Estudo sobre o Grau de Integração de Organizações de Saúde – EGIOS II

RESUMO - O movimento de integração dos cuidados de saúde tem como objectivo a procura de modelos de prestação de cuidados mais compreensivos, integrados e continuados. A determinação do grau de integração de cuidados pode ser realizada a partir da percepção dos profissionais de saúde, sendo os inquéritos por questionários uma fonte comummente utilizada neste tipo de estudos. O presente estudo, designado por EGIOS II, tem como objetivos: a) determinar o grau de percepção de integração, dos profissionais das Unidades Locais de Saúde; b) comparar a percepção do grau de integração dos profissionais entre 2010 e 2015; c) comparar a percepção do grau de integração dos profissionais que trabalham nas Unidades Locais de Saúde e em instituições não organizadas em Unidades Locais de Saúde; e d) identificar as áreas de maior e menor percepção de integração. O instrumento de recolha de dados utilizado, foi um inquérito por questionário, que pretende avaliar a percepção do grau de integração dos profissionais de acordo com as dimensões clínica, informação, normativa, administrativa, financeira e sistémica, em 53 itens. O inquérito foi estruturalmente adaptado do Health System Integration Study, tendo apresentado validade e fiabilidade. O inquérito foi aplicado em 22 instituições, a nível nacional, Unidades Locais de Saúde e a Centros Hospitalares / Hospitais e Agrupamentos de Centros de Saúde. A caraterização EGIOS II dividiu-se em quatro fases: preparação e envio dos ofícios; identificação dos interlocutores; envio dos inquéritos; e avaliação dos resultados. O inquérito apresentou uma taxa de resposta de 27%, representando 2085 respostas ao inquérito. Pode afirmar-se que globalmente o estudo apresenta representatividade estatística, com um intervalo de confiança de 95%. Os resultados indicam que os profissionais das Unidades Locais de Saúde em 2015 reportam maiores níveis de percepção de integração, quando comparados os dados com o estudo de 2010. Acrescenta-se que os profissionais das Unidades Locais de Saúde têm um maior grau de percepção de integração, do que os profissionais dos Centros Hospitalares / Hospitais e Agrupamentos de Centros de Saúde, não organizados em ULS. As dimensões administrativa, financeira e clínica são as que apresentam um menor grau de percepção de integração e as dimensões normativa e informação uma maior percepção de integração. Os órgãos de administração e órgãos de gestão intermédia apresentam uma percepção de integração superior comparativamente aos médicos e enfermeiros dos serviços hospitalares e cuidados de saúde primários. Foram identificadas nove recomendações que poderão servir como base para um plano de ação subsequente do presente estudo ou para aplicação em futuros estudos. Este estudo pode auxiliar no diagnóstico de problemas e barreiras da integração de cuidados, em que serviços atuar e ainda, identificar quais as estratégias e processos a priorizar de forma a melhorar a integração de cuidados de saúde.

Design of bio-inspired ionic liquids for protein stabilisation

Ionic Liquids (ILs) consist in organic salts that are liquid at/or near room temperature. Since ILs are entirely composed of ions, the formation of ion pairs is expected to be one essential feature for describing solvation in ILs. In recent years, protein - ionic liquid (P-IL) interactions have been the subject of intensive studies mainly because of their capability to promote folding/unfolding of proteins. However, the ion pairs and their lifetimes in ILs in P-IL thematic is dismissed, since the action of ILs is therefore the result of a subtle equilibrium between anion-cation interaction, ion-solvent and ion-protein interaction. The work developed in this thesis innovates in this thematic, once the design of ILs for protein stabilisation was bio-inspired in the high concentration of organic charged metabolites found in cell milieu. Although this perception is overlooked, those combined concentrations have been estimated to be ~300 mM among the macromolecules at concentrations exceeding 300 g/L (macromolecular crowding) and transient ion-pair can naturally occur with a potential specific biological role. Hence the main objective of this work is to develop new bio-ILs with a detectable ion-pair and understand its effects on protein structure and stability, under crowding environment, using advanced NMR techniques and calorimetric techniques. The choline-glutamate ([Ch][Glu]) IL was synthesized and characterized. The ion-pair was detected in water solutions using mainly the selective NOE NMR technique. Through the same technique, it was possible to detect a similar ion-pair promotion under synthetic and natural crowding environments. Using NMR spectroscopy (protein diffusion, HSQC experiments, and hydrogen-deuterium exchange) and differential scanning calorimetry (DSC), the model protein GB1 (production and purification in isotopic enrichment media) it was studied in the presence of [Ch][Glu] under macromolecular crowding conditions (PEG, BSA, lysozyme). Under dilute condition, it is possible to assert that the [Ch][Glu] induces a preferential hydration by weak and non-specific interactions, which leads to a significant stabilisation. On the other hand, under crowding environment, the [Ch][Glu] ion pair is promoted, destabilising the protein by favourable weak hydrophobic interactions , which disrupt the hydration layer of the protein. However, this capability can mitigates the effect of protein crowders. Overall, this work explored the ion-pair existence and its consequences on proteins in conditions similar to cell milieu. In this way, the charged metabolites found in cell can be understood as key for protein stabilisation.

Young adult Brazilian beauty consumers perception of Lancôme and the effectiveness of social media relationhips with local celebrities on their purchase intention

The aim of this research is to evaluate if a premium beauty brand, in this case, Lancôme, can influence positively the purchase intention from Brazilian young adults, between 18 and 29 years old, consumers of beauty products, by initiating a relationship with a local celebrity or “it” girl on social media. This hypothesis has not been tested, and this research is a first attempt of evaluating it. Additionally, the consumer behavior, brand preferences and social media activeness of this age segment in Brazil are further studied as important insights for beauty brands to conquer these consumers. Results did not confirm the positive influence of local celebrities on this age segment’s purchase intention but several suggestions are made for future research to revisit this topic. Furthermore, there is a significant brand love for M.A.C., an international Lancôme competitor, amongst this target, as well as a probable price sensitivity facing premium beauty brands.

Perception of organizational politics and the effect of authenticity and affective commitment on deviance and task performance in contact centers

This study aimed to understand employees’ reactions to organizational politics in Contact Centers. Drawing from a sample of 187 supervisor-employee dyads, we studied the relationship between employees’ perceptions of organizational politics and supervisor-rated task performance and deviance, and mediation effects by authenticity at work and affective commitment. Results indicate that workers tend to react to workplace politics with deviant behavior and worse task performance. We found that the relationship between perceived politics and task performance was mediated by authenticity. The relationship between perceived politics and supervisor-rated deviance was mediated by affective commitment to the organization. Implications for management are discussed.