Fundamentos teóricos e objectivos estratégicos de uma unidade de ética em saúde pública : caso de estudo : o gabinete de ética e responsabilidade da Direcção-Geral da Saúde

RESUMO - Este trabalho de projecto visa responder à questão de saber como gerir uma unidade de ética num serviço público central de saúde pública, “de forma racional e informada”, definindo os seus objectivos estratégicos (Baranger, citando Drucker, 1990) utilizando como caso de estudo o Gabinete de Assuntos Jurídicos, Ética e Responsabilidade, adiante designado por Gabinete, da Direcção‐Geral da Saúde. Para o efeito, fez‐se, em primeiro lugar, uma abordagem teórica descritiva das bases filosóficas da ética realçando a sua aplicação prática na determinação das características dos sistemas de saúde. Em seguida, analisa‐se a utilização do conceito de ética no âmbito da Saúde Pública, no contexto da bioética, verificando‐se elementos distintivos que parecem justificar a autonomização do conceito de ‘Ética em Saúde Pública’. Para tal, foram consultadas as principais fontes de princípios éticos em saúde, tais como a Declaração Universal dos Direitos do Homem, a Declaração de Helsínquia, bem como a Constituição da República Portuguesa e os Códigos Deontológicos das profissões de saúde. Nesta fase do trabalho é pesquisada, nas perspectivas nacional e internacional, a existência de unidades de ética, congéneres ou de âmbito similar, bem como respectivas áreas e níveis de intervenção, tendo‐se nesse sentido auscultado as entidades idóneas dos Estados‐Membros da União Europeia. Na segunda parte do trabalho de projecto, desenvolveu‐se o planeamento estratégico através da aplicação da metodologia balanced scorecard, apresentando‐se uma proposta de objectivos estratégicos e iniciativas a serem desenvolvidas pelo gabinete de ética sub judice, para um horizonte temporal fixado em três anos. Da utilização desta metodologia resultaram doze objectivos estratégicos, dos quais se destacam: ‘fomentar a discussão ética’; ‘promover a igualdade dos utentes do SNS’; e ‘identificar prioridades de actuação’. Entre as iniciativas a desenvolver salienta‐se o desenho de um questionário, a aplicar às comissões de ética do sistema de saúde com o objectivo de identificar prioridades de actuação do Gabinete. O trabalho finaliza‐se com as conclusões, recomendações e linhas de investigação que se considera deverem ser desenvolvidas, num futuro próximo, para o aprofundamento da matéria alvo deste estudo. ------------------ABSTRACT - This research‐project aims to answer the question of how to manage a unit of ethics within the directorate‐general of public health in a "rational and informed” way, defining their strategic goals (Baranger, quoting Drucker, 1990) using as case study the Office of Legal Affairs, Ethics and Responsibility, hereinafter referred as the Office, of the Directorate‐General of Health. For this purpose, the first part of the study, includes a framework description of the main philosophical basis of ethics, emphasizing that its practical application determines the characteristics of health systems; the use of the concept of ethics of Public Health in the context of bioethics was analyzed, and distinctive elements were found that seem to justify the autonomy of the concept of 'Ethics of Public Health'. The main sources of this part were the fundamental ethical principles in health, such as the Universal Declaration of Human Rights, the Helsinki Declaration, and also the Constitution of the Portuguese Republic and the Codes of Ethics of the health professions. At this stage of the study a description is also made, at both a national and international perspective, on the existence of similar units of ethics or with similar scope, and their areas and levels of intervention. For the international dimension the appropriate bodies of the Member States the European Union were consulted. In the second part of the research‐project, a strategic planning for the Office was designed, using the balanced scorecard methodology, and a proposal of the strategic objectives and initiatives to be developed within a time schedule of three years are presented. The use of this method resulted in twelve strategic objectives, among which we note the following: 'to promote the ethical discussion'; 'to promote equality of users of the NHS'; and ‘to identify priorities for action’. The design of a questionnaire to be answered by the ethics committees for health of the Portuguese health system, in order to identify priorities for the Office’s activities is also presented in the study. The work ends with the conclusions and recommendations, as well as a suggestion of lines for future research to further investigate the subject of this study.

Water treatments in semi-closed cooling circuits and their impact on the quality of effluents discharged by CERN

Dissertação apresentada à Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia do Ambiente, Gestão de Sistemas Ambientais

Water treatments in semi-closed cooling circuits and their impact on the quality of effluents discharged by CERN

Mestrado integrado em Engenharia do Ambiente, perfil: Gestão de Sistemas Ambientais

Design of New Materials for Passive Vibration Control

The objective of this contribution is to extend the models of cellular/composite material design to nonlinear material behaviour and apply them for design of materials for passive vibration control. As a first step a computational tool allowing determination of optimised one-dimensional isolator behaviour was developed. This model can serve as a representation for idealised macroscopic behaviour. Optimal isolator behaviour to a given set of loads is obtained by generic probabilistic metaalgorithm, simulated annealing. Cost functional involves minimization of maximum response amplitude in a set of predefined time intervals and maximization of total energy absorbed in the first loop. Dependence of the global optimum on several combinations of leading parameters of the simulated annealing procedure, like neighbourhood definition and annealing schedule, is also studied and analyzed. Obtained results facilitate the design of elastomeric cellular materials with improved behaviour in terms of dynamic stiffness for passive vibration control.

Design of New Materials for Passive Vibration Control

The aim of this contribution is to extend the techniques of composite materials design to non-linear material behaviour and apply it for design of new materials for passive vibration control. As a first step a computational tool allowing determination of macroscopic optimized one-dimensional isolator behaviour was developed. Voigt, Maxwell, standard and more complex material models can be implemented. Objective function considers minimization of the initial reaction and/or displacement peak as well as minimization of the steady-state amplitude of reaction and/or displacement. The complex stiffness approach is used to formulate the governing equations in an efficient way. Material stiffness parameters are assumed as non-linear functions of the displacement. The numerical solution is performed in the complex space. The steady-state solution in the complex space is obtained by an iterative process based on the shooting method which imposes the conditions of periodicity with respect to the known value of the period. Extension of the shooting method to the complex space is presented and verified. Non-linear behaviour of material parameters is then optimized by generic probabilistic meta-algorithm, simulated annealing. Dependence of the global optimum on several combinations of leading parameters of the simulated annealing procedure, like neighbourhood definition and annealing schedule, is also studied and analyzed. Procedure is programmed in MATLAB environment.

Obama's law : analysis of a breakthrough law on healthcare access and lessons for the Portuguese health system management

ABSTRACT - The Patient Protection and Affordable Care Act shook the foundations of the US health system, offering all Americans access to health care by changing the way the health insurance industry works. As President Obama signed the Act on 23 March 2010, he said that it stood for “the core principle that everybody should have some basic security when it comes to their health care”. Unlike the U.S., the Article 64 of the Portuguese Constitution provides, since 1976, the right to universal access to health care. However, facing a severe economic crisis, Portugal has, under the supervision of the Troika, a tight schedule to implement measures to improve the efficiency of the National Health Service. Both countries are therefore despite their different situation, in a conjuncture of reform and the use of new health management measures. The present work, using a qualitative research methodology examines the Affordable Care Act in order to describe its principles and enforcement mechanisms. In order to describe the reality in Portugal, the Portuguese health system and the measures imposed by Troika are also analyzed. The intention of this entire analysis is not only to disclose the innovative U.S. law, but to find some innovative measures that could serve health management in Portugal. Essentially we identified the Exchanges and Wellness Programs, described throughout this work, leaving also the idea of the possibility of using them in the Portuguese national health system.

The influence of burden of care and perceived stigma on expressed emotions of relatives of stable persons with schizophrenia in Nigerian semi-urban/urban settings

RESUMO: Schizophrenia’s burden defines experience of family members and is associated with high level of distress. Courtesy stigma, a distress concept, worsens caregivers’ burden of care and impacts on schizophrenia. Expressed emotion (EE), another family variable, impacts on schizophrenia. However, relationship between EE, burden of care and stigma has been little explored in western literature but not in sub-Saharan Africa particularly Nigeria. This study explored the impact of burden of care and courtesy stigma on EE among caregivers of persons with schizophrenia in urban and semi-urban settings in Nigeria. Fifty caregivers each from semi-urban and urban areas completed a socio-demographic schedule, family questionnaire, burden interview schedule and perceived devaluation and discrimination scale. The caregivers had a mean age of 42 (± 15.6) years. Majority were females (57%), married (49%), from Yoruba ethnic group (68%), monogamous family (73%) and Christians (82%). A higher proportion of the whole sample (53%) had tertiary education. Three out of ten were sole caregivers. Seventy three (73%) lived with the person they cared for. The average number of hours spent per week by a caregiver with a person with schizophrenia was 35 hours. The urban sample had significantly higher proportion of carers with high global expressed emotion (72.7%) than the semi-urban sample (27.3%). The odds of a caregiver in an urban setting exhibiting high expressed emotion are 4.202 times higher than the odds of caregiver in a semi-urban setting. Additionally, there was significance difference between the urban and semi-urban caregivers in discrimination dimension. High levels of subjective and objective burden were associated with high levels of critical comments. In conclusion, this study is the first demonstration of urban-semi-urban difference in expressed emotion in an African country and its findings provide further support to hypothesized relationship between components of EE and burden of care.

BIM-lean synergies in the management on MEP works in public facilities of intensive use – a case study

21st Annual Conference of the International Group for Lean Construction – IGLC 21 – Fortaleza, Brazil

A distributed platform for the volunteer execution of workflows on a local area network

Thesis submitted in fulfilment of the requirements for the Degree of Master of Science in Computer Science

Optimal choice between even- and uneven-aged forestry: the case of non-industrial private forest owners

An infinite-horizon discrete time model with multiple size-class structures using a transition matrix is built to assess optimal harvesting schedules in the context of Non-Industrial Private Forest (NIPF) owners. Three model specifications accounting for forest income, financial return on an asset and amenity valuations are considered. Numerical simulations suggest uneven-aged forest management where a rational forest owner adapts her or his forest policy by influencing the regeneration of trees or adjusting consumption dynamics depending on subjective time preference and market return rate dynamics on the financial asset. Moreover she or he does not value significantly non-market benefits captured by amenity valuations relatively to forest income.