Las cláusulas sociales en la contratación pública como garantía frente al dumping social intracomunitario

La contratación pública es un sólido instrumento que, cada vez más, sirve de cauce a las políticas de la Unión. El gran volumen de recursos públicos en juego justifica una reinterpretación, en clave social, de la tradicional visión económica que ha presidido dicho ámbito y a tal fin responde la previsión de cláusulas sociales en los contratos públicos. La Sentencia «RegioPost» constituye un claro ejemplo de ello. En ella, el Tribunal de Justicia de la Unión Europea reacciona contra el dumping social intracomunitario al priorizar los derechos de los trabajadores frente a la libre prestación de servicios. En concreto, el Tribunal considera compatible con el Derecho de la Unión una normativa regional que, de una parte, obligaba a los licitadores y subcontratistas de un contrato público a asumir por escrito en la oferta el compromiso de pagar a sus trabajadores desplazados a otro Estado miembro el salario mínimo fijado por éste y, de otra, permitía la exclusión del procedimiento de adjudicación de aquellos licitadores que se negasen a asumir dicha obligación. Pero, ¿cómo llega a dicha conclusión el Tribunal? Este comentario analiza su argumentación, formal en gran medida, y aporta algunas reflexiones de fondo críticas al respecto.Public procurement is a powerful and increasingly common tool of EU policies. Given the enormous importance of public procurement in terms of public expenditure, it seems justified to promote a social-policy based reinterpretation of the traditional economic approach, for example by including social considerations among the bid specifications. The ECJ’s ruling in the ‘RegioPost’ case is a clear example thereof. In it, the ECJ reacts against transnational ‘social dumping’ by prioritizing workers’ rights over the freedom to provide services. More specifically, the ECJ considers that regional legislation that, on one hand, requires tenderers and their subcontractors to pay the host country’s minimum wage to posted workers and, on the other hand, allows the contracting authority to exclude those tenderers and subcontractors refusing to accept that obligation from the procedure is compatible with EU law. But how does the ECJ reach that conclusion? This commentary analyzes the ECJ’s very formal reasoning and provides some critical reflections on the ruling

String-based Multi-adjoint Lattices for Tracing Fuzzy Logic Computations

Classically, most programming languages use in a predefined way thenotion of “string” as an standard data structure for a comfortable management of arbitrary sequences of characters. However, in this paper we assign a different role to this concept: here we are concerned with fuzzy logic programming, a somehow recent paradigm trying to introduce fuzzy logic into logic programming. In this setting, the mathematical concept of multi-adjoint lattice has been successfully exploited into the so-called Multi-adjoint Logic Programming approach, MALP in brief, for modeling flexible notions of truth-degrees beyond the simpler case of true and false. Our main goal points out not only our formal proof verifying that stringbased lattices accomplish with the so-called multi-adjoint property (as well as its Cartesian product with similar structures), but also its correspondence with interesting debugging tasks into the FLOPER system (from “Fuzzy LOgic Programming Environment for Research”) developed in our research group

Characterization of mothers, mode of deliveries and newborns in Campinas, São Paulo, 2001 and 2005

OBJETIVO: Comparar dados pré-natais, dos partos e dos recém-nascidos de Campinas em 2001 e 2005. MÉTODOS: Estudo transversal que analisou 13.656 documentos do Sistema de Informações sobre Nascidos Vivos (Sinasc) de 2005, comparando-as aos resultados de 2001. Analisou-se o local de moradia e parto, idade materna, estado civil, escolaridade, ocupação, paridade, consultas de pré-natal, tipo de parto, duração da gestação e peso ao nascer. Para avaliar a associação entre as variáveis, utilizou-se o teste de qui-quadrado, sendo significante p<0,05. RESULTADOS: Os nascidos nos Distritos de Saúde (DS) com piores índices de condições de vida (ICV) diminuíram em relação a 2001. A taxa de adolescentes passou de 17,7% para 14,7%. Em 2001, 39,4% das mães trabalhavam e, em 2005, 42,9%. Quanto à presença de companheiro, 35,9 e 54,3% não o referiam em 2001 e 2005, respectivamente. A escolaridade passou de 37,8% de mães com até sete anos de estudo para 25,7%, com aumento das que estudaram entre oito e 11 anos e 12 anos ou mais. O comparecimento a mais de seis consultas no pré-natal passou de 74,4 para 86,6%. Houve aumento de cesáreas (54,9 para 60,3%) e de prematuridade (7,1 para 8,9%). Não houve alteração no perfil de peso ao nascimento. CONCLUSÕES: Verificou-se queda da paridade nos DS com piores ICV e no percentual de mães adolescentes. Elevou-se o número de trabalhadoras, mulheres sem companheiro, escolaridade e frequência ao pré-natal.OBJECTIVE: To compare data related to prenatal care, deliveries and newborns from Campinas, Brazil, in 2001 and 2005. METHODS: This cross-sectional study analyzed 13,656 Live Birth Certificates from 2005, comparing them to of 2001. The analyzed variables were: place of birth and dwelling, maternal age, marital status, schooling, number of births, number of prenatal consultations, mode of delivery, length of pregnancy and birthweight. Association between variables was evaluated by the chi-square test, being significant p<0.05. RESULTS: In 2005, there was a decrease in the number of newborns from Health Districts with worse living conditions in comparison to 2001. The rate of teenage pregnancies varied from 17.7% in 2001 to 14.7% in 2005. Working mothers were 42.9% of the sample in 2005 and 39.4% in 2001. In 2005, single mothers were 54.3% compared to 35.9% in 2001. Mothers with seven or less years of schooling were 37.8% in 2001, compared to 25.7% in 2005. In 2005, 86.6% of mothers had more than six prenatal visits compared to 74.4% in 2001. There was an increase in the rates of cesarean section (from 54.9% in 2001 to 60.3% in 2005) and prematurity (from 7.1% in 2001 to 8.9% in 2005). No significant changes in birthweight were observed. CONCLUSIONS: This study shows a decrease in the rate of births in the Health Districts with worse conditions of living and in teenage pregnancies. Rates of working mothers, single mothers, years of schooling, number of prenatal consultations increased

Resiliência e problemas de saúde mental em crianças e adolescentes vítimas de violência

OBJECTIVE: To understand the process of resilience (social support and resources of the family environment) and the chance of mental health problems in children and adolescents (9–16 years) who have been victims of domestic violence, assisted in specialized services (Group 1 – G1) and in school services without reports of domestic violence (Group 2 – G2). METHODS: Various semi-structured instruments were applied to the pairs (guardian and child or adolescent): the Strengths and Difficulties Questionnaire (SDQ); the Resiliency Scales for Children and Adolescents (RSCA), including Scale I (SI – sense of control), Scale II (SII – relationship skills) and Scale III (SIII – emotional reactivity); the Social Support Appraisals; the Home Environment Resources Scale and a questionnaire created by the authors to characterize the population. RESULTS: There was no difference in the prevalence of resilience between G1 and G2. Children and adolescents of both groups had a higher chance of low resilience in the absence of perception of social support from the teacher (SI; SIII) and other people in the community (SI; SII). Girls had higher chance of low resilience (SIII). The establishment of routine or rules in the lives of the children and adolescents facilitated the development of resilience (SIII). In G1, the prevalence of mental health problems was 65% for the self-application version of the SDQ for children and adolescents (SDQ/CA) and 54% for the version answered by the guardians (SDQ/G). In G2, it was 33% for SDQ/CA and 37.9% for SDQ/G. Domestic violence against children and adolescents was a risk factor for the development of mental disorders (SDQ/G). Subjects with low resilience (SI) had a higher chance of developing mental health problems (SDQ/CA). Despite originating from the same regions, the groups had socioeconomic differences, which showed no relationship with resilience. CONCLUSIONS: The quality and perception of social support and resources present in the home environment may have facilitated the development of resilience in the studied children and adolescents. Violence may have increased the chance of mental health problems, domestic violence being an aggravating factor. There is need for research on aspects that predict resilience and investment in intervention strategies for this population, as a way to promote mental health.OBJETIVO: Compreender o processo de resiliência (suporte social e recursos do ambiente familiar) e a chance de problemas de saúde mental em crianças e adolescentes (9–16 anos) vítimas de violência doméstica acompanhados em serviços especializados (Grupo 1 – G1) e em escolares sem relatos de situações de violência doméstica (Grupo 2 – G2). MÉTODOS: Diversos instrumentos semiestruturados foram aplicados às díades (responsável e criança ou adolescente): Strengths and Difficulties Questionnaire (SDQ); Resiliency Scales for Children and Adolescents (RSCA), incluindo a Escala I (EI – sentido do controle), a Escala II (EII – capacidade de relacionamento) e a Escala III (EIII – reatividade emocional); Social Support Appraisals; Inventário de Recursos no Ambiente Familiar e um questionário elaborado pelos autores para caracterizar a população. RESULTADOS: Não houve diferença na prevalência de resiliência entre G1 e G2. As crianças e adolescentes de ambos os grupos tiveram maior chance de baixa resiliência na ausência de percepção do suporte social do professor (EI; EIII) e de outras pessoas da comunidade (EI; EII). Meninas apresentaram maior chance de baixa resiliência (EIII). O estabelecimento de rotina ou regras na vida das crianças e adolescentes facilitou o desenvolvimento da resiliência (EIII). No G1 a prevalência de problemas de saúde mental foi de 65% pela versão de autoaplicação do SDQ para crianças e adolescentes (SDQ/CA) e de 54% pela versão respondida pelos responsáveis (SDQ/R). No G2 foi de 33% pelo SDQ/CA e de 37,9% pelo SDQ/R. A violência doméstica infantojuvenil foi fator de risco para o desenvolvimento de transtornos mentais (SDQ/R). Os sujeitos com baixa resiliência (EI) apresentaram maior chance de problemas de saúde mental (SDQ/CA). Embora provenientes das mesmas regiões, os grupos apresentaram diferenças socioeconômicas, as quais não apresentaram relação com a resiliência. CONCLUSÕES: A qualidade e percepção do suporte social e de recursos presentes no ambiente familiar podem ter facilitado o desenvolvimento da resiliência nas crianças e adolescentes estudados. A violência pode ter aumentado a chance de problemas de saúde mental, sendo a violência doméstica um agravante. Há necessidade de pesquisas sobre os aspectos preditores de resiliência e de investimento em estratégias de intervenção para esta população, como forma de promover a saúde mental

Global sensitivity analysis of leaf-canopy-atmosphere RTMs: Implications for biophysical variables retrieval from top-of-atmosphere radiance data

Knowledge of key variables driving the top of the atmosphere (TOA) radiance over a vegetated surface is an important step to derive biophysical variables from TOA radiance data, e.g., as observed by an optical satellite. Coupled leaf-canopy-atmosphere Radiative Transfer Models (RTMs) allow linking vegetation variables directly to the at-sensor TOA radiance measured. Global Sensitivity Analysis (GSA) of RTMs enables the computation of the total contribution of each input variable to the output variance. We determined the impacts of the leaf-canopy-atmosphere variables into TOA radiance using the GSA to gain insights into retrievable variables. The leaf and canopy RTM PROSAIL was coupled with the atmospheric RTM MODTRAN5. Because of MODTRAN's computational burden and GSA's demand for many simulations, we first developed a surrogate statistical learning model, i.e., an emulator, that allows approximating RTM outputs through a machine learning algorithm with low computation time. A Gaussian process regression (GPR) emulator was used to reproduce lookup tables of TOA radiance as a function of 12 input variables with relative errors of 2.4%. GSA total sensitivity results quantified the driving variables of emulated TOA radiance along the 400-2500 nm spectral range at 15 cm-1 (between 0.3-9 nm); overall, the vegetation variables play a more dominant role than atmospheric variables. This suggests the possibility to retrieve biophysical variables directly from at-sensor TOA radiance data. Particularly promising are leaf chlorophyll content, leaf water thickness and leaf area index, as these variables are the most important drivers in governing TOA radiance outside the water absorption regions. A software framework was developed to facilitate the development of retrieval models from at-sensor TOA radiance data. As a proof of concept, maps of these biophysical variables have been generated for both TOA (L1C) and bottom-of-atmosphere (L2A) Sentinel-2 data by means of a hybrid retrieval scheme, i.e., training GPR retrieval algorithms using the RTM simulations. Obtained maps from L1C vs L2A data are consistent, suggesting that vegetation properties can be directly retrieved from TOA radiance data given a cloud-free sky, thus without the need of an atmospheric correction

Use of non-invasive ventilation in acute pulmonary edema and chronic obstructive pulmonary disease exacerbation in emergency medicine: predictors of failure

OBJECTIVE: This study analyzed acute respiratory failure caused by acute pulmonary edema, as well as chronic obstructive pulmonary disease exacerbation, that was treated with non-invasive mechanical ventilation to identify the factors that are associated with the success or failure non-invasive mechanical ventilation in urgent and emergency service. METHODS: This study was a prospective, descriptive and analytical study. We included patients of both genders aged &gt;18 years who used non-invasive mechanical ventilation due to acute respiratory failure that was secondary to acute pulmonary edema or chronic obstructive pulmonary disease exacerbation. Patients with acute respiratory failure that was secondary to pathologies other than acute pulmonary edema and chronic obstructive pulmonary disease or who presented with contraindications for the technique were excluded. Expiratory pressures between 5 and 8 cmH2O and inspiratory pressures between 10 and 12 cmH2O were used. Supplemental oxygen maintained peripheral oxygen saturation at &gt;90%. The primary outcome was endotracheal intubation. RESULTS: A total of 152 patients were included. The median non-invasive mechanical ventilation time was 6 hours (range 1 - 32 hours) for chronic obstructive pulmonary disease patients (n=60) and 5 hours (range 2 - 32 hours) for acute pulmonary edema patients (n=92). Most (75.7%) patients progressed successfully. However, reduced APACHE II scores and lower peripheral oxygen saturation were observed. These results were statistically significant in patients who progressed to intubation (p<0.001). BiPAP (Bi-level Positive Airway Pressure portable ventilator), as continuous positive airway pressure use increased the probability of endotracheal intubation 2.3 times (p=0.032). Patients with acute pulmonary edema and elevated GCS scores also increased the probability of success. CONCLUSION: Respiratory frequency &gt;25 rpm, higher APACHE II scores, BiPAP use and chronic obstructive pulmonary disease diagnosis were associated with endotracheal intubation. Higher GCS and SpO2 values were associated with NIV success. Non-invasive mechanical ventilation can be used in emergency services in acute respiratory failure cases caused by acute pulmonary edema and chronic obstructive pulmonary disease exacerbation, but patients with variables related to a higher percentage of endotracheal intubation should be specially monitored.OBJETIVO: Analisar os casos de insuficiência respiratória aguda decorrente de edema agudo de pulmão e de agudização da doença pulmonar obstrutiva crônica, submetidos à ventilação mecânica não invasiva, a fim de identificar fatores associados ao sucesso ou ao insucesso do método em um serviço de urgência e emergência. MÉTODOS: Estudo descritivo e analítico prospectivo. Foram incluídos pacientes de ambos os gêneros, com idade &gt;18 anos, que utilizaram ventilação mecânica não invasiva devido ao quadro de insuficiência respiratória secundária a edema agudo de pulmão ou agudização da doença pulmonar obstrutiva crônica. Foram excluídos os pacientes com insuficiência respiratória aguda secundária a patologias diferentes de edema agudo de pulmão e doença pulmonar obstrutiva crônica, ou que apresentavam contraindicação para a técnica. A rotina da instituição é utilizar a pressão expiratória entre 5 e 8 cmH2O, e a inspiratória entre 10 a 12 cmH2O, além de suplementação de oxigênio para manter a saturação periférica de oxigênio &gt;90%. A variável desfecho considerada foi a intubação endotraqueal. RESULTADOS: Foram incluídos 152 pacientes. A mediana do tempo de ventilação mecânica não invasiva foi de 6 (1 - 32) horas para os pacientes com doença pulmonar obstrutiva crônica (n=60) e de 5 (2 - 32) horas para os pacientes com edema agudo de pulmão (n=92); 75,7% evoluíram com sucesso. Foram observados pior escore de APACHE II e menor saturação periférica de oxigênio, de forma estatisticamente significante, nos pacientes que evoluíram para intubação (p<0,001). O uso de BiPAP relacionou-se a 2,3 vezes mais chance de ocorrência de intubação endotraqueal que o de CPAP (p=0,032). Entre os pacientes com diagnóstico de edema agudo de pulmão e com pontuação mais elevada na ECG também apresentaram mais chance de sucesso CONCLUSÃO: As variáveis associadas à intubação endotraqueal foram frequência respiratória &gt; 25rpm, maior valor de APACHE II, uso de BiPAP e diagnóstico de doença pulmonar obstrutiva crônica. Já maiores valores de ECG e SpO2 estão associados ao sucesso da ventilação mecânica não invasiva. A ventilação mecânica não invasiva pode ser utilizada em serviços de urgência/emergência para casos de insuficiência respiratória aguda decorrente de edema agudo de pulmão e exacerbação da doença pulmonar obstrutiva crônica, com cuidado especial na monitoração dos pacientes com variáveis relacionadas à maior porcentagem de intubação endotraqueal.27828

Effects of Pilates mat exercises on muscle strength and on pulmonary function in patients with cystic fibrosis

Objective: To analyze the effects of Pilates mat exercises in patients with cystic fibrosis (CF). Methods: This was a clinical trial involving 19 CF patients recruited from either the CF Outpatient Clinic of the State University at Campinas Hospital de Clinicas or the Children's Institute of the University of So Paulo School of Medicine Hospital das Clinicas. All of the patients performed Pilates mat exercises for four months (one 60-min session per week). the variables studied (before and after the intervention) were respiratory muscle strength, MIP, MEP, FVC, and FEV1. Results: After the intervention, MIP was significantly higher in the male patients (p = 0.017), as were MIP and MEP in the female patients (p = 0.005 and p = 0.007, respectively). There were no significant differences between the pre- and post-intervention values of FVC or FEV1, neither in the sample as a whole nor among the patients of either gender. Conclusions: Our results show that Pilates mat exercises have beneficial effects on respiratory muscle strength in CF patients.Univ Estadual Campinas, Campinas, SP, BrazilUniv Estadual Campinas, Programa Posgrad Saude Crianca & Adolescente, Campinas, SP, BrazilUniv Estadual Campinas, Dept Pediat, Fac Ciencias Med, Campinas, SP, BrazilUniv São Paulo, Fac Med, Inst Crianca, Unidade Pneumol Pediat, São Paulo, BrazilUniversidade Federal de São Paulo, Programa Posgrad Reabilitacao, São Paulo, BrazilUniversidade Federal de São Paulo, Programa Posgrad Reabilitacao, São Paulo, BrazilWeb of Scienc

Absentismo laboral en trabajadores públicos de Mallorca

Objetivo. Valorar los procesos de absentismo en una empresa pública en el periodo 1991-2008 y la influencia de algunas variables socio demográficas. Material y método. Estudio descriptivo transversal un total de 10154 procesos de absentismo (incapacidad temporal, accidente de trabajo e indisposición) en trabajadores públicos. Se analiza la influencia de la edad y el sexo. Resultados. Se estudian un total de 6542 episodios de incapacidad temporal, 2297 indisposiciones y 615 accidentes laborales. El número total de días perdidos es de 302147. Las mujeres y los trabajadores mayores de 45 años son los grupos que presentan mayor número de procesos de absentismo y los que pierden mayor número de días. Conclusiones. El presente trabajo es uno de los primeros que presenta datos de indisposiciones, un aspecto del absentismo que muy pocas veces se ha analizado.Objective. Assess the processes of absenteeism in a public company between 1991-2008 and the influence of some socio demographic variables. Methods. Cross-sectional study of 10154 absences processes (temporary disability, industrial accident and mild ailments) in public workers. The influence of age and sex is analyzed. Results. 6542 episodes of temporary disability, 2297 mild ailments and 615 industrial accidents were studied. The total number of “lost days” is 302147. Women and workers over 45 are the groups with the highest number of absenteeism processes and more “lost days”. Conclusions. This work is one of the first to present data of mild ailments, one aspect of absenteeism rarely been analyzed

Social Determinants of Health, the Family, and Children’s Personal Hygiene: A Comparative Study

Habits of personal hygiene are mostly acquired during childhood, and are, therefore, influenced by one’s family. Poor hygiene habits are a risk factor for preventable disease and social rejection. Social Determinants of Health (SDH) consist of contextual factors, structural mechanisms, and the individual’s socioeconomic position, which, via intermediary determinants, result in inequities of health and well–being. Dysfunctional family situations may, therefore, be generated by an unequal distribution of factors determining SDH. Little attention has been paid to the influence of the family on personal hygiene and the perception of social rejection in children. We designed a study to examine differences in personal hygiene and in the perception of social rejection between children in reception centers and children living in a family setting. A validated questionnaire on children’s personal hygiene habits was completed by 51 children in reception centers and 454 children in normal families. Hygiene habits were more deficient among the children in reception centers than among the other children in all dimensions studied. Deficient hygiene habits were observed in the offspring of families affected by the main features of social inequality, who were more likely to perceive social rejection for this reason and less likely to consider their family as the greatest influence on their personal hygiene practices