentes humanos".

    OpenAIRE

    Thereza Christina Lopes Coutinho

    2002-01-01

    O objetivo deste trabalho foi avaliar, in vitro, ao Microscópio de Luz Polarizada (MLP), o potencial cariostático dos selantes resinosos, dos cimentos ionoméricos, do diamino fluoreto de prata e do verniz fluoretado aplicados em superfície oclusal de molares permanentes humanos. Para tanto, 70 terceiros molares humanos hígidos, extraídos por razões clínicas, foram divididos aleatoriamente em sete grupos (N=10): GI – controle (sem selamento); GII – selante resinoso sem flúor Delton ®; G III – ...

  2. Formación del formador de personas adultas: de la realización profesional a la transformación permanente de los entornos comunitarios

    Directory of Open Access Journals (Sweden)

    Antonio MEDINA RIVILLA

    2009-11-01

    Full Text Available RESUMEN: La formación y actualización permanente es un deber y un derecho de los formadores, y un compromiso de las administraciones e instituciones educativas. Los modelos y estrategias de formación del formador se han ido adaptando a las situaciones en las que actúan los formadores. Entre los modelos que más hemos desarrollado con los formadores destacamos:El proceso de autoconocimiento e identidad profesional desde la narrativa justificada de la propia autobiografía formativa.La construcción del saber práctico.El proceso de desarrollo profesional en equipo, con apoyo entre colegas.La creación de una cultura de colaboración. Estas amplias perspectivas se complementan con la transformación de la práctica reflexiva individualizada, que facilita el avance del conocimiento profesional y la madurez formativa de los formadores.Estas perspectivas se integran en un modelo pensativo-colaborativo, fundamentado en un proceso de indagación continua y de avance del saber profesional en coherencia con las teorías implícitas de los formadores/as. El formador/a ha de encontrar las claves para diseñar su itinerario de profesionalización y vivirlo en continua mejora y diálogo con colegas, abierto a las demandas de la comunidad y a los retos -sociolaborales, necesitados de un aprendizaje a lo largo de la vida.ABSTRACT: The formation and permanent update is a duty and a right of the forming ones, and a commitment of the administrations and educational institutions. The models and strategies of formation of the forming one have been adapting to situations in which they actuate the forming ones. Among the models that more we have developed with the forming ones we stand out:The process of self-knowledge and identity professional from the narrative of the own formative autobiography.The construction of to know practically.The process of professional development in equipment, with support between colleagues.The creation of a culture of collaboration

  3. Job-based health insurance: costs climb at a moderate pace.

    Science.gov (United States)

    Claxton, Gary; DiJulio, Bianca; Whitmore, Heidi; Pickreign, Jeremy; McHugh, Megan; Finder, Benjamin; Osei-Anto, Awo

    2009-01-01

    Each year the Kaiser/HRET Survey of Employer Health Benefits takes a snapshot of the state of employee benefits in the United States, based on interviews with public and private employers. Our findings for 2009 show that families continue to face higher premiums, up about 5 percent from last year, and that cost sharing in the form of deductibles and copayments for office visits is greater as well. Average annual premiums in 2009 were $4,824 for single coverage and $13,375 for family coverage. Enrollment in high-deductible health plans held steady. We offer new insights about health risk assessments and how firms responded to the economic downturn.

  4. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions.

    Science.gov (United States)

    Frølich, Anne

    2012-02-01

    The quality of health care services offered to people suffering from chronic diseases often fails to meet standards in Denmark or internationally. The population consisting of people with chronic diseases is large and accounts for about 70% of total health care expenses. Given that resources are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved. The aim of this dissertation is to describe the effect of determinants, such as organisational structures and management practices including two selected incentives, on the quality of care in chronic diseases. The dissertation is based on four studies with the following purposes: 1) macro- or healthcare system-level identification of organisational structures and principles that affect the quality of health care services, based on a comparison of KP and the Danish health care system; 2) meso- or organisation-level identification of management practices with positive effects on screening rates for hemoglobin A1c and lipid profile in diabetes; 3) evaluation of the effect of the CCM on quality of health care services and continuity of care in a Danish setting; 4) micro- or practice-level evaluation of the

  5. Biomasa microbiana y actividad ureasa del suelo en una pradera permanente pastoreada de Chile Soil microbial biomass and urease activity in a grazed permanent pasture from Chile

    Directory of Open Access Journals (Sweden)

    Pedro Antonio Núñez Ramos

    2012-12-01

    Full Text Available En los sistemas de pasturas; la productividad de la pradera puede estar influenciada por el manejo; debido a su impacto sobre los microorganismos del suelo y el reciclaje de nutrientes. El objetivo de este trabajo fue evaluar la biomasa microbiana (BM del suelo asociada al nitrógeno (BMN; carbono (BMC y la actividad ureasa (AU en una pradera permanente del sur de Chile. Entre la primavera de 2005 y el invierno de 2006 fueron evaluados dos sistemas de pastoreo: pastoreo intenso (PI; pastoreo suave (PS y un tratamiento control (C. El diseño fue en bloques al azar con tres repeticiones. En relación a los valores promedios medidos de las variables en pre y post pastoreo; se produjo un incremento en los contenidos de CB en un 21,8 y 8,6% para PI y PS; mientras que en el control fue sólo de 1,9%. Los contenidos de NB también fueron incrementados en un 16 y 19% para PI y PS; respectivamente en comparación con el control (4%. La actividad ureasa aumentó en 13 y 27% para PI y PS; respectivamente en comparación con el control (5%. El pastoreo; produce un flujo más alto de residuos orgánicos en el suelo; lo que estimula la actividad de la biomasa microbiana y; por tanto; aumentó la AU y los contenidos de CB y NB. Esto sugiere que; en los sistemas de pastoreo; se mejora la fertilidad biológica de los suelos y la disponibilidad de nutrientes.In pasture systems, management practices can affect pasture productivity differently due to their impact on soil microorganisms and nutrient cycling. The objective of this study was to evaluate the relationship between soil microbial biomass (MB nitrogen (MBN, carbon (MBC and urease activity (UA in a permanent pasture in southern Chile. Two grazing systems were evaluated between spring 2005 and winter 2006 : heavy grazing (HG, light grazing (LG and a control treatment (C. Treatments were arranged in a randomized block design with three replications. Concerning the average values of the variables measured at

  6. La representación parlamentaria en América latina. Las comisiones permanentes y los partidos en el congreso

    Directory of Open Access Journals (Sweden)

    Luisa BÉJAR

    2009-04-01

    Full Text Available RESUMEN: El principal argumento de este escrito es que la heterogeneidad de los diseños institucionales que prima en el campo electoral en América Latina (Carroll y Shugart, 2005 también se reproduce en el parlamentario. El perfil morfológico del sistema de comisiones propio de cada Congreso y el lugar que la ley les asigna en el proceso legislativo son prueba evidente de ello. Mientras el marco normativo de algunas legislaturas no deja lugar a dudas en cuanto a la intención de delegar en los partidos las decisiones encomendadas a estos cuerpos; en otros casos, ello ocurre en menor medida. En los casos formalmente ceñidos a una lógica de partido, por otra parte, se alientan esquemas de delegación de corte muy diverso. En este escrito se revisa el acomodo institucional del sistema de comisiones de la Cámara Baja en: Argentina; Bolivia; Brasil; Colombia; Chile; México; Paraguay; República Dominicana y Uruguay. En este sentido, el estudio examina tanto la importancia concedida a su trabajo, como algunos aspectos de su morfología que afectan la estructura de incentivos que acota el desarrollo del proceso legislativo. Asimismo, se analizan los procedimientos utilizados en cada Congreso para enfrentar los problemas de acción colectiva. Por último, se presentan algunas ideas para la elaboración de una futura taxonomía sobre la relación que guardan en la región los partidos y las comisiones permanentes del Congreso.ABSTRACT: The main argument of this paper is that the heterogeneity of the institutional framework that prevails in Latin America’s electoral field (Carroll y Shugart, 2005, also reproduces itself in the parliamentary one. This is proved by the morphologic profile of each Congress’ commission system and the place that the law assigns to the system. While some legislative frameworks clearly intend to delegate to parties the decisions entrusted to this bodies; in other cases, this takes place in a less important way. In

  7. Modèle mathématique pour l'étude des équilibres physico-chimiques de permanentes.

    Science.gov (United States)

    Chiodi, F

    1989-12-01

    Résumé La plupart des permanentes du commerce sont constituées d'acide thioglycolique (éventuellement associéà l'acide thiolactique), neutralisé par l'ammoniac, elles sont additionnées de carbonate d'ammonium comme tampon. Le système peut etre traité comme la neutralisation d'un mélange d'acides thioglycolique et carbonique par l'ammoniac, et il est complètement défini par trois paramètres, trois concentrations, ou deux concentrations et le pH, ou trois paramètres analytiques indépendants. Les calculs théoriques de l'équilibre sont compliqués du fait qu'il s'agit de l'équilibre de deux diacides faibles neutralisés par une base faible. Un modèle mathématique développé exclusivement par des équations théoriques permet l'interprétation des équilibres et la réalisation des calculs fiable pour la préparation des formules remplissant certaines caractéristiques. Le modèle permet de réaliser facilement des simulations en faisant varier les concentrations, les acides (par la voie des constantes de dissociation) ou d'associer différents acids et/ou bases organiques ou minérales. Une application complémentaire du modèle est de tracer la courbe dérivée à la courbe de neutralisation et de cette façon mesurer l'effet tampon en différents points par la mesure de sa pente. Synopsis Mathematical model for the study of physico-chemical equilibria in permanent wave solutions Most waving lotions on the market are prepared with thioglycolic acid (eventually associated with thiolactic acid) neutralized with ammonium hydroxide and buffered with ammonium bicarbonate. The system can be treated as the neutralization of a mix of carbonic acid and thioglycolic acid by ammonia and it is completely defined by three parameters: three concentrations; or two concentrations and pH; or three independent analytical parameters. Theoretical calculations of the equilibrium are difficult because the equilibrium involves at least two weak acids with a weak base

  8. Construcción narrativa de los vínculos de familias sustitutas permanentes del programa aldeas infantiles SOS Bogotá

    Directory of Open Access Journals (Sweden)

    Carlos Arturo Castelblanco

    2012-07-01

    Full Text Available Abstract This article presents a research intervention from a systemic approach-constructivist-constructionist based on the conversational narrative - the phenomenon is to understand the narrative construction of permanent substitute families of the ONG children’s villages SOS Bogota-Colombia in relation to the senses of family identity, belonging, permanence and organizational process associated with the construction of possibilities of welfare and autonomy. Participated two foster families consisting of mother, aunt, nine children or young people, as well as juvenile companions, the psychosocial team and management of the organization. The approach is qualitative design of conversational scenarios and reflective equipment. As results is understandable experience to link families based in the relational discursive dynamics, narrated, lived and validated in multiple ways and strategies against the dilemmas that live to build family in an organizational context. It redefines the concept of family as well, seeing it now as a metaphor, generative system where they develop and strengthen the dimensions of being, allowing their emancipation. It also covers the conversational narrative as reflective gear construction itself, which accounts for the self-adaptive learning context recursive structures in language. Resumen El presente artículo expone una investigación-intervención desde un enfoque sistémico-constructivista-construccionista basado en la narrativa conversacional, cuyo objeto consistió en comprender la construcción narrativa de los vínculos de las familias sustitutas permanentes de la ONG Aldeas Infantiles SOS Bogotá-Colombia, en relación con los sentidos de identidad familiar, pertenencia, permanencia y proceso organizacional, asociados a la construcción de posibilidades de bienestar y autonomía. Participaron dos familias sustitutas, constituidas por madre, tía social y nueve niños o jóvenes, además de acompa

  9. Voces de Complementariedad: una Nueva Propuesta Para la Prevención de la Violencia en el Ámbito de la Educación Permanente

    Directory of Open Access Journals (Sweden)

    Cecilia Vicentini

    2003-01-01

    Full Text Available Se realizó una investigación de carácter cualitativo para demostrar que exis-te necesidad en este nuevo siglo de construir un nuevo pensamiento racional a través de la práctica de la complementariedad si queremos disminuir los niveles de violencia en el planeta. Hasta ahora hemos aceptado un mundo basado en polaridades y opuestos y hemos hecho la guerra porque no podemos aceptar las diferencias entre las personas. Hemos aceptado vivir en un mundo dividido donde la separación es vista como algo normal, como el resultado de la prácti-ca de viejas formas de pensamiento; esta situación es una de las causas princi-pales de la violencia hoy día, estamos tan distantes unos de otros que no pode-mos construir espacios comunes donde encontramos y estar juntos El objetivo principal del estudio fue proponer la necesidad de la complemen-tariedad a través de la construcción de puentes entre los seres humanos, entre hombres y mujeres, entre grupos en conflicto dentro de una nación y entre naciones. Nosotros, como seres humanos, necesitamos participar en la cons-trucción de nuevas realidades, necesitamos desarrollar el poder de imaginar y sonar nuevas formas de existencia en el planeta tierra. De Beauport es una experta educativa emergente que propone un modelo de inteligencias múltiples como camino de prevención de la violencia; ella plantea que hay 3 obstáculosp rincipales a la paz: la creencia de que para resolver los conflictos debemos utili-zar la fuerza, sea mental o física; el manejo inadecuado del miedo y las frustra-ciones y la práctica de un dualismo que ocasiona que la gente se vea como opuestos y en permanente confrontación. Estos tres factores forman la plataforma del presente estudio, realizado en el contexto de una sociedad muy polarizada en el aspecto político, en el cual la violencia se está convirtiendo en una situación crítica: la sociedad venezolana. El objetivo principal del estudio fue experimentar estrategias para

  10. Educação Permanente em SBV e SAVC: impacto no conhecimento dos profissionais de enfermagem Educación permanente en SBV y SAV: impacto en el conocimiento de los profesionales de enfermería Permanent Education in BLS and ACLS: impact on the knowledge of nursing professionals

    Directory of Open Access Journals (Sweden)

    Sandro Gonçalves de Lima

    2009-12-01

    Full Text Available FUNDAMENTO: O conhecimento teórico e as habilidades práticas das equipes de Suporte Básico de Vida (SBV e Suporte Avançado de Vida (SAV estão entre os determinantes mais importantes das taxas de sucesso em reanimação cardiopulmonar. OBJETIVO: Avaliar o impacto de um programa permanente de treinamento em SBV e SAV no conhecimento dos profissionais de enfermagem. MÉTODO: Estudo de corte transversal. A população foi composta por profissionais de enfermagem de um hospital de nível terciário. Foram realizadas avaliações antes e após o treinamento. Abordaram-se pontos críticos das diretrizes do International Liaison Committee on Resuscitation (ILCOR. RESULTADOS: Foram avaliados 213 profissionais (76 enfermeiros, 35,7%; 38 auxiliares, 17,8%; e 99 técnicos, 46,7%. As médias na avaliação pré-curso foram estatisticamente diferentes (pFUNDAMENTO: El conocimiento teórico y las habilidades prácticas de los equipos de Soporte Básico de Vida (SBV y Soporte Avanzado de Vida (SAV están entre los determinantes más importantes de los índices de éxito en reanimación cardiopulmonar. OBJETIVO: Evaluar el impacto de un programa permanente de entrenamiento en SBV y SAV en el conocimiento de los profesionales de enfermería. MÉTODO: Estudio de corte transversal. La población estaba compuesta por profesionales de enfermería de un hospital de nivel terciario. Se realizaron evaluaciones antes y después del entrenamiento. Se abordaron puntos críticos de las directrices del International Liaison Committee on Resuscitation (ILCOR. RESULTADOS: Se evaluaron 213 profesionales (76 enfermeros, 35,7%, 38 auxiliares, 17,8% y 99 técnicos, 46,7%. Los promedios en la evaluación previa al curso fueron estadísticamente diferentes (pBACKGROUND: The theoretical knowledge and practical skills of the Basic Life Support (BLS and the Advanced Life Support (ALS are among the most important determining factors of the cardiopulmonary reanimation success rates

  11. Measuring integrated care.

    Science.gov (United States)

    Strandberg-Larsen, Martin

    2011-02-01

    The positive outcomes of coordination of healthcare services are to an increasing extent becoming clear. However the complexity of the field is an inhibiting factor for vigorously designed trial studies. Conceptual clarity and a consistent theoretical frame-work are thus needed. While researchers respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser Permanente has been put forward as an example for European healthcare systems to follow, although the evidence base is far from conclusive. The thesis has five objectives: 1) To contribute to the understanding of the concept of integration in healthcare systems and to identify measurement methods to capture the multi-dimensional aspects of integrated healthcare delivery. 2) To assess the level of integration of the Danish healthcare system. 3) To assess the use of joint health plans as a tool for coordination between the regional and local level in the Danish healthcare system. 4) To compare the inputs and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine the associations between specific organizational factors and clinical integration within each system. The literature was systematically searched to identify methods for measurement of integrated healthcare delivery. A national cross-sectional survey was conducted among major professional stake-holders at five different levels of the Danish healthcare system. The survey data were used to allow for analysis of the level of integration achieved. Data from the survey were

  12. Prevalence of Childhood and Adolescent Overweight and Obesity from 2003 to 2010 in an Integrated Health Care Delivery System

    Directory of Open Access Journals (Sweden)

    Scott Gee

    2013-01-01

    Full Text Available An observational study of the Kaiser Permanente Northern California (KPNC BMI coding distributions was conducted to ascertain the trends in overweight and obesity prevalence among KPNC members aged 2–19 between the periods of 2003–2005 and 2009-2010. A decrease in the prevalence of overweight (−11.1% change and obesity (−3.6% change and an increase in the prevalence of healthy weight (+2.7% change were demonstrated. Children aged 2–5 had the greatest improvement in obesity prevalence (−11.5% change. Adolescents aged 12–19 were the only age group to not show a decrease in obesity prevalence. Of the racial and ethnic groups, Hispanics/Latinos had the highest prevalence of obesity across all age groups. The KPNC prevalence of overweight and obesity compares favorably to external benchmarks, although differences in methodologies limit our ability to draw conclusions. Physician counseling as well as weight management programs and sociodemographic factors may have contributed to the overall improvements in BMI in the KPNC population. Physician training, practice tools, automated BMI reminders and performance feedback improved the frequency and quality of physician counseling. BMI screening and counseling at urgent visits, in addition to well-child care visits, increased the reach and dose of physician counseling.

  13. Telecommunications: One World-Mind. Kaiser News.

    Science.gov (United States)

    Fabun, Don, Ed.

    Until a few years ago, the concept of communication was restricted to conventional means: words and media. But recent research has discovered unusual means of communicating, both between animals, between humans, and between humans and animals which are fascinating and may offer hope for the future of man. This research, described in journalistic…

  14. Redshift sensitivity of the Kaiser effect

    International Nuclear Information System (INIS)

    Simpson, Fergus

    2010-01-01

    We explore potential strategies for testing general relativity via the coherent motions of galaxies. Our position at z=0 provides the reference point for distance measures in cosmology. By contrast, the cosmic microwave background at z≅1100 acts as the point of reference for the growth of a large-scale structure. As a result, we find there is a lack of synergy between growth and distance measures. We show that, when measuring the gravitational growth index γ using redshift-space distortions, typically 80% of the signal corresponds to the local growth rate at the galaxy bin location, while the remaining fraction is determined by its behavior at higher redshifts. In order to clarify whether modified gravity may be responsible for the dark energy phenomenon, the aim is to search for a modification to the growth of structure. One might expect the magnitude of this deviation to be commensurate with the apparent dark energy density Ω Λ (z). This provides an incentive to study redshift-space distortions at as low a redshift as is practical. Specifically, we find the region around z=0.5 offers the optimal balance of available volume and signal strength.

  15. Transforming and Sustaining the Care Environment

    OpenAIRE

    Goldfisher, Anne M.; Hounslow, Barbara; Blank, Judi

    2014-01-01

    Background: Caring Science Theory and Practices have been part of the Kaiser Permanente's Strategic Priority for Kaiser Permanente Northern Region since 2010. Their goal is to ensure the continued spread across the medical center of practices guided by the Caring Sciences framework that fosters caring-healing environments and that reinforce helping-trusting relationships between caregivers and between caregivers and patients. Methods: Gaining senior-level leader sponsorship is an essential el...

  16. Educação permanente em saúde: uma estratégia de gestão para pensar, refletir e construir práticas educativas e processos de trabalhos Permanent education in the healthcare field: a management strategy to think, reflect and build educational practices and work processes

    Directory of Open Access Journals (Sweden)

    Flávia Carotta

    2009-03-01

    Full Text Available Este trabalho relata a experiência de implantação da Política Nacional de Educação Permanente em Saúde (EPS, proposta pelo Ministério da Saúde (Portaria 198 de fevereiro de 2004 no município de Embu, Estado de São Paulo, Essa implantação foi adotada pela gestão municipal com o objetivo de identificar e definir ações educativas que qualifiquem a atenção e a gestão em saúde através da formação e do desenvolvimento dos trabalhadores do setor. A EPS trabalha com ferramentas que buscam a reflexão crítica sobre a prática cotidiana dos serviços de saúde, sendo, por si só, um processo educativo aplicado ao trabalho que possibilita mudanças nas relações, nos processos, nos atos de saúde e nas pessoas. Outras potencialidades dessa estratégia são: fortalecimento do controle social; repolitização do Sistema Único de Saúde (SUS; incentivo ao protagonismo de usuários e trabalhadores no processo saúde e doença e a produção de um impacto positivo sobre a saúde individual e coletiva da população.The present work reports the experience of the local authority of Embu, in the State of São Paulo, in the implementation of the National Policy of Permanent Health Education (PHE proposed by the Ministry of Health. This strategy was adopted by the municipal management with the objective of identifying and defining educational actions that qualify health care and management through the education and development of the workers of the sector. PHE works with tools that aim at the critical reflection on the daily practice of the health services, being an educational process applied to work that enables changes in the relations, processes, healthcare practices and persons. Other potentialities of this strategy are: strengthening of social control; re-politicization of the Brazilian public health system (SUS; stimulation to the leading role of users and workers in the health and disease process; and production of a positive impact

  17. Hepatitis C screening trends in a large integrated health system.

    Science.gov (United States)

    Linas, Benjamin P; Hu, Haihong; Barter, Devra M; Horberg, Michael

    2014-05-01

    As new hepatitis C virus (HCV) therapies emerge, only 1%-12% of individuals are screened in the US for HCV infection. Presently, HCV screening trends are unknown. We utilized the Kaiser Permanente Mid-Atlantic States' (KPMAS) data repository to investigate HCV antibody screening between January 1, 2003 and December 31, 2012. We identified the proportion screened for HCV and 5-year cumulative incidence of screening, the screening positivity rate, the provider types performing HCV screening, patient-level factors associated with being screened, and trends in screening over time. There were 444,594 patients who met the inclusion criteria. Overall, 15.8% of the cohort was ever screened for HCV. Adult primary care and obstetrics and gynecology providers performed 75.9% of all screening. The overall test positivity rate was 3.8%. Screening was more frequent in younger age groups (P <.0001) and those with a documented history of illicit drug use (P <.0001). Patients with missing drug use history (46.7%) were least likely to be screened (P <.0001). While the rate of HCV screening increased in the later years of the study among those enrolled in KPMAS 2009-2012, only 11.8% were screened by the end of follow-up. Screening for HCV is increasing but remains incomplete. Targeting screening to those with a history of injection drug will not likely expand screening, as nearly half of patients have no documented drug use history. Routine screening is likely the most effective approach to expand HCV screening. Copyright © 2014. Published by Elsevier Inc.

  18. Extração de eletrodo de marcapasso endocárdico permanente pela aplicação de radiofreqüência

    Directory of Open Access Journals (Sweden)

    Roberto COSTA

    1998-04-01

    Full Text Available Introdução: Uma nova opção terapêutica para a remoção de cabos-eletrodo endocárdicos permanentes desativados é apresentada, utilizando a radiofreqüência para facilitar a liberação do eletrodo a partir do endocárdio, permitindo a extração transvenosa do sistema. Os resultados obtidos nos 4 primeiros pacientes tratados são apresentados. Casuística: Quatro pacientes portadores de processos infecciosos em eletrodos transvenosos abandonados foram submetidos a procedimento para remoção do cateter. Todos os pacientes eram portadores de eletrodos de fixação passiva por aletas implantados no ventrículo direito de 8,5 a 18,8 anos (M = 12,9 ± 5,6 antes. Em todos os casos a técnica da tração contínua havia sido utilizada exaustivamente, não se conseguindo a remoção. Métodos: Utilizou-se gerador de radiofreqüência Radionics RFG3D com anodo de 85 cm2 justaposto ao dorso do paciente e usou-se como catodo o próprio eletrodo a ser removido. Concomitante à tração contínua do cabo-eletrodo a aplicação de radiofreqüência era iniciada. Para cada paciente foram realizadas até três aplicações de 50 W com um tempo máximo de aplicação de 60 segundos em cada aplicação. O tempo e a potência foram determinados empiricamente pela equipe médica, considerando-se insucesso a não liberação do eletrodo a partir do miocárdio após a aplicação do montante de energia acima descrito. Resultados: O cabo-eletrodo foi removido completamente em 2 pacientes. Em 1, a radiofreqüência dissolveu a solda do condutor à ponta do eletrodo, que ficou presa ao miocárdio e no último paciente não houve liberação do cabo após o uso da máxima energia preestabelecida. Não houve complicações ou óbitos. Conclusões: A radiofreqüência pode ser usada como opção terapêutica para a liberação transvenosa de eletrodos abandonados. Maior experiência deve ser obtida para determinar a energia que deve ser utilizada para maximizar os

  19. The Permanent Disposal of Highly Radioactive Wastes by Incorporation into Glass; Elimination Permanente de Dechets Hautement Radioactifs par Incorporation dans le Verre; 041e 041a 041e 041d 0427 0414 ; La Evacuacion Permanente de Desechos de Elevada Radiactividad Incorporandolos en Vidrio

    Energy Technology Data Exchange (ETDEWEB)

    Watson, L. C.; Aikin, A. M.; Bancroft, A. I. [Atomic Energy of Canada Ltd. (Canada)

    1960-07-01

    Development of a process for the incorporation of the high-level wastes from chemical processing operations into glass for permanent disposal has continued at Chalk River. The process has been demonstrated by making glass containing up to 50 curies of five- to six-year old mixed fission products per kg. The operation was batch wise, on a scale of four kg per batch. These operations showed that the fission products could be incorporated into glass safely and conveniently. Consideration of the many problems involved in the permanent storage or disposal of the highly radioactive glass has resulted in the conclusion that it should be buried in the ground or stored in artificial vaults. In such conditions, the disposal may always be-subjected to further control if required. If disposal is made directly to the ground, the principal method by which fission products can be released to the environment is by leaching from the glass into water. It is therefore considered important to know the rate at which fission products will be dispersed by this mechanism. Considerable data on leaching by water have been obtained in the laboratory. It has been found that the rates of release depend on the composition of the glass. For all the compositions tested the measurements showed that the rate of leaching of fission products from the glass decreased with time. After several months in water the rate of release of several compositions was about 10{sup -4} per cent per year from a two kg hemisphere of glass. The data obtained have been used to estimate the release of fission products from glass containing the large quantities of fission products which will accumulate from operation of power reactors. (author) [French] On poursuit a Chalk River les travaux de mise au point d'un procede permettant d'incorporer dans le verre, pour elimination permanente, des dechets hautement radioactifs provenant d'operations de traitement chimique! Aux fins de demonstration du procede, on a fabrique du

  20. How dentists diagnose and treat defective restorations: evidence from the dental practice-based research network

    DEFF Research Database (Denmark)

    Gordan, Valeria V; Garvan, Cynthia W; Richman, Joshua S

    2009-01-01

    , Norway and Sweden. METHODS: A questionnaire was sent to all DPBRN practitioner-investigators who reported doing some restorative dentistry (n = 901). Questions included clinical case scenarios that used text and clinical photographs of defective restorations. Dentists were asked what type of treatment......OBJECTIVES: To (1) identify and quantify the types of treatment that dentists use to manage defective dental restorations and (2) identify characteristics that are associated with these dentists' decisions to replace existing restorations. The Dental Practice-Based Research Network (DPBRN) consists...... of dentists in outpatient practices from five regions: AL/MS: Alabama/Mississippi; FL/GA: Florida/Georgia; MN: dentists employed by HealthPartners and private practitioners in Minnesota; PDA: Permanente Dental Associates in cooperation with Kaiser Permanente's Center for Health Research and SK: Denmark...

  1. La difusión e interpretación del Patrimonio cultural e histórico-educativo como tema de estudio en el Centro de Formación Permanente de la Universidad de Sevilla

    Directory of Open Access Journals (Sweden)

    Pablo Álvarez Domínguez

    2010-06-01

    Full Text Available (ES Recoge este texto el resultado de una experiencia educativa organizada por el Museo Pedagógico Andaluz y desarrollada el pasado mes de mayo de 2010 en el Centro de Formación Permanente de la Universidad de Sevilla, con la finalidad de propiciar una reflexión teórico-práctica ligada a las nuevas posibilidades didácticas y de difusión del patrimonio cultural e histórico-educativo que se pueden desplegar en el ámbito museístico, con el fin de facilitar su estudio, comprensión y valoración.

  2. La Diputación Permanente en la Constitución de Cádiz o el intento frustrado de crear un órgano con funciones de garantía constitucional

    Directory of Open Access Journals (Sweden)

    Ángel Luis Alonso de Antonio

    2012-01-01

    Full Text Available La Diputación Permanente de la Constitución de 1812 es el órgano de continuidad parlamentaria para mantener la representación de la voluntad popular en los períodos en los que las Cortes no estuvieran trabajando en plenitud. Significó también un intento frustrado de establecer un mecanismo eficaz para garantizar el cumplimiento del propio texto constitucional y por tanto su defensa ante las violaciones por parte de otros órganos del Estado. The Permanent Delegation of the Constitution of 1812 is the parliamentary body to maintain continuity of the representation of popular will in the periods in which the courts were not working fully. It also meant an unsuccessful attempt to establish an effective mechanism to ensure compliance with the constitutional text itself and therefore its defense against violations by other state bodies.

  3. Métodos para determinação de parâmetros de máquinas síncronas de ímãs permanentes

    OpenAIRE

    Guilherme Homrich

    2016-01-01

    A teoria de duplo eixo é geralmente utilizada para modelar e caracterizar máquinas síncronas de polos salientes. O conhecimento das indutâncias de eixo direto e eixo em quadratura são fundamentais para o desenvolvimento destes modelos e para o projeto de controladores destas máquinas. No entanto, métodos tradicionais para determinação destas indutâncias através de ensaios tornam-se impraticáveis em máquinas síncronas de ímãs permanentes pela impossibilidade de controlar a corrente de campo. R...

  4. A influência da perda bilateral do primeiro molar inferior permanente na morfologia dentofacial: um estudo cefalométrico The influence of bilateral lower first permanent molar loss on dentofacial morfology: a cephalometric study

    Directory of Open Access Journals (Sweden)

    David Normando

    2010-12-01

    Full Text Available OBJETIVO: avaliar as alterações cefalométricas em pacientes com perda bilateral do primeiro molar inferior permanente. MÉTODOS: foram analisadas 68 telerradiografias laterais de pacientes de consultórios particulares. A amostra foi dividida em dois grupos pareados quanto ao sexo e idade - 34 indivíduos sem perdas (grupo controle e 34 com perda bilateral do primeiro molar inferior permanente (grupo com perda. Foram excluídos da amostra pacientes que haviam perdido outros dentes que não o primeiro molar inferior, casos de agenesia e pacientes com menos de 16 anos de idade. Buscou-se avaliar somente indivíduos que tivessem relatado a perda há pelo menos 5 anos. RESULTADOS: demonstraram que a perda bilateral do primeiro molar inferior permanente leva ao suave fechamento do ângulo GnSN (P=0,05, um giro anti-horário do plano oclusal (P=0,0001, uma suave diminuição da altura facial anteroinferior (P=0,05, uma acentuada inclinação lingual (P=0,04 e retrusão dos incisivos inferiores (P=0,03. Por outro lado, a perda bilateral do primeiro molar inferior permanente não foi capaz de influenciar a relação maxilomandibular no sentido anteroposterior (P=0,21, a quantidade de mento (P=0,45, a inclinação dos incisivos superiores (P=0,12 e a posição anteroposterior dos incisivos superiores (P=0,46. CONCLUSÃO: a perda bilateral dos primeiros molares inferiores é capaz de produzir alterações marcantes no posicionamento dos incisivos inferiores e no plano oclusal, além de uma suave redução vertical da faceOBJECTIVE: To evaluate cephalometric changes in patients after bilateral loss of lower first permanent molar teeth. METHODS: Sixty-eight lateral radiographs of patients from private practices were analyzed. The sample was divided into two groups matched for age and gender: 34 individuals without loss (control group and 34 presenting with bilateral loss of lower first permanent molar teeth (loss group. Patients who had lost teeth other

  5. Implantação das mesas nacionais de negociação permanente do Sistema Único de Saúde em secretarias estaduais e municipais de saúde

    Directory of Open Access Journals (Sweden)

    Carinne Magnago

    Full Text Available Resumo O objetivo deste artigo é avaliar a implantação da mesa de negociação permanente e identificar os entraves e os avanços decorridos dos processos de negociação no âmbito dos estados e dos municípios brasileiros. O método usado foi estudo descritivo e exploratório, de abrangência nacional. A coleta de dados se deu em 2012 e 2013, por meio de survey com 519 gestores de saúde e grupos focais com 49 gestores e 11 integrantes da Mesa Nacional de Negociação Permanente. Dados foram analisados por estatística descritiva e por análise de conteúdo. Verificou-se existência de 132 mesas de negociação, das quais apenas 87 estão em funcionamento. Os principais motivos para não implantação das mesas são a falta de assessoria técnica e a utilização de outras ferramentas para negociação do trabalho. As principais mudanças nas relações de trabalho em decorrência da atuação das mesas de negociação foram a realização de concursos e de processos seletivos públicos, políticas de desprecarização do trabalho e a implantação de planos de cargos, carreiras e salários. Conclui-se que apesar da potencialidade das mesas como dispositivos de negociação, sua implantação e seu pleno funcionamento esbarram em grandes desafios.

  6. Política de formação e educação permanente em saúde no brasil: bases legais e referências teóricas

    Directory of Open Access Journals (Sweden)

    Renata Lúcia Gigante

    Full Text Available Resumo Este artigo teve como objetivo discutir as inter-relações dos relatórios das Conferências Nacionais de Saúde com as propostas apresentadas em documentos oficiais do Sistema Único de Saúde referentes à formação e desenvolvimento de recursos humanos, buscando relacioná-los à incorporação de novos referenciais pedagógicos pautados pelas metodologias ativas de ensino-aprendizagem. O estudo aqui apresentado foi do tipo exploratório, referente à pesquisa na literatura das áreas de saúde e educação, no período de 1941 – realização da 1a Conferência Nacional de Saúde – até 2007, quando foi publicada a portaria n. 1.996 GM/MS. Essa portaria definiu novas diretrizes e estratégias para a implementação da Política Nacional de Educação Permanente em Saúde, com o objetivo de evidenciar a importância da formação de recursos humanos para a consolidação do Sistema Único de Saúde. Verificou-se que há correlação entre as reivindicações que emergem de necessidades sociais identificadas na construção do Sistema Único de Saúde e as propostas inscritas nas legislações pertinentes. Destaca-se que o sucesso de projetos de educação permanente depende de profunda imbricação entre processos educativos e de intervenção institucional, que contemplem a complexidade dos modos de fazer saúde.

  7. Historia poblacional, orígenes africanos y microevolución de los actuales afro-colombianos inferidos desde caracteres epigenéticos en la dentición decidua y permanente

    Directory of Open Access Journals (Sweden)

    Delgado Burbano, Miguel E.

    2006-01-01

    Full Text Available Setenta y cinco rasgos coronales no-métricos en la dentición permanente y decidua fueron registrados en 178 modelos dentales de individuos afro-colombianos pertenecientes a la comunidad de Guapi. Se recolectaron datos comparativos de 33 grupos africanos, otro grupo afro-estadounidense en la dentición permanente, en 4 grupos afro-americanos y otros 12 grupos de diferente ascendencia étnica, en la dentición decidua. Un análisis multivariado de componentes principales basado en frecuencias dentales, mostró que los afro-colombianos poseen gran afinidad genética con el Africa Sub-Sahariana, específicamente con grupos del Occidente, del Oriente y del Sur-Oriente africano. Este mismo análisis detectó una marcada divergencia dental con las poblaciones Norafricanas. Los resultados de esta investigación concuerdan con recientes estudios genéticos, basados en marcadores de ADNmt. A pesar que la dentición es evolutivamente conservativa y estable en una escala diacrónica corta, se concluyó que en 400 años de microevolución de los africanos en Colombia, su pool genético original se ha modificado levemente, debido a la influencia de presiones selectivas y flujo génico interétnico, con nativos americanos y grupos de origen caucásico. Se sugiere que los grupos afro-descendientes del Norte, Centro y Sur de América poseen historias poblacionales y evolutivas distintas, debido tanto a procesos de diferenciación fenotípica regional y local como a orígenes geográficos y étnicos diferentes.

  8. Simulación del Comportamiento Dinámico de un Pequeño Aerogenerador de Imán Permanente Sin Multiplicador en operación autónoma haciendo uso del MatLab

    Directory of Open Access Journals (Sweden)

    Osley López González

    2011-10-01

    Full Text Available En este trabajo los autores hacen uso del software MATLAB SIMULINK versión 7.7.0.471 R2008b para el análisis del comportamiento de un sistema generación eólico de 2 kW autónomo sin multiplicador con generador de imanes permanentes y batería de Plomo-ácido. Se utilizan para ello los modelos de los generadores de imanes permanentes, batería, convertidores así como otros elementos del sistema eléctrico existente en el toolbox SimPowerSystems de este software y se obtiene y discute el comportamiento dinámico de las variables del conjuntoturbina-generador, las variables del bus de directa, así como también las variables de la carga, ante diferentes condiciones de trabajo del sistema. Los resultados basados en simulaciones muestran el correcto funcionamiento de todas las variables de control que regulan el sistema generador eólico-elemento almacenador-carga eléctrica consumida, cuando se somete a perturbaciones típicas como lo son la variación en racha del viento y variación de la carga repentina. The utilization of the popular software MATLAB SIMULINK 7.7.0.471 in order to analyze a 2kW Direct driven Permanent Magnet generator for wind turbine in autonomous operation, including battery of Lead-acid is exposed by the authors. The existent models of the SimPowerSystems MATLAB toolbox are used in order to obtain and discuss the dynamic behavior of the principal variables under different conditions of work of the system.

  9. Reporting on a Talk I Gave Some Months Ago, the Headline in "La Opinion," Los Angeles' Premier Spanish Language Newspaper, Declared the City's School System "en crisis permanente." No One Wrote in to Disagree. The Claremont Letter. Volume 3, Issue 1

    Science.gov (United States)

    Kerchner, Charles T.

    2008-01-01

    Reporting on a talk the author gave some months ago, the headline in "La Opinion," Los Angeles' premier Spanish language newspaper, declared the city's school system "en crisis permanente." No one wrote in to disagree. Indeed, at the end of "Learning from L.A.: Institutional Change in American Public Education" (Harvard Education Press) the author…

  10. A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults

    OpenAIRE

    Agmon M; Belza B; Nguyen HQ; Logsdon RG; Kelly VE

    2014-01-01

    Maayan Agmon,1 Basia Belza,2 Huong Q Nguyen,2,3 Rebecca G Logsdon,2 Valerie E Kelly41The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa, Israel; 2School of Nursing, University of Washington, Seattle, WA, USA; 3Department of Research and Evaluation, Kaiser Permanente, CA, USA; 4School of Medicine, University of Washington, Seattle, WA, USABackground: Injury due to falls is a major problem among older adults. Decrements in dual-task postu...

  11. Percepção da educação permanente, continuada e em serviço para enfermeiros de um hospital de ensino La percepción de la educación permanente, continuada y en servicio para el enfermero del hospital de enseñanza The perception of permanent, continuous, in service education for nurses in a school hospital

    Directory of Open Access Journals (Sweden)

    Amarílis Schiavon Paschoal

    2007-09-01

    Full Text Available Este estudo tem como objetivo discutir a concepção de educação permanente, continuada e em serviço junto a enfermeiros de um hospital de ensino. É uma pesquisa de natureza qualitativa, na qual a coleta dos dados foi realizada pela técnica do grupo focal, durante seis sessões gravadas em áudio e vídeo. Participaram deste estudo nove enfermeiros de um hospital de ensino. Para analisar os dados, utilizou-se a técnica do discurso do sujeito coletivo, que consiste na organização e tabulação de dados qualitativos de natureza verbal obtidos por meio de depoimentos, da qual resultou um único discurso. A pesquisa demonstrou que os enfermeiros diferenciaram os termos educação permanente, continuada e em serviço, construindo conceitos próprios, ressaltando a importância da diferenciação para definir o tipo de ação a ser tomada diante da necessidade educativa apresentada.Este estudio tiene como objetivo la discusión de la concepción de los términos de la educación permanente, continuada y en servicio con enfermeros del hospital de enseñanza. Es una investigación de naturaleza cualitativa, en que fueron recogidos los datos a través de la técnica del grupo focal, durante seis sesiones grabadas en audio y video. Participaron de este estudio nueve enfermeros de un hospital de enseñanza. Para analizar los datos fue utilizada la técnica del discurso del sujeto colectivo, que consiste en la organización y tabulación de datos cualitativos de naturaleza verbal obtenidos por medio de deposiciones, que resultó de un único discurso. La investigación demostró que los enfermeros diferenciaron los términos educación permanente, continuada y en servicio, construyendo conceptos propios, resaltando la importancia de la diferenciación para definir el tipo de acción a ser tomada delante de la necesidad educativa representada.This study is aimed at discussing the conception of permanent, continuous, in service education among nurses

  12. Perda precoce de molares permanentes e fatores associados em escolares de 9, 12 e 15 anos da rede pública municipal de Campina Grande, Estado da Paraíba, Brasil = Early loss of permanent molars and associated factors in schoolchildren aged 9, 12 and 15 years attending public schools in Campina Grande, Paraíba State, Brazil

    Directory of Open Access Journals (Sweden)

    Francineide Guimarães Carneiro de Melo

    2011-01-01

    Full Text Available Este estudo avaliou a perda precoce de molares permanentes em escolares da rede pública de Campina Grande, Estado da Paraíba, com idades de nove, 12 e 15 anos. A amostra compreendeu 873 escolares, aleatoriamente selecionados. O instrumento de coleta consistiu de um questionário e de uma ficha clínica. As variáveis do estudo compreenderam os aspectos relativos à perda dentária (tipo de elemento dental, localização na arcada dentária e a região do arco, à prevenção e à autopercepção em saúde bucal. A análise estatística compreendeu a distribuição de frequências e os testes do Qui-quadrado e Exato de Fisher. Os resultados revelaram a prevalência de 17,2% de perda dentária, sem diferenças entre os sexos, frequência de escovação e palestra educativa (p > 0,05. Os elementos dentários 36 (42,5% e 46 (33,9% foram os mais frequentemente perdidos. Observou-se a associação positiva entre perda dentária e as variáveis idade, visita ao cirurgião-dentista (OR = 2,19; IC95%: 1,35-3,59, satisfação com o sorriso (OR = 0,40; IC95%: 0,24-0,65 e a dificuldade na mastigação (OR = 2,16; IC95%: 1,48- 3,16. Conclui-se que a prevalência da perda precoce de molares permanentes foi elevada, sendo necessária a imediata adoção de ações curativas a fim de reduzir a perda precoce desses elementos dentários.This study evaluate the early loss of permanent molars in schoolchildren aged 9, 12 and 15 years attending public schools in the city of Campina Grande, Paraíba State, Brazil. The sample was composed of 873 randomly selected schoolchildren. The instrument for data collection was a questionnaire and a clinical chart. The following variables were analyzed: tooth loss (tooth type, localization in the dental arch and region of the arch, prevention and selfperception of oral health. The statistical analysis was done by frequency distribution and the chisquare and fisher’s exact tests were used. The results showed a prevalence of

  13. Significados atribuídos pela equipe de enfermagem sobre educação permanente em uma instituição cardiovascular

    Directory of Open Access Journals (Sweden)

    Cintia Koerich

    2016-01-01

    Full Text Available Objective: to understand the meanings attributed by the nursing staff to permanent educational practices in a reference cardiovascular hospital. Methods: this is a qualitative study, which used the Grounded Theory in Data for collecting and analyzing data. The sample consisted of 22 nursing professionals. Results: the study presents two categories that highlight the need for further clarification of the nursing staff about the concept of permanent education in health, as well as reinforce the permanent education of nurses as a management practice which needs to be incorporated into other assignments in daily work. Conclusion: it is admitted the need to work the concepts of permanent education in health even in professional qualification, as well as place greater emphasis on managerial training of nurses, so they acquire the power to take their assignment as a nursing care manager and the nursing staff education contribute to the necessary changes in the health services.

  14. Health

    International Nuclear Information System (INIS)

    Donckt, van der.

    1976-01-01

    The article is a critical review of the work group VI ''health'' in the ''sages report'', the criteria of total body dosis for radionuclides as strontium 90 and iodine 131 are discussed. It emphasizes the lack of adequate solution for the effluents as carbon-14, tritium and iodine 129 as well as for the high radioactivity waste management: the toxicity of plutonium and its cancerous properties are recalled. The risks of accidents in the nuclear facilities and their effect on the population in the proximity of the power plant and the contamination from cooling media are considered as well as sabotage risks. (A.F.)

  15. Measuring integrated care

    DEFF Research Database (Denmark)

    Strandberg-Larsen, Martin

    2011-01-01

    respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser...... differences were found in the perception of clinical integration in the two settings. More primary care clinicians in the Northern California region of Kaiser Permanente reported being part of a clinical integrated environment than did Danish general practitioners. By measuring the level of clinical...... and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine...

  16. GEOPROCESSAMENTO APLICADO NO DIAGNÓSTICO DOS CONFLITOS DE USO E OCUPAÇÃO DO SOLO EM ÁREAS DE PRESERVAÇÃO PERMANENTE NO RIBEIRÃO DAS AGULHAS – BOTUCATU (SP

    Directory of Open Access Journals (Sweden)

    Sérgio Campos et al.

    2017-03-01

    Las Áreas de Preservación Permanente (APP tienen una función ambiental para preservar los recursos naturales, la biodiversidad, el flujo genético de fauna y flora, el suelo y la seguridad del bienestar de las poblaciones humanas. La degradación de los bosques ribereños contribuye a la sedimentación e incremento en la turbidez del agua, a la erosión de las orillas de los cursos de agua y al transporte de sustancias contaminantes, como pesticidas y fertilizantes agrícolas. El trabajo tuvo como objetivo determinar el uso incorrecto de las áreas de preservación permanente de la cuenca del río das Agulhas – Botucatu (SP, basada en la carta planialtimétrica de Botucatu y la imagen de satélite de 2011. La metodología consistió en el uso de GIS-IDRISI Selva para la georreferenciación, la generación de los amortiguamientos de las APPs y la superposición de los conflictos de uso y ocupación. El gran uso de la cuenca se correspondió con pastizales, 675,34ha. Las APPs (166,10ha se utilizan inadecuadamente, con 93, 33ha de pastizales. El diagnóstico indica la necesidad de un plan de protección vinculado al medio ambiente, y destinado a la recuperación de áreas degradadas, que permita la regeneración de la cubierta natural de las APPs, que se utilizan sin cumplir con la legislación ambiental brasileña. Las geotecnologías fueron herramientas indispensables para el diagnóstico del uso y ocupación del suelo en el área analizada. Palabras clave: SIG; Uso y Ocupación del Suelo; Preservación del Medio Ambiente.

  17. Prevalência, necessidade de tratamento e fatores predisponentes do traumatismo na dentição permanente de escolares de 11 a 13 anos de idade Prevalence, treatment needs, and predisposing factors for traumatic injuries to permanent dentition in 11-13-year-old schoolchildren

    Directory of Open Access Journals (Sweden)

    J. Traebert

    2004-04-01

    Full Text Available Este estudo objetivou determinar a prevalência do traumatismo dentário na dentição permanente e observar associações com fatores predisponentes. Foi realizado um estudo transversal com escolares de 11 a 13 anos de Biguaçu, Santa Catarina, Brasil. Os exames foram realizados por um cirurgião-dentista utilizando os mesmos critérios do Children's Dental Health Survey do Reino Unido. Foram observados tipo de dano, tratamento providenciado e necessidade, overjet incisal, adequabilidade da cobertura labial, idade, sexo e nível de educação dos pais. Foram examinadas 2.260 crianças e as prevalências encontradas foram: 10,4%, 10,6% e 11,2% aos 11, 12 e 13 anos, respectivamente. A necessidade de tratamento foi de 6,3 incisivos por mil examinados. Escolares do sexo masculino e com overjetmaior que 5mm tiveram mais traumatismo dentário do que escolares do sexo feminino e com overjetincisal até 5mm. Cobertura labial inadequada e nível de educação dos pais não estiveram estatisticamente associados com o traumatismo dentário. Concluiu-se que ser do sexo masculino ou ter um overjetincisal maior do que 5mm aumenta a chance de sofrer traumatismo dentário.The objective of this study was to assess the prevalence of traumatic injuries to the permanent incisors and the association with clinical predisposing factors and parents' schooling. A cross-sectional survey was conducted with schoolchildren aged 11 to 13 years in Biguaçu, Brazil. Dental examinations were conducted by a dentist, and the criteria for traumatic dental injuries used in the children's dental health survey in the United Kingdom were adopted. the study recorded the type of damage sustained, treatment performed or needed, the size of incisal overjet, and whether lip coverage was adequate. Socio-demographic data included sex, age, and parents' level of schooling. a total of 2,260 children were examined, and prevalence rates were 10.4%, 10.6%, and 11.2% in 11, 12, and 13-year

  18. Diagnóstico ambiental e delimitação de Áreas de Preservação Permanente em um assentamento rural = Environmental diagnosis and delimitation of PPAs (Permanent Preservation Areas in a rural settlement

    Directory of Open Access Journals (Sweden)

    Nelson Alexandre Fagundes

    2008-01-01

    Full Text Available Leia-se neste artigo a tentativa de diagnosticar, delimitar e situar as Áreas de Preservação Permanentes e de Reserva Legal dentro de um assentamento rural, do Incra; visando à experimentação de ferramentas de geoprocessamento para a restauração das matas ribeirinhas, pela delimitação destas áreas, respeitando a legislação ambiental vigente, e partindo de uma ampla avaliação ambiental descritiva da paisagem, encontrada no Projeto de Assentamento Federal Capela. Um diagnóstico da paisagem local é apresentado na forma de um memorial fotográfico. Neste trabalho, serão delimitadas e quantificadas somente asAPP’s de entorno de corpos d’água.This article aims to diagnose, demarcate and situate Permanent Preservation Areas and Legal Reserves within an Incra Rural Settlement. This effort was conducted while testing the effective application of geoprocessing tools in the restoration of riparian forests and the delimitation of these areas, in accordance withexisting environmental legislation, and based on a broad descriptive environmental evaluation of the local landscape, located at the Capela Federal Settlement Project. A landscape diagnosis is shown in a photographic memorial as well. For this study, only the PPAs surrounding water bodies will be delimited and quantified.

  19. Las redes sociales en los procesos de adaptación a cambios permanentes de hábitat* Un estudio con habitantes de la Depresión Momposina (Norte de Colombia

    Directory of Open Access Journals (Sweden)

    Gabriel Garrido Escudero

    2001-01-01

    Full Text Available En este artículo se describen las redes sociales durante los procesos de adaptación a los permanentes cambios que viven los pobladores de la Depresión Momposina en La Travesía, corregimiento de Mompox (Colombia. La información se recogió en una muestra de 262 personas, mediante la triangulación se compararon los resultados cuantitativos y los cuantitativos y se contrastó la información desde diversas estrategias para describir de mejor forma los fenómenos estudiados. Con base en lo encontrado se observa que las redes continúan teniendo funcionalidad y un alto grado de intensidad cuando los pobladores se desplazan de un lugar a otro, debido a la cercanía física, a la cercanía económica y a la cercanía emocional existente, lo cual hace patente la importancia de las redes como potenciadoras de desarrollo social en el contexto de la cultura anfibia.

  20. Endodoncia regenerativa: utilización de fibrina rica en plaquetas autóloga en dientes permanentes vitales con patología pulpar. Revisión narrativa de la literatura*

    Directory of Open Access Journals (Sweden)

    Tatiana Ramírez Giraldo

    2014-01-01

    Full Text Available Actualmente una de las mayores controversias en el tratamiento de dientes permanentes con diagnóstico de pulpitis está en la decisión de realizar una Terapia Pulpar Vital (TPV o un tratamiento convencional de conductos. Diferentes estudios han reportado que se pueden obtener resultados previsibles mediante la realización de una TPV. El éxito del tratamiento dependerá de una adecuada comprensión de la  biología pulpar, un estricto protocolo de tratamiento y una adecuada selección del caso. Con este fin, diferentes materiales han sido sugeridos. Recientemente se ha utilizado la Fibrina Rica en Plaquetas, biomaterial que cumple con propiedades biológicas para lograr una mayor rapidez y adecuada cicatrizacion del tejido. Es necesario desarrollar tratamientos dirigidos a preservar la vitalidad de la pulpa, evitando recurrir como primera opción al tratamiento convencional de conductos, teniendo como objetivo conservar o regenerar el complejo dentino pulpar.

  1. La formación permanente en competencia digital docente y la mejora de la calidad del centro educativo desde la perspectiva de los docentes: un estudio de caso

    Directory of Open Access Journals (Sweden)

    Mercè Gisbert Cervera

    2015-07-01

    Full Text Available La sociedad del s. XXI demanda sistemas educativos flexibles y con capacidad de adaptación constante, capaces de hacer frente a las necesidades formativas, en forma de competencias, propias de un ciudadano que utiliza las TIC de forma natural y habitual en su vida cotidiana. Para ello se precisa de docentes competentes digitales que puedan formar a estas nuevas generaciones de ciudadanos. La formación permanente en TIC de los maestros, además de necesaria, dado el carácter dinámico de la tecnología, es un elemento de mejora de la calidad institucional de los centros educativos. Este trabajo, realizado a partir de una investigación-acción, evidencia que el propio centro de trabajo es capaz de organizar y diseñar su plan de formación, como parte de un proceso más amplio de mejora de la calidad basado en la incorporación de las TIC. A la vez, gestiona los ejes articuladores de una estrategia formativa que facilita la transferencia de ésta a la actividad del docente y aumenta la calidad del centro como institución. 

  2. DELIMITAÇÃO E PROTEÇÃO DAS ÁREAS DE PRESERVAÇÃO PERMANENTE DE CHAPADAS: ESTUDO DE CASO DA MINERAÇÃO DE AREIA EM ENCOSTAS NO NORTE DE MINAS GERAIS

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    Vitor Vieira Vasconcelos

    2011-12-01

    Full Text Available A mineração de areia de encosta para construção civil, na região Norte de Minas Gerais, tem causado uma séria de conflitos sócio-ambientais. A Polícia Ambiental e os órgãos de licenciamento ambiental têm encontrado dificuldades técnicas e administrativas para lidar com a situação. Este artigo apresenta uma proposta de utilização de técnicas de geoprocessamento e topografia, integradas à interpretação do direito ambiental, com fins de abordar os problemas citados de forma mais eficiente. Enfatiza-se, especialmente, a delimitação e a proteção de Áreas de Preservação Permanente de bordas de chapadas, onde ocorre tipicamente a mineração de areia de encosta. Por fim, apresentam-se propostas que auxiliem na transição para um modelo mais sustentável da mineração para construção civil na Região Norte de Minas Gerais.

  3. Limites e possibilidades do ensino à distância (EaD na educação permanente em saúde: revisão integrativa

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    Adriane das Neves Silva

    2015-04-01

    Full Text Available Trata-se de um estudo sobre o uso do ensino a distância (EaD como uma estratégia de ensino na educação permanente em saúde (EPS, que teve como objetivo identificar e analisar os limites e possibilidades do uso da EaD na EPS. Estudo de revisão integrativa. O resultado aponta que a EaD é uma estratégia inovadora possível e potencial para a EPS, facilitando o desenvolvimento da aprendizagem dentro ou fora da instituição de saúde, porém é evidente a escassez de pesquisas na área. As limitações para a realização dos programas estão relacionadas à variável tempo, preparação para lidar com as tecnologias e importância do tutor como facilitador da aprendizagem. Conclui-se que o uso da EaD tem tido uma importante contribuição para o desenvolvimento dos recursos humanos em saúde, seja no processo de formação e/ou no processo contínuo de conhecimento.

  4. Endodoncia regenerativa: utilización de fibrina rica en plaquetas autóloga en dientes permanentes vitales con patología pulpar. Revisión narrativa de la literatura*

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    Tatiana Ramírez Giraldo

    2014-07-01

    Full Text Available Actualmente una de las mayores controversias en el tratamiento de dientes permanentes con diagnóstico de pulpitis está en la decisión de realizar una Terapia Pulpar Vital (TPV o un tratamiento convencional de conductos. Diferentes estudios han reportado que se pueden obtener resultados previsibles mediante la realización de una TPV. El éxito del tratamiento dependerá de una adecuada comprensión de la  biología pulpar, un estricto protocolo de tratamiento y una adecuada selección del caso. Con este fin, diferentes materiales han sido sugeridos. Recientemente se ha utilizado la Fibrina Rica en Plaquetas, biomaterial que cumple con propiedades biológicas para lograr una mayor rapidez y adecuada cicatrizacion del tejido. Es necesario desarrollar tratamientos dirigidos a preservar la vitalidad de la pulpa, evitando recurrir como primera opción al tratamiento convencional de conductos, teniendo como objetivo conservar o regenerar el complejo dentino pulpar.

  5. Qualidade física do solo em pomar de laranjeira no noroeste do paraná com manejo da cobertura permanente na entrelinha Soil physical quality in an orange orchard in northwestern parana as affected by groundcover management

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    Jonez Fidalski

    2007-06-01

    Full Text Available O tráfego de máquinas e a compactação do solo ocorrem próximo à copa das plantas de citros, aumentando as restrições físicas do solo ao crescimento das raízes. Estratégias de manejo incluem o uso de coberturas permanentes do solo nas entrelinhas de pomares de laranjeira, mas são desconhecidos os seus efeitos na qualidade física do solo. O objetivo deste estudo foi quantificar o impacto de sistemas de manejo com cobertura permanente do solo em alguns indicadores de qualidade física do solo em um pomar de laranjeira. O estudo foi realizado em um experimento de longa duração de laranjeira 'Pêra' sobre limoeiro 'Cravo' com sistemas de cobertura permanente do solo nas entrelinhas, no município de Alto Paraná, noroeste do Paraná, em um Argissolo Vermelho distrófico latossólico, com horizonte superficial de textura arenosa. Os tratamentos de cobertura permanente nas entrelinhas com a gramínea mato-grosso ou batatais (Paspalum notatum manejada com roçada e a leguminosa amendoim forrageiro (Arachis pintoi foram comparados ao manejo tradicional, em que a vegetação espontânea foi dessecada com herbicida pós-emergente. O delineamento experimental utilizado foi de bloco ao acaso com três repetições. Em maio de 2003, a amostragem de solo foi realizada sob rodado e entrerrodado das máquinas nas entrelinhas do pomar. As amostras indeformadas de solo obtidas no centro da camada de 0-15 cm de profundidade foram utilizadas para determinação dos seguintes indicadores: conteúdo de água na capacidade de campo, porosidade total do solo e densidade do solo, a partir dos quais foram estimados os indicadores capacidade de aeração do solo e capacidade de armazenamento de água do solo. Amostras de solo deformadas foram coletadas nas camadas de 0-5 e 10-15 cm de profundidade, para determinação dos teores de C orgânico do solo e cálculo da taxa de estratificação de C orgânico do solo. Os indicadores de qualidade do solo

  6. Transgressões no campo da Ciência da Informação: abordagens de uma prática científica em permanente constituição

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    Meri Nadia Marques Gerlin

    2017-04-01

    Full Text Available O estudo apresenta conceitos ligados à disciplinaridade no campo da Ciência da Informação, assim como, inicia uma discussão em torno da natureza interdisciplinar dessa ciência atravessada pela transgressão metodológica. Reflete sobre a capacidade de interação com outras disciplinas que a atravessam, buscando, com isso, obter soluções de problemas perante a composição de seu objeto: a informação. Para tanto, dialoga-se com autores como Le Coadic, Bicalho e Oliveira, Francelin, Japiassú, Marques, Morin, Pinheiro, Tálamo e Smit. Considera-se que compreender como se deram as transgressões disciplinares no campo da Ciência da Informação torna-se condição essencial para dar conta de pensar a relação inter, multi e, principalmente, transdisciplinar necessária à manutenção de uma prática científica em permanente constituição.

  7. MECANISMOS DE GERAÇÃO DE ESCOAMENTO E ÁREAS HIDROLOGICAMENTE SENSÍVEIS: UMA ABORDAGEM HIDROGEOMORFOLÓGICA PARA DELIMITAÇÃO DE ÁREAS DE PRESERVAÇÃO PERMANENTE

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    Cesar Augusto Crovador SIEFERT

    2012-03-01

    Full Text Available Este artigo apresenta uma revisão conceitual sobre a relação entre os mecanismos de geração de escoamento e as áreas hidrologicamente sensíveis (AHS. Propõe-se a aproximação do conceito de AHSs na delimitação de áreas de preservação permanente (APPs devido à capacidade de geração de escoamento superficial por saturação destas áreas, estabelecendo assim a transferência de sedimentos e poluentes incidentes à jusante em direção aos canais. Reconhece-se a importância das AHSs como um novo paradigma na delimitação de APPs de acordo com características hidrogeomorfológicas da bacia hidrográfica. Por fim, observa-se ainda a necessidade de um aprofundamento na busca de um indicador de sensibilidade hidrológica das paisagens que possa ser utilizado em bacias hidrográficas com distintas características fisiográficas.

  8. Implementación de un mantenimiento basado en la condición usando modelado y simulación: caso de estudio de un motor sin-crónico de imanes permanentes

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    Jabid Quiroga Méndez

    2011-05-01

    Full Text Available Este artículo introduce la arquitectura de un CBM (mantenimiento basado en la condición en una aplicación eléctrica. La detección de fallas de manera oportuna y eficiente constituye uno de los retos más importantes asociados al CBM y el enfoque basado en modelos en el medio para conseguirlo. Un caso de estudio en un motor sincrónico de imanes permanentes (PMSM es ejecutado para ilustrar cómo el modelado es utilizado en la implementación de un CBM. El monitoreo fue implementado en tiempo real usando Matlab® y dSpace®. Se emplea como indicadora de falla la diferencia entre los valores de la componente secuencial negativa para las corrientes predichas usando una red neuronal multicapa y la corriente obtenida del motor. Resultados experimentales demostraron la efectividad del modelo propuesto en la detección de la falla de cortocircuito en el estator en distintos niveles de severidad y carga, obteniendo una confiabilidad en la detección mayor al 95%.

  9. Continuing education in health from the perspective of Augustine of Hippo.

    Science.gov (United States)

    Fernandes, Fabíola Chaves; Cortez, Elaine Antunes; Laprovita, Daniel; Almeida, Lidiane Peixoto de; Ferreira, Aline Figueiredo; Corvino, Marcos Paulo Fonseca

    2017-01-01

    To reflect about continuing education from the perspective of Augustine of Hippo and his theories based on the construction of knowledge and the learning process. This is a theoretical reflection study whose aim is to propose dimensions of analysis, emphasizing the history and challenges of continuing education. Such dimensions analyze the production of knowledge in Augustinian pedagogy, its historical aspects and its close relationship with lifelong education in health professions. The results show the difficulty of continuing education to reach adequate importance in health services, and that of academia in appropriating the thoughts of renowned philosophers such as Augustine. This is a result of ignorance about the convergence of these principles and their relevance. Continuing education and Augustinian pedagogy walk hand in hand in terms of care, meeting the needs that originate from practice and that are reflected in it, challenging isolated knowledge and putting different areas of knowledge to work together. Refletir sobre a educação permanente na perspectiva de Agostinho de Hipona e suas teorias pautadas na construção do conhecimento e no processo de aprendizagem. Trata-se de uma reflexão teórica cujo intuito é propor dimensões de análise, enfatizando a história e os desafios da educação permanente. Tais dimensões analisam a produção do conhecimento na pedagogia agostiniana, seus aspectos históricos e sua relação próxima com a educação permanente em saúde. Revela a dificuldade da educação permanente em ter sua dimensão alcançada noserviço de saúde, tal qual a da academia de apropriar-se do pensamento de filósofos renomados como Agostinho, fruto do desconhecimento da convergência desses pressupostos e de sua relevância. Considera-se que a educação permanente e a pedagogia agostiniana caminham juntas no cuidar, atendendo às necessidades advindas da prática e nela refletida, confrontando os saberes isolados e com eles operando

  10. How Digital Health Technology Aids Physicians

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    Nik Tehrani

    2015-06-01

    Full Text Available There is so much health and medical information available today that physicians cannot be expected to know it all. Thus, advances in technology have become a necessity for doctors to track patient information and care, and add to patient databases for reference and to conduct research. It is important to understand the new language of digital health, such as Personal Health Record (PHR, Electronic Medical Record (EMR and Electronic Health Record (EHR, all of which sound similar, but are not interchangeable. The ideal comprehensive IT system would empower patients, advance healthcare delivery and transform patient data into life-saving research (Kaiser, 2015. OmniFluent Health is language translation software that will allow for better patient/practitioner communication and avoid errors. Digital technology employs the use of big data that is shared, accessed, compiled and applied using analytics. However, information transfer, especially as mandated by current ethics of use of technology, has resulted into breach of patient privacy. Improved digital technology is providing the health care field with upgrades that are necessary, electronic files and health records, from mobile apps, and remote monitoring devices.

  11. Técnica Alternativa para Montagem de Insetos em Lâminas Permanentes para Visualização em Microscopia Óptica

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    Franziska Huber

    2011-03-01

    Abstract. Various chemicals are used in the mounting of insects on permanent slides for optical microscopy. The high cost, little availability in ordinary commerce and the dangers make their use impractical for some studies. Among the various chemicals used for the microscopic mounting of insects are Xylene, Canada Balsam, Hydroxide Potassium, Alcohols, Phenol and Creosote. All these chemicals present, individually or collectively, some risks to human health. In order to find alternative materials of easy access and low toxicity, for the permanent mout of insects, this study tested the efficacy of some alternatives materials. Were tested: Colorless varnish (Acrilex ® as a substitute for Canada balsam and solvent (Acrilex ®, Immersion Oil for microscopy (Merck ® and Xylene as substitutes for creosote. There were mounted especimens of Ctenocephalides sp., Aedes aegypti (Linnaeus and Pediculus sp.. The use of Varnish Colorless proved to be an efficient and cheap substitute to Canada Balsam because it offered transparency, optimal visualization, and rapid drying. The immersion oil might be used instead of Creosote, both mounted in Balsam, as in varnish. The last combination was more advantageous due to rapid drying of the varnish. Solvent did not get good results appearing to damage insect chitin, an effect observed especially when combined with the varnish.

  12. Propaganda de medicamentos: como conciliar uso racional e a permanente necessidade de expandir mercado? Medication advertising: how to reconcile rational use and the permanent need for market expansions?

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    Álvaro Nascimento

    2007-07-01

    Full Text Available A indústria farmacêutica, agências de publicidade, empresas de comunicação e o comércio varejista têm implementado uma intensa estratégia de marketing com vistas a elevar o consumo de medicamentos. A revolução científica e tecnológica, por sua vez, altera o padrão de enfrentamento terapêutico de doenças e seu impacto no setor saúde faz surgir o fenômeno da medicalização e da lógica de que estes bens e serviços devam ser considerados mercadorias como as demais. Esta realidade impõe um desafio: na utilização de medicamentos, até onde prevalece a exigência terapêutica estritamente voltada para o controle de enfermidades e começa a pressão mercadológica a estimular o seu consumo? A exploração do valor simbólico do medicamento pela grande mídia passa a representar um poderoso instrumento de indução de hábitos para elevar seu consumo. A magnitude do problema levou a que o Estado há muito busque regular a propaganda de medicamentos por meio de leis, decretos e códigos, que vêm sendo desrespeitados ao longo do tempo. Em 30 de novembro de 2000, a Agência Nacional de Vigilância Sanitária (Anvisa publica a Resolução de Diretoria Colegiada (RDC 102, tentando novamente impor limites ao setor. Para além de um maior esforço fiscalizador, este trabalho discute o próprio modelo regulador adotado, que não tem conseguido alcançar o objetivo a que se propõe.The pharmaceutical industry, advertising agencies, communication companies, and the retail market have implemented an intense marketing strategy aimed at boosting medication consumption. The scientific and technological revolution, in turn, changed illnesses treatment standards and its impact on the health sector gave rise both to the medicalization phenomenon and to the logic that these goods and services should be considered as merchandise, as any other. This fact brings a challenge about: in medication use, to what extent should therapeutic requirements aimed

  13. Predicting the 6-month risk of severe hypoglycemia among adults with diabetes: Development and external validation of a prediction model.

    Science.gov (United States)

    Schroeder, Emily B; Xu, Stan; Goodrich, Glenn K; Nichols, Gregory A; O'Connor, Patrick J; Steiner, John F

    2017-07-01

    To develop and externally validate a prediction model for the 6-month risk of a severe hypoglycemic event among individuals with pharmacologically treated diabetes. The development cohort consisted of 31,674 Kaiser Permanente Colorado members with pharmacologically treated diabetes (2007-2015). The validation cohorts consisted of 38,764 Kaiser Permanente Northwest members and 12,035 HealthPartners members. Variables were chosen that would be available in electronic health records. We developed 16-variable and 6-variable models, using a Cox counting model process that allows for the inclusion of multiple 6-month observation periods per person. Across the three cohorts, there were 850,992 6-month observation periods, and 10,448 periods with at least one severe hypoglycemic event. The six-variable model contained age, diabetes type, HgbA1c, eGFR, history of a hypoglycemic event in the prior year, and insulin use. Both prediction models performed well, with good calibration and c-statistics of 0.84 and 0.81 for the 16-variable and 6-variable models, respectively. In the external validation cohorts, the c-statistics were 0.80-0.84. We developed and validated two prediction models for predicting the 6-month risk of hypoglycemia. The 16-variable model had slightly better performance than the 6-variable model, but in some practice settings, use of the simpler model may be preferred. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Modelación y análisis de susceptibilidad a la deformación permanente de mezclas asfálticas Modeling and analysis of susceptibility to permanent deformation in asphalt mixtures

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    Julián Vidal V

    2011-08-01

    Full Text Available La deformación permanente de mezclas asfálticas del Área Metropolitana del Valle de Aburra - Antioquia, las cuales se fabrican en nuestro medio bajo las especificaciones INVIAS (Instituto Nacional de Vías y del Valle de Aburrá, se estudiaron utilizando un modelo constitutivo propuesto anteriormente. Este modelo mostró previamente ser efectivo en predecir la deformación de mezclas asfálticas en el Reino Unido bajo diferentes tipos de carga bajo condiciones uniaxiales y triaxiales, y temperaturas comprendidas entre 0 °C y 40 °C. Para el caso de las mezclas del Valle de Aburrá se emplearon temperaturas en un intervalo de 20 °C a 50 °C y se implementó el modelo propuesto con el fin de predecir la susceptibilidad a la deformación permanente. Mediante el estudio experimental de las mezclas se encontró que el comportamiento de estado estable de estas siguió el modelo modificado de Cross (Wang, 2011, con las mezclas exhibiendo comportamiento viscoso lineal y no-lineal a bajos y altos niveles de esfuerzos, respectivamente. Tanto para condiciones de carga como de recuperación se observó una dependencia de la temperatura en el material que fue adecuadamente predicha por el modelo de Arrheniusbajo el intervalo de temperaturas estudiado. Al realizar la modelación del comportamiento de las mezclas se encontró que el modelo propuesto por Ossa et al. (2010 aplica a las mezclas estudiadas y se determinó que la susceptibilidad a la deformación de estas varía considerablemente dependiendo de los materiales utilizados por el productor y en especial el agregado empleado, a pesar de ser mezclas teóricamente similares.Permanent deformation of asphaltic mixtures in the Metropolitan Area of Valle de Aburra - Antioquia, which are built under IVIAS' specifications (Instituto Nacional de Vías and Valle de Aburrá, were studied by employing a constitutive model proposed previously. This model had proved to be effective in predicting deformations of

  15. MAPEAMENTO GEOMORFOLÓGICO DE DETALHE PARA DELIMITAÇÃO DE ÁREAS DE PRESERVAÇÃO PERMANENTE (APP DE ZONAS COSTEIRAS EM ATENDIMENTO AO CADASTRO AMBIENTAL RURAL (CAR

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    Anderson Targino da Silva Ferreira

    2016-12-01

    Full Text Available Este trabalho teve como objetivo apresentar a metodologia para o mapeamento de Áreas de Preservação Permanente (APP de zonas costeiras em atendimento ao Cadastro Ambiental Rural (CAR, adequada para escala de detalhe que exige o imóvel rural. A metodologia consistiu na geração do Modelo Digital de Elevação (MDE da zona costeira, a partir do posicionamento GNSS (Global Navigation Satellite Systems; no mapeamento das feições morfológicas costeiras, com reconhecimento in situ; e no atendimento à legislação ambiental vigente quanto às definições de APP. No controle de qualidade do MDE do estudo de caso, as discrepâncias entre as altitudes do modelo e as de referência tiveram erro médio quadrático de 0,047 m. No mapa de APP, o índice de exatidão kappa com valor de 83% indicou que a probabilidade das categorias mapeadas (40% de APP e 60% passível de uso terem sido classificadas corretamente representou uma avaliação muito boa, indicando a alta sensibilidade do mapa em classificar as unidades geomorfológicas do terreno. Os resultados obtidos mostraram que a metodologia empregada tem amplo potencial (acurácia, eficiência, rapidez e baixo custo na delimitação de APP de zonas costeiras em atendimento ao CAR, onde as feições morfológicas são normalmente de pequenas dimensões.

  16. Modelagem da vida de fadiga e do acúmulo de deformações permanentes em pavimentos asfálticos por meio de um modelo de dano contínuo

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    Victor Ferreira Teixeira

    2009-10-01

    Full Text Available

    É sabido que as condições das rodovias brasileiras têm grande impacto sobre a economia nacional. Diante disso, nasce a necessidade de uma busca por métodos de análise de pavimentos que possam prever com maior precisão as falhas as quais o pavimento está submetido. Dentre os principais métodos utilizados atualmente, pode-se citar os métodos puramente empíricos e aqueles mecanístico-empíricos que fazem uso da resposta estrutural do pavimento. A aprimoração de técnicas numéricas como o Método dos Elementos Finitos (MEF ou o Método dos Elementos de Contorno (MEC tem feito com que os métodos mecanístico-empíricos ganhem cada vez mais espaço e sejam mais usados no dimensionamento de pavimentos. O presente trabalho apresenta um modelo mecanístico que considera a evolução do dano causado pelos carregamentos e, conseqüentemente, possibilita uma melhor simulação da vida de fadiga da camada asfáltica. O modelo também possibilita uma melhor modelagem do acúmulo de deformação permanente nos pavimentos através do uso da Teoria da Viscoelasticidade, permitindo assim avaliar as duas principais falhas dos pavimentos flexíveis.

  17. FEIÇÕES GEOMORFOLÓGICAS, ÁREAS DE PRESERVAÇÃO PERMANENTE E IMPLANTAÇÃO DE MEGAPROJETO DE INFRAESTRUTURA URBANA/HOTELEIRA NA VIA COSTEIRA DE NATAL/RN

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    Marceu Melo

    2018-04-01

    Full Text Available O litoral do planeta sustenta diversas atividades econômicas, abriga grande parte da população mundial e é considerado ambiente de relativa fragilidade. O desenvolvimento da atividade turística no Rio Grande do Norte está diretamente associada ao litoral e adquiriu maior relevância no final da década de 1970 e início da década de 1980, no contexto da política dos megaprojetos turísticos, através da implantação do projeto Via Costeira em Natal, que objetivava ampliar a infraestrutura hoteleira da capital do estado. O projeto foi aprovado e parcialmente implantado, embora tenha sofrido diversas críticas e reformulações, sobretudo devido às características naturais da área proposta para sua instalação, composta majoritariamente por dunas móveis ou cobertas por vegetação do Bioma Mata Atlântica. O objetivo deste trabalho foi verificar quais elementos geomorfológicos foram afetados pela sua implantação e, a partir destes, delimitar as Áreas de Preservação Permanente (APPs definidas pela legislação. Os resultados demonstraram que o projeto foi realizado em quase sua totalidade sobre APPs. Concluímos que a medida mais adequada é declarar os trechos não ocupados como áreas non aedificandi e executar projetos de recuperação das áreas degradadas.

  18. Tipo de arcada y plano terminal molar de la dentición temporal y su correlación con las clases de maloclusión de la dentición permanente

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    Ana Pascual Serna

    2015-12-01

    Full Text Available El objetivo fue establecer la correlación del tipo de arcada y plano terminal molar de la dentición temporal con las clases de maloclusión de Angle en niños de 5 años de edad que acuden al Hospital Nacional “Daniel Alcides Carrión”de Cerro de Pasco, 2010 - 2011. La investigación se desarrolló bajo un diseño descriptivo longitudinal prospectivo. La muestra estuvo conformada por 40 niños escogidos por muestreo no probabilístico. Se realizó inicialmente la evaluación clínica del tipo de arcada y plano terminal molar de la dentición temporal y posteriormente al erupcionar las primeras molares permanentes se verificó la correlación con las clases de maloclusión de Angle, el tratamiento estadístico de la hipótesis fue con la Chi Cuadrada. Entre los resultados podemos mencionar que existe diferencia estadística significativa para asumir que el tipo de plano terminal molar y tipo de arcada de la dentición temporal se correlaciona con las clases de maloclusión de Angle, teniendo en consideración que la X2c=12,724>X2t = 9,488(4gl-95 %, rechazándose la Ho. En conclusión, el tipo de plano terminal molar recto y el tipo de arcada abierta de la dentición temporal se relaciona con mayor frecuencia con la normoclusión y la Clase I de maloclusión. Mientras que el tipo de plano terminal molar escalón mesial y el tipo de arcada cerrada de la dentición temporal se relaciona con la Clase III de maloclusión.

  19. La inclusión educativa de alumnos con discapacidades graves y permanentes en la Unión Europea. [Educational inclusion of students with severe and permanent disabilities in the European Union

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    López-Torrijo, Manuel

    2009-06-01

    Full Text Available This article presents a comparative study of the care of students with severe and permanent educational needs in the six EU countries with greater rates of educational inclusion, (Italy, Greece, Portugal, Norway, Cyprus and Iceland. Such study has been done bearing in mind the following indicators: Analysis of educational needs, identification of deficit, schooling of students in Specific Centres for Special Education, legislative frame, responsibility for schooling and rendering of services, frame and models of schooling, state and functions of Specific Centres of Special Education, curricula of the inclusion, Human resources, family role and funding. From the aforementioned lines are deduced the trends in policies and educational practices carried out are followed. Conclude the necessary changes for the improvement of the future educational educational inclusion. Este artículo presenta un estudio comparado de la atención realizada a los alumnos con discapacidades graves y permanentes en los seis países de la UE que presentan mayores índices de inclusión educativa (Italia, Grecia, Portugal, Noruega, Chipre e Islandia. Dicho estudio está realizado teniendo en cuenta los siguientes indicadores: concepción de las necesidades educativas especiales, identificación de los déficit, alumnado escolarizado en Centros Específicos de Educación Especial, marco legislativo, responsabilidad de escolarización y prestación de servicios, modelo y modalidades de escolarización, estado y funciones de los Centros Específicos de Educación Especial, currículo de la inclusión, recursos humanos, papel de las familias y financiación. De ahí se deducen las tendencias en las políticas y las prácticas educativas realizadas y se concluyen los cambios necesarios para mejorar la inclusión educativa en un futuro.

  20. Validation of a questionnaire to measure sexual health knowledge and understanding (Sexual Health Questionnaire) in Nepalese secondary school: A psychometric process.

    Science.gov (United States)

    Acharya, Dev Raj; Thomas, Malcolm; Cann, Rosemary

    2016-01-01

    School-based sex education has the potential to prevent unwanted pregnancy and to promote positive sexual health at the individual, family and community level. To develop and validate a sexual health questionnaire to measure young peoples' sexual health knowledge and understanding (SHQ) in Nepalese secondary school. Secondary school students (n = 259, male = 43.63%, female = 56.37%) and local experts (n = 9, male = 90%, female = 10%) were participated in this study. Evaluation processes were; content validity (>0.89), plausibility check (>95), item-total correlation (>0.3), factor loading (>0.4), principal component analysis (4 factors Kaiser's criterion), Chronbach's alpha (>0.65), face validity and internal consistency using test-retest reliability (P > 0.05). The principal component analysis revealed four factors to be extracted; sexual health norms and beliefs, source of sexual health information, sexual health knowledge and understanding, and level of sexual awareness. Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy demonstrated that the patterns of correlations are relatively compact (>0.80). Chronbach's alpha for each factors were above the cut-off point (0.65). Face validity indicated that the questions were clear to the majority of the respondent. Moreover, there were no significant differences (P > 0.05) in the responses to the items at two time points at seven weeks later. The finding suggests that SHQ is a valid and reliable instrument to be used in schools to measure sexual health knowledge and understanding. Further analysis such as structured equation modelling (SEM) and confirmatory factor analysis could make the questionnaire more robust and applicable to the wider school population.

  1. A Conversation About Health Care Reform

    Science.gov (United States)

    Fuchs, Victor R.

    1994-01-01

    Professor Victor R. Fuchs is the Henry J. Kaiser Jr Professor at Stanford (California) University, where he applies economic analysis to social problems of national concern, with special emphasis on health and medical care. He holds joint appointments in the Economics Department and the School of Medicine's Department of Health Research and Policy. Professor Fuchs is a Distinguished Fellow of the American Economic Association and a member of the American Philosophical Society, the American Academy of Arts and Sciences, and the Institute of Medicine of the National Academy of Sciences. He was the first economist to receive the Distinguished Investigator Award of the Association for Health Services Research and has also received the Baxter Foundation Health Services Research Prize. Professor Fuchs is president-elect of the American Economic Association. His latest book, The Future of Health Policy, was published by Harvard University Press in 1993. The following edited conversation between Professor Fuchs and Linda Hawes Clever, MD, Editor of the journal, took place on April 8, 1994. PMID:7941523

  2. Permanente homoseksuele verhoudings van liefde en trou

    Directory of Open Access Journals (Sweden)

    J Potgieter

    2006-09-01

    Full Text Available In this article, the argument is made that homosexual relationships of love and commitment was known by the writers of the Bible. Though definitions like �gay� or �homosexuality� was not known, sexual identity was known. According to the anthropology of the Mediterranean people, somebody�s identity was found in the way he or she lived: �If I have a homosexual relationship, then my identity was homosexual�. This article shows that permanent homosexual relationships of love and commitment were known among the Greek philosophers. People like Plato, Aristotle and Pausanius had permanent homosexual partners. Even Paul knew about permanent homosexual relationships of love and commitment. Sufficient evidence has been found in cities like Rome, Corinth and Ephesus on the existence of such relationships.

  3. Forsegling af okklusal dentincaries i permanente molarer

    DEFF Research Database (Denmark)

    Qvist, Vibeke; Borum, Mette Kit; Dynes Møller, Kirsten

    2017-01-01

    Der findes ingen eksakte tal for forekomsten af fødevareallergi i den danske befolkning. Den kumulerede forekomst af fødevareallergi hos børn i de første tre leveår skønnes at være på 7-8 %, hvoraf hovedparten vokser sig fra det. Punktprævalensen af diagnosticeret fødevareallergi hos voksne er 3 ...

  4. LA ENTREVISTA, UN DIÁLOGO PERMANENTE.

    Directory of Open Access Journals (Sweden)

    Yolanda Puyana V.

    2012-04-01

    Full Text Available El objeto del presente artículo es mostrar tres escenarios sobre la entrevista que son útiles para la docencia y acción profesional de trabajo social. Se busca profundizar sobre la entrevista desde diferentes perspectivas teóricas y metodológicas. En primer término, se tratará el enfoque humanista de Karl Rogers y la mirada etnográfica de Roberta Greene. En segundo término, se esboza el aporte de Sigmud Freud. Finalmente se señala la contribución a la entrevista del modelo sistémico de la Escuela de Terapia Familiar de Milán.

  5. The cost conundrum: financing the business of health care insurance.

    Science.gov (United States)

    Kelly, Annemarie

    2013-01-01

    Health care spending in both the governmental and private sectors skyrocketed over the last century. This article examines the rapid growth of health care expenditures by analyzing the extent of this financial boom as well some of the reasons why health care financing has become so expensive. It also explores how the market concentration of insurance companies has led to growing insurer profits, fewer insurance providers, and less market competition. Based on economic data primarily from the Government Accountability Office, the Kaiser Family Foundation, and the American Medical Associa tion, it has become clear that this country needs more competitive rates for the business of health insurance. Because of the unique dynamics of health insurance payments and financing, America needs to promote affordability and innovation in the health insurance market and lower the market's high concentration levels. In the face of booming insurance profits, soaring premiums, many believe that in our consolidated health insurance market, the "business of insurance" should not be exempt from antitrust laws. All in all, it is in our nation's best interest that Congress restore the application of antitrust laws to health sector insurers by passing the Health Insurance Industry Antitrust Enforcement Act as an amendment to the McCarran-Ferguson Act's "business of insurance" provision.

  6. Overview on the permanent magnets technology of rare earth based on Nd-Fe-B; Panorama general sobre tecnologia de imanes permanentes de tierras raras a base de Nd-Fe-B

    Energy Technology Data Exchange (ETDEWEB)

    Rosales Vazquez, Maria Ines [Instituto de Investigaciones Electricas, Cuernavaca (Mexico)

    1990-12-31

    In this paper the technological development in the area of permanent magnetic materials, is shown, from the 1930`s when the first aluminum-nickel-cobalt (Al-Ni-Co) magnets appeared. As a result of the continuous worldwide research in this field, it was made known, during the 1980`s decade of a new type of magnets based on Neodymium (Nd). In accordance with the outstanding magnetic properties of these magnets, at the Instituto de Investigaciones Electricas (IIE), their development was initiated, focussed on the stages and parameters definition of their manufacturing process. Up to now, the research has been oriented to the preparation of magnets of the isotropic agglutinated type and the manufacturing process encompasses the following stages: a) Alloy preparation; b) Microcrystals obtainment; c) Magnet preparation. The preliminary results that have been obtained in the magnetic characterization show that the quality of the prepared magnets is comparable to the quality of the imported magnets and/or to the ones other research groups report. [Espanol] En este trabajo se muestra el desarrollo tecnologico del area de materiales magneticos permanentes a partir de los anos treinta en que surgieron los primeros imanes de aluminio-niquel-cobalto (Al-Ni-Co). Como resultado de la constante investigacion a nivel mundial en ese campo, durante el decenio de los ochenta se informo en torno a un nuevo tipo de imanes a base de neodimio (Nd). Atendiendo a las propiedades magneticas sobresalientes de estos imanes, en el Instituto de Investigaciones Electricas (IIE), se inicio el desarrollo de los mismos, enfocandolo a la definicion de las etapas y parametros del proceso de fabricacion. Hasta ahora, la investigacion se ha orientado a la preparacion de imanes de tipo isotropico aglutinado y el proceso de fabricacion comprende las etapas: a) preparacion de la aleacion; b) obtencion de microcristales, y c) preparacion de los imanes. Los resultados preliminares que se han obtenido en la

  7. Conflitos no uso da terra em Áreas de Preservação Permanente em um polo de produção de biodiesel no Estado do Pará

    Directory of Open Access Journals (Sweden)

    Arlete Silva de Almeida

    2014-07-01

    Full Text Available As Áreas de Preservação Permanente (APPs desempenham um papel fundamental na manutenção dos principais fatores que regulam os processos hidrológicos e de conservação biológica. Na Amazônia, as APPs vêm sendo ocupadas com atividades econômicas de alto impacto ambiental que levam à supressão de vegetação, desrespeitando o regime legal desse tipo de área protegida. Este artigo analisa os conflitos de uso da terra dentro das áreas destinadas à preservação e propõe uma delimitação dessas áreas de acordo com o Código Florestal Brasileiro de 2012, no municipio de Moju, um dos mais importantes polos de produção de biodiesel do estado do Pará. A pesquisa utilizou imagem multiespectral de alta resolução do satélite RapidEye de 2010 para uma classificação supervisionada que determinou oito classes de cobertura e uso da terra, com especial atenção para a floresta, o cultivo agrícola e cultivo de óleo de palma (Elaeis guineensis. As terras alteradas do município perfazem 30,29% do total, sendo que 17,07% estão ocupadas pela pecuária. Somente 5,2% do território de Moju é legalmente definido como APP. Destas áreas, 29,3% se encontram em uso conflituoso, onde predomina a pastagem, presente em 15,6% das APPs do município. O cultivo de palma corresponde a apenas 0,63% da área da APP e a 2,17% do município. A aplicação das novas regras de recomposição de APPs pelo novo Código Florestal Brasileiro irá resultar em perda de 60,69% de área recuperada em APPs neste município.

  8. Overview on the permanent magnets technology of rare earth based on Nd-Fe-B; Panorama general sobre tecnologia de imanes permanentes de tierras raras a base de Nd-Fe-B

    Energy Technology Data Exchange (ETDEWEB)

    Rosales Vazquez, Maria Ines [Instituto de Investigaciones Electricas, Cuernavaca (Mexico)

    1991-12-31

    In this paper the technological development in the area of permanent magnetic materials, is shown, from the 1930`s when the first aluminum-nickel-cobalt (Al-Ni-Co) magnets appeared. As a result of the continuous worldwide research in this field, it was made known, during the 1980`s decade of a new type of magnets based on Neodymium (Nd). In accordance with the outstanding magnetic properties of these magnets, at the Instituto de Investigaciones Electricas (IIE), their development was initiated, focussed on the stages and parameters definition of their manufacturing process. Up to now, the research has been oriented to the preparation of magnets of the isotropic agglutinated type and the manufacturing process encompasses the following stages: a) Alloy preparation; b) Microcrystals obtainment; c) Magnet preparation. The preliminary results that have been obtained in the magnetic characterization show that the quality of the prepared magnets is comparable to the quality of the imported magnets and/or to the ones other research groups report. [Espanol] En este trabajo se muestra el desarrollo tecnologico del area de materiales magneticos permanentes a partir de los anos treinta en que surgieron los primeros imanes de aluminio-niquel-cobalto (Al-Ni-Co). Como resultado de la constante investigacion a nivel mundial en ese campo, durante el decenio de los ochenta se informo en torno a un nuevo tipo de imanes a base de neodimio (Nd). Atendiendo a las propiedades magneticas sobresalientes de estos imanes, en el Instituto de Investigaciones Electricas (IIE), se inicio el desarrollo de los mismos, enfocandolo a la definicion de las etapas y parametros del proceso de fabricacion. Hasta ahora, la investigacion se ha orientado a la preparacion de imanes de tipo isotropico aglutinado y el proceso de fabricacion comprende las etapas: a) preparacion de la aleacion; b) obtencion de microcristales, y c) preparacion de los imanes. Los resultados preliminares que se han obtenido en la

  9. El conocimiento de los records como motivación en la preparación del equipo permanente de atletismo de la ESBU Antero Fernández Vargas del municipio San Juan y Martínez

    Directory of Open Access Journals (Sweden)

    José Manuel Vives Morejón

    2009-09-01

    Full Text Available Ha sido en los últimos años la introducción del deporte participativo, una de las vías que facilite a la gran masa estudiantil la práctica del deporte de forma masiva y organizada. Los profesores preparan a sus alumnos en los deportes según el nivel de enseñanza, lo que representa un gran estimulo para el profesor de Educación Física y sus alumnos, los cuales transitan desde la base hasta el nivel nacional, de ahí que se necesite conocer el estado en que se encuentran sus alumnos desde el punto de vista físico, deportivo y motivacional. El atletismo es uno de los deportes que está presente en todos los niveles de participación, pero en nuestra escuela ocupa el último lugar dentro de la preferencia de los estudiantes, lo que nos incitó investigar al respecto con vistas a lograr niveles óptimos de motivación para la práctica sistemática de este deporte, de ahí que durante la realización de las pruebas de eficiencia física, competencias mensuales de atletismo, deporte participativo, hemos recopilado cada uno de los eventos y diseñado en el centro un sistema de estimulación desde la clase, el mural de educación física y los actos centrales de la escuela para dar a cono cer los mejores resultados, quedando establecidos como records dentro de la escuela de forma permanente, esto ha motivado a los estudiantes a querer conocer sus potencialidades en cada uno de los eventos y si han superado los resultados alcanzados por los estudiantes en cursos anteriores, lo que se ha convertido en un recurso importante para estimular la preparación de los integrantes del equipo de atletismo de nuestra escuela, donde todos quieren estar en el equipo y entre los recordistas del centro.

  10. ANÁLISE DA CORRELAÇÃO ENTRE AS VARIÁVEIS DE DENSIFICAÇÃO DO COMPACTADOR GIRATÓRIO SUPERPAVE E A RESISTÊNCIA À DEFORMAÇÃO PERMANENTE EM MISTURAS ASFÁLTICAS CONVENCIONAIS E COM UTILIZAÇÃO DE RESÍDUOS

    Directory of Open Access Journals (Sweden)

    Felipe Coutinho Onofre

    2011-09-01

    Full Text Available

    Quando se comparam as metodologias de dosagem Superpave e Marshall de misturas asfálticas, uma das vantagens da primeira é a obtenção do gráfico de compactação. Tem sido verificado para misturas densas e contínuas do tipo Concreto Asfáltico (CA que determinadas áreas observadas nesse gráfico podem diferenciar estas misturas quanto à trabalhabilidade e à resistência à deformação permanente. No presente estudo, os parâmetros Compaction Densification Index (CDI e Traffic Densification Index (TDI foram utilizados como indicadores da compactabilidade. Desenvolveu-se um estudo de correlação entre estas variáveis e a resistência à deformação permanente de misturas asfálticas. Foram avaliadas três misturas asfálticas contendo: (i apenas agregados graníticos, (ii 50% de agregados graníticos e 50% de escória de aciaria e (iii 50% de agregados graníticos e 50% de Resíduo de Construção e Demolição (RCD. As variáveis escolhidas para determinação da resistência à deformação permanente foram o ensaio uniaxial de carga repetida (amostras compactadas para dois percentuais de Volume de vazios e o ensaio com um simulador de tráfego do tipo LCPC. Foi utilizado também o Processamento Digital de Imagens (PDI para a determinação da esfericidade dos agregados estudados, propriedade que influencia na resistência à deformação permanente. Os resultados indicam que as variáveis CDI e TDI podem ser usadas como parâmetros de estudo para prever a resistência à deformação permanente, mesmo para misturas com utilização de resíduos. A caracterização pela técnica do PDI mostrou que o agregado de origem granítica possui uma forma menos próxima a uma esfera em relação aos res

  11. Textura do solo e a estimativa do teor de água no ponto de murcha permanente com psicrômetro Soil texture and the estimation by Dewpoint Potential Meter of water retention at wilting point

    Directory of Open Access Journals (Sweden)

    Vilson Antonio Klein

    2010-07-01

    Full Text Available A determinação do volume de água disponível às plantas é fundamental para o correto manejo da irrigação e definição quanto ao uso dos solos agrícolas. Os principais fatores que exercem influência na retenção e disponibilidade de água às plantas são a textura e a estrutura do solo. O objetivo deste trabalho foi quantificar a influência da textura na retenção da água, na condição de ponto de murcha permanente (PMP das plantas (-1,5MPa, sendo utilizado um psicrômetro modelo WP4-T. Determinaram-se a textura de 100 amostras de solo e o teor de água no PMP. Os resultados indicaram que, em potenciais maiores que -1,0MPa, o psicrômetro mostrou-se pouco preciso, não se recomendando a sua utilização nessa condição. O PMP aumentou de 0,059 para 0,29g g-1, quando o teor de argila aumentou de 120 para 779g kg-1. Obteve-se um bom ajuste dos resultados do teor de água no PMP em função do teor de argila do solo, e 91% da variação do teor de água no PMP puderam ser atribuídos à variação no teor de argila. Conclui-se que o psicrômetro é um equipamento que pode ser utilizado para determinar o PMP, e a equação PMP (g g-1=0,0003*Argila (g kg-1+0,0118 pode ser utilizada para estimar o PMP.The determination of the available water to plants is essential to right irrigation management and definition regarding the use in agricultural soils. The main factors that exert influence on retention and availability of water to plants are texture and soil structure. The aim of this study was to quantify the influence of the texture on water retention in the condition of permanent wilting point (PWP of plants (-1,5MPa using a WP4-T Dewpoint Potentia Meter. The texture of 100 soil sample and soil moisture at PWP was determined. Results indicated that, in potentials higher than -1,0MPa, WP4-T seemed not very precise, therefore its use is not recommended in this condition. PWP increased from 0,059 to 0,29g g-1, while the clay content

  12. Qualidade de Organossolo sob diferentes usos antrópicos em áreas de preservação permanente no Distrito Federal Quality of Histosol under different on anthropic uses in permanent preservation areas in the Distrito Federal

    Directory of Open Access Journals (Sweden)

    Luciano N. de A. e Moura

    2013-01-01

    Full Text Available O uso e a ocupação das terras devem ser planejados de forma racional a fim de evitar impactos ambientais negativos nos recursos naturais, particularmente em áreas ambientalmente protegidas por lei. O objetivo deste trabalho foi avaliar atributos de qualidade dos solos em áreas de preservação permanente da Microbacia do Ribeirão do Gama, Distrito Federal, Brasil, para verificar o efeito do uso antrópico. Foram avaliados atributos físicos, químicos e biológicos de qualidade de organossolos em cinco áreas de uso e ocupação diversificada das terras: três áreas cultivadas (hortaliças, eucalipto e mandioca e duas áreas preservadas (pastagem nativa e mata de galeria. As amostras de solo foram coletadas nas camadas de 0-10 e 10-20 cm. Os dados obtidos pelas análises físicas, químicas e biológicas dos solos foram avaliados estatisticamente por meio do software Sisvar 4.6. Os resultados obtidos mostraram influência dos usos e ocupações diferentes das terras em relação aos atributos de qualidade dos solos. O manejo dos solos adotado nessas áreas foi considerado o principal fator de alteração dos atributos físicos, químicos e biológicos, destacando-se a compactação dos solos sob áreas de vegetação nativa e diminuição da matéria orgânica nos solos em sistemas cultivados.The use and occupation of soil should be planned in a rational way to avoid negative environmental impacts on natural resources, particularly in areas environmentally protected by law. This study aimed to evaluate quality attributes of soil in permanent preservation areas of a Ribeirão do Gama Watershed, Distrito Federal, Brazil, to verify the influence of anthropic use. The physical, chemical and biological attributes of Histosol quality were assessed in five areas of diversified use and soil occupation: three areas under cultivation (vegetables, eucalyptus and cassava and two preserved areas (native pasture and gallery forest. Soil samples were

  13. Análise comparativa de envoltórios para drenos tubulares em condições de fluxo não-permanente Comparative analysis of envelopes for tubular drains under non-steady state flow conditions

    Directory of Open Access Journals (Sweden)

    Denise M. de Almeida

    2001-04-01

    Full Text Available Com esta pesquisa, objetivou-se avaliar a eficiência de envoltórios em drenos tubulares sob condições de fluxo não-permanente; para tanto, foram utilizados, em tanques de alvenaria, os envoltórios de geotêxteis XT-4, XT-2, bidim OP-30 e bidim OP-20, envelopes de brita no 1, com espessuras de 0,05, 0,10 e 0,15 m, além de um tratamento com ausência de envoltório. As variáveis-resposta utilizadas para se testar os tratamentos consistiram da lâmina drenada num tempo de 30 min, da massa de areia carreada após este tempo de drenagem e do desempenho hidráulico dos drenos, com base no cálculo da resistência de entrada ao fluxo e da relação entre vazão e carga hidráulica a 0,55 m da interface solo-dreno. As lâminas drenadas não diferiram estatisticamente a nível de 5% de probabilidade; no entanto, os geotêxteis bidim OP-20 e XT-4 mostraram-se, nesta ordem, como as melhores opções, face à análise de desempenho e se considerando os aspectos custo e facilidade de instalação. Quanto à análise da variável carreamento de areia, verificou-se a influência da espessura do envoltório ao se analisar os tratamentos com brita, além da opção das mantas, como excelente filtro. Os dados de resistência de entrada demonstraram a importância do uso de envoltórios ao se comparar o tratamento sem envoltório (r ent = 0,0102 d m-1 com o tratamento brita 0,15m (r ent = 0,0032 d m-1 cuja redução foi de 68,7%.The aim of the research was to evaluate the performance of eight types of envelopes installed around tubular drains in a horizontal tank model, with the treatments bidim OP-20, bidim OP-30, XT-2 and XT-4, 0.15, 0.10 and 0.05 m thick gravel and the treatment drain without a wrapper. The response-variables for the treatments used consisted of the depth of water drained in thirty minutes, the mass of sediment transported by the water during this same time interval and the hydraulic performance of the drains based on the entrance

  14. Nutrição e produção da laranjeira "Folha Murcha" em porta-enxertos e plantas de cobertura permanente na entrelinha Nutrition and yield of the 'Folha Murcha' orange in rootstocks and groundcover management systems

    Directory of Open Access Journals (Sweden)

    Jonez Fidalski

    2006-06-01

    Full Text Available O estado nutricional e a produção de citros não são conhecidos para as diferentes combinações copa/porta-enxertos e plantas de coberturas permanente na entrelinha. O estudo foi instalado em um experimento de laranjeira "Folha Murcha" [Citrus sinensis (L. Osb.] com oito anos de idade, conduzido entre 1997 a 2002, no município de Paranavaí, região Noroeste do Paraná. O solo corresponde a um Argissolo Vermelho distr��fico típico textura areia/franco arenoso. O delineamento experimental foi de blocos ao acaso, sendo os tratamentos constituídos por sete porta-enxertos: limoeiro "Cravo", limoeiro "Rugoso da África", limoeiro "Volcameriano", tangerineira "Cleópatra", tangerineira "Sunki", citrangeiro "C-13" e Trifoliata, com três plantas em cada parcela experimental. As repetições foram constituídas por três blocos com a cobertura Paspalum notatum e por um bloco com Arachis pintoi. Foram avaliados os teores dos nutrientes foliares e a produção de frutos da laranjeira "Folha Murcha". O manejo das entrelinhas com a leguminosa elevou os teores de N à faixa excessiva nas folhas do porta-enxerto limoeiro "Cravo", e reduziu a produção de frutos da laranjeira "Folha Murcha" em relação à gramínea. Nas entrelinhas com gramínea, a produção de frutos da laranjeira "Folha Murcha" foi dependente das safras agrícolas e dos teores foliares de Ca, Mg e Zn. A absorção máxima de Ca pelas folhas de laranjeira "Folha Murcha" precede a de Mg e Zn. Nestas condições, os porta-enxertos tangerineira "Cleópatra" e limoeiro "Rugoso da África" apresentaram maior produção de frutos de laranjeira "Folha Murcha".The nutritional status and yield of citrus are not known for different canopy/rootstocks and soil groundcover management systems. The study was set up in a 8-year-old 'Folha Murcha' [Citrus sinensis (L. Osb.] orange experiment, and was carried out from 1997 to 2002 in Paranavai, in the northwest region of the state of Parana

  15. Soil carbon and nitrogen mineralization under different tillage systems and Permanent Groundcover cultivation between Orange trees Mineralização do carbono e nitrogênio sob diferentes preparos de solo e coberturas permanentes intercalares em pomar de laranjeira

    Directory of Open Access Journals (Sweden)

    Elcio Liborio Balota

    2011-06-01

    Full Text Available The objective of this work was to evaluate the alterations in carbon and nitrogen mineralization due to different soil tillage systems and groundcover species for intercropped orange trees. The experiment was established in an Ultisol soil (Typic Paleudults originated from Caiuá sandstone in northwestern of the state of Paraná, Brazil, in an area previously cultivated with pasture (Brachiaria humidicola. Two soil tillage systems were evaluated: conventional tillage (CT in the entire area and strip tillage (ST with a 2-m width, each with different groundcover vegetation management systems. The citrus cultivar utilized was the 'Pera' orange (Citrus sinensis grafted onto a 'Rangpur' lime rootstock. The soil samples were collected at a 0-15-cm depth after five years of experiment development. Samples were collected from under the tree canopy and from the inter-row space after the following treatments: (1 CT and annual cover crop with the leguminous Calopogonium mucunoides; (2 CT and perennial cover crop with the leguminous peanut Arachis pintoi; (3 CT and evergreen cover crop with Bahiagrass Paspalum notatum; (4 CT and cover crop with spontaneous B. humidicola grass vegetation; and (5 ST and maintenance of the remaining grass (pasture of B. humidicola. The soil tillage systems and different groundcover vegetation influenced the C and N mineralization, both under the tree canopy and in the inter-row space. The cultivation of B. humidicola under strip tillage provided higher potential mineralization than the other treatments in the inter-row space. Strip tillage increased the C and N mineralization compared to conventional tillage. The grass cultivation increased the C and N mineralization when compared to the others treatments cultivated in the inter-row space.No presente trabalho, foi avaliada a mineralização do Carbono e Nitrogênio devido ao cultivo intercalar de diferentes coberturas permanentes em pomar de laranjeira. O experimento foi

  16. One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program.

    Science.gov (United States)

    Groeneweg, Marti; Forrester, Sara H; Arnold, Beth; Palazzo, Lorella; Zhu, Weiwei; Yoon, Paul; Scearce, Tim

    2018-05-01

    Multiple sclerosis (MS) is associated with high total health care cost, the majority of which is attributable to medications. Patients with MS are less likely to experience relapses, emergency department (ED) visits, and hospitalizations when they are adherent to disease-modifying treatments. Disease management programs are hypothesized to improve medication adherence thereby improving clinical and economic outcomes. To evaluate the clinical and economic effects of a specialty pharmacy and chronic disease management program for patients with MS from a health plan perspective. This study was a retrospective analysis using prescription drug claims, medical claims, and electronic medical record information (2013-2015) 1 year before and after enrollment in the disease management program for members with 24 months of continuous health plan coverage. Medication adherence was calculated using proportion of days covered (PDC). Relapse rate was defined as an MS outpatient visit associated with a corticosteroid dispense within 7 days of the visit or an MS hospitalization. Disease progression was assessed using the Modified Expanded Disability Status Scale (mEDSS). Resource use included outpatient visits, ED visits, and hospitalizations. Cost information was collected as health plan-paid amount and was reported in 2013 U.S. dollars. The analysis included 377 patients (mean age 55 years, 76.4% female). After enrollment in the program, 78.7% of the study group had a PDC of ≥ 0.80 compared with 70.0% before enrollment (P management for patients with MS can increase the proportion of patients adherent to medication. The increase in health plan spend on MS medications is not offset by savings in health care resource utilization. This study was funded by Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington Pharmacy Administration. The authors have no disclosures to report.

  17. Association between clinical parameters and the presence of active caries lesions in first permanent molars Associação entre parâmetros clínicos e a presença de lesões ativas de cárie em primeiros molares permanentes

    Directory of Open Access Journals (Sweden)

    Juliana Maria Quaglio

    2006-12-01

    Full Text Available The aim of the present study was to evaluate the association between clinical parameters and the presence of active caries lesions on the occlusal surface of first permanent molars. Forty eight children (5.8-13.8 years-old with at least one first permanent molar present were selected. The clinical parameters evaluated were gender, age, DMF-T and dmf-t, presence of active white spots in other teeth, general plaque index, tooth's dental arch (upper or lower, tooth's side (right or left, presence of visible plaque and eruption degree of the first permanent molars. The first permanent molars were evaluated through visual inspection by two examiners in order to assess the presence of active or inactive caries lesions on the occlusal surface. Univariate and multivariate analyses for determination of the association between clinical parameters and the presence of active caries lesions in these teeth were performed. The presence of active white spots in other teeth was associated with the presence of active caries lesions in the first permanent molars, in both univariate and multivariate analyses (Odds ratio = 8.8 and 1.9, respectively. The presence of abundant visible plaque on the occlusal surface of the first permanent molars (Odds ratio = 3.5 in the univariate analysis, and 3.9 in the multivariate one also presented a significant association. In conclusion, the presence of active white spots in other teeth and the presence of considerable visible plaque were associated with the presence of active caries lesions on the occlusal surfaces of first permanent molars.O objetivo do presente trabalho foi avaliar a associação entre parâmetros clínicos e presença de lesões ativas de cárie sobre a superfície oclusal de primeiros molares permanentes. Quarenta e oito crianças (5,8-13,8 anos com pelo menos um primeiro molar permanente foram selecionadas. Os parâmetros clínicos avaliados foram sexo, idade, CPO-D e ceo-d, presença de manchas brancas

  18. Parliament representation in Latin America. The permanent commissions and the parties in Congress La representación parlamentaria en América latina. Las comisiones permanentes y los partidos en el congreso

    Directory of Open Access Journals (Sweden)

    Luisa BÉJAR

    2009-04-01

    delegación de corte muy diverso. En este escrito se revisa el acomodo institucional del sistema de comisiones de la Cámara Baja en: Argentina; Bolivia; Brasil; Colombia; Chile; México; Paraguay; República Dominicana y Uruguay. En este sentido, el estudio examina tanto la importancia concedida a su trabajo, como algunos aspectos de su morfología que afectan la estructura de incentivos que acota el desarrollo del proceso legislativo. Asimismo, se analizan los procedimientos utilizados en cada Congreso para enfrentar los problemas de acción colectiva. Por último, se presentan algunas ideas para la elaboración de una futura taxonomía sobre la relación que guardan en la región los partidos y las comisiones permanentes del Congreso.ABSTRACT: The main argument of this paper is that the heterogeneity of the institutional framework that prevails in Latin America’s electoral field (Carroll y Shugart, 2005, also reproduces itself in the parliamentary one. This is proved by the morphologic profile of each Congress’ commission system and the place that the law assigns to the system. While some legislative frameworks clearly intend to delegate to parties the decisions entrusted to this bodies; in other cases, this takes place in a less important way. In the cases formally related with a party logic, on the other hand, diverse delegation schemes are encouraged. In this article we analyze the institutional framework of the commission systems of the low chamber in: Argentina; Bolivia; Brazil; Colombia; Chile; Mexico; Paraguay; Dominican Republic and Uruguay. In this sense, this work examines the importance given to their job and some aspects of its morphology that affect the structure of incentives that narrows the development of the legislative process. We also analyze the procedures used by each Congress to solve its problems of collective action. Lastly, some ideas for the elaboration of a future taxonomy on the relationship between parties and permanent commissions in

  19. Site Support Program Plan for ICF Kaiser Hanford Company

    International Nuclear Information System (INIS)

    Benedetti, R.L.

    1994-10-01

    This document describes the Hanford Reservation site support program plan for each support division, in terms of safety, environmental concerns, costs, and reliability. Support services include the following: Piped Utilities; Electrical utilities; transportation; Energy management; General Administration Support Buildings; electrical safety upgrades. Contained in this Volume II is information covering the following: Operations and maintenance Utilities; Piped Utilities; Water systems Administration and Sampling; electrical utilities

  20. The basics of repeats in Kaiser Aminpur’s poems

    Directory of Open Access Journals (Sweden)

    Ahmad Ghanipour Malekshah

    2016-09-01

    Sometimes the repetition of words, phonemes, etc with the aim of affecting them musically will stimulate audience's emotion and in some other situation the musical capacity of words, phonemes cause the establishment of repetition.  Furthermore, the aesthetic pleasure which is produced from musical repetition along with emotion and feeling in Aminpour poem's as a stylistic feature can be reviewed and analyzed.

  1. Site Support Program Plan for ICF Kaiser Hanford Company

    International Nuclear Information System (INIS)

    Benedetti, R.L.

    1994-10-01

    This document describes the Hanford Reservation site support program plan for each support division, in terms of safety, environmental concerns, costs, and reliability. Support services include the following: Piped Utilities; Electrical utilities; transportation; Energy management; General Administration Support Buildings; electrical safety upgrades. This Volume III discusses Operations and Maintenance Transportation and the Transportation Department including fleet maintenance, railroad operations and track maintenance, bus operations, solid waste disposal, special delivery services, and road maintenance

  2. Kaiser Franz Joseph I und die Serben 1848–1908

    Directory of Open Access Journals (Sweden)

    Wolfgang Rohrbach

    2017-02-01

    Full Text Available A century from death of Emperor Franz Joseph I (+21.11.1916 triggered a great number of publications about life and almost seven decades long reign of a popular monarch. As the political struggle between Russia, Prussia, Italy and Ottoman Empire are depicted with moderation, Serbia is described unidimensional, with an emphasis on the last decade of Emperors rule. In order to remedy this shortcoming, this contribution is focusing on a period between 1848 and 1908. Today we know much more about relations between Franz Joseph and King Milan Obrenović, as well as with dignitaries of Serbian Orthodox Church, and military, academic and artistic elite. It is, therefore, possible to refute entrenched notions about constant enmity and hostility between Austria and Serbia. In this work, an emphasis is put on cooperation between Austria and Serbia from 1848, when Serbs at Emperors request held a number of important political and military positions, whereas Serbian artists took part in the reconstruction of Imperial Vienna. The university of Vienna hosted the oldest institute for slavistic (1849, becoming, therefore, a crossroad of the cultural and social development of the Balkans.

  3. Parents, Children & Media: A Kaiser Family Foundation Survey

    Science.gov (United States)

    Rideout, Victoria

    2007-01-01

    Over the past few years, media use among children and teens has become more prevalent than ever. With the launch of the iPod, the explosion in instant messaging, the birth of mobile video and YouTube, and the advent of social networking sites like MySpace, young people are rarely out of contact, or out of reach of the media. Meanwhile,…

  4. Utilização do Sig na Delimitação das Áreas de Preservação Permanente (APP’s) na Bacia do Rio Sagrado (Morretes/PR) / Use of Gis in the Delimitation of Mandatory Preservation Areas in the Hydrographic Basin of Sagrado River (Morretes/PR)

    OpenAIRE

    Alexei Nowatzki; Leonardo José Cordeiro Santos; Eduardo Vedor de Paula

    2010-01-01

    O presente trabalho se enquadra no Programa CAD (Contaminantes, Assoreamento e Dragagem) no Estuário de Paranaguá/PR, tendo por objetivo a utilização do SIG (Sistema de Informações Geográficas) para a delimitação das Áreas de Preservação Permanente (APP's), na bacia hidrográfica do Rio Sagrado (Morretes/PR). Como etapa preliminar efetuou-se o estudo da legislação brasileira vigente (Código Florestal e resoluções CONAMA) no que se refere à delimitação das APP's. Em seguida, por meio do softwar...

  5. Irrompimento do primeiro molar permanente em crianças de 5 e 6 anos de idade: implicações da análise longitudinal para prevenção da cárie oclusal Emergence of the first permanent molar in 5-6-year-old children: implications from a longitudinal analysis for occlusal caries prevention

    Directory of Open Access Journals (Sweden)

    Paulo Frazão

    2011-06-01

    Full Text Available O tempo de irrompimento dentário é essencial para o planejamento de medidas de prevenção da cárie oclusal. Com a ampliação do ensino fundamental de oito para nove anos de duração, um número maior de crianças entre cinco e seis anos de idade é incluído na primeira série do ensino fundamental. OBJETIVO: O objetivo foi estimar as tendências do irrompimento dos primeiros molares permanentes em meninos e meninas de 5 e 6 anos de idade. MÉTODOS: Em estudo longitudinal, espaços dentários de 497 crianças de 60 meses e mais de idade foram examinados quatro vezes por um dentista calibrado (kappa > 0,97 durante 18 meses. O primeiro molar permanente foi considerado irrompido quando qualquer parte de sua superfície podia ser tocada por uma sonda de ponta esférica. A idade dos participantes foi medida em meses. Intervalos para 95% de confiança dos valores de prevalência e incidência foram apurados conforme o sexo para três coortes etárias: 60,0 a 65,9; 66,0 a 71,9; 72,0 a 77,9 meses. A razão entre as taxas de incidência foi estimada por meio de análise de regressão de Poisson. RESULTADOS: A maioria das crianças entre 66,0 e 71,9 meses e entre 72,0 e 77,9 meses tem pelo menos um molar permanente irrompido. No grupo de 66,0 a 71,9 meses, de cada três crianças pelo menos uma apresentou os quatro primeiros molares permanentes irrompidos. CONCLUSÃO. As tendências de irrompimento observadas justificam a necessidade da adoção de medidas de vigilância e de proteção específica em relação à lesão de cárie oclusal.The timing of tooth emergence is of considerable importance in the planning of prevention of occlusal caries. OBJECTIVE: The aim was to estimate the trends of emergence of the first permanent molars in girls and boys between 5-6 years of age, since more children are included in the first grade after Brazilian elementary education has been extended from eight to nine years of duration. METHODS: Dental spaces of 497

  6. Inclusión educativa de alumnos con discapacidades graves y permanentes : análisis de un modelo : la Comunidad Valenciana (España = Educational inclusion of students with severe and permanent disabilities : analysis of a model : the Region of Valencia

    Directory of Open Access Journals (Sweden)

    Manuel López-Torrijo

    2014-09-01

    Full Text Available Este artículo analiza la inclusión educativa del alumnado con discapacidades graves y permanentes en la Comunidad Valenciana (España a través de los siguientes indicadores: concepción de las discapacidades graves y permanentes; responsabilidad de la escolarización y prestación de servicios; marco normativo; identificación, valoración y atención temprana; incidencia en la población; modelos y modalidades de escolarización; propuesta curricular; Centros y Unidades Específicos de Educación Especial; recursos personales y materiales; papel de las familias y financiación. Utiliza el método descriptivo en la revisión legislativa, documental, y bibliográfica, así como en el análisis de las fuentes estadísticas. Concluye señalando las mejoras inmediatas aplicables para una inclusión educativa real y de calidad.This article analyzes the educational inclusion of students with severe and permanent disabilities in the Region of Valencia with the following indicators: design of severe and permanent disabilities, regulatory framework, responsibility for providing schooling and services, identification and assessment of deficits, prevalence, proposed curriculum (model and modalities of care, special schools, human and material resources, role of families and funding. It utilizes the descriptive method in the legislative, documental and bibliographic revision, as well as in the analysis of statistical sources. The analysis concludes by pointing out the challenges that must guide future improvements to achieve a true educational equality.

  7. Health Benefits In 2015: Stable Trends In The Employer Market.

    Science.gov (United States)

    Claxton, Gary; Rae, Matthew; Panchal, Nirmita; Whitmore, Heidi; Damico, Anthony; Kenward, Kevin; Long, Michelle

    2015-10-01

    The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2015, average annual premiums (employer and worker contributions combined) were $6,251 for single coverage and $17,545 for family coverage. Both premiums rose 4 percent from 2014, continuing several years of modest growth. The percentage of firms offering health benefits and the percentage of workers covered by their employers' plans remained statistically unchanged from 2014. Eighty-one percent of covered workers were enrolled in a plan with a general annual deductible. Among those workers, the average deductible for single coverage was $1,318. Half of large employers either offered employees the opportunity or required them to complete biometric screening. Of firms that offer an incentive for completing the screening, 20 percent provide employees with incentives or penalties that are tied to meeting those biometric outcomes. The 2015 survey included new questions on financial incentives to complete wellness programs and meet specified biometric outcomes as well as questions about narrow networks and employers' strategies related to the high-cost plan tax and the employer shared-responsibility provisions of the Affordable Care Act. Project HOPE—The People-to-People Health Foundation, Inc.

  8. Medical malpractice reform and employer-sponsored health insurance premiums.

    Science.gov (United States)

    Morrisey, Michael A; Kilgore, Meredith L; Nelson, Leonard Jack

    2008-12-01

    Tort reform may affect health insurance premiums both by reducing medical malpractice premiums and by reducing the extent of defensive medicine. The objective of this study is to estimate the effects of noneconomic damage caps on the premiums for employer-sponsored health insurance. Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance Surveys. Damage caps were obtained and dated based on state annotated codes, statutes, and judicial decisions. Fixed effects regression models were run to estimate the effects of the size of inflation-adjusted damage caps on the weighted average single premiums. State tort reform laws were identified using Westlaw, LEXIS, and statutory compilations. Legislative repeal and amendment of statutes and court decisions resulting in the overturning or repealing state statutes were also identified using LEXIS. Using a variety of empirical specifications, there was no statistically significant evidence that noneconomic damage caps exerted any meaningful influence on the cost of employer-sponsored health insurance. The findings suggest that tort reforms have not translated into insurance savings.

  9. Perda precoce de molares permanentes e fatores associados em escolares de 9, 12 e 15 anos da rede pública municipal de Campina Grande, Estado da Paraíba, Brasil - doi: 10.4025/actascihealthsci.v33i1.8373 Early loss of permanent molars and associated factors in schoolchildren aged 9, 12 and 15 years attending public schools in Campina Grande, Paraíba State, Brazil - doi: 10.4025/actascihealthsci.v33i1.8373

    Directory of Open Access Journals (Sweden)

    Sérgio D’Avila Lins Bezerra Cavalcanti

    2011-05-01

    Full Text Available Este estudo avaliou a perda precoce de molares permanentes em escolares da rede pública de Campina Grande, Estado da Paraíba, com idades de nove, 12 e 15 anos. A amostra compreendeu 873 escolares, aleatoriamente selecionados. O instrumento de coleta consistiu de um questionário e de uma ficha clínica. As variáveis do estudo compreenderam os aspectos relativos à perda dentária (tipo de elemento dental, localização na arcada dentária e a região do arco, à prevenção e à autopercepção em saúde bucal. A análise estatística compreendeu a distribuição de frequências e os testes do Qui-quadrado e Exato de Fisher. Os resultados revelaram a prevalência de 17,2% de perda dentária, sem diferenças entre os sexos, frequência de escovação e palestra educativa (p > 0,05. Os elementos dentários 36 (42,5% e 46 (33,9% foram os mais frequentemente perdidos. Observou-se a associação positiva entre perda dentária e as variáveis idade, visita ao cirurgião-dentista (OR = 2,19; IC95%: 1,35-3,59, satisfação com o sorriso (OR = 0,40; IC95%: 0,24-0,65 e a dificuldade na mastigação (OR = 2,16; IC95%: 1,48-3,16. Conclui-se que a prevalência da perda precoce de molares permanentes foi elevada, sendo necessária a imediata adoção de ações curativas a fim de reduzir a perda precoce desses elementos dentários.This study evaluate the early loss of permanent molars in schoolchildren aged 9, 12 and 15 years attending public schools in the city of Campina Grande, Paraíba State, Brazil. The sample was composed of 873 randomly selected schoolchildren. The instrument for data collection was a questionnaire and a clinical chart. The following variables were analyzed: tooth loss (tooth type, localization in the dental arch and region of the arch, prevention and self-perception of oral health. The statistical analysis was done by frequency distribution and the chi-square and fisher’s exact tests were used. The results showed a prevalence of

  10. Instrument Development of Integrative Health and Wellness Assessment™.

    Science.gov (United States)

    McElligott, Deborah; Eckardt, Sarah; Montgomery Dossey, Barbara; Luck, Susan; Eckardt, Patricia

    2017-12-01

    The nurse coach role was developed to address the needs of our nation and the world for health and wellbeing. The Theory of Integrative Nurse Coaching provides a foundation for coaching interventions supporting health promotion, and a framework for the development of the Integrative Health and Wellness Assessment (IHWA) short form. This 36-question Likert-type scale self-reporting tool assists participants in assessing healthy behaviors through a self-reflection process, provides information for the coaching relationship, and may be an outcome measurement. This article describes the history of the IHWA tool and the development and pilot testing of the IHWA short form using guidelines provided by DeVellis. Results of the Kaiser-Meyer-Olkin test yielded a value of .520, and the Bartlett's test of sphericity was significant. Cronbach's alpha overall scale internal consistency was .88 ( n = 36). Pilot study results indicate that the scale could be improved through additional revision, and an ongoing study is in progress.

  11. 2014 Hypertension Guideline: Recommendation for a Change in Goal Systolic Blood Pressure

    Science.gov (United States)

    Handler, Joel

    2015-01-01

    The 2014 Kaiser Permanente Care Management Institute National Hypertension Guideline was developed to assist primary care physicians and other health care professionals in the outpatient treatment of uncomplicated hypertension in adult men and nonpregnant women aged 18 years and older. The new guideline reflects general acceptance, with minor modifications, of the “Evidence-Based Guideline” report by the panel members appointed to the National Heart, Lung, and Blood Institute 8th Joint National Committee. A major practice change is the recommendation for goal systolic blood pressure less than 150 mmHg in patients aged 60 years and older who are treated for hypertension in the absence of diabetes or chronic kidney disease. This article describes the reasons for, evidence for, and consequences of the change, and is followed by the National Guidelines handout. PMID:26057683

  12. A gestão urbana e ocupação em áreas de preservação permanente na cidade de Guarapuava (PR: o caso do arroio do Carro Quebrado / Management in urban areas and occupation of permanent preservation areas in the city of Guarapuava (PR: the case of the

    Directory of Open Access Journals (Sweden)

    Nilmar Pussinini

    2011-04-01

    Full Text Available Na cidade, o capitalismo se reproduz de forma muito dinâmica. É nela, que o ambiente, antes natural, torna-se cada vez mais artificial, ou seja, ambiente construído. Com isso, cada vez mais o relevo e os rios são cobertos pelas edificações. Neste contexto, falar de áreas de preservação permanente nas cidades correlacionando-as com as políticas públicas que gerenciam e gestam as cidades, bem como o processo de produção e reprodução do espaço urbano é algo complexo, pois envolve muitos interesses, principalmente dos agentes que o produzem. Neste contexto o trabalho visa discutir as condições socioambientais das áreas de preservação permanente na cidade. As áreas de preservação permanente são preocupações da temática ambiental relacionadas à sociedade e ao ambiente. Preservá-las é uma preocupação social, que envolve a discussão de conceitos como a natureza, preservação, e qualidade de vida no meio ambiente urbano. Através de imagens de satélite, fotografias aéreas e dados coletados, diretamente no campo, buscamos localizar e espacializar as informações, de forma a obter uma visão de conjunto da distribuição do curso hídrico estudado, juntamente com as condições das áreas ao seu em torno que, a priori, deveriam ser destinadas à preservação permanente. Em Guarapuava, há uma importante rede de drenagem, contudo, os rios urbanos estão praticamente todos canalizados, e aqueles que ainda preservam seu curso original, estão degradados pelo lançamento de esgoto e assoreamento. Pensar condições e formas de planejamento e de gestão pública voltados para a conservação dessas áreas que a priori seriam de preservação, é um caminho para a recuperação dos cursos hídricos que ainda resistem à expansão da cidade. AbstractIn the urban area, capitalism increases really dinamically, it is in this place that the natural environment becomes more and more artificial, that is, a built environment. Thus

  13. Consider outsourcing IT projects when cutting-edge technology, specialized focus are needed.

    Science.gov (United States)

    1999-05-01

    Looking outside to meet information technology needs proves a smart way to avert extra staffing costs. Kaiser Permanente saves thousands each year by contracting out cutting-edge IT projects instead of hiring more full-time staff it doesn't need. Learn how the organization incorporates outsourcing and other temporary work methods into its IT staffing strategy.

  14. Pathways: improving outcomes, not just 'cookbook medicine'.

    Science.gov (United States)

    O'Malley, S

    1997-04-01

    A Kaiser Permanente medical director cites four benefits to be derived from using clinical guidelines: better outcomes, faster patient recovery, reduced costs, and increased physician accountability. And, he notes, physicians are free to deviate from the guidelines--so long as they can justify their actions.

  15. Joint Venture Arrangement for RN to BSN: A Model of Synergy between Academia and Service.

    Science.gov (United States)

    Bargagliotti, L. Antoinette; And Others

    1991-01-01

    Joint venture among educational and practice institutions is well on its way toward becoming the norm in nursing education and practice. Kaiser Permanente and the University of San Francisco School of Nursing offer a venture that allows registered nurses to pursue a bachelor of science in nursing degree. (JOW)

  16. Treatment changes in patients with psoriasis on etanercept or adalimumab

    DEFF Research Database (Denmark)

    Lee, Erica B; Amin, Mina; Egeberg, Alexander

    2018-01-01

    PURPOSE: To determine the frequency of and reasons for treatment changes in patients with psoriasis. MATERIALS AND METHODS: A retrospective chart review of 140 patients with psoriasis treated with adalimumab or etanercept seen at Kaiser Permanente Los Angeles Medical Center between September 20, ...

  17. Review of HIV Pre exposure prophylaxis (PrEP) and example of HIV PrEP Toolkit

    Science.gov (United States)

    2017-08-28

    at Initiation of Sexual Activity Correct & Consistent Condom Use Prevention of mother-to- child transmission July 16, 2012: FDA approves...Okulicz JF, Medicine 2016 PrEP Utilization in a Managed Care System (Kaiser Permanente) 1200 ~ 1045 1000 . 800 600 . 400 200 0 835 657 0

  18. Psychiatric and Medical Conditions in Transition-Aged Individuals With ASD.

    Science.gov (United States)

    Davignon, Meghan N; Qian, Yinge; Massolo, Maria; Croen, Lisa A

    2018-04-01

    Children with autism spectrum disorder (ASD) have a variety of medical and psychiatric conditions and an increased use of health care services. There is limited information about the prevalence of psychiatric and medical conditions in adolescents and young adults with ASD. Our objective was to describe the frequency of medical and psychiatric conditions in a large population of diverse, insured transition-aged individuals with ASD. Participants included Kaiser Permanente Northern California members who were enrolled from 2013 to 2015 and who were 14 to 25 years old. Individuals with ASD ( n = 4123) were compared with peers with attention-deficit/hyperactivity disorder ( n = 20 615), diabetes mellitus ( n = 2156), and typical controls with neither condition ( n = 20 615). Over one-third (34%) of individuals with ASD had a co-occurring psychiatric condition; the most commonly reported medical conditions included infections (42%), obesity (25%), neurologic conditions (18%), allergy and/or immunologic conditions (16%), musculoskeletal conditions (15%), and gastrointestinal (11%) conditions. After controlling for sex, age, race, and duration of Kaiser Permanente Northern California membership, most psychiatric conditions were significantly more common in the ASD group than in each comparison group, and most medical conditions were significantly more common in the ASD group than in the attention-deficit/hyperactivity disorder and typical control groups but were similar to or significantly less common than the diabetes mellitus group. Although more research is needed to identify factors contributing to this excess burden of disease, there is a pressing need for all clinicians to approach ASD as a chronic health condition requiring regular follow-up and routine screening and treatment of medical and psychiatric issues. Copyright © 2018 by the American Academy of Pediatrics.

  19. Does the diagnosis of breast or ovarian cancer trigger referral to genetic counseling?

    Science.gov (United States)

    Powell, C Bethan; Littell, Ramey; Hoodfar, Elizabeth; Sinclair, Fiona; Pressman, Alice

    2013-03-01

    Kaiser Permanente Northern California is a large integrated health care delivery system in the United States that has guidelines for referring women with newly diagnosed BRCA1-and BRCA2-associated cancers for genetic counseling. This study assesses adherence to genetic counseling referral guidelines within this health system. Chart review was performed to identify patients with cancer who met the following pathology-based Kaiser Permanente Northern California guidelines for referral for genetic counseling: invasive breast cancer, younger than age 40; nonmucinous epithelial ovarian, fallopian tube, or peritoneal cancer, younger than age 60; women with synchronous or metachronous primary cancers of the breast and ovaries; and male breast cancer. We assessed compliance with referral guidelines. An electronic notice was sent to the managing physician of patients with newly diagnosed cancer to assess the feasibility of this intervention. A total of 340 patients were identified with breast cancer at younger than age 40 or with ovarian, peritoneal, or tubal cancer between January and June, 2008. Upon chart review, 105 of these patients met pathology-based criteria for referral to genetic counseling, of whom 47 (45%) were referred within the 2-year study period. Of the 67 subjects with breast cancer, 40 subjects (60%) were referred. In contrast, only 7 (21%) of 33 patients with ovarian cancer were referred (P < 0.001). A pilot study was performed to test the feasibility of notifying managing oncologists with an electronic letter alerting them of eligibility for genetic referral of patients with new diagnosis (n = 21). In the 3 to 6 months after this notification, 12 of these 21 patients were referred for counseling including 5 of 7 patients with a diagnosis of ovarian cancer. There is a missed opportunity for referring patients to genetic counseling, especially among patients with ovarian cancer. A pilot study suggests that alerting treating physicians is a feasible

  20. Identificação de conflito de uso da terra em áreas de preservação permanente no entorno do parque nacional do Caparaó, Estado de Minas Gerais Identification of land use conflicts in permanent preservation áreas in the surroundings of the Caparaó national park, Minas Gerais State, Brazil

    Directory of Open Access Journals (Sweden)

    Fernando Soares de Oliveira

    2008-10-01

    Full Text Available Este estudo teve como objetivos elaborar um mapa de uso da terra com base nas imagens do satélite IKONOS II, delimitar de maneira automática as áreas de preservação permanente e identificar a ocorrência de conflitos de usos, tendo como referência legal o Código florestal e a Resolução n.º 303 do CONAMA. A pesquisa foi desenvolvida na entorno do Parque Nacional do Caparaó, pertencente aos municípios de Alto Jequitibá, Alto Caparaó, Caparaó e Espera Feliz, todos situados no estado de Minas Gerais. Utilizando os recursos disponíveis no geoprocessamento, foi possível mapear 8 classes de uso da terra e delimitar as áreas de preservação permanente situadas em áreas com altitudes superior a 1.800 metros (8,42 ha, no terço superior dos morros (18,67 ha; encostas com declividade superior a 45 graus (92,96 ha; nascentes e suas respectivas áreas de contribuição (1.989,44 ha; margens dos cursos d´água com largura inferior a 10 metros (3.957,19 ha; e no terço superior das sub-bacias (6.031,54 ha, perfazendo um total de 12.098,22 ha (48,06% da área total da bacia. A área de uso indevido correspondeu a 8.922,91 ha (73,75%, sendo as classes cafezal (5.183,43 ha e pastagem (3.650,74 ha as principais ocorrências nessas áreas. Apenas 2.160,69 ha (18,40% das áreas de preservação permanente estão protegidas por vegetação nativa.The objective of this work was to prepare a map of land use based on the IKONOS II sattelite images, to automatically determine the permanent preservation areas and to identify the occurrence of use conflicts, using as legal reference the Forest Code and the nº 303 Resolution of the CONAMA. The research was developed around the Caparaó National Park, in lands of the municipalities of Alto Jequitibá, Alto Caparaó, Caparaó and Espera Feliz, all of them located in the State of Minas Gerais. Using the resources available in the geographic processing, it was possible to map 8 classes of land use and to

  1. Educação permanente em saúde e as Diretrizes Curriculares Nacionais para Educação das relações étnico-raciais e para ensino de História e Cultura Afro-Brasileira e Africana

    Directory of Open Access Journals (Sweden)

    Rosana Batista Monteiro

    Full Text Available Resumo Este texto é um ensaio sobre algumas contribuições que o curso de especialização em Saúde da Mulher Negra pode ter produzido para a abordagem dos conteúdos relacionados nas Diretrizes Curriculares Nacionais para a Educação das Relações Étnico-raciais e para o Ensino de História e Cultura Afro-brasileira e Africana, bem como em atenção à Política Nacional de Saúde Integral da População Negra, com destaque para a educação permanente. A partir de breve contextualização sobre o debate no campo das relações raciais e ações afirmativas no Brasil passamos a apresentar a organização e funcionamento do curso, destacando seus objetivos, conteúdos, estratégias. Com foco nos profissionais da saúde, o curso contou com significativa presença de profissionais da educação básica pública, municipal e estadual, das cidades de São Luís e Pinheiro, no Maranhão, implicando a discussão do tema saúde da população negra (especialmente da mulher negra no âmbito da escola. O curso propiciou a elaboração de projetos de pesquisa relacionados diretamente com o atendimento à saúde de mulheres negras e sua relação com processos formativos de profissionais da área da saúde, bem como educação escolar e saúde de mulheres negras. Pode-se concluir, ainda que provisoriamente, que o curso, na perspectiva da educação permanente, resultou em estratégia eficaz para o desenvolvimento de conteúdos relacionados às DCNERER e, especialmente, de viabilização de implementação da Política Nacional de Saúde Integral da População Negra, realizadas ou desencadeadas nos serviços de saúde pelos cursistas.

  2. Expansão rápida da maxila ancorada em implantes: uma nova proposta para expansão ortopédica na dentadura permanente Rapid maxillary expansion anchored by implants: a new proposal to orthopedic expansion in the permanent dentition

    Directory of Open Access Journals (Sweden)

    Daniela Gamba Garib

    2007-06-01

    Full Text Available OBJETIVO: este trabalho apresenta um método para expansão ortopédica da maxila, na dentadura permanente, utilizando implantes como ancoragem. METODOLOGIA: detalharam-se os procedimentos cirúrgicos e laboratoriais da confecção de um expansor com ancoragem dento-óssea em crânio seco humano. Dois implantes de titânio foram colocados na região anterior do palato, e o parafuso Hyrax adaptado de modo que a expansão ancorou-se nos implantes e nos primeiros molares permanentes. RESULTADOS: o experimento laboratorial em crânio seco mostrou que o procedimento apresenta-se anatômica e operacionalmente viável. Os implantes suportaram a força gerada pela ativação do parafuso expansor, redundando na separação transversal das hemimaxilas. CONCLUSÕES: vislumbra-se que a expansão rápida da maxila ancorada em implantes (ERMAI poderá potencializar a eficiência da expansão ortopédica, assim como reduzir o custo periodontal dos procedimentos convencionais de expansão. Futuros estudos clínicos são necessários para testar essas hipóteses.AIM: This study presents a method for maxillary orthopedic expansion, in the permanent dentition, using implants as anchorage. METHODS: Surgical and laboratorial procedures for the construction of a tooth-bone-borne expansor was detailed in a human dry skull. Two titanium implants were placed in the anterior region of the palate and a Hyrax screw was adapted in a way that the expansion was anchored both on the palatal implants and on permanent first molars. RESULTS: The laboratorial experiment in dry skull showed that the procedure is operationally and anatomically possible. The implants supported the force generated by the expansion screw activation and the maxilla halves were transversally split. CONCLUSIONS: Rapid maxillary expansion anchored on implants can increase the efficiency of orthopedic expansion and decrease the periodontal sequela caused by conventional RME. Further clinical studies are

  3. Rapid spread of complex change: a case study in inpatient palliative care

    Directory of Open Access Journals (Sweden)

    Filipski Marta I

    2009-12-01

    Full Text Available Abstract Background Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC. Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program. Methods Quality improvement study using a case study design and qualitative analysis of in-depth semi-structured interviews with 36 national, regional, and local leaders. Results Compelling evidence of impacts on patient satisfaction and quality of care generated 'pull' among adopters, expressed as a remarkably high degree of conviction about the value of the model. Broad leadership agreement gave rise to sponsorship and support that permeated the organization. A robust social network promoted knowledge exchange and built on an existing network with a strong interest in palliative care. Resource constraints, pre-existing programs of a different model, and ambiguous accountability for implementation impeded spread. Conclusions A complex, hospital-based, interdisciplinary intervention in a large health care organization spread rapidly due to a synergy between organizational 'push' strategies and grassroots-level pull. The combination of push and pull may be especially important when the organizational context or the practice to be spread is complex.

  4. Health Benefits In 2016: Family Premiums Rose Modestly, And Offer Rates Remained Stable.

    Science.gov (United States)

    Claxton, Gary; Rae, Matthew; Long, Michelle; Damico, Anthony; Whitmore, Heidi; Foster, Gregory

    2016-10-01

    The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2016, average annual premiums (employer and worker contributions combined) were $6,435 for single coverage and $18,142 for family coverage. The family premium in 2016 was 3 percent higher than that in 2015. On average, workers contributed 18 percent of the premium for single coverage and 30 percent for family coverage. The share of firms offering health benefits (56 percent) and of workers covered by their employers' plans (62 percent) remained statistically unchanged from 2015. Employers continued to offer financial incentives for completing wellness or health promotion activities. Almost three in ten covered workers were enrolled in a high-deductible plan with a savings option-a significant increase from 2014. The 2016 survey included new questions on cost sharing for specialty drugs and on the prevalence of incentives for employees to seek care at alternative settings. Project HOPE—The People-to-People Health Foundation, Inc.

  5. Communication received from the Permanent Mission of Denmark to the Agency regarding Guidelines for the Export of Nuclear Material, Equipment and Technology; Comunicacion recibida de la Mision Permanente de Dinamarca ante el Organismo relativa a las directrices para la exportacion de materiales, equipos y tecnologia nucleares

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-01-02

    The Director General of the International Atomic Energy Agency has received Notes Verbales, dated 1 December 2005, from the Resident Representatives to the Agency of Argentina, Australia, Austria, Belarus, Belgium, Brazil, Bulgaria, Canada, China, Croatia, Czech Republic, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Japan, Republic of Korea, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, New Zealand, Poland, Portugal, Slovenia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the United Kingdom of Great Britain and Northern Ireland and the United States of America, relating to the export of nuclear material, equipment and technology [Spanish] El Director General ha recibido una nota verbal de la Mision Permanente de Dinamarca, de fecha 1 de diciembre de 2005, en la que se facilita informacion sobre las politicas y practicas del Gobierno de Dinamarca con respecto a la exportacion de materiales, equipos y tecnologia nucleares. Atendiendo a los deseos expresados al final de la nota verbal, se adjunta al presente documento el texto de dicha nota. El apendice a que se hace referencia en la nota verbal se publico previamente como INFCIRC/254/Rev.7/pt.1.

  6. Qualificação de processos de gestão e atenção no município de Caaporã, PB: relatos de tutoria de educação permanente em saúde

    Directory of Open Access Journals (Sweden)

    Yuri Wanderley Cavalcanti

    Full Text Available Objetivou-se relatar a formação em Educação Permanente em Saúde (EPS de Equipes de Saúde da Família (ESF do município de Caaporã - PB. Os problemas identificados dizem respeito a dificuldades de acesso dos usuários, fragilidade do vínculo com a comunidade e ausência de ações educativas e preventivas. As intervenções propostas envolvem a reorientação das estratégias de acesso, integração entre a ESF e comunidade e a redistribuição das tarefas entre os membros da ESF. Os resultados revelam a eliminação da fila de espera para o atendimento, o fortalecimento do vínculo com a comunidade e a introdução de ações preventivas na ESF. A EPS em Caaporã contribuiu para modificar as práticas de gestão e atenção em saúde.

  7. Iranian Health Literacy Questionnaire (IHLQ): An Instrument for Measuring Health Literacy in Iran.

    Science.gov (United States)

    Haghdoost, Ali Akbar; Rakhshani, Fatemeh; Aarabi, Mohsen; Montazeri, Ali; Tavousi, Mahmoud; Solimanian, Atoosa; Sarbandi, Fatemeh; Namdar, Hosein; Iranpour, Abedin

    2015-06-01

    Promoting Health Literacy (HL) is considered as an important goal in strategic plans of many countries. In spite of the necessity for access to valid, reliable and native HL instruments, the number of such instruments in the Persian language is scarce. Moreover, there is no good estimation of HL status in Iran. The aim of this study was to provide a valid, reliable and native instrument to measure and monitor community HL in Iran and also, to provide an estimation of HL status in two Iranian provinces. By applying the multistage cluster sampling, 1080 respondents (540 from each gender) were recruited from Kerman and Mazandaran provinces of Iran, from February to June 2014 to participate in this cross-sectional study. The development of the Iranian Health Literacy Questionnaire (IHLQ) was initiated with a comprehensive review of the literature. Then, face, content and construct validity as well as reliability were determined. Internal consistency and test-retest reliability (ICC) of the factors was in the range of 0.71 to 0.96 and 0.73 to 0.86, respectively. In order to construct validity, Exploratory Factor Analysis (EFA) Kaiser-Meyer-Olkin (KMO) = 0.95 and Bartlett's test result of 3.017 with P < 0.001) with varimax rotation was used. Optimal reduced solution, including 36 items and seven factors, was found in EFA. Five of the factors identified were reading/comprehension skills, individual empowerment, communication/decision-making skills, social empowerment and health knowledge. It was concluded that IHLQ might be a practical and useful tool for investigating HL for Persian language speakers around the world. Since HL is dynamic and its instruments should be regularly revised, further studies are recommended to assess HL with application of IHLQ to detect its potential imperfections.

  8. PS2-5: Prevalence of Migraine in a Diverse Community – Electronic Methods for Migraine Ascertainment in a Large Integrated Health Plan

    Science.gov (United States)

    Pressman, Alice; Jacobson, Alice; Avins, Andy

    2013-01-01

    Background/Aims Migraine, a common neurological disorder, is among the top 20 causes of disability worldwide. One-year prevalence of migraine in the US is estimated to range from 8–15%, with women affected at approximately three times the rate of men. Current methods for migraine ascertainment from headache clinics and surveys are costly, affected by clinic-ascertainment bias, and do not work in situations where patient contact is not feasible. With the growing use of electronic medical records (EMR), new methods must be developed for identifying and tracking migraine prevalence over time. We sought to develop an EMR algorithm, to identify migraine, and to characterize its prevalence in Kaiser Permanente Northern California (KPNC). Methods From EMRs of all KPNC members, we collected all outpatient migraine diagnoses (ICD9 code 346.xx) and migraine-specific prescriptions (ergots, triptans, and acetaminophen with caffeine) for 2006–2010. We chart-reviewed a random sample to develop an electronic Migraine Probability Algorithm (score 0–100). We tested the algorithm in a second independent chart review. Using membership data, we calculated prevalences by age, race, and gender. Results We identified 313,174 KPNC members with evidence of migraine - 233,620 women and 79,554 men. The 5-year period-prevalence of migraine among KPNC adults was 17.1% for women and 5.9% for men. Among children, rates did not differ by gender (<2%) until the age of 10, when prevalences were higher - 5.8% for girls and 3.5% for boys. For women, prevalence peaked at ages 25–29. In contrast, males experienced flat prevalence with age (range 5%–6%). Overall, Whites had higher prevalence than Asians, but Blacks did not differ appreciably. Conclusions We used EMR data to capture migraine diagnoses and show prevalence patterns similar to those reported in the literature. Prevalence of diagnosed migraine in KPNC was 2.5–3 times higher in women than men; migraine peaked with age in women

  9. Radiological/Health physics program assessement at Rocky Flats, the process

    International Nuclear Information System (INIS)

    Psomas, P.O.

    1996-01-01

    The Department of Energy, Rocky Flats Office, Safety and Health Group, Health Physics Team (HPT) is responsible for oversight of the Radiation Protection and Health Physics Program (RPHP) of the Integrating Management Contractor (IMC), Kaiser-Hill (K-H) operations at the Rocky Flats Environmental Technology Site (RFETS). As of 1 January 1996 the Rocky Flats Plant employed 300 DOE and 4,300 contractor personnel (K-H and their subcontractors). WSI is a subcontractor and provides plant security. To accomplish the RPHP program oversight HPT personnel developed a systematic methodology for performing a functional RPHP Assessment. The initial process included development of a flow diagram identifying all programmatic elements and assessment criteria documents. Formulation of plans for conducting interviews and performance of assessments constituted the second major effort. The generation of assessment reports was the final step, based on the results of this process. This assessment will be a 6 person-year effort, over the next three years. This process is the most comprehensive assessment of any Radiation Protection and Health Physics (RPHP) Program ever performed at Rocky Flats. The results of these efforts will establish a baseline for future RPHP Program assessments at RFETS. This methodology has been well-received by contractor personnel and creates no Privacy Act violations or other misunderstandings

  10. Using the Delphi Method for Qualitative, Participatory Action Research in Health Leadership

    Directory of Open Access Journals (Sweden)

    Amber J. Fletcher PhD

    2014-02-01

    Full Text Available Current pressures on public health systems have led to increased emphasis on restructuring, which is seen as a potential solution to crises of accessibility, quality, and funding. Leadership is an important factor in the success or failure of these initiatives. Despite its importance, health leadership evades easy articulation, and its study requires a thoughtful methodological approach. We used a modified Delphi method in a Participatory Action Research (PAR project on health leadership in Canada. Little has been written about the combination of Delphi method with PAR. We offer a rationale for the combination and describe its usefulness in researching the role of leadership in a restructuring initiative in “real time” with the participation of health system decision makers. Recommendations are provided to researchers wishing to use the Delphi method qualitatively (i.e., without statistical consensus in a PAR framework while protecting the confidentiality of participants who work at different levels of authority. We propose a modification of Kaiser's (2009 post-interview confidentiality form to address power differentials between participants and to enhance confidentiality in the PAR process.

  11. Diagnosis of the permanent preservation areas in the watersheds of municipal district of Bandeirantes, Paraná, Brazil / Diagnóstico das áreas de preservação permanente das microbacias hidrográficas do município de Bandeirantes – Paraná

    Directory of Open Access Journals (Sweden)

    Otávio Jorge Grigoli Abi Saab

    2009-10-01

    Full Text Available The expansion of the agricultural limits, the industrial development and the increase of populations indexes demanded substantial increases in the production of victuals. These factors took to the growing degradation of the natural resources. The devastation of the areas of forests along the rivers and streams, around the riverhead and tops of hills, in the past, they force its recomposition, for law force, as permanent preservation areas (PPA’s. This work had for objective to define the watersheds of the municipal district of Bandeirantes – PR, Brazil, to measure the permanent preservation areas, total and existent, along the courses of water, riverhead and top of hills and to identify the conflict use of the soil in these areas. The geographical information system was used SPRING 4.1, image of Landsat ETM+, bands 2, 3, 4 and 5, cartographic base of the IBGE, scale 1:50000 and aerial pictures, scale 1:25000. It was verified that the municipal district presents 8,6% of PPA’s with ciliary forest, being 11,38%, referring 8,21% and 5,25% to rivers, streams and riverhead, respectively. Referring PPA’s meets of top of hills and in superiors slopes at 100%, they have equivalent area for 24,94 ha and 8,7 ha, however 100% of these areas are without forest. The watersheds that presented smaller index of PPA’s was those with better agricultural aptitude.A expansão das fronteiras agrícolas, o desenvolvimento industrial e o aumento dos índices populacionais demandaram aumentos substanciais na produção de alimentos. Estes fatores levaram à degradação crescente dos recursos naturais. A devastação das áreas de florestas ao longo dos rios e córregos, entorno das nascentes e topos de morros, no passado, obrigam sua recomposição, por força de lei, como áreas de preservação permanente (APP. Este trabalho teve por objetivo delimitar as microbacias do município de Bandeirantes, mensurar as áreas de preservação permanente, total e

  12. Incremento del índice de dientes permanentes cariados, perdidos por caries y obturados, entre escolares de Loja, España Increasing decayed, missing, and filled teeth index among school children in Loja, Spain

    Directory of Open Access Journals (Sweden)

    Diego Almagro-Nievas

    2001-06-01

    Full Text Available Objetivo. Identificar variables clínicas, socioeconómicas y de hábitos alimentarios e higiénicos, predictoras del incremento del índice (DMFT, por sus siglas en inglés de dientes definitivos que están cariados, ausentes por caries y obturados en la cohorte de escolares de la localidad de Loja, Granada, España, en un trienio (1994-1997. Material y métodos. Estudio de cohorte retrospectivo sobre 812 alumnos a los que se les realizó una exploración dental siguiendo la metodología recomendada por la Organización Mundial de la Salud. Para la construcción de modelos se usa la metodología de regresión logística. Resultado. El índice DMFT de toda la cohorte pasó de 1.86 a 4.5 (en el trienio y en los miembros de la cohorte de 12 años, de 3.71 a 4.47. El DMFT medio está asociado con el incremento del DMFT final. La asistencia al colegio 3 tiene un riesgo relativo (RR de 0.69 (IC 95% 0.60-0.8 frente a la asistencia al colegio 4, y un RR de 0.78 (IC 95% 0.67-0.90 frente a la asistencia al colegio 5. Conclusión. En el modelo final se encontró que el riesgo de incrementar la caries es por el DMFT medio del trienio, y que el factor protector es la asistencia al colegio 3. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.htmlObjective. To identify the clinical, socioeconomic, dietary, and hygienic predictors of the increasing Decayed, Missing, and Filled Teeth (DMFT index, in a cohort of school children in Loja, Granada, Spain, during a three-year period (1994-1997. Material and methods. A retrospective cohort study was conducted in 812 students to measure the DMFT index, using the methods recommended by the World Health Organization. Statistical analysis was conducted using logistic regression models. Results. During the study period, the DMFT index increased from 1.86 to 4.5 for the study cohort as a whole, and from 3.71 to 4.47 among twelve-year olds. The DMFT at mid-period was

  13. Communication of 2 June 2009 received from the Permanent Mission of the United Kingdom regarding the Export of Nuclear Material and of Certain Categories of Equipment and Other Material; Comunicacion de fecha 2 de junio de 2009 recibida de la Mision Permanente del Reino Unido en relacion con la exportacion de materiales nucleares y de determinadas categorias de equipo y otros materiales

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-07-31

    The Director General has received a note ver bale from the Permanent Mission of the United Kingdom, dated 2 June 2009, in which it requests that the Agency circulate to all Member States a letter of 28 May 2009 from the Chairman of the Zangger Committee, Mr. Pavel Klucky, to the Director General, on behalf of the Governments of Argentina, Australia, Austria, Belgium, Bulgaria, Canada, China, Croatia, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Japan, Kazakhstan, the Republic of Korea, Luxemburg, the Netherlands, Norway, Poland, Portugal, Romania, the Russian Federation, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the United Kingdom and the United States of America, concerning a number of corrections to the communication regarding the export of nuclear material and of certain categories of equipment and other material published in INFCIRC/209/Rev.2 [Spanish] El Director General ha recibido una nota verbal de la Mision Permanente del Reino Unido, de fecha 2 de junio de 2009, en la que se pide que el Organismo distribuya a todos los Estados Miembros una carta de fecha 28 de mayo de 2009 del Presidente del Comite Zangger, Sr. Pavel Klucky, en nombre de los Gobiernos de Alemania, Argentina, Australia, Austria, Belgica, Bulgaria, Canada, China, Corea (Republica de), Croacia, Dinamarca, Eslovaquia, Eslovenia, Espana, Estados Unidos de America, Federacion de Rusia, Finlandia, Francia, Grecia, Hungria, Irlanda, Italia, Japon, Kazajstan, Luxemburgo, Noruega, Paises Bajos, Polonia, Portugal, Reino Unido de Gran Bretana e Irlanda del Norte, Rumania, Sudafrica, Suecia, Suiza, Turquia y Ucrania, en relacion con varias correcciones hechas a la comunicacion referente a la exportacion de materiales nucleares y de determinadas categorias de equipo y otros materiales publicadas en el documento INFCIRC/209/Rev.2.

  14. Communication of 10 January 2008 received from the Permanent Mission of the United Kingdom regarding the Export of Nuclear Material and of Certain Categories of Equipment and Other Material; Comunicacion de fecha 10 de enero de 2008 recibida de la Mision Permanente del Reino Unido en relacion con la exportacion de materiales nucleares y de determinadas categorias de equipo y otros materiales

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-02-26

    The Director General has received a note ver bale from the Permanent Mission of the United Kingdom, dated 10 January 2008, in which it requests that the Agency circulate to all Member States a letter of 12 December 2006 from the Chairman of the Zangger Committee, Mr. Pavel Klucky, to the Director General, on behalf of the Governments of Argentina, Australia, Austria, Belgium, Bulgaria, Canada, China, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Japan, Republic of Korea, Luxemburg, the Netherlands, Norway, Poland, Portugal, Romania, Russian Federation, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the United Kingdom of Great Britain and Northern Ireland and the United States of America, concerning the export of nuclear material and of certain categories of equipment and other material [Spanish] El Director General ha recibido una nota verbal de la Mision Permanente del Reino Unido, de fecha 10 de enero de 2008, en la que se pide que el Organismo distribuya a todos los Estados Miembros una carta de fecha 12 de diciembre de 2006, relativa a la exportacion de materiales nucleares y de determinadas categorias de equipo y otros materiales, dirigida por el Presidente del Comite Zangger, Sr. Pavel Klucky, en nombre de los Gobiernos de Alemania, Argentina, Australia, Austria, Belgica, Bulgaria, Canada, China, Croacia, Dinamarca, Eslovaquia, Eslovenia, Espana, Estados Unidos de America, Federacion de Rusia, Finlandia, Francia, Grecia, Hungria, Irlanda, Italia, Japon, Luxemburgo, Noruega, Paises Bajos, Polonia, Portugal, Reino Unido de Gran Bretana e Irlanda del Norte, Republica Checa, Republica de Corea, Rumania, Sudafrica, Suecia, Suiza, Turquia y Ucrania.

  15. Communication Received from the Permanent Mission of Brazil regarding Certain Member States' Guidelines for the Export of Nuclear Material, Equipment and Technology; Comunicacion recibida de la Mision Permanente del Brasil relativa a las directrices de ciertos Estados Miembros para la exportacion de materiales, equipos y tecnologia nucleares

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-07-16

    The Agency has received a Note Verbale from the Permanent Mission of Brazil, dated 22 March 2007, in which it requests that the Agency circulate to all Member States a letter of 12 December 2006 from the Chairman of the Nuclear Suppliers Group, Ambassador Jose Artur Denot Medeiros, to the Director General, on behalf of the Governments of Argentina, Australia, Austria, Belarus, Belgium, Brazil, Bulgaria, Canada, China, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Japan, Kazakhstan, Republic of Korea, Latvia, Lithuania, Luxemburg, Malta, Netherlands, New Zealand, Norway, Poland, Portugal, Romania, Russian Federation, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the United Kingdom of Great Britain and Northern Ireland and the United States of America, providing further information on those Governments' Guidelines for Nuclear Transfers [Spanish] El Organismo ha recibido una nota verbal de la Mision Permanente del Brasil, de fecha 22 de marzo de 2007, en la que le solicita que distribuya a todos los Estados Miembros una carta de 12 de diciembre de 2006 enviada al Director General por el Presidente del Grupo de Suministradores Nucleares, el Embajador Jose Artur Denot Medeiros, en nombre de los Gobiernos de Alemania, Argentina, Australia, Austria, Belarus, Belgica, Brasil, Bulgaria, Canada, Croacia, China, Chipre, Dinamarca, Eslovaquia, Eslovenia, Espana, Estados Unidos de America, Estonia, Federacion de Rusia, Finlandia, Francia, Grecia, Hungria, Irlanda, Italia, Japon, Kazajstan, Letonia, Lituania, Luxemburgo, Malta, Noruega, Nueva Zelandia, Paises Bajos, Polonia, Portugal, Reino Unido de Gran Bretana e Irlanda del Norte, Republica Checa, Republica de Corea, Rumania, Sudafrica, Suecia, Suiza, Turquia y Ucrania, por la que se proporciona mas informacion sobre las Directrices de esos Gobiernos para las transferencias nucleares.

  16. Communication Received from the Permanent Mission of Brazil regarding Certain Member States' Guidelines for the Export of Nuclear Material, Equipment and Technology; Communication recue de la mission permanente du Bresil concernant les Directives de certains Etats Membres applicables a l'exportation de matieres, d'equipements et de technologie nucleaires

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-12-03

    The Agency has received a Note Verbale from the Permanent Mission of Brazil, dated 22 March 2007, in which it requests that the Agency circulate to all Member States a letter of 12 December 2006 from the Chairman of the Nuclear Suppliers Group, Ambassador Jose Artur Denot Medeiros, to the Director General, on behalf of the Governments of Argentina, Australia, Austria, Belarus, Belgium, Brazil, Bulgaria, Canada, China, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Japan, Kazakhstan, Republic of Korea, Latvia, Lithuania, Luxemburg, Malta, Netherlands, New Zealand, Norway, Poland, Portugal, Romania, Russian Federation, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the United Kingdom of Great Britain and Northern Ireland and the United States of America, providing further information on those Governments' Guidelines for Nuclear Transfers [French] L'Agence a recu une note verbale de la mission permanente du Bresil, en date du 22 mars 2007, lui demandant de diffuser a tous les Etats Membres une lettre du 12 decembre 2006 du president du Groupe des fournisseurs nucleaires, l'ambassadeur Artur Denot Medeiros, adressee au Directeur general au nom des gouvernements des Etats suivants : Afrique du Sud, Allemagne, Argentine, Australie, Autriche, Belarus, Belgique, Bresil, Bulgarie, Canada, Chine, Chypre, Croatie, Danemark, Espagne, Estonie, Etats-Unis d'Amerique, Federation de Russie, Finlande, France, Grece, Hongrie, Irlande, Italie, Japon, Kazakhstan, Lettonie, Lituanie, Luxembourg, Malte, Norvege, Nouvelle-Zelande, Pays-Bas, Pologne, Portugal, Republique de Coree, Republique tcheque, Roumanie, Royaume-Uni de Grande-Bretagne et d'Irlande du Nord, Slovaquie, Slovenie, Suede, Suisse, Turquie et Ukraine. Cette lettre apporte des informations supplementaires sur les Directives de ces gouvernements applicables aux transferts nucleaires.

  17. Communication Received from the Permanent Mission of the Netherlands regarding Certain Member States' Guidelines for the Export of Nuclear Material, Equipment and Technology; Communication recue de la mission permanente des Pays-Bas concernant les Directives de certains Etats Membres applicables a l'exportation de matieres, d'equipements et de technologie nucleaires

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-09-05

    The Agency has received a Note Verbale from the Permanent Mission of the Kingdom of the Netherlands, dated 12 July 2011, in which it requests that the Agency circulate to all Member States a letter of 12 July 2011 from the Chairman of the Nuclear Suppliers Group, Ambassador Piet de Klerk, to the Director General, on behalf of the Governments of Argentina, Australia, Austria, Belarus, Belgium, Brazil, Bulgaria, Canada, China, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Kazakhstan, Republic of Korea, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, New Zealand, Norway, Poland, Portugal, Romania, Russian Federation, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the United Kingdom of Great Britain and Northern Ireland and the United States of America, providing further information on those Governments' Guidelines for Nuclear Transfers [French] L'Agence a recu une note verbale de la mission permanente du Royaume des Pays-Bas, en date du 12 juillet 2011, lui demandant de communiquer a tous les Etats Membres une lettre du 12 juillet 2011 du president du Groupe des fournisseurs nucleaires, l'ambassadeur Piet de Klerk, adressee au Directeur general au nom des gouvernements des Etats suivants : Afrique du Sud, Allemagne, Argentine, Australie, Autriche, Belarus, Belgique, Bresil, Bulgarie, Canada, Chine, Croatie, Chypre, Danemark, Espagne, Estonie, Etats-Unis d'Amerique, Federation de Russie, Finlande, France, Grece, Hongrie, Irlande, Islande, Italie, Japon, Kazakhstan, Lettonie, Lituanie, Luxembourg, Malte, Norvege, Nouvelle-Zelande, Pays-Bas, Pologne, Portugal, Republique de Coree, Republique tcheque, Roumanie, Royaume-Uni de Grande-Bretagne et d'Irlande du Nord, Slovaquie, Slovenie, Suede, Suisse, Turquie et Ukraineb. Cette lettre apporte des informations supplementaires sur les Directives de ces gouvernements applicables aux transferts nucleaires.

  18. El uso de la triangulación en un estudio de detección de necesidades de formación permanente en profesorado no universitario de la Comunidad de Madrid. Using triangulation to assess continuing education teacher needs in Madrid (Spain

    Directory of Open Access Journals (Sweden)

    Coral González

    2009-01-01

    Full Text Available El presente artículo pretende destacar la importancia de la triangulación como elemento o herramienta para comparar y validar informaciones obtenidas mediante diferentes fuentes y métodos. Para ello se apoya en los resultados de un estudio realizado en la Comunidad de Madrid con el fin de determinar las necesidades que el profesorado manifiesta con respecto a la oferta de formación permanente que se les ofrece en la actualidad. Dichos resultados son producto de la utilización de diferentes modos de recogida de información así como de diferentes técnicas de análisis de datos, hecho que los dota de mayor complejidad y riqueza. Partiendo de una breve introducción sobre la técnica de triangulación, se presentan los métodos, fuentes y análisis de datos llevados a cabo junto a los resultados y las conclusiones principales del estudio. This article aims at highlighting the importance of triangulation as tool to compare and validate information coming from different sources and procedures. To do so, we assessed the needs for in-service training demanded by teachers and offered by the educational administration in Madrid (Spain. The data was collected using different techniques and analyzed with different data-analysis method and from this combination the results are richer and more complex. Starting with a short introduction about triangulation, we present methods, sources and analysis of the data as well main results and conclusions obtained via triangulation.

  19. Sarcopenia and Health Care Utilization in Older Women

    Science.gov (United States)

    Lui, Li-Yung; McCulloch, Charles E.; Cauley, Jane A.; Paudel, Misti L.; Taylor, Brent; Schousboe, John T.; Ensrud, Kristine E.

    2017-01-01

    Background: Although there are several consensus definitions of sarcopenia, their association with health care utilization has not been studied. Methods: We included women from the prospective Study of Osteoporotic Fractures with complete assessment of sarcopenia by several definitions at the Study of Osteoporotic Fractures Year 10 (Y10) exam (1997–1998) who also had available data from Medicare Fee- For-Service Claims (N = 566) or Kaiser Encounter data (N = 194). Sarcopenia definitions evaluated were: International Working Group, European Working Group for Sarcopenia in Older Persons, Foundation for the NIH Sarcopenia Project, Baumgartner, and Newman. Hurdle models and logistic regression were used to assess the relation between sarcopenia status (the summary definition and the components of slowness, weakness and/or lean mass) and outcomes that included hospitalizations, cumulative inpatient days/year, short-term (part A paid) skilled nursing facility stay in the 3 years following the Y10 visit. Results: None of the consensus definitions, nor the definition components of weakness or low lean mass, was associated with increased risk of hospitalization or greater likelihood of short-term skilled nursing facility stay. Women with slowness by any criterion definition were about 50% more likely to be hospitalized; had a greater rate of hospitalization days amongst those hospitalized; and had 1.8 to 2.1 times greater likelihood of a short-term skilled nursing facility stay than women without slowness. There was the suggestion of a protective association of low lean mass by the various criterion definitions on short-term skilled nursing facility stay. Conclusion: Estimated effects of sarcopenia on health care utilization were negligible. However, slowness was associated with greater health care utilization. PMID:27402050

  20. Teatro y cine: un permanente diálogo intermedial

    Directory of Open Access Journals (Sweden)

    Pérez Bowie, José Antonio

    2004-04-01

    Full Text Available Se intenta trazar una panorámica de las aportaciones teóricas más significativas sobre las relaciones entre teatro y cine, con especial atención a algunas de las producidas recientemente en el ámbito español. En un primer apartado se lleva a cabo un recorrido somero sobre los principales problemas que plantea el cotejo de ambos medios y en los dos siguientes se abordan respectivamente los problemas planteados por adaptación de los textos teatrales al cine y la influencia ejercida por éste, a partir de determinado momento de su desarrollo, sobre el arte escénico. Este último apartado se completa con el análisis, a título de ejemplo, de un caso concreto: la producción de los comediógrafos de la denominada «la otra generación del 27».…

  1. Solution of a general pexiderized permanental functional equation

    Indian Academy of Sciences (India)

    49

    and the result follows by equating these last two relations. We return now to the proof of the lemma. Note from C9) that T is completely deter- mined if we know the values of T on the unit circle. Consider any two points on the unit circle (α, β) = (cos γ, sin γ), (x, y) = (cos θ, sin θ) with angles γ, θ oriented counterclock- wise.

  2. De la vie pelagique temporaire a la vie pelagique permanente

    NARCIS (Netherlands)

    Face, Louis

    1949-01-01

    Depuis longtemps certain aspect larvaire de nombreuses formes pélagiques faisant partie du plancton permanent a retenu l’attention des naturalistes et a conduit quelques-uns d’entre eux à considérer cette faune comme primitive. Si cette conclusion s’est par la suite avérée inexacte et si l’origine

  3. Lawrence Kohlberg, una obra en permanente construcción

    Directory of Open Access Journals (Sweden)

    Jaime Yañez Canal

    2012-08-01

    Full Text Available Este artículo, resultado de investigación documental del grupo Estudios sobre el Desarrollo Sociomoral, presenta un análisis sobre la historia y la evolución intelectual de Lawrece Kohlberg, pionero de la Psicología del Desarrollo Moral. Específicamente, el análisis de su obra gira alrededor de tres tópicos: la filosofía moral, la psicología del desarrollo y la pedagogía.

  4. La entrevista, un diálogo permanente.

    OpenAIRE

    Puyana V., Yolanda

    2012-01-01

    El objeto del presente artículo es mostrar tres escenarios sobre la entrevista que son útiles para la docencia y acción profesional de trabajo social. Se busca profundizar sobre la entrevista desde diferentes perspectivas teóricas y metodológicas. En primer término, se tratará el enfoque humanista de Karl Rogers y la mirada etnográfica de Roberta Greene. En segundo término, se esboza el aporte de Sigmud Freud. Finalmente se señala la contribución a la entrevista del modelo sistémico de la Esc...

  5. Un caso de aorta destrocardica o enfermedad azul permanente

    Directory of Open Access Journals (Sweden)

    Héctor Pedraza

    1935-11-01

    Full Text Available Se trata del niño E. S. de 28 meses de edad, que fue recibido por uno de nosotros en el Hospital de La Misericordia en los primeros días de mayo de 1935. El padre, oriundo, como su hijo, de la hacienda de "El Chocho", en el municipio de Fusagasugá, lo trajo a Bogotá con el objeto de que su hijo mejorara de una afección que la sufría permanentemente y desde los primeros momentos de su vida. El padre nos refiere que jamás el niño ha podido comer por más de unos cinco minutos, que el simple ejercicio de la succión del pezón de la madre o del chupo lo fatiga, que tiene que descansar cada momento, en tal forma que nunca queda satisfecho su apetito. Tampoco puede dormir tranquilo; varias veces, durante la noche o el día, se despierta asustado, fatigoso, sobresaltado. Dice que desde que nació le ha notado un tinte morado en los tegumentos y especialmente en las uñas, labios y en las conjuntivas oculares, color que lo ve aumentarse cuando el niño hace el ejercicio natural para comer o cuando se despierta repentinamente del sueño en que estaba. Además nota que el desarrollo no le satisface, es poco relativamente lo que ha crecido, tiene ya 28 meses y los padres se muestran afanosos porque no puede caminar y apenas trata de sentarse; los miembros, poco desarrollados, y su dentición comenzó únicamente a los 14 meses.

  6. Lawrence Kohlberg, una obra en permanente construcción

    OpenAIRE

    Jaime Yañez Canal; María Angélica Fonseca Lamprea; Adriana Milena Perdomo Salazar

    2012-01-01

    Este artículo, resultado de investigación documental del grupo Estudios sobre el Desarrollo Sociomoral, presenta un análisis sobre la historia y la evolución intelectual de Lawrece Kohlberg, pionero de la Psicología del Desarrollo Moral. Específicamente, el análisis de su obra gira alrededor de tres tópicos: la filosofía moral, la psicología del desarrollo y la pedagogía.

  7. Health and health promotion

    NARCIS (Netherlands)

    Kingma, E.M.

    2012-01-01

    Much of our social and political effort, including a portion of the research in this university, is directed towards the promotion of one goal: health. But what is health? Or rather, how should we define health so that it is an identifiable goalpost for our social policies and technological

  8. Irregular menses predicts ovarian cancer: Prospective evidence from the Child Health and Development Studies.

    Science.gov (United States)

    Cirillo, Piera M; Wang, Erica T; Cedars, Marcelle I; Chen, Lee-May; Cohn, Barbara A

    2016-09-01

    We tested the hypothesis that irregular menstruation predicts lower risk for ovarian cancer, possibly due to less frequent ovulation. We conducted a 50-year prospective study of 15,528 mothers in the Child Health and Development Studies cohort recruited from the Kaiser Foundation Health Plan from 1959 to 1966. Irregular menstruation was classified via medical record and self-report at age 26. We identified 116 cases and 84 deaths due to ovarian cancer through 2011 via linkage to the California Cancer Registry and Vital Statistics. Contrary to expectation, women with irregular menstrual cycles had a higher risk of ovarian cancer incidence and mortality over the 50-year follow-up. Associations increased with age (p irregular menstruation and ovarian cancer-we unexpectedly found higher risk for women with irregular cycles. These women are easy to identify and many may have polycystic ovarian syndrome. Classifying high-risk phenotypes such as irregular menstruation creates opportunities to find novel early biomarkers, refine clinical screening protocols and potentially develop new risk reduction strategies. These efforts can lead to earlier detection and better survival for ovarian cancer. © 2016 UICC.

  9. Steady state analysis and Eastern power system dynamic PDVSA EyP considering incorporating Furrial and PIGAP II generation plants; Analisis en regimen permanente y dinamico del sistema electrico de PDVSA EyP Oriente considerando la incorporacion de las plantas de generacion Furrial y PIGAP II

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, S [Universidad Nacional Experimental Politecnica, Antonio Jose de Sucre, Guayana, Bolivar (Venezuela)]. E-mail: sergiodrg200@gmail.com; Vasquez, C [Petroleos de Venezuela S.A., Maturin, Monagas (Venezuela)]. E-mail: vasquezcp@pdvsa.com

    2013-03-15

    This paper is focused on steady state and dynamic analysis of Eastern Power System of Petroleum of Venezuela S.A. (PDVSA) Exploration and Production, considering new single cycle gas turbine power plants in Punta de Mata and El Furrial operational areas that will start up in 2015. Network operating conditions were determined, specifically the behavior of power flows and voltage profiles in normal condition of operation and under Contingencies N-1 in PDVSA Power System, as well as the short-circuit levels at all buses of the transmission network. Afterward, it was evaluated the impact on the network caused by the starting of the biggest motor in the system, considering island operation, verifying that it's necessary to maintain the interconnection with the National Electric System. For motor starting study, machine dynamic model was determined by mean of parameters estimation of its equivalent circuit, as well as the application of nonlinear regression methods in order to obtain load model using the information supplied by the manufacturer. [Spanish] El presente trabajo esta enfocado al analisis del comportamiento en regimen permanente y dinamico del sistema electrico de Petroleos de Venezuela S.A. (PDVSA) Exploracion y Produccion Oriente, considerando la incorporacion de nuevas Plantas de Generacion Termoelectricas de Ciclo Simple a Gas que entraran en operacion en las areas operacionales de Punta de Mata y El Furrial para el ano 2015. Se determinaron las condiciones de operacion de la red, especificamente el comportamiento de los flujos de potencia y perfiles de voltaje en Condicion Normal de operacion y bajo Contingencias N-1 dentro del Sistema de PDVSA, asi como el incremento en los niveles de cortocircuito en todas las barras de la red de transmision. Luego se evaluo el impacto en la red originado por el arranque del motor de mayor capacidad considerando la posible operacion en isla del sistema, determinandose que es necesario operar interconectado con el

  10. Developing a tool to assess motivation among health service providers working with public health system in India.

    Science.gov (United States)

    Purohit, Bhaskar; Maneskar, Abhishek; Saxena, Deepak

    2016-04-14

    Addressing the shortage of health service providers (doctors and nurses) in rural health centres remains a huge challenge. The lack of motivation of health service providers to serve in rural areas is one of the major reasons for such shortage. While many studies have aimed at analysing the reasons for low motivation, hardly any studies in India have focused on developing valid and reliable tools to measure motivation among health service providers. Hence, the objective of the study was to test and develop a valid and reliable instrument to assess the motivation of health service providers working with the public health system in India and the extent to which the motivation factors included in the study motivate health service providers to perform better at work. The present study adapted an already developed tool on motivation. The reliability and validity of the tool were established using different methods. The first stage of the tool development involved content development and assessment where, after a detailed literature review, a predeveloped tool with 19 items was adapted. However, in light of the literature review and pilot test, the same tool was modified to suit the local context by adding 7 additional items so that the final modified tool comprised of 26 items. A correlation matrix was applied to check the pattern of relationships among the items. The total sample size for the study was 154 health service providers from one Western state in India. To understand the sampling adequacy, the Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett's test of sphericity were applied and finally factor analysis was carried out to calculate the eigenvalues and to understand the relative impact of factors affecting motivation. A correlation matrix value of 0.017 was obtained narrating multi-co-linearity among the observations. Based on initial factor analysis, 8 out of 26 study factors were excluded from the study components with a cutoff range of less than

  11. Analysis of land use and occupancy in permanent preservation areas according to the hydrography of Ribeirão Água Fria - Bofete, SP - Brazil Análise do uso e ocupação do solo em áreas de preservação permanente, segundo a hidrografia do Ribeirão Água Fria - Bofete - SP

    Directory of Open Access Journals (Sweden)

    Rafael C. Nardini

    2012-10-01

    Full Text Available The use conflicts are determined by the inadequate occupations of the soil, as it is the case of soil occupation inside of permanent preservation areas. This study aimed to determine the classes of the soil use and if there are conflicts inside of permanent preservation areas along the drainage network of the Água Fria Stream watershed, located in Bofete city - São Paulo, Brazil. It locates geographically between the coordinates: 48°09'30" to 48°18'30" longitude WGr., 22°58'30" to 23°04'30" latitude S, with an area of 15242.84 ha. The map of soil use was elaborated through the interpretation directly in the computer screen of satellite digital image. In the orbital data, the study area is inserted in the quadrant A, of image TM/Landsat - 5, orbit 220, point 76, passage 9/8th/2007. The Geographical Information System used was CartaLinx. The conflict areas of the watershed were obtained from the crossing between the maps of soil use and of PPAs. The results allowed the conclusion that more than half of the area (51.09% is occupied by pastures, reflex of sandy soils and low fertility. It was also verified that although almost half of the watershed is covered with some type of vegetation (48.78% of natural forest /reforestation, it has approximately a third of permanent preservation areas used inappropriately by pastures (88.15%, reforestation (10.42% and exposed soil (1.43%, totaling 343.07ha of conflicting areas, in a total of 993.26 ha of PPAs.Os conflitos de uso são determinados pelas ocupações inadequadas do solo, como é o caso de ocupação do solo dentro de áreas de preservação permanente. O presente trabalho teve como objetivos determinar as classes de uso do solo e se há conflitos dentro de áreas de preservação permanente ao longo da rede de drenagem da microbacia do Ribeirão Água Fria, município de Bofete (SP. Situa-se geograficamente entre as coordenadas: 48°09'30" a 48°18'30" de longitude WGr., 22°58'30" a 23°04

  12. A Measure of Barriers Toward Medical Disclosure Among Health Professionals in the United Arab Emirates.

    Science.gov (United States)

    Zaghloul, Ashraf Ahmad; Elsergany, Moetaz; Mosallam, Rasha

    2018-03-01

    There has been a growing awareness that patients are subject to injuries that can be prevented as a direct consequence of health care. Error disclosure is an effective technique to restore the lost trust with the health care system. The current study aimed to develop a valid and reliable scale to determine the factors facilitating the disclosure of health professionals in health organizations. This study had a cross-sectional design that consisted of 722 responses (response rate of 68.3%) from 1 private and 1 public hospital in Sharjah, United Arab Emirates. The data collection tool included 23 items rated on a Likert scale ranging from 5, strongly agree, to 1, strongly disagree.The internal consistency was established through calculating the split-half reliability for part 1 (12 items), which had a Cronbach coefficient of 0.65, and part 2 (11 items), which had a Cronbach coefficient of 0.62. Scale validity was assessed with the Kaiser-Meyer-Olkin measure of sampling adequacy, which had a value of 0.62, and the Bartlett test of sphericity (approximated χ = 13012.2, P = 0.0001) supported the factorability of the correlation matrix. The varimax rotation revealed 5 components that explained 77.8% of the total variance. The varimax rotation revealed 21 items loaded on the following 5 factors: fear of disclosure and provider image consequences (factor 1), apology (factor 2), organizational culture toward patient safety (factor 3), professional ethics and transparency (factor 4), as well as patient and provider education (factor 5). The disclosure of medical mistakes requires preliminary considerations to effectively and compassionately disclose these events to patients. The validity and reliability of the results support the use of this scale at hospitals as part of the health care providers' disclosure processes.

  13. Avaliação da qualidade das águas subterrâneas em áreas de preservação permanente (sistema aquífero guarani – sag, bacia hidrográfica do Rio Pardo, RS, Brasil

    Directory of Open Access Journals (Sweden)

    Adilson Ben da Costa

    2010-01-01

    Full Text Available O objetivo principal deste estudo foi avaliar a qualidade das águas subterrâneas em áreas de preservação permanente (SistemaAqüífero Guarani – SAG da Bacia Hidrográfica do Rio Pardo, RS, Brasil, através de variáveis físicas, químicas emicrobiológicas, tendo como base a resolução nº 396 do Conselho Nacional do Meio Ambiente – CONAMA. Nove pontos decoleta foram distribuídos ao longo da bacia, nos quais as águas subterrâneas foram classificadas quanto aos íons de maiorocorrência quantitativa através do diagrama de Piper. Os resultados indicaram que a maioria dos poços avaliados enquadraram-sena Classe 4 de usos da água, correspondendo a águas de usos menos restritivos. Entretanto, deve-se considerar que os aquíferos seapresentam em diferentes contextos geológicos, e que possuem características físicas, químicas e biológicas intrínsecas, comvariações hidrogeoquímicas, sendo necessário que as suas classes de qualidade sejam pautadas nessas especificidades, como seobservou no diagrama de Piper, onde as amostras P1, P2, P3, P5 e P9 classificaram-se como bicarbonatadas cálcicas, as águas dospontos P4, P6, P7 como bicarbonatadas sódicas e P8 se classificou como sulfatada. Verificou-se que a qualidade das águas depoços com profundidade inferior a 6 m está mais vulnerável devido a alterações antrópicas em função da concentração de nitrato,coliformes totais e termotolerantes, enquanto que a qualidade das águas de poços mais profundos depende basicamente de suascaracterísticas hidrogeológicas e hidrogeoquímicas naturais, em função das variáveis sulfato e sódio. Contudo, tambémapresentaram contaminação por atividade antrópica, principalmente pela variável nitrato.Abstract The aim of this research was to evaluate thequality of groundwater in areas of permanent preservation(Guarani Aquifer System – GAS in the Rio PardoHydrographical Basin, RS, Brazil, using physical, chemicaland

  14. Variação temporal do fitoplâncton de um lago pertencente à Área de Proteção Permanente no estado de Alagoas, nordeste do Brasil Temporal variation of phytoplankton in a lake in a permanent protected area in Alagoas State, Northeast Brazil

    Directory of Open Access Journals (Sweden)

    Karla Priscila Barros da Silva

    2011-12-01

    Full Text Available Este trabalho teve como objetivo determinar a variação espaço-temporal do microfitoplâncton e variáveis ambientais no Lago Azul, Área de Proteção Permanente do município de Marechal Deodoro, Alagoas. As coletas ocorreram no período de abril a setembro de 2008. As amostras do fitoplâncton foram obtidas através de arrastos horizontais superficiais, com rede de abertura de malha de 45 µm e, concomitantemente, coletadas amostras de água utilizando garrafa de Van Dorn, para a determinação dos parâmetros físico-químicos. Foram identificados 27 táxons predominando as Chlorophyta (63%, destacando-se como espécies "dominantes" Desmidium swartzii var. quadrangulatum (Ralfs A. Roy (62,3% e D. cylindricum Greville (55,1%, seguidos das Bacillariophyta (26% e Cyanobacteria (11%. O pH levemente ácido e a baixa disponibilidade de nutrientes ofereceram condições favoráveis para o desenvolvimento das Desmidiaceae: Closterium sp., Cosmarium goniodes West & West, C. margaritiferum Meneghini ex Ralfs, C. vogeciacum Gutwinski, Desmidium cylindricum Greville, D. pseudotreplonema West & West, D. swartzii var. quadrangulatum (Ralfs A. Roy, Euastrum brasiliense Borge var. minus G.S.West, Gymnozyga moniliformis Ehrenberg, Micrasterias denticulata Brébisson ex Ralfs, M. (Kützing Ralfs, M. radians Turner e Tetmemorus laevis (Kuetzing Ralfs.The objective of this work is to determine the spatial and temporal variation of microphytoplankton and environmental variables in Lake Azul, a permanent protected area in the town of Marechal Deodoro, Alagoas State, Brazil. Samples were collected from April to September 2008. Phytoplankton samples were obtained by surface-horizontal trawling with a 45µm mesh net. Water samples were taken with a Van Dorn bottle, during the phytoplankton collection, in order to determine physical-chemical parameters. A total of 27 taxa were identified, Chlorophyta were the most abundant taxa (63% of the sample followed by

  15. Psychometric properties of the Finnish version of the Women's Health Questionnaire.

    Science.gov (United States)

    Katainen, Riina E; Engblom, Janne R; Vahlberg, Tero J; Polo-Kantola, Päivi

    2017-08-01

    The Women's Health Questionnaire (WHQ) is a validated and commonly used instrument for measuring climacteric-related symptoms. A revised version was previously developed. However, validation in a Finnish population is lacking. As it is important to use qualified instruments, we performed a validation study of the WHQ in a Finnish population. In all, 3,421 women, aged 41 to 54 years, formed the study population. In the original 36-item WHQ, the items were rated on a 1 to 4 scale and on a binary scale (0-1). The scaling of the revised 23-item WHQ was 0 to 100. We evaluated the psychometric properties (internal consistency, correlations between the symptom domains, factor structure, and sampling adequacy) in all three versions. For the 1 to 4 scale and on the revised version of the WHQ, the internal consistency was acceptable (the Cronbach's α coefficients >0.70) for most of the domains. On the binary scale, the majority of the coefficient values were below the acceptable level. The original symptom domains, especially those on the revised version, were recognizable from the factors in the exploratory factor analysis, but there were some limitations. The Kaiser-Meyer-Olkin values were high. The WHQ is a valid instrument for measuring climacteric-related symptoms in Finnish middle-aged women. The psychometric properties of the revised 23-item WHQ were as good or even better than those of the original 36-item WHQ. Thus, we encourage use of the revised version.

  16. Biobanking for research: a survey of patient population attitudes and understanding

    OpenAIRE

    Rahm, Alanna Kulchak; Wrenn, Michelle; Carroll, Nikki M.; Feigelson, Heather Spencer

    2013-01-01

    Population-based biobanks are a critical resource for genetic research. It is important to know what potential participants understand about the risks and benefits of providing samples in order to ensure adequate informed consent. Kaiser Permanente Colorado (KPCO) is currently planning a biobank where adult members would be asked to contribute an additional tube of blood during a routine blood draw. Adult KPCO members in clinic waiting rooms were asked to read an informational brochure and in...

  17. Medical Device Plug-and-Play Interoperability Standards and Technology Leadership

    Science.gov (United States)

    2014-10-01

    Kaiser Permanente, Johns Hopkins Medicine, the VA, FDA, NIST, TATRC, computer and information science groups at University of Pennsylvania...for sharing the findings from our TATRC work and from our NIH Quantum work relative to the gaps in existing standards and recommendations on how they...challenges facing the industry in areas such as interoperability, cybersecurity , data stewardship, and system reliability, and policies needed to accelerate

  18. [The Internet and shared decision-making between patients and healthcare providers].

    Science.gov (United States)

    Silber, Denise

    2009-10-01

    Insurance companies like Kaiser Permanente in the United States remunerate physicians for their email correspondence with patients, increasing the efficiency of office visits. A survey by the French National Board of Physicians regarding the computerization of medical practices in April 2009, confirms that both physicians and patients in France are very favorable to the development of these tools. When patients can manage and/or access their medical files and determine which providers can access them, they become a true partner.

  19. Health education with older adults: action research with primary care professionals.

    Science.gov (United States)

    Mendonça, Francielle Toniolo Nicodemos Furtado de; Santos, Álvaro da Silva; Buso, Ana Luisa Zanardo; Malaquias, Bruna Stephanie Sousa

    2017-01-01

    To assess the development and implementation of permanent education action. Quantitative-qualitative research based on action research in three phases (diagnosis of reality, implementation of activity and evaluation), performed with health professionals and managers of basic health units. The evaluation was on the perception of changes immediately following the activity and after 120 days. In the first phase, 110 professionals took part, 36.4% of whom indicated the existence of groups for older adults at work. In the second phase, 98 professionals participated, pointing out interferences of the group in the life of older adults, items of importance and facilitation in forming groups and developing reality-based activities. The third phase showed, in the quantitative analysis, positive impact of the training, and in the qualitative analysis, reassessment of groups, greater knowledge and confidence in managing groups and increased respect for older adults. Permanent education opens pathways for the construction of differentiated care for older adults based on respect and health promotion. Avaliar o desenvolvimento e implementação de uma ação de educação permanente. Pesquisa quantitativo-qualitativa baseada na pesquisa-ação em 3 fases (diagnóstico da realidade, implementação de atividade e avaliação), realizada com profissionais de saúde e gerentes de unidades básicas. A avaliação se deu pela percepção de mudanças imediatamente à atividade e após 120 dias. Na 1ª fase, participaram 110 profissionais, dos quais 36,4% apontaram a existência de grupos para idosos no trabalho. Na 2ª fase, participaram 98 profissionais, que apontaram interferências do grupo na vida do idoso, itens de importância e facilitação para construção de grupos e atividade baseada na realidade. A 3ª fase mostrou, na análise quantitativa, impacto positivo do treinamento; e, na qualitativa, releitura dos grupos e manejo com mais conhecimento, segurança e respeito ao

  20. Occupational health

    OpenAIRE

    Coosemans, R.

    1997-01-01

    Health at work and healthy work environments are among the most valuable assets of individuals, communities and countries. Nowadays, new broader approach is promoted, recognizing the fact that occupational health is a key, but not a unique element of workers’ health. Workers health is a public health approach to resolving the health problems of working populations including all determinants of health recognized as targets of risk management. It focuses on primary prevention of occupational an...

  1. Changes in School Food Preparation Methods Result in Healthier Cafeteria Lunches in Elementary Schools.

    Science.gov (United States)

    Behrens, Timothy K; Liebert, Mina L; Peterson, Hannah J; Howard Smith, Jennifer; Sutliffe, Jay T; Day, Aubrey; Mack, Jodi

    2018-05-01

    The purpose of this study is to examine the impact of a districtwide food best practices and preparation changes in elementary schools lunches, implemented as part of the LiveWell@School childhood obesity program, funded by LiveWell Colorado/Kaiser Permanente Community Health Initiative. Longitudinal study examining how school changes in best practices for food preparation impacted the types of side items offered from 2009 to 2015 in elementary school cafeterias in a high-need school district in southern Colorado. Specifically, this study examined changes in side items (fruits, vegetables, potatoes, breads, and desserts). In Phase 1 (2009-2010), baseline data were collected. During Phase 2 (2010-2011), breaded and processed foods (e.g., frozen nuggets, pre-packaged pizza) were removed and school chefs were trained on scratch cooking methods. Phase 3 (2011-2012) saw an increased use of fresh/frozen fruits and vegetables after a new commodity order. During Phase 4 (2013-2015), chef consulting and training took place. The frequency of side offerings was tracked across phases. Analyses were completed in Fall 2016. Because of limited sample sizes, data from Phases 2 to 4 (intervention phases) were combined for potatoes and desserts. Descriptive statistics were calculated. After adjusting for length of time for each phase, Pearson chi-square tests were conducted to examine changes in offerings of side items by phase. Fresh fruit offerings increased and canned fruit decreased in Phases 1-4 (p=0.001). A significant difference was observed for vegetables (p=0.001), with raw and steamed vegetables increasing and canned vegetables decreasing from Phase 1 to 4. Fresh potatoes (low in sodium) increased and fried potatoes (high in sodium) decreased from Phase 1 to Phases 2-4 (p=0.001). Breads were eliminated entirely in Phase 2, and dessert changes were not significant (p=0.927). This approach to promoting healthier lunch sides is a promising paradigm for improving elementary

  2. Women's Health

    Science.gov (United States)

    Women have unique health issues. And some of the health issues that affect both men and women can affect women differently. Unique issues ... and men also have many of the same health problems. But these problems can affect women differently. ...

  3. International Health

    Science.gov (United States)

    ... create refugee populations with immediate and long-term health problems. Some of the major diseases currently affecting ... also an international problem which can affect people's health. Many countries and health organizations are working together ...

  4. Health Facilities

    Science.gov (United States)

    Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers, and specialized care centers, ... psychiatric care centers. When you choose a health facility, you might want to consider How close it ...

  5. Health Disparities

    Science.gov (United States)

    ... Health and Health Disparities conduct transdisciplinary research involving social, behavioral, biological, and genetic research to improve knowledge of the causes of health disparities and devise effective methods of preventing, diagnosing, and treating disease and promoting ...

  6. Quadrivalent human papillomavirus vaccine uptake in adolescent boys and maternal utilization of preventive care and history of sexually transmitted infections.

    Science.gov (United States)

    Hechter, Rulin C; Chao, Chun; Sy, Lina S; Ackerson, Bradley K; Slezak, Jeff M; Sidell, Margo A; Jacobsen, Steven J

    2013-09-01

    We examined whether maternal utilization of preventive care and history of sexually transmitted infections (STIs) predicted quadrivalent human papillomavirus vaccine (HPV4) uptake among adolescent boys 1 year following the recommendation for permissive use of HPV4 for males. We linked maternal information with electronic health records of 254 489 boys aged 9 to 17 years who enrolled in Kaiser Permanente Southern California health plan from October 21, 2009, through December 21, 2010. We used multivariable Poisson regression with robust error variance to examine whether HPV4 initiation was associated with maternal uptake of influenza vaccine, Papanicolaou (Pap) screening, and history of STIs. We identified a modest but statistically significant association between initiation of HPV4 series and maternal receipt of influenza vaccine (rate ratio [RR] = 1.16; 95% confidence interval [CI] = 1.07, 1.26) and Pap screening (RR = 1.13; 95% CI = 1.01, 1.26). Boys whose mothers had a history of genital warts were more likely to initiate HPV4 (RR = 1.47; 95% CI = 0.93, 2.34), although the association did not reach statistical significance (P = .1). Maternal utilization of preventive care and history of genital warts may influence HPV4 uptake among adolescent boys. The important role of maternal health characteristics and health behaviors needs be considered in intervention efforts to increase vaccine uptake among boys.

  7. Rectal Cancer Survivors' Participation in Productive Activities.

    Science.gov (United States)

    Hornbrook, Mark C; Grant, Marcia; Wendel, Christopher; Bulkley, Joanna E; Mcmullen, Carmit K; Altschuler, Andrea; Temple, Larissa Kf; Herrinton, Lisa J; Krouse, Robert S

    2017-01-01

    Rectal cancer and its treatment impair survivors' productivity. To assess determinants of market and nonmarket employment, job search, volunteering, and homemaking among survivors five years or longer after diagnosis. We mailed questionnaires to 1063 survivors who were members of Kaiser Permanente (Northern California, Northwest) during 2010 and 2011. Productive activities, functional health status, and bowel management at the time of the survey. Response rate was 60.5% (577/953). Higher comorbidity burdens were associated with lower productivity for men and women rectal cancer survivors. Productive survivors were younger and had lower disease stage and age at diagnosis, higher household income and educational attainment, and fewer comorbidity burdens and workplace adjustments than did nonproductive survivors (p < 0.05 each; 2-sided). Productive rectal cancer survivors were evenly split by sex. Staying productive is associated with better mental health for rectal cancer survivors. Rectal cancer survivors with multiple chronic conditions, higher disease stage, lower productive activities, and older age need better access to medical care and closer monitoring of the quality of their care, including self-care. To capture the full extent of the involvement of survivors in all types of productive activities, research should routinely include measures of employment, searching for employment, homemaking, and volunteering. Counting market and nonmarket productive activities is innovative and recognizes the continuum of contributions survivors make to families and society. Health care systems should routinely monitor rectal cancer survivors' medical care access, comorbidities, health-related quality of life, and productive activities.

  8. Seasonal maturation of Glypthelmins vitellinophilum (Trematoda: Digenea in Lysapsus limellus (Anura: Pseudidae from an Argentinian subtropical permanent pond Maturação sazonal de Glypthelmins vitellinophilum (Trematoda: Digenea em Lysapsus limellus (Anura: Pseudidae em uma lagoa permanente subtropical da Argentina

    Directory of Open Access Journals (Sweden)

    M. I. Hamann

    2006-02-01

    Full Text Available From December 1995 to November 2000, the seasonal maturation of Glypthelmins vitellinophilum Dobbin, 1958, in its definitive host, the frog Lysapsus limellus Cope, 1862, was studied in a subtropical permanent pond in northeastern Argentina. The objectives of this study were: 1 to determine the infrapopulation dynamics of the parasite, analyzing the seasonal maturation cycle throughout the years; and 2 to examine the relationship between the intensity of trematode infection in different developmental stages (recruitment, growth and maturation and the host's body length. Of a total of 1,400 frogs examined over 60 months (5 years, 38% were found to be infected with G. vitellinophilum, and the intensity of infection was 1-15 trematodes per frog. Specimens of G. vitellinophilum were present in L. limellus throughout the years, but did not show a pronounced seasonal maturation cycle. Possible reasons for these findings are discussed with reference to climatic fluctuations and biotic factors. The infective period of the parasite (stage I occurred in summer, autumn and spring, coinciding with the time each frog cohort appeared. These infections were found principally in small body sizes (classes 1 and 2 of L. limellus. Juvenile and nongravid specimens of worms (stage II and III were found in frogs of different body sizes throughout the period of investigation. Gravid specimens of the parasite (stage IV were generally recorded in autumn, winter and spring, mainly in the bodies of larger frogs. The body length of Trematodes in stages I and IV was significantly and positively correlated with that of the frogs.De dezembro de 1995 a novembro de 2000, a maturação sazonal de Glypthelmins vitellinophilum Dobbin, 1958, em seu hospedeiro definitivo, a rã Lysapsus limellus Cope, 1862, foi estudada em uma lagoa permanente subtropical no nordeste da Argentina. Os objetivos deste estudo foram: 1 determinar a dinâmica de infrapopulação do parasita, analisando o

  9. Health Promotion

    DEFF Research Database (Denmark)

    Povlsen, Lene; Borup, I.

    2015-01-01

    and Adolescent Health Promotion', Salutogenesis - from theory to practice' and Health, Stress and Coping'. More than half of all doctoral theses undertaken at NHV during these years had health promotion as their theme. As a derivative, the Nordic Health Promotion Research Network (NHPRN) was established in 2007......In 1953 when the Nordic School of Public Health was founded, the aim of public health programmes was disease prevention more than health promotion. This was not unusual, since at this time health usually was seen as the opposite of disease and illness. However, with the Ottawa Charter of 1986......, the World Health Organization made a crucial change to view health not as a goal in itself but as the means to a full life. In this way, health promotion became a first priority and fundamental action for the modern society. This insight eventually reached NHV and in 2002 - 50 years after the foundation...

  10. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Colorectal cancer (CRC) is a public health challenge in developed countries and an emerging public health problem in developing ... and public health challenges in their immigrant countries. More so ..... The nutrition transition in Brazil. 46.

  11. Minority Health and Health Disparities

    Science.gov (United States)

    ... ik People" People Awakening Resilience Project (PARP), Cuqyun "Measuring" Treatment and Health Services Research Alcohol Treatment and ... addressing Health Disparities . 1 2009-2013 Health Disparities Strategic Plan, p.4 2 Ibid, p.4 3 ...

  12. Health Insurance Premium Increases for the 5 Largest School Districts in the United States, 2004–2008

    Science.gov (United States)

    Cantillo, John R.

    2010-01-01

    Background Local school districts are often one of the largest, if not the largest, employers in their respective communities. Like many large employers, school districts offer health insurance to their employees. There is a lack of information about the rate of health insurance premiums in US school districts relative to other employers. Objective To assess the change in the costs of healthcare insurance in the 5 largest public school districts in the United States, between 2004 and 2008, as representative of large public employers in the country. Methods Data for this study were drawn exclusively from a survey sent to the 5 largest public school districts in the United States. The survey requested responses on 3 data elements for each benefit plan offered from 2004 through 2008; these included enrollment, employee costs, and employer costs. Results The premium growth for the 5 largest school districts has slowed down and is consistent with other purchasers—Kaiser/Health Research & Educational Trust and the Federal Employee Health Benefit Program. The average increase in health insurance premium for the schools was 5.9% in 2008, and the average annual growth rate over the study period was 7.5%. For family coverage, these schools provide the most generous employer contribution (80.8%) compared with the employer contribution reported by other employers (73.5%) for 2008. Conclusions Often the largest employers in their communities, school districts demonstrate a commitment to provide choice of benefits and affordability for employees and their families. Despite constraints typical of public employers, the 5 largest school districts in the United States have decelerated in premium growth consistent with other purchasers, albeit at a slower pace. PMID:25126311

  13. Health insurance premium increases for the 5 largest school districts in the United States, 2004-2008.

    Science.gov (United States)

    Cantillo, John R

    2010-03-01

    Local school districts are often one of the largest, if not the largest, employers in their respective communities. Like many large employers, school districts offer health insurance to their employees. There is a lack of information about the rate of health insurance premiums in US school districts relative to other employers. To assess the change in the costs of healthcare insurance in the 5 largest public school districts in the United States, between 2004 and 2008, as representative of large public employers in the country. Data for this study were drawn exclusively from a survey sent to the 5 largest public school districts in the United States. The survey requested responses on 3 data elements for each benefit plan offered from 2004 through 2008; these included enrollment, employee costs, and employer costs. The premium growth for the 5 largest school districts has slowed down and is consistent with other purchasers-Kaiser/Health Research & Educational Trust and the Federal Employee Health Benefit Program. The average increase in health insurance premium for the schools was 5.9% in 2008, and the average annual growth rate over the study period was 7.5%. For family coverage, these schools provide the most generous employer contribution (80.8%) compared with the employer contribution reported by other employers (73.5%) for 2008. Often the largest employers in their communities, school districts demonstrate a commitment to provide choice of benefits and affordability for employees and their families. Despite constraints typical of public employers, the 5 largest school districts in the United States have decelerated in premium growth consistent with other purchasers, albeit at a slower pace.

  14. The validity and reliability of the type 2 diabetes and health promotion scale Turkish version: a methodological study.

    Science.gov (United States)

    Yildiz, Esra; Kavuran, Esin

    2018-03-01

    A healthy promotion is important for maintaining health and preventing complications in patients with type 2 diabetes. The aim of the present study was to examine the psychometrics of a recently developed tool that can be used to screen for a health-promoting lifestyle in patients with type 2 diabetes. Data were collected from outpatients attending diabetes clinics. The Type 2 Diabetes and Health Promotion Scale (T2DHPS) and a demographic questionnaire were administered to 295 participants. Forward-backward translation of the original English version was used to develop a Turkish version. Internal consistency of the scale was assessed by Cronbach's alpha. An explanatory factor analysis and confirmatory factor analysis used validity of the Type 2 Diabetes and Health Promotion Scale - Turkish version. Kaiser-Meyer-Olkin (KMO) and Bartlett's sphericity tests showed that the sample met the criteria required for factor analysis. The reliability coefficient for the total scale was 0.84, and alpha coefficients for the subscales ranged from 0.57 to 0.92. A six-factor solution was obtained that explained 59.3% of the total variance. The ratio of chi-square statistics to degrees of freedom (χ 2 /df) 3.30 (χ 2 = 1157.48/SD = 350); error of root mean square approximation (RMSEA) 0.061; GFI value of 0.91 and comparative fit index (CFI) value was obtained as 0.91. Turkish version of The T2DHPS is a valid and reliable tool that can be used to assess patients' health-promoting lifestyle behaviours. Validity and reliability studies in different cultures and regions are recommended. © 2017 Nordic College of Caring Science.

  15. Design thinking.

    Science.gov (United States)

    Brown, Tim

    2008-06-01

    In the past, design has most often occurred fairly far downstream in the development process and has focused on making new products aesthetically attractive or enhancing brand perception through smart, evocative advertising. Today, as innovation's terrain expands to encompass human-centered processes and services as well as products, companies are asking designers to create ideas rather than to simply dress them up. Brown, the CEO and president of the innovation and design firm IDEO, is a leading proponent of design thinking--a method of meeting people's needs and desires in a technologically feasible and strategically viable way. In this article he offers several intriguing examples of the discipline at work. One involves a collaboration between frontline employees from health care provider Kaiser Permanente and Brown's firm to reengineer nursing-staff shift changes at four Kaiser hospitals. Close observation of actual shift changes, combined with brainstorming and rapid prototyping, produced new procedures and software that radically streamlined information exchange between shifts. The result was more time for nursing, better-informed patient care, and a happier nursing staff. Another involves the Japanese bicycle components manufacturer Shimano, which worked with IDEO to learn why 90% of American adults don't ride bikes. The interdisciplinary project team discovered that intimidating retail experiences, the complexity and cost of sophisticated bikes, and the danger of cycling on heavily trafficked roads had overshadowed people's happy memories of childhood biking. So the team created a brand concept--"Coasting"--to describe a whole new category of biking and developed new in-store retailing strategies, a public relations campaign to identify safe places to cycle, and a reference design to inspire designers at the companies that went on to manufacture Coasting bikes.

  16. Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System

    Science.gov (United States)

    Durant, Anne Foss; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

    2015-01-01

    In early 2010, leaders within Kaiser Permanente (KP) Northern California’s Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes. PMID:26828076

  17. Red wine consumption not associated with reduced risk of colorectal cancer.

    Science.gov (United States)

    Chao, Chun; Haque, Reina; Caan, Bette J; Poon, Kwun-Yee T; Tseng, Hung-Fu; Quinn, Virginia P

    2010-01-01

    Red wine contains polyphenol antioxidants that inhibit colorectal cancer (CRC) development in animal studies. We investigated the effect of red wine intake on risk of CRC in the California Men's Health Study (CMHS). CMHS is a prospective, multiethnic cohort of middle-aged men who were members of the Kaiser Permanente (KP) California Health Plans and completed study questionnaires between 2002-2003. Incident CRC were identified from the health plan cancer registries through the end of 2007 (n = 287). To properly account for potential confounding by previous endoscopy screening, we restricted the primary analyses to CMHS men continuously enrolled in KP between 1998-2002 (n = 43,483 and CRC = 176). We used multivariable Cox regression to adjust for important confounders. We did not find an inverse association between moderate red wine intake and risk of CRC. The hazard ratio for consuming >/=1 drink/day (average = 2 drinks/day) was 1.16, 95% confidence intervals 0.56-2.40. There was no linear dose-response. The lack of clear association for red wine intake was consistently observed when we stratified the analyses by CRC stage at diagnosis and cancer site (colon or rectum). Moderate red wine consumption was not associated with reduced risk of colorectal cancer in this population of middle-aged men.

  18. A Survey of Parents with Children on the Autism Spectrum: Experience with Services and Treatments.

    Science.gov (United States)

    Becerra, Tracy A; Massolo, Maria L; Yau, Vincent M; Owen-Smith, Ashli A; Lynch, Frances L; Crawford, Phillip M; Pearson, Kathryn A; Pomichowski, Magdalena E; Quinn, Virginia P; Yoshida, Cathleen K; Croen, Lisa A

    2017-01-01

    Autism spectrum disorders (ASD) are lifelong neurodevelopmental disorders, and little is known about how parents address the health and psychosocial consequences of ASD. Few studies have examined use of various treatments and services in a large, diverse sample of children with ASD and their families. This paper presents methods to create an autism research resource across multiple large health delivery systems and describes services and treatments used by children with ASD and their families. Four study sites conducted a Web survey of parents of children and adolescents with ASD who were members of Kaiser Permanente. We tabulated data distributions of survey responses and calculated χ 2 statistics for differences between responders and nonresponders. The children of the 1155 respondents were racially and ethnically diverse (55% white, 6% black, 5% Asian, 9% multiracial, 24% Hispanic) and representative of the total population invited to participate with respect to child sex (83% male), child age (57% Education Programs (85%), family physician visits (78%), and occupational and speech therapy (55% and 60%, respectively). Home-based programs frequently included implementation of social skills training (44%) and behavior management (42%). Prescription medication use was high (48%). Caregivers reported disruption of personal and family routines because of problem behaviors. These survey data help to elucidate parents' experiences with health services for their children with ASD and serve as a potential resource for future research.

  19. Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System.

    Science.gov (United States)

    Foss Durant, Anne; McDermott, Shawna; Kinney, Gwendolyn; Triner, Trudy

    2015-01-01

    In early 2010, leaders within Kaiser Permanente (KP) Northern California's Patient Care Services division embarked on a journey to embrace and embed core tenets of Caring Science into the practice, environment, and culture of the organization. Caring Science is based on the philosophy of Human Caring, a theory articulated by Jean Watson, PhD, RN, AHN-BC, FAAN, as a foundational covenant to guide nursing as a discipline and a profession. Since 2010, Caring Science has enabled KP Northern California to demonstrate its commitment to being an authentic person- and family-centric organization that promotes and advocates for total health. This commitment empowers KP caregivers to balance the art and science of clinical judgment by considering the needs of the whole person, honoring the unique perception of health and healing that each member or patient holds, and engaging with them to make decisions that nurture their well-being. The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethic of caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes.

  20. Identifying Factors Influencing the Establishment of a Health System Reform Plan in Iran's Public Hospitals

    Directory of Open Access Journals (Sweden)

    Rasul Fani khiavi

    2016-09-01

    Full Text Available In today's world, health views have found a wider perspective in which non-medical expectations are particularly catered to. The health system reform plan seeks to improve society's health, decrease treatment costs, and increase patient satisfaction. This study investigated factors affecting the successful establishment of a health system reform plan. A mixed qualitative – quantitative approach was applied to conduct to explore influential factors associated with the establishment of a health system reform plan in Iran's public hospitals. The health systems and approaches to improving them in other countries have been studied. A Likert-based five-point questionnaire was the measurement instrument, and its content validity based on content validity ratio (CVR was 0.87. The construct validity, calculated using the factorial analysis and Kaiser Mayer Olkin (KMO techniques, was 0.964, which is a high level and suggests a correlation between the scale items. To complete the questionnaire, 185 experts, specialists, and executives of Iran’s health reform plan were selected using the Purposive Stratified Non Random Sampling and snowball methods. The data was then analyzed using exploratory factorial analysis and SPSS and LISREL software applications. The results of this research imply the existence of a pattern with a significant and direct relationship between the identified independent variables and the dependent variable of the establishment of a health system reform plan. The most important indices of establishing a health system reform plan, in the order of priority, were political support; suitable proportion and coverage of services presented in the society; management of resources; existence of necessary infrastructures; commitment of senior managers; constant planning, monitoring, and evaluation; and presentation of feedback to the plan's executives, intrasector/extrasector cooperation, and the plan’s guiding committee. Considering the

  1. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    care policy which was intended to make health care which of the two alternative methods of health care available to individuals and families in the financing options of free health or DRF was community at very little or no cost at all. However, preferred by the community members within most health facilities would appear to ...

  2. Health psychology and health promotion

    Directory of Open Access Journals (Sweden)

    Ali Delshad Noghabi

    2017-11-01

    Full Text Available Health psychology is the defined as studying of psychological and behavioral processes in health, illness, and healthcare. It contributes to is concerned with the understanding of how psychological, behavioral, and cultural factors contribute role to in physical health and illness. Psychological factors can affect health directly. For example, health is hurt by the chronically occurring environmental stressors which cumulatively affecting the hypothalamic–pituitary–adrenal axis, cumulatively, can harm health. On the other hand, a person's health is also interwoven with the Behavioral behavioral factors can also affect a person's health. For exampleinstance, certain behaviors behaviors, including smoking and excessive alcohol consumption can, over time, harm (smoking, excessive alcohol consumption health but exercise and diet low in saturated fat or can enhance health (exercise, diet low in saturated fat.

  3. CB4-03: An Eye on the Future: A Review of Data Virtualization Techniques to Improve Research Analytics

    Science.gov (United States)

    Richter, Jack; McFarland, Lela; Bredfeldt, Christine

    2012-01-01

    Background/Aims Integrating data across systems can be a daunting process. The traditional method of moving data to a common location, mapping fields with different formats and meanings, and performing data cleaning activities to ensure valid and reliable integration across systems can be both expensive and extremely time consuming. As the scope of needed research data increases, the traditional methodology may not be sustainable. Data Virtualization provides an alternative to traditional methods that may reduce the effort required to integrate data across disparate systems. Objective Our goal was to survey new methods in data integration, cloud computing, enterprise data management and virtual data management for opportunities to increase the efficiency of producing VDW and similar data sets. Methods Kaiser Permanente Information Technology (KPIT), in collaboration with the Mid-Atlantic Permanente Research Institute (MAPRI) reviewed methodologies in the burgeoning field of Data Virtualization. We identified potential strengths and weaknesses of new approaches to data integration. For each method, we evaluated its potential application for producing effective research data sets. Results Data Virtualization provides opportunities to reduce the amount of data movement required to integrate data sources on different platforms in order to produce research data sets. Additionally, Data Virtualization also includes methods for managing “fuzzy” matching used to match fields known to have poor reliability such as names, addresses and social security numbers. These methods could improve the efficiency of integrating state and federal data such as patient race, death, and tumors with internal electronic health record data. Discussion The emerging field of Data Virtualization has considerable potential for increasing the efficiency of producing research data sets. An important next step will be to develop a proof of concept project that will help us understand to benefits

  4. Health Fraud

    Science.gov (United States)

    Health fraud involves selling drugs, devices, foods, or cosmetics that have not been proven effective. Keep in ... you from getting the treatment you really need. Health fraud scams can be found everywhere, promising help ...

  5. Men's Health

    Science.gov (United States)

    ... men need to pay more attention to their health. Compared to women, men are more likely to ... regular checkups and medical care There are also health conditions that only affect men, such as prostate ...

  6. Occupational Health

    Science.gov (United States)

    Occupational health problems occur at work or because of the kind of work you do. These problems can include ... by exposure to radiation Exposure to germs in health care settings Good job safety and prevention practices ...

  7. Health Checkup

    Science.gov (United States)

    Regular health exams and tests can help find problems before they start. They also can help find problems early, ... and screenings you need depends on your age, health and family history, and lifestyle choices such as ...

  8. Children's Health

    Science.gov (United States)

    Your child's health includes physical, mental and social well-being. Most parents know the basics of keeping children healthy, like offering ... for children to get regular checkups with their health care provider. These visits are a chance to ...

  9. Health Occupations

    Science.gov (United States)

    ... around the clock, people who work in the health care industry provide care for millions of people, ... newborns to the very ill. In fact, the health care industry is one of largest providers of ...

  10. Health Topics

    Science.gov (United States)

    ... U V W X Y Z A Acne Anorexia nervosa Anxiety disorders Asthma Autoimmune diseases Return to ... Awareness Day National Women's Health Week Nursing (breastfeeding) Nutrition Return to top O Oral health Osteoporosis Ovarian ...

  11. Employee health.

    Science.gov (United States)

    2015-09-01

    The National Institute for Health and Care Excellence has produced a new guideline looking at improving the health and wellbeing of employees, with a particular focus on organisational culture and context, and the role of line managers.

  12. Health Deficiencies

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of all health deficiencies currently listed on Nursing Home Compare, including the nursing home that received the deficiency, the associated inspection date,...

  13. Mental Health

    Science.gov (United States)

    Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel and act as ... stress, relate to others, and make choices. Mental health is important at every stage of life, from ...

  14. HEALTH SYSTEMS

    International Development Research Centre (IDRC) Digital Library (Canada)

    many levels, and underscores the fact that health ... The health of mothers and their children depends on the status of women. INSIGHT ... tions find fertile ground when poverty ... Dr Gita Sen, Professor of Public Policy at the Indian Institute.

  15. Toddler Health

    Science.gov (United States)

    ... child visits are important to your toddler's health. Toddlers will get their recommended immunizations during these visits. Routine exams and screenings help you and your kids prevent and treat health problems as well as chart their growth and development.

  16. Occupational health

    CERN Document Server

    Fingret, Dr Ann

    2013-01-01

    Offers a comprehensive view of health and safety issues at work. An invaluable resource for managers, personnel professionals and occupational health practitioners. Recommended by the Institute of Personnel Management.

  17. Health Insurance

    Science.gov (United States)

    Health insurance helps protect you from high medical care costs. It is a contract between you and your ... Many people in the United States get a health insurance policy through their employers. In most cases, the ...

  18. Health Informatics.

    Science.gov (United States)

    Russell, Marie; Brittain, J. Michael

    2002-01-01

    Identifies current trends and issues in health informatics with examples of applications, particularly in English-speaking countries. Topics include health systems, professionals, and patients; consumer health information; electronic medical records; nursing; privacy and confidentiality; finding and using information; the Internet; e-mail;…

  19. Foot Health

    Science.gov (United States)

    ... straight across and not too short Your foot health can be a clue to your overall health. For example, joint stiffness could mean arthritis. Tingling ... foot checks are an important part of your health care. If you have foot problems, be sure ...

  20. Health Literacy

    Science.gov (United States)

    ... Improvement, April 19, 2017 Considerations for a New Definition of Health Literacy, April 04, 2016 Health Literacy Online, Office of Disease Prevention & Health Promotion Connect with Us Contact Us Twitter Facebook Instagram YouTube Flickr More Social Media from NIH ...

  1. HEALTH NEEDS

    Directory of Open Access Journals (Sweden)

    Olivera Radulovic

    2007-01-01

    Full Text Available Human needs are of great interest to different scientific fields: sociology, anthropology, psychology, medicine, economy… Malinowski, Maslow, Adler and From have largely contributed to studying the needs. While trying to define the need concept, not only one definition is acceptable. In psychology, need is defined as a lack or disorder, i.e. the necessity to dislodge this lack. It was Maslow who gave the fullest classification and explanation of human needs. If we start from the fact that need represents the lack or deficit of something, in this context health needs would indicate the lack of health, and the measurement of health needs would be the same as the measurement of health. Therefore, almost all human needs can be enumerated as health needs, i.e. those which, after being satisfied, can lead to physical, psychical and social welfare. According to WHO, health needs can be defined as scientifically settled evasions from health which require preventive, curative and probably regulative and eradicative measurements. According to the medical method used by the health service while regarding the needs, the emphasis is on morbidity, mortality, incidence, prevalence, inability, etc. Usually, when we have very low level of health culture, and the responsibility for personal health is in most of the cases unacceptable, for the health service user the curative services will have priority over preventive ones. The measurement of health needs is a complex task. The needs can be regarded through medical documentation and by perception of the needs by people in the community.

  2. Shared familial transmission of autism spectrum and attention-deficit/hyperactivity disorders.

    Science.gov (United States)

    Musser, Erica D; Hawkey, Elizabeth; Kachan-Liu, Svetlana S; Lees, Paul; Roullet, Jean-Baptiste; Goddard, Katrina; Steiner, Robert D; Nigg, Joel T

    2014-07-01

    To determine whether familial transmission is shared between autism spectrum disorders and attention-deficit/hyperactivity disorder, we assessed the prevalence, rates of comorbidity, and familial transmission of both disorders in a large population-based sample of children during a recent 7 year period. Study participants included all children born to parents with the Kaiser Permanente Northwest (KPNW) Health Plan between 1 January 1998 and 31 December 2004 (n = 35,073). Children and mothers with physician-identified autism spectrum disorders (ASD) and/or attention-deficit/hyperactivity disorder (ADHD) were identified via electronic medical records maintained for all KPNW members. Among children aged 6-12 years, prevalence was 2.0% for ADHD and 0.8% for ASD; within those groups, 0.2% of the full sample (19% of the ASD sample and 9.6% of the ADHD sample) had co-occurring ASD and ADHD, when all children were included. When mothers had a diagnosis of ADHD, first born offspring were at 6-fold risk of ADHD alone (OR = 5.02, p disorders shares familial transmission with ADHD. ADHD and ASD have a partially overlapping diathesis. © 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.

  3. NFP Investor Conference. Growth is back in sight.

    Science.gov (United States)

    Haugh, Richard

    2002-06-01

    In a whirlwind of high-stakes meetings in New York City in mid-May, two dozen of the nation's largest hospitals and health systems strutted their stuff with a single goal: securing their future. Their message was clear: back-to-basics works, and now it's time to grow the business. Executives from 23 providers outlined their work on increasing revenue, boosting margins and shoring up balance sheets. They presented their market positions, strategic initiatives and financial results for investment analysts, credit raters and bond traders. The third annual Non-Profit Healthcare Investor Conference was co-sponsored by the American Hospital Association, Health Forum, the Healthcare Financial Management Association and Salomon Smith Barney. The focus on growth doesn't come without challenges Several common themes emerged from the presentations, among them pressure on reimbursement, workforce shortages, liability insurance issues and capacity constraints. Yet executives agree: it all comes down to the basics, and building the strength to keep their missions alive. As Thomas Meier, vice president and treasurer of Oakland, Calif.-based Kaiser Permanente, put it: "No margin, no mission, no más."

  4. Overview of the consortium of hospitals advancing research on tobacco (chart

    Directory of Open Access Journals (Sweden)

    Riley William T

    2012-08-01

    Full Text Available Abstract Background The Consortium of Hospitals Advancing Research on Tobacco (CHART is a network of six projects and a research coordinating unit funded by the National Heart, Lung, and Blood Institute, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institutes of Health (NIH Office of Behavioral and Social Science Research. The CHART projects will assess the effectiveness and cost-effectiveness of smoking cessation interventions initiated during hospitalization and continued post-discharge. Methods/design Along with a seventh project funded previously under the NIH Challenge grants, the CHART projects will assess smoking cessation strategies delivered to approximately 10,000 hospitalized smokers across a geographically diverse group of nearly 20 private, public, academic, and community hospitals. The CHART research coordinating unit at Kaiser Permanente Center for Health Research provides organizational and data coordination support, facilitating the development of common measures for combining data from multiple CHART projects. Discussion The targeted enrollment in CHART, if achieved, will represent the largest, most diverse pooled dataset of hospitalized smokers receiving smoking cessation assistance, and is designed to contribute to the dissemination and implementation of smoking cessation interventions provided by hospital systems.

  5. Konference: Musik und Musikpraxis im Kontext der Hofkultur Kaiser Rudolfs II. in Prag

    Czech Academy of Sciences Publication Activity Database

    Muchka, Ivan

    2008-01-01

    Roč. 20, č. 2 (2008), s. 22-23 ISSN 0862-612X Institutional research plan: CEZ:AV0Z80330511 Keywords : Rudolfine music * Prague * conference Subject RIV: AL - Art, Architecture, Cultural Heritage http://www.dejinyumeni.cz/bulletin/UHS_2_2008.pdf

  6. How Whites Should Live in This Strange Place | McKaiser | South ...

    African Journals Online (AJOL)

    In this paper, I argue that Samantha Vice is correct to claim that whites should feel shame and regret, though perhaps not guilt, at their whiteness. She is wrong, however, to suggest that there is a sense in which whites should live in silence and humility, and withdraw from public political space. In particular, I argue that this ...

  7. Population Genetic Structure of the Endangered Kaiser's Mountain Newt, Neurergus kaiseri (Amphibia: Salamandridae.

    Directory of Open Access Journals (Sweden)

    Hossein Farasat

    Full Text Available Species often exhibit different levels of genetic structuring correlated to their environment. However, understanding how environmental heterogeneity influences genetic variation is difficult because the effects of gene flow, drift and selection are confounded. We investigated the genetic variation and its ecological correlates in an endemic and critically endangered stream breeding mountain newt, Neurergus kaiseri, within its entire range in southwestern Iran. We identified two geographic regions based on phylogenetic relationships using Bayesian inference and maximum likelihood of 779 bp mtDNA (D-loop in 111 individuals from ten of twelve known breeding populations. This analysis revealed a clear divergence between northern populations, located in more humid habitats at higher elevation, and southern populations, from drier habitats at lower elevations regions. From seven haplotypes found in these populations none was shared between the two regions. Analysis of molecular variance (AMOVA of N. kaiseri indicates that 94.03% of sequence variation is distributed among newt populations and 5.97% within them. Moreover, a high degree of genetic subdivision, mainly attributable to the existence of significant variance among the two regions is shown (θCT = 0.94, P = 0.002. The positive and significant correlation between geographic and genetic distances (r = 0.61, P = 0.002 following controlling for environmental distance suggests an important influence of geographic divergence of the sites in shaping the genetic variation and may provide tools for a possible conservation based prioritization policy for the endangered species.

  8. [Wilhelm Liepmann (1878-1939)--the fate of a gynecologist between the Kaiser Reich and Fascism].

    Science.gov (United States)

    Schneck, P

    1984-01-01

    The paper gives a bioergographical survey on the German obstetrician and gynaecologist Wilhelm Liepmann. He was Ass. Professor at the Berlin university. Later he became director of the German Women-Institute, which was founded by the Hauptverband der Krankenkassen. In 1933 Liepmann had to emigrate to Turkey, where he got the chair of gynaecology at the university of Istanbul.

  9. Health inequalities

    DEFF Research Database (Denmark)

    Diderichsen, Finn

    2016-01-01

    Social investment policy has become a central response to the demographic and economic challenges facing European welfare states. This focus on investment in human capabilities and their efficient use is, however, challenged by health inequalities where education, health and employment...... are increasingly linked. This paper outlines the main principles of social investment policies (learning, activation and protection) and links them to a conceptual model of health inequalities and the policy entry-points tackling them by addressing the processes of social stratification, differential exposure...... investments in health so as to enable social investments to tackle the health divide....

  10. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    user

    2Department of Community Health, University of Benin, Benin City, Nigeria. ... Mental morbidity is a public health problem that can lead to a great burden of disability in the community. ..... community study in Sao Paulo, Brazil where.

  11. Health-related quality of life questionnaire for polycystic ovary syndrome (PCOSQ-50): development and psychometric properties.

    Science.gov (United States)

    Nasiri-Amiri, Fatemeh; Ramezani Tehrani, Fahimeh; Simbar, Masoumeh; Montazeri, Ali; Mohammadpour, Reza Ali

    2016-07-01

    The determinants of the health-related quality of life of women with polycystic ovary syndrome are not fully understood. The aim of this study was to develop a comprehensive instrument to assess the health-related quality of life of Iranian women with PCOS and to assess its psychometric properties. We used a mixed-method, sequential, exploratory design including both qualitative [in-depth interview to define the components of health-related quality of life questionnaire (PCOSQ)] and quantitative approaches (to assess the psychometric properties of PCOSQ). A preliminary questionnaire was developed including 147 items which emerged from the qualitative phase of the study. Considering the optimum cutoff points for content validity ratio (CVR), content validity index (CVI), and impact score, items of the preliminary questionnaire were reduced from 147 to 88 items. Finally, by excluding highly correlated items using the exploratory factor analysis, a 50-item questionnaire was obtained. The Kaiser criteria (eigenvalues >1) and Scree plot tests demonstrated that six factors were optimum with an estimated 47.3 % of variance. Assessment of the psychometric properties of the questionnaire demonstrated a mean CVI = 0.92, CVR = 0.91, Cronbach's alpha for whole questionnaire = 0.88 (0.61-0.88 for subscales), Spearman's correlation coefficients of test-retest = 0.75, and the intra-class correlation coefficient for the PCOS questionnaire subscales ranging from 0.57 to 0.88. Eventually the final questionnaire included 50 items in six domains, 'psychosocial and emotional,' 'fertility,' 'sexual function,' 'obesity and menstrual disorders,' 'hirsutism,' and 'coping' and rated on a 5-point Likert scale. The PCOSQ-50 is a valid and reliable instrument for the assessment of quality of life of women with PCOS, capable of assessing some obscure aspects overlooked by previous HRQL questionnaires.

  12. Health literacy and health communication

    Directory of Open Access Journals (Sweden)

    Kiuchi Takahiro

    2010-11-01

    Full Text Available Abstract Health communication consists of interpersonal or mass communication activities focused on improving the health of individuals and populations. Skills in understanding and applying information about health issues are critical to this process and may have a substantial impact on health behaviors and health outcomes. These skills have recently been conceptualized in terms of health literacy (HL. This article introduces current concepts and measurements of HL, and discusses the role of HL in health communication, as well as future research directions in this domain. Studies of HL have increased dramatically during the past few years, but a gap between the conceptual definition of HL and its application remains. None of the existing instruments appears to completely measure the concept of HL. In particular, studies on communication/interaction and HL remain limited. Furthermore, HL should be considered not only in terms of the characteristics of individuals, but also in terms of the interactional processes between individuals and their health and social environments. Improved HL may enhance the ability and motivation of individuals to find solutions to both personal and public health problems, and these skills could be used to address various health problems throughout life. The process underpinning HL involves empowerment, one of the major goals of health communication.

  13. Mental Health

    Science.gov (United States)

    ... well Feeling guilty, worthless, or helpless Thinking about suicide or hurting yourself Other mental health conditions include anxiety disorders, mood disorders, and personality disorders. For a good description ...

  14. THE DISTANCE EDUCATION TO PROMOTE CONTINUOUS LEARNING OF HEALTH PROFESSIONALS: REVIEW

    Directory of Open Access Journals (Sweden)

    Lívia Lima Ferraz

    2012-12-01

    Full Text Available La asociación de la necesidad de una educación permanente con las tecnologías de información y comunicación disponibles y la flexibilidad de la Educación a Distancia obtuvieran como efecto la inserción del trabajo como un hogar importante para aprendizaje (1. La Educación Permanente es una necesidad imprescindible para los profesionales de salud, para que ellos desarrollen una posición crítica y auto evaluativa (2. Son estas características esenciales y coincidentes de los alumnos de la Educación a Distancia. La metodología deste estudio es de carácter bibliográfico. Y el objetivo es congregar fundamentos y resultados que apoye e base lo empleo de la Educación a Distancia en la Educación Permanente de lo personal de salud a partir de dos puntos relevantes: Incentivos/Políticas que fomenten su aplicación y las colaboraciones de la Educación a Distancia en educación permanente de los profesionales de salud. Fue posible constatar que la modalidad de enseñanza a distancia aparece como una estrategia importante y como una facilitadora de la Educación Permanente, principalmente, por lograr estimular características relevantes para el personal de salud y romper barreras territoriales y de tiempo.

  15. Public health

    NARCIS (Netherlands)

    Berg, van den A.E.

    2007-01-01

    Agnes van den Berg wrote an essay about human health and nature, establishing that subject as an important policy argument in developing (urban) nature in the Netherlands. She studied the public balance of fear and fascination for nature, summarising benefits on human health. In this chapter, she

  16. Health Literacy

    Science.gov (United States)

    ... medical words, and of how their health care system works Abilities, such as physical or mental limitations Personal factors, such as age, education, language abilities, and culture More than 90 million adults in the United States have low health literacy. It affects their ability ...

  17. HEALTH & FINANCE

    African Journals Online (AJOL)

    HEALTH & FINANCE. Patrick Thokwa Masobe. Patrick Thokwa Masobe completed his undergraduate studies at Grinnel/. University in the USA, and a Master. Degreefrom the University of London in. 1995. He is wrrently employed by the national Department of Health, where he led the task team charged with making.

  18. Preconception Health

    Centers for Disease Control (CDC) Podcasts

    2012-10-01

    Preconception health means taking care of your own health now so you’ll be healthy for yourself and your future baby.  Created: 10/1/2012 by National Center on Birth Defects and Developmental Disabilities (NCBDDD).   Date Released: 10/1/2012.

  19. Consumer Health

    Science.gov (United States)

    Bibel, Barbara

    2010-01-01

    This article presents an annotated bibliography of 19 titles that focus on cancer and health-care reform. These include: (1) Anderson, John W. "Stand by Her: A Breast Cancer Guide for Men." AMACOM: American Management Assn.; (2) Carstensen, Laura L. "A Long Bright Future: An Action Plan for a Lifetime of Happiness, Health, and Financial Security."…

  20. Health Reports.

    Science.gov (United States)

    1992-09-01

    Futui’e Structure of Veterans’ Health Program (Aug. 11, 1992, GAO/T-HRD-92-53). Recombinant Bovine Growth Hormone: FDA Approval Should be Withheld Until...the Mastitis Issue Is Resolved (Aug. 6, 1992, GAO/PEMD-92-26). VA Health Care: Inadequate Controls Over Scarce Medical Specialist Contracts (Aug. 5

  1. Evolution, current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization.

    Science.gov (United States)

    Heilmann, Rachel M F; Campbell, Stephanie M; Kroner, Beverly A; Proksel, Jenel R; Billups, Sarah J; Witt, Daniel M; Helling, Dennis K

    2013-01-01

    The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.

  2. Serum phosphorus and association with anemia among a large diverse population with and without chronic kidney disease

    Science.gov (United States)

    Tran, Lac; Batech, Michael; Rhee, Connie M.; Streja, Elani; Kalantar-Zadeh, Kamyar; Jacobsen, Steven J.; Sim, John J.

    2016-01-01

    Background We hypothesized that phosphorus has an effect on anemia in both normal kidney function and early chronic kidney disease (CKD). We sought to determine whether higher phosphorus levels are associated with anemia in a large diverse population without CKD and early CKD. Methods This study is a historical population-based study within the Kaiser Permanente Southern California health system (1 January 1998 to 31 December 2013) among individuals aged 18 years and older with estimated glomerular filtration rate >30 mL/min/1.73 m2 and measurements of serum phosphorus, creatinine and hemoglobin. Individuals were excluded if they had secondary causes of anemia. Odds ratio (OR) estimated for moderate anemia defined as hemoglobin phosphorus levels ≥3.5 mg/dL were associated with both mild and moderate anemia. Moderate anemia OR (95% confidence interval) was 1.16 (1.04–1.29) for every 0.5 mg/dL phosphorus increase and 1.26 (1.07–1.48) in the highest versus middle phosphorus tertile. Additional independent anemia risk factors, including female sex, Asian race, diabetes, low albumin and low iron saturation, were observed, but did not alter the anemia–phosphorus association. Conclusions Higher phosphorus levels were associated with a greater likelihood for anemia in a population with early CKD and normal kidney function. Phosphorus may be a biomarker for anemia and may affect aspects of hematopoiesis. PMID:26254460

  3. Community relations 2.0.

    Science.gov (United States)

    Kane, Gerald C; Fichman, Robert G; Gallaugher, John; Glaser, John

    2009-11-01

    Before the Internet, organizations had far more time to monitor and respond to community activity, but that luxury is long gone, leaving them in dire need of a coherent outreach strategy, fresh skills, and adaptive tactics. Drawing on the authors' study of more than two dozen firms, this article describes the changes wrought by social media in particular and shows managers how to take advantage of them--lessons that Kaiser Permanente, Domino's, and others learned the hard way. Social media platforms enhance the power of communities by promoting deep relationships, facilitating rapid organization, improving the creation and synthesis of knowledge, and enabling robust filtering of information. The authors cite many examples from the health care industry, where social media participation is vigorous and influential. For instance, members of Sermo, an online network exclusively for doctors, used the site to call attention to and organize against insurers' proposed reimbursement cuts. And on PatientsLikeMe, where people share details about their chronic diseases and the treatments they've pursued, charts and progress curves help members visualize their own complex histories and allow comparisons and feedback among peers. As you modernize your company's approach to community outreach, you'll need to assemble a social media team equipped to identify new opportunities for engagement and prevent brand damage. In the most successful firms the authors studied, community management was a dedicated function, combining marketing, public relations, and information technology skills.

  4. Patient attitudes about the clinical use of placebo: qualitative perspectives from a telephone survey.

    Science.gov (United States)

    Ortiz, Robin; Chandros Hull, Sara; Colloca, Luana

    2016-04-04

    To examine qualitative responses regarding the use of placebo treatments in medical care in a sample of US patients.Survey studies suggest a deliberate clinical use of placebos by physicians, and prior research has found that although most US patients find placebo use acceptable, the rationale for these beliefs is largely unknown. Members of the Outpatient Clinic at the Kaiser Permanente Northern California interviewed research participants who had been seen for a chronic health problem at least once in the prior 6 months. 853 women (61%) and men, white (58%) and non-white participants aged 18-75 years. Qualitative responses on perceptions of placebo use from one-time telephone surveys were analysed for common themes and associations with demographic variables. Prior results indicated that a majority of respondents felt it acceptable for doctors to recommend placebo treatments. Our study found that a lack of harm (n=291, 46.1%) and potential benefit (n=250, 39.6%) were the most common themes to justify acceptability of placebo use. Responses citing potential benefit were associated with higher education (r=0.787; pright to know and power of the mind. Older age was associated with likelihood to cite overall physician, as opposed to treatment, related themes (r=0.753; prights-and-licensing/

  5. GENDER DIFFERENCES IN QUALITY OF LIFE AMONG LONG-TERM COLORECTAL CANCER SURVIVORS WITH OSTOMIES

    Science.gov (United States)

    Grant, Marcia; McMullen, Carmit K.; Altschuler, Andrea; Mohler, M. Jane; Hornbrook, Mark C.; Herrinton, Lisa J.; Wendel, Christopher S.; Baldwin, Carol M.; Krouse, Robert S.

    2011-01-01

    Objective To describe how gender shapes the concerns and adaptations of long-term (> 5 years) colorectal cancer (CRC) survivors with ostomies. Design Qualitative study using content analysis of focus group content. Setting Member of Kaiser Permanente, residing in either Oregon, Southwest Washington State, or Northern California. Sample Four female and four male focus groups selected from quantitative survey participants with health-related quality of life (HRQOL) scores in the highest or lowest quartile. Methods Eight focus groups, discussed challenges of living with an ostomy. Content was recorded, transcribed, and analyzed using directive and summative content analysis. Main Research Variables HRQOL domains of physical, psychological, social and spiritual well being. Findings All groups reported avoiding foods that cause gas or rapid transit, and discussed how limiting the amount of food eaten controlled the output. All groups discussed physical activities, getting support from friends and family, and the importance of being resilient. Both genders identified challenges with sexuality/intimacy. Coping and adjustment difficulties were discussed by women with men only discussing these issues to a small extent. Difficulties with sleep were primarily identified by Low HRQOL women. Problems with body image and depression were discussed only by Low HRQOL women. Conclusions Common issues included diet management, physical activity, social support and sexuality. Women with low HRQOL discussed problems with depression, body image, and sleep. Implications for Nursing Application of these gender-based differences can inform educational interventions for CRC survivors with ostomies. PMID:21875846

  6. The greatest challenges reported by long-term colorectal cancer survivors with stomas.

    Science.gov (United States)

    McMullen, Carmit K; Hornbrook, Mark C; Grant, Marcia; Baldwin, Carol M; Wendel, Christopher S; Mohler, M Jane; Altschuler, Andrea; Ramirez, Michelle; Krouse, Robert S

    2008-04-01

    This paper presents a qualitative analysis of the greatest challenges reported by long-term colorectal cancer survivors with ostomies. Surveys that included an open-ended question about challenges of living with an ostomy were administered at three Kaiser Permanente regions: Northern California, Northwest, and Hawaii. The study was coordinated at the Southern Arizona Veterans Affairs Health Care System in Tucson. The City of Hope Quality of Life Model for Ostomy Patients provided a framework for the study's design, measures, data collection, and data analysis. The study's findings may be generalized broadly to community settings across the United States. Results replicate those of previous research among veterans, California members of the United Ostomy Association, Koreans with ostomies, and colorectal cancer survivors with ostomies residing in the United Kingdom. The greatest challenges reported by 178 colorectal cancer survivors with ostomies confirmed the Institute of Medicine's findings that survivorship is a distinct, chronic phase of cancer care and that cancer's effects are broad and pervasive. The challenges reported by study participants should inform the design, testing and integration of targeted education, early interventions, and ongoing support services for colorectal cancer patients with ostomies.

  7. Integrated delivery systems: the cure for fragmentation.

    Science.gov (United States)

    Enthoven, Alain C

    2009-12-01

    Our healthcare system is fragmented, with a misalignment of incentives, or lack of coordination, that spawns inefficient allocation of resources. Fragmentation adversely impacts quality, cost, and outcomes. Eliminating waste from unnecessary, unsafe care is crucial for improving quality and reducing costs--and making the system financially sustainable. Many believe this can be achieved through greater integration of healthcare delivery, more specifically via integrated delivery systems (IDSs). An IDS is an organized, coordinated, and collaborative network that links various healthcare providers to provide a coordinated, vertical continuum of services to a particular patient population or community. It is also accountable, both clinically and fiscally, for the clinical outcomes and health status of the population or community served, and has systems in place to manage and improve them. The marketplace already contains numerous styles and degrees of integration, ranging from Kaiser Permanente-style full integration, to more loosely organized individual practice associations, to public-private partnerships. Evidence suggests that IDSs can improve healthcare quality, improve outcomes, and reduce costs--especially for patients with complex needs--if properly implemented and coordinated. No single approach or public policy will fix the fragmented healthcare system, but IDSs represent an important step in the right direction.

  8. Data that drive: Closing the loop in the learning hospital system.

    Science.gov (United States)

    Liu, Vincent X; Morehouse, John W; Baker, Jennifer M; Greene, John D; Kipnis, Patricia; Escobar, Gabriel J

    2016-11-01

    The learning healthcare system describes a vision of US healthcare that capitalizes on science, information technology, incentives, and care culture to drive improvements in the quality of health care. The inpatient setting, one of the most costly and impactful domains of healthcare, is an ideal setting in which to use data and information technology to foster continuous learning and quality improvement. The rapid digitization of inpatient medicine offers incredible new opportunities to use data from routine care to generate new discovery and thus close the virtuous cycle of learning. We use an object lesson-sepsis care within the 21 hospitals of the Kaiser Permanente Northern California integrated healthcare delivery system-to offer insight into the critical elements necessary for developing a learning hospital system. We then describe how a hospital-wide data-driven approach to inpatient care can facilitate improvements in the quality of hospital care. Journal of Hospital Medicine 2016;11:S11-S17. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

  9. Health inequity

    DEFF Research Database (Denmark)

    Frausing, Kristian Park; Smærup, Michael; Maibom, Kirsten

    living alone. Social and psychological needs were of primary concern whereas practical needs were of lesser concern. The second study showed older men living alone with no/short education to rate their health significantly worse on almost all items compared to men of higher education. The third study......Background: Being male, living alone and being of low socioeconomic status (SES) are all risk factors for health inequities, including a shorter lifespan. Not much is known, however, about older low-SES men living alone. This study maps their health. Methods: Three studies were conducted. First......, an electronic survey with municipal preventive home visitors nationwide inquiring into their perception of the health and needs of old men living alone. The second study compared older men's self-rated health according to their living arrangements and educational level using data from 29.791 older men from...

  10. One health? What about plant health?

    DEFF Research Database (Denmark)

    Danielsen, Solveig

    2012-01-01

    One Health has been defined around zoonotic diseases and the sharing of infrastructure and capacities of human and animal health systems in the health triad, people-animals-environment. Plant health needs to be part of the One Health concept....

  11. Mental Health: Keeping Your Emotional Health

    Science.gov (United States)

    ... Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health Sex and Birth Control Sex and Sexuality Birth ... PPD) Home Prevention and Wellness Emotional Well-Being Mental Health Mental Health: Keeping Your Emotional Health Mental Health: ...

  12. Health Equity Talk: Understandings of Health Equity among Health Leaders

    Directory of Open Access Journals (Sweden)

    Bernadette M. Pauly

    2017-11-01

    Full Text Available Introduction: Reducing health inequities is a stated goal of health systems worldwide. There is widespread commitment to health equity among public health leaders and calls for reorientation of health systems towards health equity. As part of the Equity Lens in Public Health (ELPH program of research, public health decision makers and researchers in British Columbia collaborated to study the application of a health equity lens in a time of health system renewal. We drew on intersectionality, complexity and critical social justice theories to understand how participants construct health equity and apply a health equity lens as part of public health renewal. Methods: 15 focus groups and 16 individual semi-structured qualitative interviews were conducted with 55 health system leaders. Data were analyzed using constant comparative analysis to explore how health equity was constructed in relation to understandings and actions. Results: Four main themes were identified in terms of how health care leaders construct health equity and actions to reduce health inequities: (1 population health, (2 determinants of health, and (3 accessibility and (4 challenges of health equity talk. The first three aspects of health equity talk reflect different understandings of health equity rooted in vulnerability (individual versus structural, determinants of health (material versus social determinants, and appropriate health system responses (targeted versus universal responses. Participants identified that talking about health equity in the health care system, either inside or outside of public health, is a ‘challenging conversation’ because health equity is understood in diverse ways and there is little guidance available to apply a health equity lens. Conclusions: These findings reflect the importance of creating a shared understanding of health equity within public health systems, and providing guidance and clarity as to the meaning and application of a health

  13. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    the_monk

    Journal of Community Medicine and Primary Health Care. 26 (1) 12-20 .... large proportions of the population work in the poor people use health care services far less than. 19 ... hypertension, cancers and road traffic accidents) below 1 dollar ...

  14. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    enrol in an insurance scheme feeling that they need more information on health insurance and the willingness to enrol in a ... and utilize the benefits of different types of health insurance services. Conclusion: The findings ..... improvements in access and quality of care, and the ... the 'rising tide' of and information technology.

  15. Environmental health and health planning

    International Nuclear Information System (INIS)

    1975-07-01

    Areas of environmental concern are identified and recommendations for improving environmental health are proposed by the Environmental Health Task Force of the Western Massachusetts Health Planning Council. Environmental health concerns in Western Massachusetts are in the areas of: air pollution; dental health and the specific problem of water flouridation; housing; injury control, including accidental death and disability; land use, and the specific problem of critical receptors; noise pollution; occupational hazards, specifically occupational accidents; pesticides; radiological exposure, particularly medical X-ray exposure and nuclear exposure; rural health care; sanitation; solid waste; and water quality including private and public water supplies, road salting, and rural sewerages. Each area of concern and specific problem are broken down into sections: background information; comments which incorporate recommendations for general problem-solving activities; and resources, including lists of key organization, individuals, laws and regulations, and publications relevant to the area of concern. Recommendations are presented based on long-term and short-term environmental goals. An inventory of environmental health organizations in Western Massachusetts is included. Appendices contain the charge to the Task Force, a definition of environmental health, sources of drinking water, the sanitation and sanitary codes, and housing and sanitation standards. Portions of this document are not fully legible

  16. Health promotion in occupational health.

    Science.gov (United States)

    Kaijser, C F O

    2005-01-01

    To describe a Swedish approach to occupational health and its implications for health promotion. We start business with a new customer by creating a health policy for the whole company. Every year a follow-up is presented to top management where decisions are taken on what to do for the coming period. The result from a paper mill is presented where cost savings were five times more than expected. We have found that close follow-up and the use of personalized reminders is very useful for individuals. We have also found the importance of working more with "the softer side" i.e. looking into a person's total life situation. Management training activities are essential. This training includes for instance personality, communication and conflict handling seminars and every manager has to go through those seminars. The focus is moved from sick care to health improvement. The result is measured in long-term health for individuals. To reach that level you have to be healthy and have no absences for at least two years. The Swedish occupational health system is a unique system for creating health. With a specially trained staff including MDs, nurses, physiotherapists, psychologists, management consultants and engineers, and working from prevention to treatment, they can create a total view of both individual health and customer company wealth. Working closely together in teams and in close cooperation with customers, they can initiate great changes in both these dimensions.

  17. Sexual Health

    Directory of Open Access Journals (Sweden)

    McMahon Sharon

    2004-08-01

    Full Text Available Abstract Health Issue Much attention is devoted to women's reproductive health, but the formative and mature stages of women's sexual lives are often overlooked. We have analyzed cross-sectional data from the Sexual Behaviour module of the 2000/2001 Canadian Community Health Survey (CCHS, and reviewed the literature and available indicators of the sexual health of Canadian women. Key Findings Contemporary Canadian adolescents are becoming sexually active at younger ages than in previous generations. The gender gap between young males and females in age at first intercourse has virtually disappeared. The mean age at first intercourse for CCHS respondents aged 15–24 years was between 16 and 17. Canadian-born respondents are significantly younger at first intercourse than those who were born outside of Canada. Few adolescents recognize important risks to their sexual health. Older Canadians are sexually active, and continue to find emotional and physical satisfaction in their sexual relationships. Data Gaps and Recommendations Both health surveys and targeted research must employ a broader understanding of sexuality to measure changes in and determinants of the sexual health of Canadians. There is reluctance to direct questions about sexual issues to younger Canadians, even though increased knowledge of sexual health topics is associated with delayed onset of sexual intercourse. Among adults, sex-positive resources are needed to address aspects of aging, rather than medicalizing age-related sexual dysfunction. Age and gender-appropriate sexual health care, education, and knowledge are important not only for women of reproductive age, but for Canadians at all stages of life.

  18. Women's health

    Science.gov (United States)

    ... Nurse midwives This list may not be all-inclusive. References Freund K. Approach to women's health. In: ... of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed ...

  19. Geospatial health

    DEFF Research Database (Denmark)

    Utzinger, Jürg; Rinaldi, Laura; Malone, John B.

    2011-01-01

    Geospatial Health is an international, peer-reviewed scientific journal produced by the Global Network for Geospatial Health (GnosisGIS). This network was founded in 2000 and the inaugural issue of its official journal was published in November 2006 with the aim to cover all aspects of geographical...... information system (GIS) applications, remote sensing and other spatial analytic tools focusing on human and veterinary health. The University of Naples Federico II is the publisher, producing two issues per year, both as hard copy and an open-access online version. The journal is referenced in major...... databases, including CABI, ISI Web of Knowledge and PubMed. In 2008, it was assigned its first impact factor (1.47), which has now reached 1.71. Geospatial Health is managed by an editor-in-chief and two associate editors, supported by five regional editors and a 23-member strong editorial board...

  20. Sexual Health

    Science.gov (United States)

    ... and changes in sexual function are common. These physiological changes can include: A need for more stimulation ... page: Sexuality in later life. National Institute on Aging. https://www.nia.nih.gov/health/publication/sexuality- ...

  1. Health Research

    Science.gov (United States)

    EPA scientists are helping communities and policymakers develop and implement policies and practices designed to improve public health, especially for groups such as children, the elderly or the socioeconomically disadvantaged.

  2. Environmental Health

    Science.gov (United States)

    Our environment affects our health. If parts of the environment, like the air, water, or soil become polluted, it ... in the home can trigger asthma attacks. Some environmental risks are a part of the natural world, ...

  3. Public Health

    International Development Research Centre (IDRC) Digital Library (Canada)

    ian health ministry, and the Canadian. International ... Tanzanian and Canadian researchers began work on ... information on the major causes of death ... The effects have been dramatic. Accord- ... destroy mosquito breeding grounds, such.

  4. Travelers' Health

    Science.gov (United States)

    ... 3, Avoid Nonessential Travel Health Infrastructure Breakdown in Venezuela May 15, 2018 More Alert Level 2, Practice ... Vision Using this Site Legal Link to Us Policies FOIA Accessibility Privacy No FEAR Act Inspector General ...

  5. HEALTH & FINANCE

    African Journals Online (AJOL)

    payments and coinsurance, the establishment of a minimum set ... costs are higher for aged and sick members. ... human nature to ensure you get good value for money. This ... rating. Australia has a National Health Insurance (NHI) system.

  6. Health surveillance

    International Nuclear Information System (INIS)

    1981-01-01

    The Code includes a number of requirements for the health surveillance of employees associated with the mining and milling of radioactive ores. This guideline is particularly directed at determining the level of fitness of employees and prospective employees, detecting any symptom which might contraindicate exposure to the environment encountered in mine/mill situations, examination of any employee who may have been exposed to radiation in excess of defined limits and the accumulation and provision of data on the health of employees

  7. Fatigue in children and adolescents with cancer from the perspective of health professionals.

    Science.gov (United States)

    Silva, Michele Cristina Miyauti da; Lopes, Luís Carlos; Nascimento, Lucila Castanheira; Lima, Regina Aparecida Garcia de

    2016-08-29

    to investigate health professionals' knowledge about the concept, assessment and intervention in fatigue in children and adolescents with cancer. exploratory study with qualitative approach, with 53 health professionals (10 nurses, 33 assistant nurses, 3 physicians, 3 nutritionists, 2 psychologists and 2 physical therapists). Semi structured interviews were held, which were recorded and analyzed by means of inductive thematic content analysis. the data were organized around three themes: knowledge of health professionals about fatigue; identification of fatigue and interventions to relieve fatigue. the results indicate the health professionals' limited knowledge about fatigue, as well as the lack of investment in their training and continuing education. Most of all, the lack of research on the theme in the Brazilian context remains a barrier to support improvements in care for this symptom in children and adolescents with cancer. investigar quais conhecimentos os profissionais de saúde têm acerca do conhecimento, avaliação e intervenção sobre a fadiga em crianças e adolescentes com câncer. estudo exploratório com abordagem qualitativa, realizado com 53 profissionais de saúde (10 enfermeiros, 33 auxiliares de enfermagem, 3 médicos, 3 nutricionistas, 2 psicólogos e 2 fisioterapeutas). Foram conduzidas entrevistas semiestruturadas as quais foram gravadas e analisadas por meio do modelo de análise de conteúdo do tipo temática indutiva. os dados foram organizados ao redor de três temas: conhecimento dos profissionais da saúde sobre fadiga; identificação da fadiga e intervenções para o alívio da fadiga. os achados apontam para o conhecimento limitado dos profissionais de saúde sobre fadiga, bem como para o pouco investimento em educação continuada e permanente. Sobretudo, a escassez de estudos sobre o assunto no cenário brasileiro ainda é uma barreira para oferecer subsídios para melhoria deste sintoma em crianças e adolescentes com c

  8. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    adedamla

    Quarry industry has become a major means of livelihood in Ebonyi state, but insufficient data exists on their operations ... of Dust Mask among Crushers of Selected Quarry (Crushed ... Journal of Community Medicine and Primary Health Care.

  9. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Department of Epidemiology and Community Health, University of Ilorin, Ilorin, Nigeria .... exercise. All pupils in the selected school later done under the light ..... increased the likelihood of intestinal parasitic of Ilechukwu et al in which a ...

  10. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    2Primary Health Care Department, Ikpoba Okha Local Government Area, Benin City, ... selected from each of the ten wards in the LGA using multistage sampling technique. ..... Knowledge of HIV/AIDS Insurance Companies in Lagos State.

  11. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Subject and Methods: ... To the best of the authors' knowledge, ... increase in percentage of women visiting health categories were decided on because ..... leadership resulted in an empowering work Significant differences in the proportions of.

  12. Health Literacy and Health Outcomes

    Science.gov (United States)

    ... 1998. Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. Archives of Internal Medicine. 158(2): 166-172. ...

  13. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    Immunization is a proven cost-effective ... immunization programme and control of Vaccine was conducted to assess the ..... HFs where emphasis is on profit maximization revealed that the widespread ... World Health Organization (WHO).

  14. Health technology

    International Nuclear Information System (INIS)

    Nicolas, Delphine; Dangleant, Caroline; Ganier, Aude; Kaczmarek, Delphine

    2008-01-01

    The CEA is an organization with a primarily technological focus, and one of the key areas in which it carries out research is Health Technology. This field of research was recognized and approved by the French Atomic Energy Committee on July 20, 2004. The expectations of both the public and health care professionals relate to demands for the highest standards of health care, at minimum risk. This implies a need to diagnose illness and disease as accurately and as at early a stage as possible, to target surgery precisely to deal only with damaged organs or tissues, to minimize the risk of side effects, allergies and hospital-acquired infections, to follow-up and, as far as possible, tailor the health delivery system to each individual's needs and his or her lifestyle. The health care sector is subject to rapid changes and embraces a vast range of scientific fields. It now requires technological developments that will serve to gather increasing quantities of useful information, analyze and integrate it to obtain a full understanding of highly complex processes and to be able to treat the human body as un-invasively as possible. All the technologies developed require assessment, especially in the hospital environment. (authors)

  15. National Health Expenditure Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — National Health Expenditure Accounts are comprised of the following, National Health Expenditures - Historical and Projected, Age Estimates, State Health...

  16. Sexual Health

    Directory of Open Access Journals (Sweden)

    Dr. Christine Boyce

    2009-04-01

    Full Text Available This month two general practitioners (GPs describe their approach to sexual health consultations.The issue of a sexually active adolescent demonstrates some differences in legislation pertaining tothe requirement to involve the authorities, although in essence the young person can expect thesame response from these practitioners in two different health care systems. On the other hand apatient at risk of sexually transmitted infections is more likely to be referred to a specialistGenitourinary clinic in the UK although the protocols for screening and education are largely similar.Equally patients who are HIV positive can expect to receive the bulk of their care from specialistclinics in both countries.Midwives are the main stay of antenatal services in Australia and the UK with general practitionersminimally involved in routine cases. Also home births are a negigible proportion of all deliveries ineither country. When patients opt for a home birth our authors expressed the view that GPsgenerally do not have the skills or experience to be the main health professional in attendance.Therefore such births are primarily managed by midwives as the key health care professional. Thefocus of General practitioners is primarily to ensure that the patient is making an informed decisionabout delivering her baby at home. The GP is therefore still in an influential position to assist thewoman in making a decision about where to give birth. As a point of difference in Australia a homebirth would result in out of pocket expences for the mother.The views expressed below are those of the authors and do not necessarily reflect health policy orpractice elsewhere in their countries. However we believe they offer an interesting perspective ontheir health care systems and commend the article to our readers.Please

  17. Georges Canguilhem y el estatuto epistemológico del concepto de salud Georges Canguilhem and the epistemological status of the concept of health

    Directory of Open Access Journals (Sweden)

    Sandra Caponi

    1997-10-01

    Full Text Available Tomando como punto de partida la discusión de Canguilhem relativa al estatuto epistemológico del concepto de salud, pretendemos problematizar las conceptualizaciones dada por la OMS y una definición ampliada enunciada por la VIII Conferencia Nacional de Salud que se han convertido hoy en hegemónicas. Esas conceptualizaciones entienden la salud como equilibrio y adaptación al medio. Nuestro objetivo fundamental es evidenciar que el ámbito de los enunciados está en permanente cruzamiento con el ámbito de lo no discursivo, de lo institucional. Siendo así, la aceptación de determinado concepto de salud implica el direccionamiento de determinadas políticas y de ciertas intervenciones efectivas sobre el cuerpo y la vida de los sujetos.Taking as a point of departure Canguilhem's view on the epistemological status of the concept of health, the article examines current hegemonic concepts which see health as a question of balance and adjustment to the environment-including herein the conceptualization posed by the World Health Organization and the broad definition laid out during the 8th Health Conference. The basic goal of this examination is to show that what is defined in discursive statements constitutes an ongoing interaction with the metadiscursive statements more closely related to the world of institutions and institutional action. It is therefore argued that the adoption of a particular notion of health implies the selection of a particular direction in health care policies as well as the application of a particular set of intervention strategies regarding the lives and bodies of subjects.

  18. Human Health

    CSIR Research Space (South Africa)

    Garland, Rebecca M

    2017-10-01

    Full Text Available Southern Africa has multiple risks that contribute to the overall burden of disease (i.e. the quadruple burden of disease), which may make people more vulnerable to the health impacts from climate change. In addition, the sector is vulnerable...

  19. Mental health

    NARCIS (Netherlands)

    Lagerveld, S.; Houtman, I.L.D.

    2014-01-01

    The article will describe factors of influence on return to work RTW and evidence-based interventions that enhance return to work (RTW) after sick leave due to common mental health disorders (CMD). First the concepts of both RTW and CMD are outlined. Second, the sense of urgency for effective RTW

  20. Girls Health

    Science.gov (United States)

    ... how to stay safe anywhere. Learn more Strong body, healthy mind. Thirteen ways being fit helps you. Learn more Mental health matters. Learn ways to cope if you’re feeling sad. Learn more Spotlight: Jaelin ... your body or your period? Confused about dating or friendships? ...