Modelling and Forecasting Mortality Patterns

Thesis submitted in partial fulfillment of the requirements for the Degree of Doctor of Statistics and Information Management

Satisfação profissional dos dietistas nos hospitais do Serviço Nacional de Saúde : um primeiro estudo empírico

RESUMO - A satisfação no trabalho é entendida como um conjunto de sentimentos ou respostas afetivas relacionados com aspetos particulares do trabalho. Os autores não são unânimes na sua definição concetual. Neste estudo pretende-se compreender a satisfação profissional dos dietistas a exercer nos hospitais públicos em Portugal continental. A satisfação profissional foi avaliada através de um questionário (adaptado de Graça,1999) dividido em três partes. Foi aplicada uma escala de intervalos, na Discrepância entre as Expetativas (E) e Resultados (R), constituída por 8 dimensões e 44 itens. Mediu-se igualmente a importância motivacional que os dietistas atribuíram a cada uma das 8 dimensões, e foi feita a sua caraterização sociodemográfica da população estudada. De uma população inicial constituída por 42 elementos, contactada por email para responder ao questionário “on line”, tivemos 34 respondentes. Quatro respostas, por incompletas, não foram consideradas no tratamento. No final, temos uma amostra de conveniência constituída por 30 dietistas, todos eles a trabalhar atualmente em hospitais do SNS. A taxa de resposta válida é, pois, de 71,4%. Trata-se de um estudo descritivo, observacional e tipo transversal. A análise de dados baseou-se na estatística descritiva e analítica. O score médio global (2,59), indicador da discrepância E-R, permite classificar a amostra como estando “bastante satisfeita” em relação ao seu trabalho e à sua profissão. Em relação à ordenação das dimensões segundo a importância motivacional, a Realização pessoal e profissional & desempenho organizacional (1º) (2,57), é aquela que os inquiridos consideraram a mais importante, seguida da Relação profissional/utente (2º) (3,78) e finalmente a Autonomia & poder (3º) (3,96). Os melhores scores médios de cada dimensão são a Relação profissional/utente (1º) (1,36), seguida do Status e prestigio (2º) (1,51) e por último as Relações de trabalho e suporte social (3º) (2,39). Em conclusão, em relação à ordenação das dimensões segundo a importância motivacional, a Realização pessoal e profissional e desempenho organizacional foi considerada pelos dietistas a mais importante e a dimensão menos importante foi a do Status e prestígio. A Relação profissional/utente foi a dimensão com melhor score médio, ou seja, é a dimensão onde os dietistas se encontram mais satisfeitos, e a remuneração foi a dimensão onde a população se encontra menos satisfeita. A satisfação profissional dos dietistas que trabalham em hospitais públicos pode contribuir para melhorar a prestação de cuidados de saúde à população. Recomendamos por isso, mais investigação que aborde aquela temática, tornando mais visível a importância do dietista no contexto da saúde em Portugal.

Continuidade de cuidados numa Unidade de Saúde Familiar : o efeito nos custos

RESUMO - Caracterização do problema: O sistema de saúde português atingiu um patamar de ineficiência tal que urge ser reestruturado de forma a torná-lo sustentável. De forma a atingir este nível de sustentabilidade, uma série de soluções podem ser consideradas das quais destacamos a integração de cuidados. Este conceito exige que os diferentes níveis de saúde sigam um único caminho, trabalhando de forma coordenada e contínua. A integração de cuidados pode ser implementada através de várias tipologias entre as quais se destaca a integração clínica que por sua vez é composta pela continuidade de cuidados. Assim, ao medir a continuidade de cuidados, quantifica-se de certa forma a integração de cuidados. Objetivos: Avaliar o impacto da continuidade de cuidados nos custos. Metodologia: Os dados foram analisados através de estatísticas descritivas para verificar o seu grau de normalidade. Posteriormente foram aplicados testes t-student para analisar a existência de diferenças estatisticamente significativas entre as médias das diferentes variáveis. Foi então estudado o grau de associação entre variáveis através da correlação de spearman. Por fim, foi utilizado o modelo de regressão log-linear para verificar a existência de uma relação entre as várias naturezas de custos e os índices de continuidade. Com base neste modelo foram simulados dois cenários para estimar o impacto da maximização da continuidade de cuidados nas várias naturezas de custos. Conclusões: No geral, verifica-se uma relação muito ligeira entre a continuidade de cuidados e os custos. Mais especificamente, uma relação mais duradoura entre o médico e o doente resulta numa poupança de custos, independentemente da tipologia. Analisando a densidade da relação, observa-se uma relação positiva entre a mesma e os custos totais e o custo com Meios Complementares de Diagnóstico e Terapêutica (MCDT). Contudo verifica-se uma relação médico-doente negativa entre a densidade e os custos com medicamentos e com pessoal. Ao analisar o impacto da continuidade de cuidados nos custos, conclui-se que apenas a duração da relação médico-doente tem um impacto negativo em todas as categorias de custos, exceto o custo com medicamentos. A densidade de cuidados tem um impacto negativo apenas no custo com pessoal, influenciando positivamente as outras categorias de custos. Extrapolando para o nível nacional se o nível de densidade de uma relação fosse maximizado, existiria uma poupança de 0,18 euros, por ano, em custos com pessoal.

Análise e melhoria do processo de order-picking num sistema produtivo: caso de estudo

Dissertação para obtenção do Grau de Mestre em Engenharia e Gestão Industrial

Coherent structures in open channel flows with bed load transport over an hydraulically rough bed

Dissertação para obtenção do Grau de Mestre em Engenharia Civil – Perfil de Estruturas

Determinants of mother-baby relationship evaluated during pregnancy

ABSTRACT Background Mental health promotion is supported by a strong body of knowledge and is a matter of public health with the potential of a large impact on society. Mental health promotion programs should be implemented as soon as possible in life, preferably starting during pregnancy. Programs should focus on malleable determinants, introducing strategies to reduce risk factors or their impact on mother and child, and also on strengthening protective factors to increase resilience. The ambition of early detecting risk situations requires the development and use of tools to assess risk, and the creation of a responsive network of services based in primary health care, especially maternal consultation during pregnancy and the first months of the born child. The number of risk factors and the way they interact and are buffered by protective factors are relevant for the final impact. Maternal-fetal attachment (MFA) is not yet a totally understood and well operationalized concept. Methodological problems limit the comparison of data as many studies used small size samples, had an exploratory character or used different selection criteria and different measures. There is still a lack of studies in high risk populations evaluating the consequences of a weak MFA. Instead, the available studies are not very conclusive, but suggest that social support, anxiety and depression, self-esteem and self-control and sense of coherence are correlated with MFA. MFA is also correlated with health practices during pregnancy, that influence pregnancy and baby outcomes. MFA seems a relevant concept for the future mother baby interaction, but more studies are needed to clarify the concept and its operationalization. Attachment is a strong scientific concept with multiple implications for future child development, personality and relationship with others. Secure attachment is considered an essential basis of good mental health, and promoting mother-baby interaction offers an excellent opportunity to intervention programmes targeted at enhancing mental health and well-being. Understanding the process of attachment and intervening to improve attachment requires a comprehension of more proximal factors, but also a broader approach that assesses the impact of more distal social conditions on attachment and how this social impact is mediated by family functioning and mother-baby interaction. Finally, it is essential to understand how this knowledge could be translated in effective mental health promoting interventions and measures that could reach large populations of pregnant mothers and families. Strengthening emotional availability (EA) seems to be a relevant approach to improve the mother-baby relationship. In this review we have offered evidence suggesting a range of determinants of mother-infant relationship, including age, marital relationship, social disadvantages, migration, parental psychiatric disorders and the situations of abuse or neglect. Based on this theoretical background we constructed a theoretical model that included proximal and distal factors, risk and protective factors, including variables related to the mother, the father, their social support and mother baby interaction from early pregnancy until six months after birth. We selected the Antenatal Psychosocial Health Assessment (ALPHA) for use as an instrument to detect psychosocial risk during pregnancy. Method Ninety two pregnant women were recruited from the Maternal Health Consultation in Primary Health Care (PHC) at Amadora. They had three moments of assessment: at T1 (until 12 weeks of pregnancy) they filed out a questionnaire that included socio-demographic data, ALPHA, Edinburgh post-natal Depression Scale (EDPS), General Health Questionnaire (GHQ) and Sense of Coherence (SOC); at T2 (after the 20th weeks of pregnancy) they answered EDPS, SOC and MFA Scale (MFAS), and finally at T3 (6 months after birth), they repeated EDPS and SOC, and their interaction with their babies was videotaped and later evaluated using EA Scales. A statistical analysis has been done using descriptive statistics, correlation analysis, univariate logistic regression and multiple linear regression. Results The study has increased our knowledge on this particular population living in a multicultural, suburb community. It allow us to identify specific groups with a higher level of psychosocial risk, such as single or divorced women, young couples, mothers with a low level of education and those who are depressed or have a low SOC. The hypothesis that psychosocial risk is directly correlated with MFAS and that MFA is directly correlated with EA was not confirmed, neither the correlation between prenatal psychosocial risk and mother-baby EA. The study identified depression as a relevant risk factor in pregnancy and its higher prevalence in single or divorced women, immigrants and in those who have a higher global psychosocial risk. Depressed women have a poor MFA, and a lower structuring capacity and a higher hostility to their babies. In average, depression seems to reduce among pregnant women in the second part of their pregnancy. The children of immigrant mothers show a lower level of responsiveness to their mothers what could be transmitted through depression, as immigrant mothers have a higher risk of depression in the beginning of pregnancy and six months after birth. Young mothers have a low MFA and are more intrusive. Women who have a higher level of education are more sensitive and their babies showed to be more responsive. Women who are or have been submitted to abuse were found to have a higher level of MFA but their babies are less responsive to them. The study highlights the relevance of SOC as a potential protective factor while it is strongly and negatively related with a wide range of risk factors and mental health outcomes especially depression before, during and after pregnancy. Conclusions ALPHA proved to be a valid, feasible and reliable instrument to Primary Health Care (PHC) that can be used as a total sum score. We could not prove the association between psychosocial risk factors and MFA, neither between MFA and EA, or between psychosocial risk and EA. Depression and SOC seems to have a clear and opposite relevance on this process. Pregnancy can be considered as a maturational process and an opportunity to change, where adaptation processes occur, buffering risk, decreasing depression and increasing SOC. Further research is necessary to better understand interactions between variables and also to clarify a better operationalization of MFA. We recommend the use of ALPHA, SOC and EDPS in early pregnancy as a way of identifying more vulnerable women that will require additional interventions and support in order to decrease risk. At political level we recommend the reinforcement of Immigrant integration and the increment of education in women. We recommend more focus in health care and public health in mental health condition and psychosocial risk of specific groups at high risk. In PHC special attention should be paid to pregnant women who are single or divorced, very young, low educated and to immigrant mothers. This study provides the basis for an intervention programme for this population, that aims to reduce broad spectrum risk factors and to promote Mental Health in women who become pregnant. Health and mental health policies should facilitate the implementation of the suggested measures.

A DSL for querying building data streams of energy, eeather and occupation data

The superfluous consumption of energy is faced by the modern society as a Socio-Economical and Environmental problem of the present days. This situation is worsening given that it is becoming clear that the tendency is to increase energy price every year. It is also noticeable that people, not necessarily proficient in technology, are not able to know where savings can be achieved, due to the absence of accessible awareness mechanisms. One of the home user concerns is to balance the need of reducing energy consumption, while producing the same activity with all the comfort and work efficiency. The common techniques to reduce the consumption are to use a less wasteful equipment, altering the equipment program to a more economical one or disconnecting appliances that are not necessary at the moment. However, there is no direct feedback from this performed actions, which leads to the situation where the user is not aware of the influence that these techniques have in the electrical bill. With the intension to give some control over the home consumption, Energy Management Systems (EMS) were developed. These systems allow the access to the consumption information and help understanding the energy waste. However, some studies have proven that these systems have a clear mismatch between the information that is presented and the one the user finds useful for his daily life, leading to demotivation of use. In order to create a solution more oriented towards the user’s demands, a specially tailored language (DSL) was implemented. This solution allows the user to acquire the information he considers useful, through the construction of questions about his energy consumption. The development of this language, following the Model Driven Development (MDD) approach, took into consideration the ideas of facility managers and home users in the phases of design and validation. These opinions were gathered through meetings with experts and a survey, which was conducted to the purpose of collecting statistics about what home users want to know.

Analysis of panoramio photo tags in order to extract land use information

In the recent past, hardly anyone could predict this course of GIS development. GIS is moving from desktop to cloud. Web 2.0 enabled people to input data into web. These data are becoming increasingly geolocated. Big amounts of data formed something that is called "Big Data". Scientists still don't know how to deal with it completely. Different Data Mining tools are used for trying to extract some useful information from this Big Data. In our study, we also deal with one part of these data - User Generated Geographic Content (UGGC). The Panoramio initiative allows people to upload photos and describe them with tags. These photos are geolocated, which means that they have exact location on the Earth's surface according to a certain spatial reference system. By using Data Mining tools, we are trying to answer if it is possible to extract land use information from Panoramio photo tags. Also, we tried to answer to what extent this information could be accurate. At the end, we compared different Data Mining methods in order to distinguish which one has the most suited performances for this kind of data, which is text. Our answers are quite encouraging. With more than 70% of accuracy, we proved that extracting land use information is possible to some extent. Also, we found Memory Based Reasoning (MBR) method the most suitable method for this kind of data in all cases.

How to optimize Lipton’s business model in order to stimulate tea consumption in Portugal and increase Lipton Leaf tea market share?: The importance of distribution and sales channels management in a B2B2C market

Field Lab Entrepreneurial Innovative Ventures

Statistics as a basis for discrimination in the insurance business

The European Court of Justice has held that as from 21 December 2012 insurers may no longer charge men and women differently on the basis of scientific evidence that is statistically linked to their sex, effectively prohibiting the use of sex as a factor in the calculation of premiums and benefits for the purposes of insurance and related financial services throughout the European Union. This ruling marks a sharp turn away from the traditional view that insurers should be allowed to apply just about any risk assessment criterion, so long as it is sustained by the findings of actuarial science. The naïveté behind the assumption that insurers’ recourse to statistical data and probabilistic analysis, given their scientific nature, would suffice to keep them out of harm’s way was exposed. In this article I look at the flaws of this assumption and question whether this judicial decision, whilst constituting a most welcome landmark in the pursuit of equality between men and women, has nonetheless gone too far by saying too little on the million dollar question of what separates admissible criteria of differentiation from inadmissible forms of discrimination.

Walking Through the Revolution: A Spatial Reading of Literary Echoes

This paper presents an embryo of a literary guide on the Carnation Revolution to be explored for educational historical excursions other than leisure and tourism. We propose a historical trail through the centre of Lisbon, city of the Carnation Revolution, called Walk through the Revolution. The trail aims to reinforce collective memory about the major events that occurred in the early moments leading to the coup. The trail is made up by nine places of rememberance, for which literary excerpts are suggested and which are supported by a digital research procedure. A set of seven fixed and observer-independent categories are used to analyse the literary contents of 23 literary works published up to 2013. These literary works refer to events that happened between the eve of April 25 and May 1, 1974. At the same time, literary descriptions are explored using a spatial approach in order to define the literary geography of the most iconic military actions and popular demonstrations that occurred in Lisbon and the surroundings. The literary geography and the cartography of the historical events are then compared. Data analysis and visualization benefit from the use of standardised and quantitative methods, including basic statistics and geographic information systems.

O emprego de uma força de segurança de natureza militar nas missões de paz

The conflicts currently taking place around the world demand that the international intervention fits the intensity and extent of the threat. This is particularly important in post-conflict scenarios, leading to a greater participation of the Security Forces in those scenarios, in order to foster lasting peace, enforce the order and improve law enforcement services in those regions. The transition from armed conflict to peacekeeping may entail high risk situations and greater instability periods, so-called “intermediate situations”. Accordingly, in the face of persisting high volatility, a robust response is still required post-conflict. Therefore, it is appropriate to deploy Security Forces with military nature and status, the gendarmeries, which have training and response capabilities similar to Armed Forces in peacekeeping operations. Their double facet as police and military forces enables them to perform police duties in high risk and unsafe environments. In light of these features, the Portuguese gendarmerie, Guarda Nacional Republicana (GNR), is able to carry out tasks in these scenarios, which it has been doing through individual operatives or larger units. This dissertation focuses on the use of Security Forces of military nature in peacekeeping missions, in particular the Portuguese GNR, relying mostly on the inductive approach and using literature research, document analysis, interviews and statistics. After a brief description of international peacekeeping missions, we describe the contribution of Security Forces of a military nature in such operations. Then we introduce and analyse the GNR, focusing on its deployment in different kinds of peacekeeping operations, from its first participation in 1995 until today. We also report some reactions to the performance of GNR. Finally, we discuss whether there is indeed a unique role for this type of forces in international peacekeeping missions.

Quadratic programming versus second order con programming in portfolio optimization

Despite the extensive literature in finding new models to replace the Markowitz model or trying to increase the accuracy of its input estimations, there is less studies about the impact on the results of using different optimization algorithms. This paper aims to add some research to this field by comparing the performance of two optimization algorithms in drawing the Markowitz Efficient Frontier and in real world investment strategies. Second order cone programming is a faster algorithm, appears to be more efficient, but is impossible to assert which algorithm is better. Quadratic Programming often shows superior performance in real investment strategies.

What should Fundação Calouste Gulbenkian do in order to attract the National Millennials?

Branding Lab