Modelos de sistemas de financiamento dos cuidados de saúde: o impacto nos custos

Ao longo das últimas décadas tem-se verificado um crescente aumento dos custos de saúde na generalidade dos países e, em particular, nos países desenvolvidos. Este facto tem suscitado o aumento de estudos sobre os determinantes dos custos de saúde, bem como uma crescente preocupação por parte dos decisores políticos. No cerne da discussão está a importância da organização e do modelo de financiamento dos sistemas de saúde, de forma a promover a eficiência e a assegurar o acesso equitativo aos cuidados de saúde. A presente dissertação procura analisar a evolução dos custos com a saúde dos 15 países mais antigos da União Europeia, da Suíça e dos Estados Unidos da América, entre o período de 2000 e 2013. Os objetivos principais deste trabalho são os de compreender os aspetos gerais dos modelos de financiamento de saúde presentes concentrando-nos na questão das fontes de financiamento para analisar o impacto que estas têm nos custos de saúde dos países, nomeadamente no montante de custos e na sua evolução recente. Os resultados deste estudo sugerem que o crescimento do PIB se encontra associado ao aumento dos gastos de saúde, culminando com as conclusões propostas por estudos anteriores. A evidência sobre o impacto do envelhecimento das populações não é conclusiva. A forma como os sistemas de saúde dos diferentes países são organizados e financiados, também influenciam a evolução dos custos de saúde.

Dynamic modelling and analysis of hydraulic forces in radial blood pumps

Dissertação de mestrado integrado em Biomedical Engineering Biomaterials, Biomechanics and Rehabilitation

Treating the entire person

[Excerpt] A critical case from a Portuguese hospital reveals how the ultimate healthcare customer, the patient, is a complete system, not a jumble of parts. (...) The lean production philosophy has made inroads into service sectors, including medical care in the United Kingdom and the United States. Unfortunately, numerous medical organizations in those two countries and the rest of the world treat patients like they are made up of parts, not as a whole system. This leads to disjointed handoffs, bottlenecks in information flow that delay treatment, and sending the patient back and forth from department to department. The following case in Portugal shows how most of the world’s health systems still suffer from functional silos and how waste is all over the place. In this case, the missing links in communication between doctors, nurses, auxiliary staff, the patient and her family led to the patient’s death. Adopting lean healthcare with its proven tools would be a solution to many of the problems described. When a patient dies in a hospital, the family often is told that the doctors did everything they could. Normally, that is the case, as healthcare providers – doctors, nurses, auxiliary staff, therapists – do their best with the system they have.

Information systems assessment in pathologic anatomy service

Information technologies changed the way of how the health organizations work, contributing to their effectiveness, efficiency and sustainability. Hospital Information Systems (HIS) are emerging on all of health institutions, helping health professionals and patients. However, HIS are not always implemented and used in the best way, leading to low levels of benefits and acceptance by users of these systems. In order to mitigate this problem, it is essential to take measures able to ensure if the HIS and their interfaces are designed in a simple and interactive way. With this in mind, a study to measure the user satisfaction and their opinion was made. It was applied the Technology Acceptance Model (TAM) on a HIS implemented on various hospital centers (AIDA), being used the Pathologic Anatomy Service. The study identified weakness and strengths features of AIDA and it pointed some solutions to improve the medical record.

Prognostics health management: perspectives in engineering systems reliability prognostics

The Prognostic Health Management (PHM) has been asserting itself as the most promising methodology to enhance the effective reliability and availability of a product or system during its life-cycle conditions by detecting current and approaching failures, thus, providing mitigation of the system risks with reduced logistics and support costs. However, PHM is at an early stage of development, it also expresses some concerns about possible shortcomings of its methods, tools, metrics and standardization. These factors have been severely restricting the applicability of PHM and its adoption by the industry. This paper presents a comprehensive literature review about the PHM main general weaknesses. Exploring the research opportunities present in some recent publications, are discussed and outlined the general guide-lines for finding the answer to these issues.

Sefficiency (sustainable efficiency) of water–energy–food entangled systems

Supplemental data for this article can be accessed at http://dx.doi.org/10.1080/07900627.2015.1070091. It includes an easy-to-use spreadsheet that calculates the efficiencies used in this paper, that is Sefficiency with energy considerations.

Application of acoustic emission technique for bond characterization in FRP-masonry systems

The acoustic emission (AE) technique is used for investigating the interfacial fracture and damage propagation in GFRP-and SRG-strengthened bricks during debonding tests. The bond behavior is investigated through single-lap shear bond tests and the fracture progress during the tests is recorded by means of AE sensors. The fracture progress and active debonding mechanisms are characterized in both specimen types with the aim of AE outputs. Moreover, a clear distinction between the AE outputs of specimens with different failure modes, in both SRG-and GFRP-strengthened specimens, is found which allows characterizing the debonding failure mode based on acoustic emission data.

Integrated management systems as complex adaptive systems

It is a difficult task to avoid the “smart systems” topic when discussing smart prevention and, similarly, it is a difficult task to address smart systems without focusing their ability to learn. Following the same line of thought, in the current reality, it seems a Herculean task (or an irreparable omission) to approach the topic of certified occupational health and safety management systems (OHSMS) without discussing the integrated management systems (IMSs). The available data suggest that seldom are the OHSMS operating as the single management system (MS) in a company so, any statement concerning OHSMS should mainly be interpreted from an integrated perspective. A major distinction between generic systems can be drawn between those that learn, i.e., those systems that have “memory” and those that have not. These former systems are often depicted as adaptive since they take into account past events to deal with novel, similar and future events modifying their structure to enable success in its environment. Often, these systems, present a nonlinear behavior and a huge uncertainty related to the forecasting of some events. This paper seeks to portray, for the first time as we were able to find out, the IMSs as complex adaptive systems (CASs) by listing their properties and dissecting the features that enable them to evolve and self-organize in order to, holistically, fulfil the requirements from different stakeholders and thus thrive by assuring the successful sustainability of a company. Based on the revision of literature carried out, this is the first time that IMSs are pointed out as CASs which may develop fruitful synergies both for the MSs and for CASs communities. By performing a thorough revision of literature and based on some concepts embedded in the “DNA” of the subsystems implementation standards it is intended, specifically, to identify, determine and discuss the properties of a generic IMS that should be considered to classify it as a CAS.

Improving quality of medical service with mobile health software

An increasing number of m-Health applications are being developed benefiting health service delivery. In this paper, a new methodology based on the principle of calm computing applied to diagnostic and therapeutic procedure reporting is proposed. A mobile application was designed for the physicians of one of the Portuguese major hospitals, which takes advantage of a multi-agent interoperability platform, the Agency for the Integration, Diffusion and Archive (AIDA). This application allows the visualization of inpatients and outpatients medical reports in a quicker and safer manner, in addition to offer a remote access to information. This project shows the advantages in the use of mobile software in a medical environment but the first step is always to build or use an interoperability platform, flexible, adaptable and pervasive. The platform offers a comprehensive set of services that restricts the development of mobile software almost exclusively to the mobile user interface design. The technology was tested and assessed in a real context by intensivists.

The importance of the category of consciousness and education for sustainability in methodologies for eco‐efficiency in school buildings

This document reports the importance of the category of consciousness and education for sustainability in the school environment. Education in school has a potential to make the benefits of the building construction visible for society and media, showing to the students, parents and communities how sustainability in built environment could improve the people life in economic, social and environment aspects. Thus, this paper addresses the main events related to sustainability, such as the Stockholm Conference, the Brundtland report, United Nations Conference on Environment and Development (UNCED) and Agenda 21, until reaching the necessity of the elaboration of Methodologies for environmental assessment of building, and later, the development of the specific methodologies according to the buildings. It is also described some examples of sustainability in schools in Germany, Finland and Italy and what kind of sustainable systems those countries are currently using.

Filamentous fungi in free water and biofilms from Brazilian drinking water systems

In some regions of Brazil, especially where the water is scarce, drinking water is stored in water storage tanks. This practice gives the consumer the guarantee of available water. The water storage conditions such as the exposure to hot weather when the tanks are on rooftops allow the development of microorganisms and microbial biofilms which can deteriorate the water quality and increase the risk to human health [1,2]. This study describes the filamentous fungi (FF) detected in free water and biofilms in drinking water storage tanks in Recife - Pernambuco, Brazil. Five sampling times in triplicate were performed at two distinct points. Colony-forming units (CFU) of FF fungi were determined with 0.45 µm filtration membranes using peptone glucose rose Bengal agar (PGRBA). From the 30 samples analysed a total of 1136 CFU were obtained. The water biofilms were collected from samplers consisting of polyethylene coupons, previously installed in the reservoirs. These coupons were transferred to PGRBA plates and incubated using with the same conditions described for free FF. For the in situ detection of FF in biofilms the Calcofluor White staining technique was used. This procedure demonstrated FF forming biofilms on the surfaces of the coupons. Brazilian legislation does not define limits for FF in drinking water. However considering the potential risk of fungal contamination, the data obtained in this study will contribute to developing future quantitative and qualitative parameters for the presence of fungi in drinking water distribution systems in Brazil. [1] HageskaL, G, Lima, N, Skaar, I. The study of fungi in drinking water. Mycological Research, 113, 2009, 165-172. [2] Skaar I, Hageskal G. Fungi in Drinking Water. In.: Paterson RRM, Lima N. (Eds.) Molecular Biology of Food and Water Borne Mycotoxigenic and Mycotic Fungi. CRC Press, Taylor & Francis Group, Boca Raton, 2015, 597-606.

Testing Nelder-Mead based repulsion algorithms for multiple roots of nonlinear systems via a two-level factorial design of experiments

This paper addresses the challenging task of computing multiple roots of a system of nonlinear equations. A repulsion algorithm that invokes the Nelder-Mead (N-M) local search method and uses a penalty-type merit function based on the error function, known as 'erf', is presented. In the N-M algorithm context, different strategies are proposed to enhance the quality of the solutions and improve the overall efficiency. The main goal of this paper is to use a two-level factorial design of experiments to analyze the statistical significance of the observed differences in selected performance criteria produced when testing different strategies in the N-M based repulsion algorithm. The main goal of this paper is to use a two-level factorial design of experiments to analyze the statistical significance of the observed differences in selected performance criteria produced when testing different strategies in the N-M based repulsion algorithm.

Attachment to parents: the mediating role of inhibition of exploration and individuality on health behaviors

This study’s goal was to analyze whether the quality of university students’ relationship with their parents mediated the association between mental health and physical symptoms and health behavior. Participants were 250 university students (66% female and 34% male), aged between 17 and 29 years old (M = 20.88, SD = 2.03) that answered the Father/Mother Attachment Questionnaire (FMAQ), the Physical Symptoms Scale from the Rotterdam Symptom Checklist (RSCL), the Health Behavior Questionnaire (HBQ), and the Hospital Anxiety and Depression Scale (HADS). The results showed that the indirect effect of physical symptoms on health behavior was significantly mediated by the father’s and mother’s inhibition of exploration and individuality (IEI). Also the indirect effect of psychological distress on health behavior was significantly mediated by the father’s and mother’s IEI. These results suggest that young adults who had more restrictions to their individuality show worse health behaviors. Separation Anxiety and Dependence (SAD) and Quality of Emotional Bond (QEB), the other 2 attachment scales, were not mediators of the relationship between physical symptoms/ psychological distress and health behavior. This study shows the importance of promoting positive parenting practices that contribute to healthier behavior choices and less risky behaviors, as well as the need for more studies that clearly identify these practices in young adult populations.

Cost-efficient one-part alkali-activated mortars with low global warming potential for floor heating systems applications

Increasing building energy efficiency is one the most cost-effective ways to reduce emissions. The use of thermal insulation materials mitigates heat loss in buildings, therefore minimising heat energy needs. In recent years, several papers were published on the subject of foam alkali-activated cements with enhanced thermal conductivity. However, on those papers cost analysis was strangely avoided. This paper presents experimental results on one-part alkali-activated cements. It also includes global warming potential assessment and cost analysis. Foam one-part alkali-activated cements cost simulations considering two carbon dioxide social costs scenarios are also included. The results show that one-part alkali-activated cements mixtures based on 26%OPC + 58.3%FA + 8%CS + 7.7%CH and 3.5% hydrogen peroxide constitute a promising cost-efficient (67 euro/m3), thermal insulation solution for floor heating systems. This mixture presents a low global warming potential of 443 KgCO2eq/m3. The results confirm that in both carbon dioxide social cost scenarios the mixture 26 OPC + 58.3 FA + 8 CS + 7.7 CH with 3.5% hydrogen peroxide foaming agent is still the most cost efficient.

Rational manipulation of mRNA folding free energy allows rheostat control of pneumolysin production by Streptococcus pneumoniae

Rational manipulation of mRNA folding free energy allows rheostat control of pneumolysin production by Streptococcus pneumoniae