Avaliação de operadoras de saúde por usuários pelo método Analytic Hierarchy Process

OBJETIVO: Analisar a qualidade dos serviços oferecidos por empresas operadoras de planos de saúde, segundo a percepção de usuários. MÉTODOS: Estudo transversal com 360 usuários de sete operadoras de planos de saúde da cidade de Curitiba, PR, e região metropolitana em 2008. Foi aplicado questionário sobre as preferências dos usuários em relação a seis atributos (localização dos pontos de atendimento; efetividade da ação dos médicos, clínicas e hospitais; rapidez e amabilidade no atendimento; facilidade na liberação de guias; preço; abrangência da rede credenciada) de cada uma das empresas operadoras. Para a análise das respostas foi utilizado o método Analytic Hierarchy Process (AHP, ou Processo Analítico de Hierarquia), ferramenta de análise de decisão e planejamento de múltiplos critérios. RESULTADOS: O atributo mais valorizado pelos usuários foi "preço". As empresas foram agrupadas em dois conjuntos de preferências em relação aos atributos: dos sete planos de saúde, dois apresentaram menor preferência (entre 23% e 19%) e cinco, maior preferência (em torno de 10%). CONCLUSÕES: Com esse tipo de pesquisa, as empresas operadoras de planos de saúde poderiam reformular suas estruturas, processos, preços e redes credenciadas com o objetivo de melhorar seu posicionamento no mercado.

Oviposition preference hierarchy in Ceratitis capitata (Diptera, Tephritidae): influence of female age and experience

The influence of two factors, age and previous experience, on the oviposition hierarchy preference of Ceratitis capitata (Wiedemann, 1824) females was studied. Two populations were analyzed: one reared in laboratory during 17 years and the other captured in nature. In the first experiment the oviposition preference for four fruits, papaya, orange, banana and apple was tested at the beginning of oviposition period and 20 days past. The results showed that the wild females as much the laboratory ones had an oviposition preference hierarchy at the beginning of peak period of oviposition. However this hierarchic preference disappeared in a later phase of life. In the second experiment the females were previously exposed to fruits of different hierarchic positions and afterwards their choice was tested in respect to the oviposition preference for those fruits. The results showed that there was an influence of the previous experience on the posterior choice of fruits to oviposition when the females were exposed to fruits of lower hierarchic position.

Vitellogenesis in Manduca sexta

Eggs of Manduca sexta contain four well-characterized protein derived from hemolymph: vitellogenin and lipophorin (very high density lipoproteins); microvitellogenin, a 26,000 dalton female-specific protein lacking lipid and carbohydrate, and insecticyanin, a blue biliprotein composed of four identical 22,000 dalton subunits. In addition, eggs contain a large store of triacyl glycerols. It has been shown that vitellogenin and lipophorin are actively taken up by follicles in vitro. The lipid components of these two proteins together account for only 10% of egg lipid. The follicle actively sequesters intact high density lipophorin, which, inside the oocyte, is stripped of much of its neutral lipid and two molecules of apolipophorin III. On the other hand, low density lipophorin donates diacylglycerol to the oocyte without its protein components being sequestered. Most of the egg lipid is transported from the fat body by a shuttle system involving low density lipophorin.

The cell biology of mosquito vitellogenesis

Insect vitellogenesis involves coordinated activities of the fat body and oocytes. We have studied these activities at the cellular level in the mosquito. During each vitellogenic cycle, the fat body undergoes three successive stages: 1) proliferation of biosynthetic organelles, 2) vitellogenin synthesis, 3) termination of vitellogenin synthesis and degradation of biosynthetic organelles by lysosomes. Analysis with monoclonal antibodies and radiolabelling demonstrated that the mosquito yolk protein consists of two subunits (200-kDa and 65-kDa). Both subunits are glycosylated, their carbohydrate moieties are composed of high-mannose oligosaccharides. The yolk protein subunits are derived from a single 220 kDa precursor detected by an in vitro translation. Oocytes become competent to internalize proteins as a result of juvenile hormone-mediated biogenesis of endocytotic organelles. The yolk protein is then accumulated by receptor-mediated endocytosis. A pathway of the yold protein and factors determining its routing in the oocyte have been studied.

Vitellogenesis in insects and other groups: a review

The eggs from oviparous organisms contain large amounts of vitellus, or yolk, wich are utilized by the growing embryo. Vitellogenesis is the process of vitellus accumulation and involves massive heterosynthetic synthesis of the protein vitellogenin (Vg) and its deposition in the oocyte. This work summarizes data on Vg structure, synthesis, uptake by oocytes and its fate during embryogenesis. The hormonal control of vitellogenesis and its tissue, sex and temporal regulation are also discussed. Where it is available, data on structure and expression of Vg-coding genes are reviewed. Insect vitellogenesis is priorized although other oviparous animal groups outside insects are also treated.

Culex quinquefasciatus vitellogenesis: morphological and biochemical aspects

The vitellogenic process in Culex quinquefasciatus, which is triggered by a blood meal, involves the synthesis, distribution and storage of the nutrients necessary for embryo development. The fat body of an adult female Cx. quinquefasciatus revealed two cell types: large trophocytes and small, eosinophilic, "oenocyte-like" cells, which show no morphological changes throughout the gonotrophic cycle. Trophocytes, which only begin to synthesise vitellogenin (Vg) 12 h post-blood meal (PBM), undergo a series of morphological changes following engorgement. These changes include the expansion of the rough endoplasmic reticulum (RER) and Golgi complex, which are later destroyed by autophagosomes. At 84 h PBM, trophocytes return to their pre-engorgement morphology. The ovarian follicles of non-blood-fed Cx. quinquefasciatus contain a cluster of eight undifferentiated cells surrounded by follicular epithelium. After engorgement, the oocyte membrane facing the perioocytic space increases its absorptive surface by microvilli development; large amounts of Vg and lipids are stored between 24 and 48 h PBM. Along with yolk storage in the oocyte, follicular cells exhibit the development of RER cisternae and electron-dense granules begin to fill the perioocytic space, possibly giving rise to endochorion. Later in the gonotrophic cycle, electron-dense vesicles, which are possible exochorion precursors, fuse at the apical membrane of follicular cells. This fusion is followed by follicular cell degeneration.

Understanding the hierarchy governance choice of some wineries in Brazil - case study of 3 Brazilian wineries

ABSTRACT This study aims to contribute towards understanding the multiple factors, which influence firm's governance decisions. To identify some of these factors, three cases in the Brazilian wine industry were analyzed: Miolo located in Vale dos Vinhedos (South of Brazil) and in Vale do Rio São Francisco (Northeast of Brazil); Don Laurindo located in Vale dos Vinhedos; and ViniBrasil located in Vale do Rio São Francisco. For the most part, all three firms procure the grapes they use for their wine production in-house. Only Miolo purchases an insignificant amount of grapes outside of its production. By Brazilian standards, these regions have a long tradition of grape production and it is not difficult to purchase sufficient quantity of grapes to produce wine. However, the wineries are concerned also about the quality of the grapes they use and purchasing high-quality grapes might be critical issue. On the other hand, the quality of grapes is easily measured and the cost to buy in the market is cheaper than producing in-house. Furthermore, also the level of asset specificity present in the grape-grower-wine-producer transaction seems, by itself, insufficient to justify the use of hierarchical governance forms. Then, the aim of the article is to analyze the reasons why these wineries largely rely on hierarchy governance forms to procure their grape-inputs. What explains their use of hierarchy governance, given that both asset specificity and measurement problems appear to be relatively low?

Knowledge hierarchy and professional knowledge

The aim of this article is to substantiate, in the sociological point of view, the distinction between the social and cognitive processes that produce knowledge in knowledge abstract systems - KAS - to generate cultural inequality and the micro processes of knowledge usage, which build local and cultural knowledge from common sense. It is circumscribed to this aim a problematization of knowledge usage developed by middle class salaried professional groups, rich in cultural capital but without equivalent symbolical capital, in a capitalist society at risk. In order to achieve this goal, the classical contributions of Pierre Bourdieu, Boaventura Sousa Santos, Donald Schön and Basil Bernstein (among others) are taken as a basis regarding the limitation of critical and reflexive thinking and the virtues of professional knowledge to support an epistemology of professional practice.

Modelos quantitativos de apoio as decisões: II

O sucesso da aplicação de técnicas de Análise das Decisões como apoio em problemas com um único objetivo predominante abriu caminho para estudos de problemas mais ambiciosos como os de decisões com multicritérios e decisões e de grupo (estes dois tipos utilizam metodologias muito semelhantes). Como evolução natural da Análise das Decisões, resultou a metodologia MAUT (Multi-Attribute Utility Theory). Seu rigorismo teórico torna as aplicações difíceis para um analista menos preparado. Como conseqüência, surgiu a metodologia AHP (Analytic Hierarchy Process) de utilização extremamente simples. A crítica ao AHP veio da escola européia que criou uma série de métodos conhecidos pela abreviação comum: MCDA (Multicriteria Decision Aid).

A blockmodel study of managerial hierarchies, verbal networks, and organizational culture in four hospitals

This study demonstrates and applies a social network methodology for studying the dynamics of hierarchies in organizations. Social network (blockmodel) analysis of verbal networks in four hospitals contrasted hierarchical and structurally equivalent partitions of the sociomatrices of frequent ties and perceptions of organizational culture. It was found that the verbal networks in these organizations follow a center periphery pattern rather than a hierarchical logic and that perceptions of culture vary more by verbal network than by formal hierarchy. The perceptions of culture of central groups in one organization are much like those of peripheral groups in another. In all four hospitals, structurally equivalent social networks are more important in predicting subcultures than are hierarchical groupings and hierarchy has a limited impact on the development of verbal networks. These findings suggest the value of an amoeba rather than a pyramid metaphor in interpreting the cultures and relational structures of organizations.

SPATIOTEMPORAL TRENDS OF CASES OF PANDEMIC INFLUENZA A(H1N1)PDM09 IN ARGENTINA, 2009-2012

The aim of this paper was to analyze the spatiotemporal variations of cases of influenza A(H1N1)pdm09 in Argentina. A space-time permutation scan statistic was performed to test the non-randomness in the interaction between space and time in reported influenza A(H1N1)pdm09 cases. In 2009, two clusters were recorded in the east of Buenos Aires Province (May and June) and in the central and northern part of Argentina (July and August). Between 2011 and 2012, clusters near areas bordering other countries were registered. Within the clusters, in 2009, the high notification rates were first observed in the school-age population and then extended to the older population (15-59 years). From 2011 onwards, higher rates of reported cases of influenza A(H1N1)pdm09 occurred in children under five years in center of the country. Two stages of transmission of influenza A(H1N1)pdm09 can be characterized. The first stage had high rates of notification and a possible interaction with individuals from other countries in the major cities of Argentina (pattern of hierarchy), and the second stage had an increased interaction in some border areas without a clear pattern of hierarchy. These results suggest the need for greater coordination in the Southern Cone countries, in order to implement joint prevention and vaccination policies.

Prediction of hyperglycemia in preterm newborn infants

Many conditions are associated with hyperglycemia in preterm neonates because they are very susceptible to changes in carbohydrate homeostasis. The purpose of this study was to evaluate the occurrence of hyperglycemia in preterm infants undergoing glucose infusion during the first week of life, and to enumerate the main variables predictive of hyperglycemia. This prospective study (during 1994) included 40 preterm neonates (gestational age <37 weeks); 511 determinations of glycemic status were made in these infants (average 12.8/infant), classified by gestational age, birth weight, glucose infusion rate and clinical status at the time of determination (based on clinical and laboratory parameters). The clinical status was classified as stable or unstable, as an indication of the stability or instability of the mechanisms governing glucose homeostasis at the time of determination of blood glucose; 59 episodes of hyperglycemia (11.5%) were identified. A case-control study was used (case = hyperglycemia; control = normoglycemia) to derive a model for predicting glycemia. The risk factors considered were gestational age (<=31 vs. >31 weeks), birth weight (<=1500 vs. >1500 g), glucose infusion rate (<=6 vs. >6 mg/kg/min) and clinical status (stable vs. unstable). Multivariate analysis by logistic regression gave the following mathematical model for predicting the probability of hyperglycemia: 1/exp{-3.1437 + 0.5819(GA) + 0.9234(GIR) + 1.0978(Clinical status)} The main predictive variables in our study, in increasing order of importance, were gestational age, glucose infusion rate and, the clinical status (stable or unstable) of the preterm newborn infant. The probability of hyperglycemia ranged from 4.1% to 36.9%.

Aceitação e preferência de frutos para oviposição em duas populações de Ceratitis capitata (Diptera, Tephritidae)

The influence of four host fruits, orange (Citrus sinensis L.), papaya (Carica papaya L.), mango (Mangifera indica L.) and apple (Malus domestica Borkh) on oviposition behavior of Ceratitis capitata (Wiedemann, 1824) was evaluated. Experiments were carried out on two C. capitata laboratory-reared populations: one with artificial diet for 10 years with periodic introduction of wild flies and other reared with artificial diet for 20 years without wild flies introduction. In acceptance experiments two pieces of a single fruit type were exposed to a group of 10 females; after 48 hours, these were changed by two new pieces of the same fruit type, and, in the end of the fourth day, the experiments were concluded. In preference experiments, two pieces of different fruits were offered to the females. These experiments were driven under the same conditions of the acceptance ones. Acceptance and preference experiments for both populations showed the following choice hierarchy: papaya > mango > orange > apple. The acceptance experiments showed no differences in the number of eggs/female/day laid in the first 48 hours and in the last 48 hours of the experiments. The amount of eggs in the two pieces of fruits offered to the females was similar. In spite of the two populations present similar behavior in relation to host hierarchy, the number of laid eggs was different, being larger for the population reared without wild flies introduction.