CLINICAL AND EPIDEMIOLOGICAL PROFILE OF ELDERLY PATIENTS WITH CHAGAS DISEASE FOLLOWED BETWEEN 2005-2013 BY PHARMACEUTICAL CARE SERVICE IN CEARÁ STATE, NORTHEASTERN BRAZIL

By controlling the transmission of Chagas disease, the challenge of providing assistance to millions of infected patients that reach old age arises. In this study, the socioeconomic, demographic and comorbidity records of all elderly chagasic patients followed at the Pharmaceutical Care Service of the Chagas Disease Research Laboratory were assessed. The information related to the clinical form of the disease was obtained from medical records provided by the Walter Cantídio University Hospital. The profile of the studied population was: women (50.5%); mean age of 67 years; retired (54.6%); married (51.6 %); high illiteracy rate (40.2%); and family income equal to the minimum wage (51.5%). The predominant clinical forms of Chagas disease were cardiac (65.3%) and indeterminate (14.7%). The main electrocardiographic changes were the right bundle branch block (41.0%), associated or not with the anterosuperior left bundle branch block (27.4%). The average number of comorbidities per patient was 2.23 ± 1.54, with systemic arterial hypertension being the main one found (67.0%). It was found that the elderly comprise a vulnerable group of patients that associate aging with cardiac and/or digestive disorders resulting from the evolution of Chagas disease and other comorbidities, which requires special attention from health services to ensure more appropriate medical and social care.

Analysis of mental health service financial models with a particular emphasis of Ireland

ABSTRACT: Financing is a critical factor in ensuring the optimal development and delivery of a mental health system. The primary method of financing worldwide is tax-based. However many low income countries depend on out-of-pocket payments. There is a report on Irish Health Care funding but none that deals exclusively with mental health care. This paper analyses the various financial models that exist globally with respect to financing the mental health sector, examines the impact of various models on service users, especially in terms of relative ‘financial burden’ and provides a more detailed examination of the current mental health funding situation in Ireland After extensive internet and hardcopy research on the above topics, the findings were analysed and a number of recommendations were reached. Mental health service should be free at the point of delivery to achieve universal coverage. Government tax-based funding or mandatory social insurance with government top-ups, as required, appears the optimal option, although there is no one funding system applicable everywhere. Out-of-pocket funding can create a crippling financial burden for service users. It is important to employ improved revenue collection systems, eliminate waste, provide equitable resource distribution, ring fence mental health funding and cap the number of visits, where necessary. Political, economic, social and cultural factors play a role in funding decisions and this can be clearly seen in the context of the current economic recession in Ireland. Only 33% of the Irish population has access to free public health care and the number health insurance policy holders has dramatically declined, resulting in increased out-of-pocket payments. This approach risks negatively impacting on the social determinants of health, increasing health inequalities and negatively affecting economic productivity. It is therefore important the Irish government examines other options to provide funding for mental health services.

Promoção da saúde mental em espaço urbano

RESUMO: A saúde pública deve estar atenta aos contextos e às mudanças sociais, políticas, económicas, científicas e tecnológicas com que se confrontam constantemente as comunidades, particularmente em situações de grandes transformações como o momento que a União Europeia atravessa. A urbanização é provavelmente a mudança demográfica mais importante das últimas décadas. Tendo importantes repercussões sobre a saúde mental, é importante desenvolver a investigação neste domínio, de forma multidisciplinar e integrando a compreensão dos diferentes determinantes sociais, psicológicos e físicos. As políticas de saúde mental tornaram-se uma parte importante da política social e da sociedade de bem-estar, em particular se considerarmos a urbanização das nossas comunidades. Considerar a saúde mental em espaço urbano é fundamentalmente estudar como um espaço particular pode influenciar a saúde. Baseado nesta reflexão, desenvolveu-se uma investigação participada de base comunitária, com recurso a uma metodologia de estudo de caso. Recorreu-se a dezenas de documentos de referência local, registos em arquivo, à observação direta, à observação participante e à observação in loco do espaço urbano. Foi utilizada uma amostragem em bola de neve, estratificada, para selecionar 697 habitantes de uma cidade da área metropolitana de Lisboa. Estes habitantes foram entrevistados por 42 entrevistadores, previamente formados, assim como foram enviados questionários online dirigidos aos professores (196) e aos Técnicos Superiores de Serviço Social (12) em exercício no espaço urbano em estudo, para a caraterização sociodemográfica e para avaliação de indicadores de saúde, de indicadores relacionados com a saúde e de indicadores estruturais de saúde mental. Os resultados mostraram um espaço urbano promotor de saúde estrutura-se para capacitar os seus cidadãos a se integrarem ativamente no funcionamento da sua comunidade. Foram identificadas algumas caraterísticas como 1) o início do processo de promoção da saúde mental ser o mais precoce possível; 2) a participação comunitária ativa, num sentimento de segurança individual e comunitária, envolvendo estruturas governamentais e não-governamentais; 3) a solidariedade e a inclusão, promovendo o voluntariado e a promoção do suporte social e desenvolvendo a coesão social; 4) o reconhecimento das necessidades expressas pelos habitantes; 5) a identificação de respostas para a conciliação entre vida pessoal, familiar e profissional; 6) as estruturas de acompanhamento dos grupos sociais mais desfavorecidos; 7) as estratégias de combate ao isolamento envolvendo a população sénior e outros grupos minoritários ativamente no processo de reorganização do seu funcionamento social; 8) uma efetiva governança e gestão relacional por parte dos poderes locais, centrando a vida quotidiana da comunidade nas pessoas. A investigação participada de base comunitária constitui um instrumento útil e eficaz no desenho de planos locais de promoção da saúde mental para encontrar respostas ao desafio em saúde pública: a saúde mental e a urbanização.

A marketing plan for the ice cream brand Max Adventures in food service

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

On the cloud deployment of a session abstraction for service/data aggregation

Dissertação para obtenção do Grau de Mestre em Engenharia Informática

Service-oriented architecture for device lifecycle support in industrial automation

Dissertação para obtenção do Grau de Doutor em Engenharia Electrotécnica e de Computadores Especialidade: Robótica e Manufactura Integrada

Protesting or justifying? A latent class model for contingent valuation with attitudinal data

This article develops a latent class model for estimating willingness-to-pay for public goods using simultaneously contingent valuation (CV) and attitudinal data capturing protest attitudes related to the lack of trust in public institutions providing those goods. A measure of the social cost associated with protest responses and the consequent loss in potential contributions for providing the public good is proposed. The presence of potential justification biases is further considered, that is, the possibility that for psychological reasons the response to the CV question affects the answers to the attitudinal questions. The results from our empirical application suggest that psychological factors should not be ignored in CV estimation for policy purposes, allowing for a correct identification of protest responses.

Valuation of marine and coastal ecosystems: The role of ecological-economic modeling

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics

An internal analysis of Amorim Turismo’s operations regarding food and beverage with a focus on operational efficiency and quality of service

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Drivers and barriers to value creation in mobile service delivery

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Contaminação microbiológica e parasitológica em alfaces (Lactuca sativa) de restaurantes self-service, de Niterói, RJ

Analisou-se 30 amostras de alfaces de restaurantes self-service de Niterói quanto à presença de bactérias e parasitas. Dezesseis amostras apresentaram coliformes fecais, 16 mesófilos acima de 10(7) UFC/g e 3 cistos de Entamoeba coli. Estes dados indicam a necessidade da orientação dos manipuladores quanto a higienização no preparo de hortaliças.

Service-oriented infrastructure to support the control, monitoring and management of a shop floor system

Dissertação para obtenção do Grau de Mestre em Engenharia Electrotécnica e de Computadores

Contributo para a validação da versão portuguesa do instrumento de avaliação VOICE (service users perceptions of impatient care, Views on Inpatient Care)

RESUMO: Nos últimos anos assistiu-se a um reposicionamento das pessoas portadoras de doença mental na sociedade, no sentido de viverem em pleno os seus direitos, sem restrições. Esta tendência acompanhou as transformações que se têm vivido na forma como os utentes dos serviços de saúde interagem com os mesmos e com os profissionais de saúde, de forma a permitir uma maior autonomização e responsabilização no que concerne ao tratamento da sua doença, a relação que estabelecem com o seu médico, e a participação na avaliação e monitorização da qualidade dos serviços. Mais recentemente, também no mundo científico, esta afirmação se fez sentir, com o surgimento de investigação liderada por utentes, no sentido de estudar de forma adequada questões que partem do seu ponto de vista, e que possibilitem a produção de conhecimento significativa no contexto das suas experiências. Com o presente trabalho pretende-se contribuir para a validação da versão portuguesa do VOICE (Service Users’ Perceptions of Inpatient Care, Views on Inpatient Care) (Evans et al., 2012), instrumento para a avaliação dos serviços de internamento de agudos em psiquiatria, construído a partir de um investigação liderado por utentes e partindo das suas perspectiva. O VOICE é constituído por 19 questões, agrupadas em sete domínios: admissão; cuidados e tratamento; medicação; equipa de técnicos do internamento; terapia e atividades; ambiente e diferenças. O presente estudo envolveu uma amostra de 85 utentes de um serviço de internamento de agudos de uma instituição psiquiátrica do Norte de Portugal. A versão portuguesa do VOICE apresentou boa aceitação por parte dos utentes e boas características psicométricas - a consistência interna foi alta (α = 0,87) e todos, exceto um item (item 6), apresentam elevadas correlações item-total (variando de 0,18 - item 6 a 0,71 - item 11; M = 0,54, DP = 0,15), sugerindo ser um instrumento útil na avaliação dos serviços de internamento de agudos. No futuro torna-se necessário alargar o estudo a outros contextos de internamento e envolvendo amostras mais alargadas.-------------- ABSTRACT: In recent years there has been a gradual process to help people with the experience of mental illness regaining their full rights. Following the advances in the understanding of mental health problems, and the use of medication to help patients overcome symptoms, service-users have become more autonomous and responsible in the way they deal with health professionals, and are now called to participate in assessing and monitoring mental health services and policies. In the context of these transformations we have assisted to the emergence of research led by service-users (in this case of psychiatric and mental health services) in order to emphasize their point of view, and to enable the production of significant knowledge resulting from their experiences, and perceptions. The present study aims to contribute to the dissemination of service-user led research, based on the adaptation and validation of the Portuguese version of the VOICE - Service Users' Perceptions Questionnaire, Views on Inpatient Care. (Evans et al., 2012). The VOICE is composed of 19 questions, grouped in seven domains: admissions, care and treatment, medication, team of technicians during hospitalization, therapy and activities, environment and diversity. The present study involved a sample of 85 inpatient of a psychiatric institution in Northern Portugal. The Portuguese version of the VOICE showed good psychometric properties and was well accepted by patients [high internal consistency (α = 0,87); and high correlation of each item, except item 6, with the total score (ranging from 0.18 on item 6 to 0.71 on item 11; average=0,54; SD=0,15), suggesting it to be a useful tool for assessing inpatient services. In the future there is a need to extend the study to other contexts and include larger samples.

Resilience of logistic service providers facing a port strike: a case study

The purpose of this thesis is to study the impact of a port strike on companies that perform as logistic service providers in a supply chain (SC), here denominated 3PL (third-party logistic providers). These companies are highly dependent on ports to perform their activity, since they provide international services. Consequently, a disruption in a port can seriously impair their business. A stevedores’ strike is one of the possible disruptions that can affect ports. This study aims to analyze the negative effects caused by this disruption, and what strategies 3PLs may implement in order to keep their performance levels stable and have a quick recovery time. Within this objective, the first step will be to establish a theoretical context about the maritime port’s sector and 3PLs in a SC context, to then expand the concept of a resilient SC, and finally to develop a theoretical framework in order to better contextualize the case study. Subsequently, the impact of a port strike will be quantified by using a case study comprising three companies, covering the areas of land and sea distribution and port operations. Information from primary sources was assembled in two phases: first via e-mail and, in a second phase, through a personal interview. The information from secondary sources was obtained through television news, internet and conferences, enabling its cross-analysis. Finally, by analyzing the collected data, it will be possible to draw conclusions about the measures carried out by each company to minimize the negative effects of the strike, thus contributing to a more resilient SC. As a conclusion, a stevedores’ strike will create a snow-ball of negative effects in the SC, degrading all relevant KPIs (key performance indicators) of the 3PLs under study. No mitigation and contingency strategies available proved really effective to reduce the negative effects of a port strike disruption.

Achieving better service level results, through improvements in procedures

This project aims to prepare Worten Empresas (WE) fulfilling the increasing market demand through process changings, focusing on the Portuguese market, particularly on internal B2B clients1. Several methods were used to measure the current service level provided - process mapping, resources assessment, benchmark and a survey. The results were then used to compare against service level actually desired by WE’s customer, and then to identify the performance gaps in response times and quality of the follow-up during the sales process. To bridge the identified gaps, both a set of recommendations and an implementation plan were suggested to improve and monitor customer experience. This study concluded that it is possible to fulfill the increasing level of demand and at the same time improve customer satisfaction by implementing changes at the operations level.