Performance management in health centres: evidence from a field study

There has been a growing interest in research on performance measurement and management practices, which seems to reflect researchers’ response to calls for the need to increase the relevance of management accounting research. However, despite the development of the new public management literature, studies involving public sector organizations are relatively small compared to those involving business organizations and extremely limited when it comes to public primary health care organizations. Yet, the economic significance of public health care organizations in the economy of developed countries and the criticisms these organizations regularly face from the public suggests there is a need for research. This is particularly true in the case of research that may lead to improvement in performance measurement and management practices and ultimately to improvements in the way health care organizations use their limited resources in the provision of services to the communities. This study reports on a field study involving three public primary health care organisations. The evidence obtained from interviews and archival data suggests a performance management practices in these institutions lacked consistency and coherence, potentially leading to decreased performance. Hierarchical controls seemed to be very weak and accountability limited, leading to a lack of direction, low motivation and, in some circumstances to insufficient managerial abilities and skills. Also, the performance management systems revealed a number of weaknesses, which suggests that there are various opportunities for improvement in performance in the studied organisations.

From antimicrobial agents to health promotion

A emergência de multiresistência apresentada por microrganismos é um dos grandes desafios que enfrentam actualmente os profissionais de Saúde e a população em geral. Os factores que contribuem para o desenvolvimento de resistência a antibióticos na comunidade podem ser categorizados como comportamentais ou ambientais/políticas. O objectivo deste trabalho foi caracterizar a situação actual na visão dos Pais de alunos do pré-escolar e 1º ciclo. De modo a avaliar as necessidades de intervenção e as actividades a serem desenvolvidas, um instrumento para estudar os hábitos e comportamentos adoptados na utilização de antibióticos, foi adaptado, validado e aplicado numa amostra piloto.

Clinical Education - a fundamental curricular unit for all health practitioners

Clinical education is recognized as being crucial for the training of health professionals. This subject is debated amongst teachers, students and professionals. Besides the clinical and research skills, we look for other competencies such as oratory, creative thinking or leadership. We present the results of a study with 4th graders. It’s a exploratory study; the main purpose was to evaluate the outcomes of a unit of clinical education prepared according a new set of competencies and methodologies. The competencies were seen as valuable. Organization, leading or supporting a colleague, rethinking a program to serve client and family are equally important.

Peculiarities of the professional education and qualification appraisal of assistants of pharmacists in Lithuania

Following the alterations and additions to the pharmaceutical law of Lithuanian Republic the pharmaceutical activity in Lithuanian pharmacies is carried out by pharmacy specialists – pharmacists and pharmacy assistants (pharmacy technicians). The ability of pharmacy specialists to adapt, to improve and to develop their competencies is one of the success preconditions for Lithuanian health care pharmacy sector. Work aim: to investigate the changes among the specialists employed in pharmacies and pharmacy sector as well as to highlight the necessity to develop the qualification of pharmacy assistants (pharmacy technicians) according to the modern pharmaceutical legal basis in Lithuania. In 2008–2011 the research in Lithuanian pharmacy sector was performed which identified the changes in the numbers of pharmacies and their staff: the number of pharmacies decreased, while the number of pharmacists increased and the number of the assistants of pharmacists (pharmacy technicians) decreased. The decrease in the number of the assistants of pharmacists (pharmacy technicians) and the danger of their extinction in the future has been identified. The qualification appraisal for pharmacy assistants (pharmacy technicians) is implemented through the leveling studies at the Pharmacy technique department at the Health care faculty of Kauno Kolegija University of applied sciences and pharmacy study programme at the faculty of Pharmacy of Medical Academy at Lithuanian University of Health Sciences. 75 % of respondents use their own money to pay for the qualification appraisal, and 25 % of respondents get financial support for the qualification appraisal activities from the pharmacy managers.

International mobility in the Pharmacy degree at the school of allied health sciences of Oporto

Background: The Erasmus program is a subprogram of the Lifelong Learning program, exclusive for Higher Education that promotes (among other initiatives), the mobility of students(studies, training or internships). The mobility of students of higher education seeks to improve the quality and development of future professionals, providing a multidisciplinary and multicultural experience. Setting: Academic Pharmacy/Pharmacy Technicians Methods: We conducted a descriptive and transversal study on the implementation of the mobility program and analyze the results, which involved applying a survey to students. Results: Since 2009/2010, the Pharmacy Degree at ESTSP has established 7 SMs protocols resulting in an average mobility of 5 students IN and 7 Students OUT. We have also endeavoured in SMp Protocols for extracurricular training with an average of 3 students OUT. The application process is normally open during the year before the mobility period. For most of the students involved, this was a first time opportunity to be in a foreign country and more than 70% choose the mobility program because it is seen as a possibility to improve their curriculum, for personal development or even to pursue employment opportunities abroad. The mobility for teachers is also encouraged. Conclusions: The exchange of experiences and training, acquired during cooperation activities should be an element of continuous dynamics and institutional affirmation. Initiatives such as the ERASMUS Program contribute to the educational and scientific enrichment, and promote international competitiveness among Higher Education Institutions.

Group decision making and Quality-of-information in e-Health systems

Knowledge is central to the modern economy and society. Indeed, the knowledge society has transformed the concept of knowledge and is more and more aware of the need to overcome the lack of knowledge when has to make options or address its problems and dilemmas. One’s knowledge is less based on exact facts and more on hypotheses, perceptions or indications. Even when we use new computational artefacts and novel methodologies for problem solving, like the use of Group Decision Support Systems (GDSSs), the question of incomplete information is in most of the situations marginalized. On the other hand, common sense tells us that when a decision is made it is impossible to have a perception of all the information involved and the nature of its intrinsic quality. Therefore, something has to be made in terms of the information available and the process of its evaluation. It is under this framework that a Multi-valued Extended Logic Programming language will be used for knowledge representation and reasoning, leading to a model that embodies the Quality-of-Information (QoI) and its quantification, along the several stages of the decision-making process. In this way, it is possible to provide a measure of the value of the QoI that supports the decision itself. This model will be here presented in the context of a GDSS for VirtualECare, a system aimed at sustaining online healthcare services.

Polycyclic aromatic hydrocarbon levels in three pelagic fish species from Atlantic Ocean: inter-specific and inter-season comparisons and assessment of potential public health risks

The concentrations of 18 polycyclic aromatic hydrocarbons (PAHs) were determined in three commercially valuable fish species (sardine, Sardina pilchardus; chub mackerel, Scomber japonicus; and horse mackerel, Trachurus trachurus) from the Atlantic Ocean. Specimens were collected seasonally during 2007–2009. Only low molecular weight PAHs were detected, namely, naphthalene, acenaphthene, fluorene and phenanthrene. Chub mackerel (1.80–19.90 microg/kg ww) revealed to be significantly more contaminated than horse mackerel (2.73–10.0 microg/kg ww) and sardine (2.29–14.18 microg/kg ww). Inter-specific and inter-season comparisons of PAHs bioaccumulation were statistically assessed. The more relevant statistical correlations were observed between PAH amounts and total fat content (significant positive relationships, p < 0.05), and season (sardine displayed higher amounts in autumn–winter while the mackerel species showed globally the inverse behavior). The health risks by consumption of these species were assessed and shown to present no threat to public health concerning PAH intakes.

Comparing the content of instruments assessing environmental factors using the International Classification of Functioning, Disability and Health

Purpose: To describe and compare the content of instruments that assess environmental factors using the International Classification of Functioning, Disability and Health (ICF). Methods: A systematic search of PubMed, CINAHL and PEDro databases was conducted using a pre-determined search strategy. The identified instruments were screened independently by two investigators, and meaningful concepts were linked to the most precise ICF category according to published linking rules. Results: Six instruments were included, containing 526 meaningful concepts. Instruments had between 20% and 98% of items linked to categories in Chapter 1. The highest percentage of items from one instrument linked to categories in Chapters 2–5 varied between 9% and 50%. The presence or absence of environmental factors in a specific context is assessed in 3 instruments, while the other 3 assess the intensity of the impact of environmental factors. Discussion: Instruments differ in their content, type of assessment, and have several items linked to the same ICF category. Most instruments primarily assess products and technology (Chapter 1), highlighting the need to deepen the discussion on the theory that supports the measurement of environmental factors. This discussion should be thorough and lead to the development of methodologies and new tools that capture the underlying concepts of the ICF.

Monitorização de pesticidas em águas de Esposende

De forma a proteger o ambiente e a saúde humana, é imperativo evitar, prevenir ou reduzir as concentrações prejudiciais de poluentes nocivos na água subterrânea. A necessidade da obtenção de níveis de protecção da água subterrânea, encontra-se estabelecida em normas de qualidade e devem ser desenvolvidas metodologias que permitam a avaliação do estado químico da água subterrânea. Este trabalho experimental centrou-se no desenvolvimento de uma metodologia analítica de detecção e quantificação por cromatografia gasosa com detector de captura de electrões dos pesticidas atrazina e respectivos metabolitos (desetilatrazina e deisopropilatrazina), simazina, terbutilazina e o metabolito desetiterbutilazina, folpete, dimetoato, diazinão, malatião, cloropirifos e o azinfos-metilo em águas de poços. O estudo progressivo baseou-se na colheita de água a 20 poços agrícolas na zona de Esposende, área considerada pelo Ministério da Agricultura do Desenvolvimento Rural e Pescas como sendo uma zona vulnerável. O método utilizado para a validação da técnica cromatográfica baseou-se na norma ISO 8466-1:1990. Os parâmetros de validação considerados foram: especificidade/selectividade, capacidade de identificação, limites de detecção e quantificação, relação sinal/ruído, linearidade e curva de calibração, precisão (repetibilidade, precisão intermédia e reprodutibilidade), eficiência de extracção e arrastamento. O método demonstrou ser capaz de identificar e quantificar os analitos, sem interferência de outros compostos. Obteve-se um valor para os parâmetros da precisão inferior a 10%, enquanto os mais baixos limites de detecção e de quantificação foram, respectivamente, 0,014 e 0,047 μg L-1. Na preparação de amostras optou-se pelo método de extracção em fase sólida, tendo sido testadas cinco diferentes tipos de colunas extractivas; Lichrolut® EN/RP-18; Strata SDB-L e C18-E; Chromabond HR-P e HR-X, sendo que as colunas Lichrolut® EN/RP- 18 apresentaram melhores resultados para a globalidade dos pesticidas. Da análise efectuada aos 20 poços agrícolas verificou-se que apenas 3 não apresentavam qualquer vestígio dos pesticidas monitorizados, sendo que as restantes apresentavam valores entre 0,05 e 53,2 μg L-1, valores superiores aos impostos pela legislação em vigor (Decreto-Lei n.º 208/2008 de 28 de Outubro para água subterrânea e Decreto-Lei nº306/2007 referente a água para consumo). Verificou-se que os proprietários dos poços agrícolas, dos quais se procedeu à amostragem de água para análise não têm a consciência da falta de qualidade dessa água, nem dos malefícios que possam advir do seu consumo.

Outdoor and indoor benzene evaluation by GC-FID and GC-MS/MS

The evaluation of benzene in different environments such as indoor (with and without tobacco smoke), a city area, countryside, gas stations and near exhaust pipes from cars running on different types of fuels was performed. The samples were analyzed using gas chromatography (GC) with flame ionization detection (FID) and tandem mass spectrometric detection (MS/MS) (to confirm the identification of benzene in the air samples). Operating conditions for the GC-MS analysis were optimized as well as the sampling and sample preparation. The results obtained in this work indicate that i) the type of fuel directly influences the benzene concentration in the air. Gasoline with additives provided the highest amount of benzene followed by unleaded gasoline and diesel; ii) the benzene concentration in the gas station was always higher than the advisable limit established by law (5 μg m−3) and during the unloading of gasoline the achieved concentration was 8371 μg m−3; iii) the data from the countryside (Taliscas) and the urban city (Matosinhos) were below 5 μg m−3 except 5 days after a fire on a petroleum refinery plant located near the city; iv) it was proven that in coffee shops where smoking is allowed the benzene concentration is higher (6 μg m−3) than in coffee shops where this is forbidden (4 μg m−3). This method may also be helpful for environmental analytical chemists who use GC-MS/MS for the confirmation or/and quantification of benzene.

Mercury, cadmium, lead and arsenic levels in three pelagic fish species from the Atlantic Ocean: intra- and inter-specific variability and human health risks for consumption

Three commonly consumed and commercially valuable fish species (sardine, chub and horse mackerel) were collected from the Northeast and Eastern Central Atlantic Ocean in Portuguese waters during one year. Mercury, cadmium, lead and arsenic amounts were determined in muscles using graphite furnace and cold vapour atomic absorption spectrometry. Maximum mean levels of mercury (0.1715 ± 0.0857 mg/kg, ww) and arsenic (1.139 ± 0.350 mg/kg, ww) were detected in horse mackerel. The higher mean amounts of cadmium (0.0084 ± 0.0036 mg/kg, ww) and lead (0.0379 ± 0.0303 mg/kg, ww) were determined in chub mackerel and in sardine, respectively. Intra- and inter-specific variability of metals bioaccumulation was statistically assessed and species and length revealed to be the major influencing biometric factors, in particular for mercury and arsenic. Muscles present metal concentrations below the tolerable limits considered by European Commission Regulation and Food and Agriculture Organization of the United Nations/World Health Organization (FAO/WHO). However, estimation of non-carcinogenic and carcinogenic health risks by the target hazard quotient and target carcinogenic risk, established by the US Environmental Protection Agency, suggests that these species must be eaten in moderation due to possible hazard and carcinogenic risks derived from arsenic (in all analyzed species) and mercury ingestion (in horse and chub mackerel species).

Polycyclic aromatic hydrocarbons in gas and particulate phases of indoor environments influenced by tobacco smoke: levels, phase distributions, and health risks

As polycyclic aromatic hydrocarbons (PAHs) have a negative impact on human health due to their mutagenic and/or carcinogenic properties, the objective of this work was to study the influence of tobacco smoke on levels and phase distribution of PAHs and to evaluate the associated health risks. The air samples were collected at two homes; 18 PAHs (the 16 PAHs considered by U.S. EPA as priority pollutants, dibenzo[a,l]pyrene and benzo[j]fluoranthene) were determined in gas phase and associated with thoracic (PM10) and respirable (PM2.5) particles. At home influenced by tobacco smoke the total concentrations of 18 PAHs in air ranged from 28.3 to 106 ngm 3 (mean of 66.7 25.4 ngm 3),∑PAHs being 95% higher than at the non-smoking one where the values ranged from 17.9 to 62.0 ngm 3 (mean of 34.5 16.5 ngm 3). On average 74% and 78% of ∑PAHs were present in gas phase at the smoking and non-smoking homes, respectively, demonstrating that adequate assessment of PAHs in air requires evaluation of PAHs in both gas and particulate phases. When influenced by tobacco smoke the health risks values were 3.5e3.6 times higher due to the exposure of PM10. The values of lifetime lung cancer risks were 4.1 10 3 and 1.7 10 3 for the smoking and nonsmoking homes, considerably exceeding the health-based guideline level at both homes also due to the contribution of outdoor traffic emissions. The results showed that evaluation of benzo[a]pyrene alone would probably underestimate the carcinogenic potential of the studied PAH mixtures; in total ten carcinogenic PAHs represented 36% and 32% of the gaseous ∑PAHs and in particulate phase they accounted for 75% and 71% of ∑PAHs at the smoking and non-smoking homes, respectively.

Air pollution from traffic emissions in Oporto, Portugal: health and environmental implications

Air pollution represents a serious risk not only to environment and human health, but also to historical heritage. In this study, air pollution of the Oporto Metropolitan Area and its main impacts were characterized. The results showed that levels of CO, PM10 and SO2 have been continuously decreasing in the respective metropolitan area while levels of NOx and NO2 have not changed significantly. Traffic emissions were the main source of the determined polycyclic aromatic hydrocarbons (PAHs; 16 PAHs considered by U.S. EPA as priority pollutants, dibenzo[a,l]pyrene and benzo[j]fluoranthene) in air of the respective metropolitan area. The mean concentration of 18 PAHs in air was 69.9±39.7 ng m−3 with 3–4 rings PAHs accounting for 75% of the total ΣPAHs. The health risk analysis of PAHs in air showed that the estimated values of lifetime lung cancer risks considerably exceeded the health-based guideline level. Analytical results also confirm that historical monuments in urban areas act as passive repositories for air pollutants present in the surrounding atmosphere. FTIR and EDX analyses showed that gypsum was the most important constituent of black crusts of the characterized historical monument Monastery of Serra do Pilar classified as “UNESCO World Cultural Heritage”. In black crusts, 4–6 rings compounds accounted approximately for 85% of ΣPAHs. The diagnostic ratios confirmed that traffic emissions were the major source of PAHs in black crusts; PAH composition profiles were very similar for crusts and PM10 and PM2.5.

The Portuguese law on social economy

This study is a reflection on the Portuguese Framework Law on Social Economy, highlighting, from a critical point-of-view, its contribution to the explicit institutional and legal recognition of the social economy sector. It does so by defining the concept of social economy and listing the entities engaged in this sector, by defining its guiding principles and the mechanisms for its promotion and encouragement, and also by describing the creation of a tax and competition regime which will take into account its specificities. The setting up of this foundations of the social economy was based on the constitutional principle of protection of the social and cooperative sector, which substantiates the adoption of differentiating solutions in view of the positive discrimination of this sector.

Enterprises' internationalisation strategy: skills in exportation and customs law

Economical development has always been connected to the commercial exchanges between people, due to the necessity to suppress their needs. With the increasing growth of international business and more competitive and demanding markets, exportation has become an important first step to internationalisation. Unlike what happened in the past, companies must be aware that the enrolment in the current global market is risky and requires elaborated technical procedures. Internationalisation should not be treated as an isolated event of business management. The first part of this paper aims to understand the export process and fit it in the current stage of international trade, keeping in mind the framework of export under the customs law. Then, we tried to understand how Portuguese companies should face this process in their internationalisation strategy, and what skills organisations must acquire to be able to export competitively in the current scenario of globalisation. The investigation was based on interviews in companies that, through a process of internationalisation by exportation, have implemented themselves strongly in extern markets. This investigation allowed us to analyse the companies’ motivations to become international, as well as the selection criteria for the export destinations. It was also possible to identify the main obstacles to the internationalisation of Portuguese companies. We concluded that companies that choose exportation as a way to become international acquire specific skills that enable them to become competitive in international trade. However, studies have failed to answer the second initial question about whether the measures implemented by Customs potentiate exports.