Evaluation of maternal and neonatal hospital care: quality index of completeness

OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System.METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country.RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country.CONCLUSIONS The index of completeness proved to be of great value for monitoring the maternal and neonatal hospital care of Brazilian Unified Health System and indicated that the quality of health care was unsatisfactory. However, its application does not replace specific evaluations.

Investment focused strategies in electricity markets using the ITEM-game simulator

This paper presents a methodology to establish investment and trading strategies of a power generation company. These strategies are integrated in the ITEM-Game simulator in order to test their results when played against defined strategies used by other players. The developed strategies are focused on investment decisions, although trading strategies are also implemented to obtain base case results. Two cases are studied considering three players with the same trading strategy. In case 1, all players also have the same investment strategy driven by a market target share. In case 2, player 1 has an improved investment strategy with a target share twice of the target of players 2 and 3. Results put in evidence the influence of the CO2 and fuel prices in the company investment decision. It is also observed the influence of the budget constraint which might prevent the player to take the desired investment decision.

Effect of the exposure to maternal smoking during pregnancy and childhood on the body mass index until adolescence

OBJECTIVE Investigate the effect of exposure to smoking during pregnancy and early childhood on changes in the body mass index (BMI) from birth to adolescence.METHODS A population-based cohort of children (0-5 years old) from Cuiabá, Midwest Brazil, was assessed in 1999-2000 (n = 2,405). Between 2009 and 2011, the cohort was re-evaluated. Information about birth weight was obtained from medical records, and exposure to smoking during pregnancy and childhood was assessed at the first interview. Linear mixed effects models were used to estimate the association between exposure to maternal smoking during pregnancy and preschool age, and the body mass index of children at birth, childhood and adolescence.RESULTS Only 11.3% of the mothers reported smoking during pregnancy, but most of them (78.2%) also smoked during early childhood. Among mothers who smoked only during pregnancy (n = 59), 97.7% had smoked only in the first trimester. The changes in body mass index at birth and in childhood were similar for children exposed and those not exposed to maternal smoking. However, from childhood to adolescence the rate of change in the body mass index was higher among those exposed only during pregnancy than among those who were not exposed.CONCLUSIONS Exposure to smoking only during pregnancy, especially in the first trimester, seems to affect changes in the body mass index until adolescence, supporting guidelines that recommend women of childbearing age to stop smoking.

Strategies for price reduction of HIV medicines under a monopoly situation in Brazil

ABSTRACT OBJECTIVE To analyze Government strategies for reducing prices of antiretroviral medicines for HIV in Brazil. METHODS Analysis of Ministry of Health purchases of antiretroviral medicines, from 2005 to 2013. Expenditures and costs of the treatment per year were analyzed and compared to international prices of atazanavir. Price reductions were estimated based on the terms of a voluntary license of patent rights and technology transfer in the Partnership for Productive Development Agreement for atazanavir. RESULTS Atazanavir, a patented medicine, represented a significant share of the expenditures on antiretrovirals purchased from the private sector. Prices in Brazil were higher than international references, and no evidence was found of a relationship between purchase volume and price paid by the Ministry of Health. Concerning the latest strategy to reduce prices, involving local production of the 200 mg capsule, the price reduction was greater than the estimated reduction. As for the 300 mg capsule, the amounts paid in the first two years after the Partnership for Productive Development Agreement were close to the estimated values. Prices in nominal values for both dosage forms remained virtually constant between 2011 (the signature of the Partnership for Productive Development Agreement), 2012 and 2013 (after the establishment of the Partnership). CONCLUSIONS Price reduction of medicines is complex in limited-competition environments. The use of a Partnership for Productive Development Agreement as a strategy to increase the capacity of local production and to reduce prices raises issues regarding its effectiveness in reducing prices and to overcome patent barriers. Investments in research and development that can stimulate technological accumulation should be considered by the Government to strengthen its bargaining power to negotiate medicines prices under a monopoly situation.

Maternal mental health and nutritional status of six-month-old infants

ABSTRACT OBJECTIVE To analyze if maternal mental health is associated with infant nutritional status at six month of age. METHODS A cross-sectional study with 228 six-month-old infants who used primary health care units of the city of Rio de Janeiro, Southeastern Brazil. Mean weight-for-length and mean weight-for-age were expressed in z-scores considering the 2006 World Health Organization reference curves. Maternal mental health was measured by the 12-item General Health Questionnaire. The following cutoff points were used: ≥ 3 for common mental disorders, ≥ 5 for more severe mental disorders, and ≥ 9 for depression. The statistical analysis employed adjusted linear regression models. RESULTS The prevalence of common mental disorders, more severe mental disorders and depression was 39.9%, 23.7%, and 8.3%, respectively. Children of women with more severe mental disorders had, on average, a weight-for-length 0.37 z-scores lower than children of women without this health harm (p = 0.026). We also observed that the weight-for-length indicator of children of depressed mothers was, on average, 0.67 z-scores lower than that of children of nondepressed women (p = 0.010). Maternal depression was associated with lower mean values of weight-for-age z-scores (p = 0.041). CONCLUSIONS Maternal mental health is positively related to the inadequacy of the nutritional status of infants at six months.

Assessment of data-driven modeling strategies for water delivery canals

Conferência: CONTROLO’2012 - 16-18 July 2012 - Funchal

Chaînes opératoires and resource-exploitation strategies in chimpanzee (Pan troglodytes) nut cracking

Journal of Human Evolution, V. 55, pp. 148-163

A stochastic programming approach for the development of offering strategies for a wind power producer

A stochastic programming approach is proposed in this paper for the development of offering strategies for a wind power producer. The optimization model is characterized by making the analysis of several scenarios and treating simultaneously two kinds of uncertainty: wind power and electricity market prices. The approach developed allows evaluating alternative production and offers strategies to submit to the electricity market with the ultimate goal of maximizing profits. An innovative comparative study is provided, where the imbalances are treated differently. Also, an application to two new realistic case studies is presented. Finally, conclusions are duly drawn.

Optimal offering strategies for wind power producers considering uncertainty and risk

This paper provides a two-stage stochastic programming approach for the development of optimal offering strategies for wind power producers. Uncertainty is related to electricity market prices and wind power production. A hybrid intelligent approach, combining wavelet transform, particle swarm optimization and adaptive-network-based fuzzy inference system, is used in this paper to generate plausible scenarios. Also, risk aversion is explicitly modeled using the conditional value-at-risk methodology. Results from a realistic case study, based on a wind farm in Portugal, are provided and analyzed. Finally, conclusions are duly drawn.

A new approach to assess defragmentation strategies in dynamically reconfigurable FPGAs

Fragmentation on dynamically reconfigurable FPGAs is a major obstacle to the efficient management of the logic space in reconfigurable systems. When resource allocation decisions have to be made at run-time a rearrangement may be necessary to release enough contiguous resources to implement incoming functions. The feasibility of run-time relocation depends on the processing time required to set up rearrangements. Moreover, the performance of the relocated functions should not be affected by this process or otherwise the whole system performance, and even its operation, may be at risk. Relocation should take into account not only specific functional issues, but also the FPGA architecture, since these two aspects are normally intertwined. A simple and fast method to assess performance degradation of a function during relocation and to speed up the defragmentation process, based on previous function labelling and on the application of the Euclidian distance concept, is proposed in this paper.

Learning in higher education: strategies to overcome challenges faced by adult students – lessons drawn from two case studies in Portugal

This paper appears in International Journal of Information and Communication Technology Education edited by Lawrence A. Tomei (Ed.) Copyright 2007, IGI Global, www.igi-global.com. Posted by permission of the publisher. URL:http://www.idea-group.com/journals/details.asp?id=4287.

Recém-nascidos de muito baixo peso e famílias migrantes : maternidade Dr. Alfredo da Costa : uma janela sobre a sociedade contemporânea portuguesa…

RESUMO - A migração transnacional de pessoas tem-se afirmado como um fenómeno global e crescente, provocando, nos diversos contextos nacionais implicados, mudança social e desafios adaptativos das sociedades e instituições. O universo da saúde poderá contudo constituir uma esfera privilegiada de interacção senão de inclusão e coesão social, requestionando os conceitos de cidadania. A sustentação de bons indicadores de saúde, nomeadamente materna e infantil, decorre de estratégias abrangentes de saúde pública e de políticas visionárias que contemplem sempre e também os mais necessitados. Procurando conhecer melhor os contextos em que ocorre o nascimento de recém-nascidos de muito baixo peso, este projecto corresponde a um estudo exploratório na maior maternidade do país, procurando entender a eventual associação de factores de índole social e familiar, nomeadamente ser de origem migrante. --------------------------- ABSTRACT - Transnational migration of people has clearly become a global and growing issue causing, on different national grounds, social change and adaptative challenges to society and its institutions. The health universe may, however, be a privileged scenery for integration and social cohesion making one re-think the concept of citizenship. Keeping up good health statistics, including maternal and child health results from wide public health strategies and fore seeking health policies not disregarding the underprivileged or the less visible fringes of society. Aiming to clarify on what context very low birth weight happens this project consists mainly in an explorative study on the biggest maternity in Portugal. Social and familiar factors are screened for possible association with migrant origin in ver

Self-scheduling and bidding strategies of thermal units with stochastic emission constraints

This paper is on the self-scheduling problem for a thermal power producer taking part in a pool-based electricity market as a price-taker, having bilateral contracts and emission-constrained. An approach based on stochastic mixed-integer linear programming approach is proposed for solving the self-scheduling problem. Uncertainty regarding electricity price is considered through a set of scenarios computed by simulation and scenario-reduction. Thermal units are modelled by variable costs, start-up costs and technical operating constraints, such as: forbidden operating zones, ramp up/down limits and minimum up/down time limits. A requirement on emission allowances to mitigate carbon footprint is modelled by a stochastic constraint. Supply functions for different emission allowance levels are accessed in order to establish the optimal bidding strategy. A case study is presented to illustrate the usefulness and the proficiency of the proposed approach in supporting biding strategies. (C) 2014 Elsevier Ltd. All rights reserved.

Race-to-halt energy saving strategies

Energy consumption is one of the major issues for modern embedded systems. Early, power saving approaches mainly focused on dynamic power dissipation, while neglecting the static (leakage) energy consumption. However, technology improvements resulted in a case where static power dissipation increasingly dominates. Addressing this issue, hardware vendors have equipped modern processors with several sleep states. We propose a set of leakage-aware energy management approaches that reduce the energy consumption of embedded real-time systems while respecting the real-time constraints. Our algorithms are based on the race-to-halt strategy that tends to run the system at top speed with an aim to create long idle intervals, which are used to deploy a sleep state. The effectiveness of our algorithms is illustrated with an extensive set of simulations that show an improvement of up to 8% reduction in energy consumption over existing work at high utilization. The complexity of our algorithms is smaller when compared to state-of-the-art algorithms. We also eliminate assumptions made in the related work that restrict the practical application of the respective algorithms. Moreover, a novel study about the relation between the use of sleep intervals and the number of pre-emptions is also presented utilizing a large set of simulation results, where our algorithms reduce the experienced number of pre-emptions in all cases. Our results show that sleep states in general can save up to 30% of the overall number of pre-emptions when compared to the sleep-agnostic earliest-deadline-first algorithm.