Made available in DSpace on 2016-03-22T17:26:20Z (GMT). No. of bitstreams: 1 resumof.pdf: 30646 bytes, checksum: e0a0b378bf294ddb1c8861a1ed9d7975 (MD5) Previous issue date: 2010-04-19 / This paper presents the results of an evaluative study on the socio-educational actions carried out in Apoio Socioeducativo em Meio Aberto (Socio-Environmental Support Open Meeting - ASEMA) Castilhos, using as parameter the National Grading Services Socioassistenciais. It starts with a theoretical approach to the ASEMA as a service of socioassistencial Sistema Único de Assistência Social (Integrated Social Welfare Sistem SUAS), highlighting his transition to the Coexistence Service and Strengthening Linkages the realization of research due to the inclusion of professional research associate inquiries about the results actually produced by this type of service socioassistencial privileged the case study, from a qualitative approach in the critical-dialectical approach, using tools such as participant observation and semi-structured interviews with parents or guardians and children and adolescents by ASEMA Castilhos. The central question of this study is as follows: From the new parameters set by the National Grading Services Socioassistenciais, what the results are operated with the social and educational initiatives undertaken ASEMA Castilhos in children and adolescents and their nuclear families? The evaluation of the actions developed shows that ASEMA is a space for socialization, learning and protection of children and adolescents, as well as contributing to some aspects to improve the quality of life of users and their nuclear families. However, it was observed that the requirement to attend the service imposed on users linked to the Program to Eradicate Child Labor and the loss given by the regular education public school system are negative aspects that permeate the activities of ASEMA. This assessment also pointed to the need for some changes and the adequacy of service to the new guidelines of the SUAS, and be referenced to the Reference Center for Social Assistance, strengthening of networking and intersectoral and systematic monitoring and evaluation of socio-educational development / O presente trabalho apresenta os resultados de uma pesquisa avaliativa sobre as ações socioeducativas desenvolvidas no Apoio Socioeducativo em Meio Aberto (ASEMA) Castilhos, usando como parâmetro a Tipificação Nacional de Serviços Socioassistenciais. Inicia com uma abordagem teórica sobre o ASEMA, como um serviço socioassistencial do Sistema Único de Assistência Social (SUAS), destacando a sua transição para o Serviço de Convivência e Fortalecimento de Vínculos (SCFV). A realização da pesquisa decorrente da inserção profissional da pesquisadora associada aos questionamentos sobre os resultados efetivamente produzidos por este tipo de serviço socioassistencial, privilegiou o estudo de caso, a partir de uma abordagem qualitativa dentro do enfoque dialético-crítico, usando como instrumentos a observação participante e entrevistas semiestruturadas com os pais ou responsáveis e com as crianças e adolescentes atendidos pelo ASEMA Castilhos. A questão central do estudo é a seguinte: A partir dos novos parâmetros estabelecidos pela Tipificação Nacional de Serviços Socioassistenciais, quais são os resultados operados com as ações socioeducativas desenvolvidas no ASEMA Castilhos nas crianças e adolescentes atendidos e em seus núcleos familiares? A avaliação das ações desenvolvidas evidencia que o ASEMA é um espaço de socialização, aprendizagem e proteção a crianças e adolescentes, além de contribuir com alguns aspectos para a melhoria da qualidade de vida dos usuários e de seus núcleos familiares. No entanto, observou-se que a obrigatoriedade em frequentar o Serviço imposta aos usuários vinculados ao Programa de Erradicação do Trabalho Infantil (PETI), bem como a deficitária educação regular ministrada pelo sistema público de ensino são aspectos negativos que permeiam as atividades do ASEMA. Esta avaliação, ainda, apontou para a necessidade de algumas mudanças e da adequação do Serviço às novas diretrizes do SUAS, como ser referenciado ao Centro de Referência da Assistência Social (CRAS), fortalecimento do trabalho em rede e da intersetorialidade e avaliação e monitoramento sistemáticos das ações socioeducativas desenvolvidas

External post-tensioning is an attractive technique for strengthening reinforced concrete structures because of its ability to actively control stresses and deflections, speed of installation, minimum interruption for the existing structure, and ease of inspection under service conditions. However, external prestressing implies exposing the tendons to the environment outside the concrete section, which may lead to corrosion in steel tendons. Therefore, the interest in using fiber reinforced polymer (FRP) tendons, which are corrosion resistant, has increased. The present work investigated, experimentally and analytically, the flexural performance of reinforced concrete beams strengthened with externally post-tensioned Carbon FRP (CFRP) tendons, under monotonic and fatigue loadings. Initially, tensile fatigue tests were carried out on CFRP tendon-anchor assemblies to assess their response under repeated cyclic loads, before implementing them in the beam tests. New wedge-type anchors (Waterloo anchors) were used in gripping the CFRP specimens. The assemblies exhibited excellent fatigue performance with no premature failure occurring at the anchorage zone. The fatigue tests suggested a fatigue limit of a stress range of 10% of the tendon ultimate capacity (approximately 216 MPa). Monotonic and fatigue experiments on twenty-eight beams (152x254x3500 mm) were then undertaken. Test parameters included the tendon profile (straight and double draped), the initial loading condition of the beam prior to post-tensioning (in-service and overloading), the partial prestressing ratio (0.36 and 0.46), and the load ranges applied to the beam during the fatigue life (39% to 76% of the yield load). The CFRP tendons were post-tensioned at 40% of their ultimate capacity. The monotonic tests of the post-tensioned beams suggested that overloading the beam prior to post-tensioning increased the beam deflections and the strains developed in the steel reinforcing bars at any stage of loading. However, overloading had no significant effect on the yield load of the strengthened beam and the mode of failure at ultimate. It also had no discernable effect on the increase in the tendon stress at yielding. The maximum increase in the CFRP stress at yield load was approximately 20% of the initial post-tensioning stress, for the in-service and overloaded beams. A very good performance of the strengthened beams was observed under fatigue loading. The fatigue life of the beams was mainly governed by the fatigue fracture of the internal steel reinforcing bars at a flexural crack location. Fracture of the bars occurred at the root of a rib where high stress concentration was likely to occur. No evidence of wear or stress concentration were observed at the deviated points of the CFRP tendons due to fatigue. The enhancement in the fatigue life of the strengthened beams was noticeable at all load ranges applied. Post-tensioning considerably decreased the stresses in the steel reinforcing bars and, consequently, increased the fatigue life of the beams. The increase in the fatigue life was slightly affected by the loading history of the beams. At the same load range applied to the beam, increasing the amount of the steel reinforcing bars for the same post-tensioning level decreased the stress range in the bars and significantly increased the fatigue life of the strengthened beams. In the analytical study, a monotonic model that predicts the non-linear flexural response of the CFRP post-tensioned beams was developed and implemented into a computer program. The model takes into account the loading history of the strengthened beams prior to post-tensioning (in-service and overloading). Good agreement was obtained between the measured and the predicted monotonic results. A strain-life based fatigue model was proposed to predict the fatigue life of the CFRP post-tensioned beams. The model takes into consideration the stress-strain history at the stress raisers in the steel bars. It accounts for the inelastic deformation occurring at the ribs during cycling and the resulting changes in the local mean stresses induced. Good agreement between the experimental and predicted fatigue results was observed. A step-by-step fatigue design approach is proposed for the CFRP externally post-tensioned beams. General conclusions of the study and recommendations of future work are given.

Im Rahmen des Transferprojektes sollen baubetriebliche Rahmenbedingungen und Kennwerte, die zur Beurteilung der wirtschaftlichen Anwendung des Verfahrens geeignet sind, erarbeitet werden. Untersucht werden soll die Applikation von textilbewehrtem Beton im Bereich der Sanierung und Verstärkung von großflächigen Betonbauteilen. Generell können Bauaufgaben in sehr vielen Fällen durch verschiedene Bauverfahren realisiert werden, die sich regelmäßig hinsichtlich der Kosten, der benötigten Bauzeit aber auch hinsichtlich der gelieferten Qualität und des Einflusses auf die Umwelt unterscheiden. Aus baubetrieblicher Sicht wird traditionell über den kalkulatorischen Verfahrensvergleich jenes Verfahren ermittelt, mit dem die Realisierung am wirtschaftlichsten ausgeführt werden kann. Falls qualitative Kriterien beim Verfahrensvergleich mit berücksichtigt werden sollen, stehen verschiedene Methoden zur Auswahl. Der Begriff Nutzwertanalyse wird häufig als Synonym für diese nichtmonetären Bewertungsverfahren verwendet. In diesem Sinne ist auch der Titel des Beitrages zu verstehen. Die Grundlage bilden die baubetrieblichen Rahmenbedingungen, welche im Rahmen dieses Forschungsprojektes bestimmt werden. Hierzu zählen unter anderem die Entwicklung einer Trockenmischung des zu verwendenden Betons aus der bisher verwendeten Standardrezeptur der TU Dresden und geeigneter Maschinen für die Applikation des textilbewehrten Betons.

Durch die beanspruchungsgerechte Anordnung von Fasermaterialien wie Glas oder Carbon mit hervorragenden Trageigenschaften entstehen technische Textilien, die in eine Betonmatrix eingebracht werden können, so daß ein neuer, innovativer Verbundwerkstoff entsteht, der sowohl bei der Herstellung neuer Betonbauteile verwendet werden kann als auch für den Einsatz in der Instandsetzung und Verstärkung bestehender Bauwerke geeignet ist. Da die verwendeten Materialien im Gegensatz zum Stahl nicht korrosionsempfindlich sind und gleichzeitig hohe Festigkeiten aufweisen, können Verstärkungen aus textilbewehrtem Beton mit sehr geringen Abmessungen ausgeführt werden. Bei Holzkonstruktionen können textile Verstärkungen die durch die Anisotropie bedingten Festigkeits- und Steifigkeitsunterschiede kompensieren und die Dauerhaftigkeit erhöhen. Bei Verzicht auf Knotenbleche aus Stahl und durch Applikation von textilen Strukturen können beachtliche Steigerungen der Tragfähigkeit und der Duktilität von Verbindungen erreicht werden. In den fünf Projektbereichen werden in theoretischen und experimentellen Untersuchungen die Grundlagen für die Werkstoffe, die mechanische Beschreibung, die konstruktive Durchbildung und die Bemessung, die technologische Aufbringung, bautechnische Umsetzung und die Langzeiteigenschaften und damit für die Sicherheit und die Lebensdauer bei der Verwendung textiler Bewehrungen für die Instandsetzung und Verstärkung geschaffen. / The stress-oriented arrangement of fibre materials, such as glass or carbon, which have an excellent load-bearing capacity, leads to technical textiles that may be incorporated into a concrete matrix. So a new, innovative composite material is produced, which can be used for the production of new concrete members and also for the restoration and strengthening of existing structures. As the materials used are noncorrosive compared to steel and as they show great strength at the same time, textile-reinforced concrete can be used for strengthening tasks of small dimensions. With regard to timber structures, textile reinforcement can compensate the strength and stiffness differences caused by anisotropy and can increase durability. If textile structures are used instead of steel gussets this may lead to a considerable increase in the ultimate strength and the ductility of joints. The five fields of the project are designed that theoretical and experimental investigations are carried out to provide the fundamentals of the materials. Additionally information will be obtained about the mechanical description, the detailing and the dimensioning, the techniques of applying, the realisation on the site and the long-term behaviour. All leading to a safety concept and also a service life concept for the use of textile reinforcements for restoration and strengthening.

Γίνεται μια γενική ανφορά στο πρόβλημα της ενίσχυσης φέρουσας τοιχοποιίας με σύνθετα υλικά και παρουσιάζονται οι μέχρι τώρα τεχνικές και τρόποι εφαρμογής της μεθόδου. Στη συνέχεια αναπτύσεται λογισμικό το οποίο συνδιάζει την χρήση των πεπερασμένων στοιχείων και των προσομοιωμάτων θλιπτήρων-ελκυστήρων για την σύνθεση του τασικού πεδίου μεμονομένων δομικών στοιχείων Φ.Τ. Αντικειμενικός σκοπός είναι η σύνθεση ενός δικτυώματος από την επίλυση του οποίου να προκύπτει η τοπολογία των οπλισμών και η εκτίμηση του απαιτούμενου εμβαδού σύνθετου υλικού. Παρουσιάζονται τα πειραματικά αποτελέσματα που έχουν προκύψει απο δοκίμια περισφιγμένα διαφόρους τύπους σύνθετου υλικού, για διαφορετικά γεωμετρικέ χαρακτηριστικά και ποσότητες οπλισμού, καθώς και υλικό εμποτισμού. Βαθμονομείται ένα αναλτυικό προσομοίωμα για την περισφιγμένη τοιχοποιία με σύνθετα υλικά. Καταστρώνονται οι εξισώσεις σχεδιασμού Φ.Τ. ενισχυμένης με σύνθετα υλικά για τις κλασσικές περιπτώσεις καταπόνησης και συντίθεται λογισμικό που χρησιμοποιεί τις εξισώσεις αυτές. / Strengthening of masonry structures with FRPs. A general overview of the method and presentation of all the related topics that are known until today. Evaluation of a software that combines the finite element method with the strut-and -tie models in the composition of the stress field of a given load bearing masonry element. The purpose of the method is to compose a truss, from the given stress field, in order to identify the topology of the reinforcment (FRP strips), as well as the amount of the strips needed to be placed in the positions of the struts. Experimental investigation of the confined masonry with FRPs. Presentation of the experimental data using specimens with various b/h ratios confined with different type of fibers, layers of reinforcement, smoothening radious of the corners and with different type of impregnation materials. Synthesis of the equations governing the most important cases of strengthening masonry structures with FRPs and composition of a software for the design of such cases.

The activity of Vilnius non-governmental organisations (NGO’s) working with children at risk while strengthening social cohesion is analysed in the research work. The problems of children at risk are multiplying and public institutions need help of NGO’s. General characteristics of NGO’s are reviewed and systematised in the theoretical part of the work. The legal regulation and topics of activity in strengthening social cohesion are presented in this part as well. Besides the analysis of social exclusion and its factors, the situation of children at risk in Lithuania is described and the politics of Lithuanian government in regard to children at risk is discussed.

Although the White Paper on Families (2013) stipulates that family resilience should be strengthened in family preservation services, no guidelines exist for social workers in the South African context to do so. A need for practice guidelines for social workers in rendering services to families to strengthen family resilience was identified. The following central research question was formulated: How and by doing what, can social workers foster and sustain family resilience? The Intervention Design and Development (IDD) model of Rothman and Thomas (1994) was adapted for the study which included qualitative research to explore and describe the understanding, experiences and suggestions of social workers on family resilience for informing the family resilience intervention guidelines. Data was collected through focus- group and face-to-face semi-structured interviews with social workers employed by the Department of Social Development, and the NGOs from Gauteng, North West and Limpopo province. Tesch’s steps (cited in Creswell 2009:186) were used to analyse the data systematically and data was verified by Guba’s model (cited in Krefting 1991:214–222). Implementing steps 1–5 of phase 1, steps 1–3 of phase 2, step 2 of phase 3 and steps 1–3 of phase 4 of the IDD model, “Practice Guidelines for Social Workers to foster and sustain Family Resilience” (“The Guidelines”) were developed by translating the family resilience theory into practice to guide social workers to be able to develop and implement a family resilience intervention. The content of “The Guidelines” include an introduction containing the social work service delivery principles, the theoretical approaches of service delivery to families and the legislative and policy framework for services to families that would underpin a family resilience intervention. Section 1 of “The Guidelines” was developed and structured around the understanding of the family resilience construct and the family resilience process model on how family resilience operates. Section 2 of “The Guidelines” is presented in a question and answer format. This section provides practical guidelines on how to identify the target group for family resilience interventions, the reciprocal relationship between individual resilience and family resilience, family resilience interventions following the social work intervention process (i.e. intake, developmental assessment, a family developmental plan, and intervention strategies in accordance with the basket of services for families and monitoring and evaluation), how to integrate the domains of family resilience into the family resilience intervention, the need for education of both the social worker and client family on family resilience, the multi-dimensional aspects of the family requiring a multi-disciplinary approach and the role that the safety of family members play when rendering a family resilience intervention. / Social Work / D. Phil. (Social Work)

Cette étude vise à analyser la coque qui est en contact avec un matériau qui la confine, et qu’elle subite une pression latérale externe. Les conditions de contact entre les deux corps, frottant ou pas, la rigidité du confinement ainsi que les conditions de chargement, la pression qui peut être directement appliquée à la coque comme elle peut être induite par le matériau de confinement qui par retrait ou retreint ou convergence radiale induit des contraintes, ceux sont là les paramètres qui nous paraissent essentiels à jauger pour la problématique du flambage avec contact d’une coque sous pression externe. Une campagne expérimentale où plusieurs configurations de confinement sont considérées. La nature du milieu extérieur associé au confinement et donc sa rigidité, le type de confinement, discret ou locale au bien total (surface entière de la coque), sont évalués. Une instrumentation adéquate, couplant des mesures ponctuelles et de champ nous a permis de correctement mettre en exergue la phénoménologie. Les simulations numériques par éléments finis à l’aide du code de calcul Abaqus/Standard 6.12-3 intègrent les différentes non linéarité mise en musique dans ce problème, les grands déplacements et rotations du fait du flambage, la non linéarité matériau. Ces travaux montrent que même pour un confinement externe avec une très faible rigidité de membrane, comme pour le sable ou le polystyrène expansé, un gain important de capacité portante est observé, le flambage est retardé. L’augmentation est substantielle dans le cas d’un confinement total, non négligeable et consistante dans le cas d’un confinement local. Nous avons aussi constaté que la charge de flambage et le mode associé dépendent de la configuration de contact, notamment de la rigidité à la flexion du confinement. / Motivated by practical engineering applications, thin-walled cylindrical shells are widely used as structural elements. Because of their low flexural strength, these structures are very sensitive to buckling when exposed to external pressur. Conventional stiffening which makes it possible to improve the bearing capacity is to add stiffening rings connected by axial stiffeners or axial stiffeners. In these configurations the stiffening elements are an integral part of the structure with a continuity of material. One can ask the question of the effect of contiguous but non-continuous adjacent external structures ensuring total or local surface external contact. These are real configurations, such as those of buried pipelines, pipelines, or the case of insulated structures. This study aims to analyze these cases where the shell is in contact with a material which confines it, and that it undergoes an external lateral pressure. The contact conditions between the two bodies, whether rubbing or not, the stiffness of the confinement as well as the loading conditions, the pressure which can be directly applied to the shell as it may be induced by the confinement material which by withdrawal or shrinkage or Radial convergence induces stresses, these are the parameters that we consider essential for gauging the problem of buckling with contact of an external pressure shell. To answer these questions, we conducted an experimental campaign where several configurations of confinement are considered. The nature of the external environment associated with the confinement and therefore its rigidity, the type of confinement, discrete local or the total property (entire surface of the shell), are evaluated. Appropriate instrumentation, coupling point and field measurements, has allowed us to correctly highlight the phenomenology. Numerical modeling is also carried out using finite element method by Abaqus/Standard 6.12-3 code. Numerical simulations integrate the different nonlinearities in this problem, large displacements and rotations due to buckling, nonlinearity material, in some cases the buckling is plastic, but also the nonlinearity induced by an evolutionary contact. The modeling is carried out in 2D and 3D mesh, and in the latter case either by means of shell elements or by massive elements, the first aim being to corroborate the experimental observations more or less precisely. This work shows that even for external confinement with very low membrane rigidity, as for sand or expanded polystyrene, a significant gain in bearing capacity is observed, the buckling is delayed. The increase is substantial in the case of a total confinement which is not negligible and consistent in the case of local confinement. We have also found that the buckling load and the associated mode depend on the contact configuration, in particular the flexural rigidity of the confinement.

Made available in DSpace on 2011-05-04T12:42:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2010 / A coordenação dos cuidados é um tema pendente tanto para os países europeus, quanto para países latinoamericanos. Mudanças no perfil epidemiológico, sobretudo, predomínio das doenças crônicas e a reconhecida fragmentação dos sistemas de saúde e a descontinuidade na prestação do cuidado tornaram premente a busca de soluções. A coordenação dos cuidados pode ser definida como a articulação entre os diversos serviços e ações relacionados à atenção em saúde de forma que, independentemente do local onde sejam prestados, estejam sincronizados e voltados ao alcance de um objetivo comum. O presente estudo teve por objetivo descrever e analisar o desenvolvimento de estratégias e instrumentos de coordenação dos cuidados em municípios brasileiros com experiências exitosas de expansão e consolidação da Estratégia Saúde da Família (ESF) com base em dois eixos: fortalecimento da Atenção Primária à Saúde (APS) e integração entre níveis assistenciais . Partiu-se de duas premissas. Somente uma APS fortalecida em seus atributos essenciais poderia assumir a coordenação doscuidados. Logo, nos interessou saber quais as iniciativas empreendidas pelos municípios brasileiros para fortalecer a ESF. Segundo, sendo a integração da rede um elemento necessário para alcançar melhor coordenação dos cuidados, quais as estratégias e instrumentos desenvolvidos por grandes centros urbanos para integrar a ESF aos demais níveis do sistema? Os municípios analisados foram Aracaju, Belo Horizonte, Florianópolis e Vitória. A consolidação de uma APS forte foi avaliada pela posição ocupada pela ESF no sistema de saúde, capacidade de resolução, reconhecimento profissional e social de seus trabalhadores, descentralização das ações de saúde coletiva para a APS e conseqüentes reflexos no acesso e utilização dos serviços. As estratégias de integração entre níveis assistenciais foram descritas e analisadas com base na identificação das estruturas de regulação da rede de serviços de saúde, instrumentos de integração e de continuidade informacional e organização de fluxos. Neste estudo não tivemos como objetivo medir ou avaliar a coordenação dos cuidados em si, mas descrever e analisar elementos que contribuam para sua consecução. Os resultados apresentados são produtos de três fontes principais, trianguladas para responder às perguntas de investigação: entrevistas com gestores e estudos transversais com aplicação de questionários a amostra de famílias cadastradas e profissionais das equipes de Saúde da Família. Os resultados apontam que em todos os municípios foram identificadas ações para fortalecer as estruturas de APS no contexto do Sistema Único de Saúde, em etapas distintas de implementação. As iniciativas mais exitosas foram aquelas que buscaram ampliar a acessibilidade, consolidar a função de porta de entrada, aumentar sua capacidade resolutiva e articular medidas de saúde pública, vigilância e assistência. Ainda assim, permanecem desafios para melhor equalizar atendimento à demanda espontânea e à programada de formamais resolutiva e para tornar a Unidade de Saúde da Família o serviço de uso regular. A baixa credibilidade e o insuficiente reconhecimento dos profissionais de atenção primária representam obstáculo à coordenação dos cuidados por esse nível de atenção. Em relação à integração da rede, estratégias semelhantes, com resultados diferenciados, foram encontradasnos quatro casos como investimentos em sistemas informatizados e descentralizados de regulação, monitoramento das filas de espera, aumento da oferta de serviços próprios municipais, implantação de protocolos clínicos e prontuários eletrônicos. Ainda assim, a ausência de regulação e de fluxos formais para a atenção hospitalar torna incompleto o processo de integração da rede. A insuficiência na oferta de atenção especializada, agravada pela pouca integração entre prestadores estaduais e municipais foi outra dificuldade identificada. A quase ausência de contra-referência também minimiza as possibilidades de coordenação dos cuidados pela equipe de APS. O retrato oferecido pela pesquisa mostra que Belo Horizonte e Vitória apresentaram sistematicamente melhores resultados na avaliação de profissionais e usuários em relação aos dois eixos de análise. Pode-se afirmar que a APS se fortaleceu e está mais integrada à rede nos casos estudados, embora ainda não seja acoordenadora de todo o ciclo de cuidados. A necessidade de estabelecer objetivos comuns, de forma que o cuidado em saúde tenha o usuário como centro e seja organizado de acordo com suas expectativas pessoais e necessidades em saúde, componentes do atributo da coordenação, aponta alguns caminhos para a construção de um Sistema Único de Saúde mais equânime, de melhor qualidade e voltado às necessidades de saúde da população. / Coordination of care is an issue pending in both European and Latin American countries. Changes in epidemiological profile, particularly the predominance of chronic diseases, plus the acknowledged fragmentation in health systems and discontinuity in care, recommend urgent solutions. Coordination of care can be defined as an interrelationship among healthcare-related services and actions such that, regardless of where they occur, they are synchronised and directed to achieving a common purpose. The intention of this study was to describe and analyse the development of strategies and instruments for coordinating care in Brazilian municipalities with successful experience in expanding and consolidating the Family Health Strategy (Estratégia Saúde da Família, ESF) through two key axis: “strengthening Primary Health Care” (PHC) and “integrating among levels of care”. The study rests on two assumptions. Firstly, only PHC that is strong in its essential attributes will be capable of coordinating care. It was therefore of interest to learn what measures Brazilian municipalities had taken to strengthen the ESF. Secondly, given that system integration is a necessary element for achieving improved coordination of care, what strategies and instruments have been developed for integrating the ESF with the other system levels in major urban centres? The municipalities studied were Aracaju, Belo Horizonte, Florianópolis and Vitória. Whether or not strong” PHC had been established was evaluated in terms of the position the ESF occupied in the health system, its resolution capacity, professional’s and social’s recognition of health workers, the decentralisation of collective health measures to PHC and the consequences as reflected in service access and use. Strategies for integration among levels of care were described and analysed by identifying structures for regulating the health service system, instruments for information integration and continuity, and flow organisation. This study was not intended to measure or evaluate coordination of care as such, but to describe and analyse elements that contribute to that end. The results presented draw on three main sources – interviews of managers and transverse studies using questionnaires applied to samples of families enrolled and Family Health team workers – which were triangulated to answer the research questions. The results show that measures to strengthen PHC structures were identified, at different stages of implementation, in the context of the Unified Health System (Sistema Único de Saúde, SUS) in all the municipalities. The most successful initiatives were those seeking to expand accessibility, consolidate the gateway function, increase resolution capacity and coordinate among public health, surveillance and care measures. Nonetheless, challenges remain for care to meet spontaneous demand better and to be planned to achieve higher rates of resolution and make the Family Health Unit the service of first resort. Primary health care workers' low credibility and lack of professional recognition represent obstacles to coordination of care through this service level. As regards system integration, similar strategies with differing outcomes were encountered in the four cases, such as investment in computerised, decentralised regulation systems, waiting list monitoring, increased supply of the municipalities' own services, and introduction of clinical protocols and electronic patient records. All the same, the lack of regulation and of formal flows for hospital care renders the process of network integration incomplete. Another difficulty identified was insufficient supply of specialised care, aggravated by the low degree of integration among state and municipal providers. The near absence of counter-referral also lessens the likelihood of care being coordinated by the PHC team. The picture offered by the study shows that Belo Horizonte and Vitória score systematically better in health workers' and users' evaluations as regards the two dimensions of analysis. PHC has been strengthened and is better integrated into the health system in the cases studied, although it is not yet coordinating the overall care cycle. The need to set common goals, so that health care centres on users and is organised to meet their personal expectations and health needs, which are components of the coordination function, signals some paths to building a Unified Health System that is more equitable, higher quality and directed to the health needs of the population.

Objectives: We sought to examine the gender differences between C - reactive protein (CRP) and muscle strengthening activity (MSA) in U.S. adults (≥20 years of age) Background: Elevated levels of CRP have been shown to be associated with an increase in risk of cardiovascular disease (CVD). Studies analyzing the relationship between physical activity (PA) and CRP by gender have produced mixed results. Methods: The sample (n=9,135) included participants in the 1999-2004 National Health and Nutrition Examination Survey (NHANES). Three categories of reported MSA participation were created: no MSA (referent group), some MSA (≥1 to/wk), and meeting the 2008 Department of Health and Human Services (DHHS) recommendation (>2 d/wk). The dependent variable was elevated CRP (>3 to 10 mg/L). Results: Gender stratified analysis revealed significantly lower odds of having elevated CRP for women reporting some MSA (OR 0.61; 95% CI 0.45-0.83, P=0.0023), or volumes of MSA meeting the DHHS recommendation (OR 0.66; 95% CI 0.54-0.82, P=0.0004). Significantly lower odds of men having elevated CRP was observed in those reporting MSA volumes meeting the recommendation (OR 0.73; 95% CI 0.61-0.88, P=0.0011). Following adjustment for waist circumference (WC) these odds remained significant in men but not women. Conclusions: Women reporting any MSA were found to have lower odds of having elevated CRP when compared to those reporting no MSA prior to adjustment for WC. Significantly lower odds in men were only observed in those meeting the recommendation. These results suggest that WC may mediate the associations between MSA and CRP and this relationship may be stronger in women.