O impacto da variação do preço na procura de cuidados de saúde

RESUMO - Assiste-se a um crescimento exponencial das despesas em saúde, quer na Europa como nos Estados Unidos. Em Portugal, os gastos totais com a saúde ascenderam a 10,2% do PIB, em 2006, contra os 8,8% registados no início da década anterior. É importante perceber o que motiva este crescimento quer em termos globais, quer no que diz respeito ao consumo de recursos, bem como até em termos da despesa pública. Este projecto tem dois objectivos fundamentais: em primeiro lugar, contribuir para o estudo dos factores determinantes da procura de cuidados de saúde em Portugal e, consequentemente, determinar as elasticidades procura – preço para diferentes tipos de cuidados de saúde. Metodologia: Estudo observacional baseado na análise empírica de dados administrativos (claims) respeitantes à utilização dos cuidados de saúde por parte de 12.230 indivíduos detentores de um plano de seguro de saúde individual, numa seguradora privada em Portugal. As elasticidades procura – preço para os diferentes tipos de cuidados de saúde obtiveram-se utilizando as variações percentuais das quantidades dos diferentes cuidados de saúde, antes e depois da variação do preço pago pelo indivíduo, para cada tipo de cuidado de saúde. Resultados: De acordo com a teoria económica tradicional o aumento do preço a pagar reduz o consumo de cuidados de saúde, e a procura é elástica, ou seja, os valores da elasticidade procura – preço obtidos são superiores a 1, em valor absoluto, logo o aumento do preço levou a uma redução mais do que proporcional das quantidades procuradas. A procura de cuidados de saúde em ambulatório é mais sensível à variação do preço do que a procura de cuidados de internamento. ------- ABSTRACT - We are witnessing an exponential growth of health care expenditures around the world. In Portugal, the total expenditure on health amounted to 10.2% of GDP in 2006, against 8.8% at the beginning of previous decade. It is important to understand what motivates this growth both in overall terms, with respect to resource consumption, and even in terms of public spending. This study was designed two achieve two objectives: first, to contribute to the study of demand for health care and, more specifically, to analyze the effect of price changes on the utilization of health care services; and secondly, to estimate the demand elasticity for different types of heath care. Methodology: Observational study based on empirical analysis of administrative data (claims) from a private health insurance Company in Portugal. The sample used had information regarding 12.230 individuals. Demand elasticity for the different types of health care services was obtained by the quotient between the percentage changes in the quantity of health care services, before and after the change in the price paid by the corresponding percentage change in the price. Results: This study showed that, for all medical services, price increases were associated with reductions in the quantity of care consumed as predicted by neoclassical demand theory, and we are in the presence of an elastic demand. This means that price elasticity is greater than 1 in absolute value so the increase in the price led to a more than proportional reduction in the quantity demanded. Demand elasticity was more responsive to changes in the price of specialist and emergency care than to changes in the price of inpatient care.

Vigilância activa de eventos após vacinação

A vigilância de efeitos indesejáveis após a vacinação é complexa. Existem vários actores de confundimento que podem dar origem a associações espúrias, meramente temporais mas que podem provocar uma percepção do risco alterada e uma consequente desconfiança generalizada acerca do uso das vacinas. Com efeito as vacinas são medicamentos complexos com características únicas cuja vigilância necessita de abordagens metodológicas desenvolvidas para esse propósito. Do exposto se entende que, desde o desenvolvimento da farmacovigilância se tem procurado desenvolver novas metodologias que sejam concomitantes aos Sistemas de Notificação Espontânea que já existem. Neste trabalho propusemo-nos a desenvolver e testar um modelo de vigilância de reacções adversas a vacinas, baseado na auto-declaração pelo utente de eventos ocorridos após a vacinação e testar a capacidade de gerar sinais aplicando cálculos de desproporção a datamining. Para esse efeito foi constituída uma coorte não controlada de utentes vacinados em Centros de Saúde que foram seguidos durante quinze dias. A recolha de eventos adversos a vacinas foi efectuada pelos próprios utentes através de um diário de registo. Os dados recolhidos foram objecto de análise descritiva e análise de data-mining utilizando os cálculos Proportional Reporting Ratio e o Information Component. A metodologia utilizada permitiu gerar um corpo de evidência suficiente para a geração de sinais. Tendo sido gerados quatro sinais. No âmbito do data-mining a utilização do Information Component como método de geração de sinais parece aumentar a eficiência científica ao permitir reduzir o número de ocorrências até detecção de sinal. A informação reportada pelos utentes parece válida como indicador de sinais de reacções adversas não graves, o que permitiu o registo de eventos sem incluir o viés da avaliação da relação causal pelo notificador. Os principais eventos reportados foram eventos adversos locais (62,7%) e febre (31,4%).------------------------------------------ABSTRACT: The monitoring of undesirable effects following vaccination is complex. There are several confounding factors that can lead to merely temporal but spurious associations that can cause a change in the risk perception and a consequent generalized distrust about the safe use of vaccines. Indeed, vaccines are complex drugs with unique characteristics so that its monitoring requires specifically designed methodological approaches. From the above-cited it is understandable that since the development of Pharmacovigilance there has been a drive for the development of new methodologies that are concomitant with Spontaneous Reporting Systems already in place. We proposed to develop and test a new model for vaccine adverse reaction monitoring, based on self-report by users of events following vaccination and to test its capability to generate disproportionality signals applying quantitative methods of signal generation to data-mining. For that effect we set up an uncontrolled cohort of users vaccinated in Healthcare Centers,with a follow-up period of fifteen days. Adverse vaccine events we registered by the users themselves in a paper diary The data was analyzed using descriptive statistics and two quantitative methods of signal generation: Proportional Reporting Ratio and Information Component. themselves in a paper diary The data was analyzed using descriptive statistics and two quantitative methods of signal generation: Proportional Reporting Ratio and Information Component. The methodology we used allowed for the generation of a sufficient body of evidence for signal generation. Four signals were generated. Regarding the data-mining, the use of Information Component as a method for generating disproportionality signals seems to increase scientific efficiency by reducing the number of events needed to signal detection. The information reported by users seems valid as an indicator of non serious adverse vaccine reactions, allowing for the registry of events without the bias of the evaluation of the casual relation by the reporter. The main adverse events reported were injection site reactions (62,7%) and fever (31,4%).

Soliton-type and other travelling wave solutions for an improved class of nonlinear sixth-order Boussinesq equations

An improved class of nonlinear bidirectional Boussinesq equations of sixth order using a wave surface elevation formulation is derived. Exact travelling wave solutions for the proposed class of nonlinear evolution equations are deduced. A new exact travelling wave solution is found which is the uniform limit of a geometric series. The ratio of this series is proportional to a classical soliton-type solution of the form of the square of a hyperbolic secant function. This happens for some values of the wave propagation velocity. However, there are other values of this velocity which display this new type of soliton, but the classical soliton structure vanishes in some regions of the domain. Exact solutions of the form of the square of the classical soliton are also deduced. In some cases, we find that the ratio between the amplitude of this wave and the amplitude of the classical soliton is equal to 35/36. It is shown that different families of travelling wave solutions are associated with different values of the parameters introduced in the improved equations.

Desenvolvimento de métodos de análise físico-química em águas usando um analisador multiparamétrico AQUAKEM

Trabalho Final de mestrado para obtenção do grau de Mestre em Engenharia Química e Biológica

Análise do comportamento sísmico da barragem de Luzzone: desenvolvimento de um programa de EF3D utilizando uma formulação em deslocamentos e pressões

Trabalho Final de Mestrado elaborado no Laboratório Nacional de Engenharia Civil (LNEC) para a obtenção do grau de Mestre em Engenharia Civil pelo Instituto Superior de Engenharia de Lisboa no âmbito do protocolo entre o ISEL e o LNEC

Modelação do comportamento dinâmico de sistemas barragem-fundação-albufeira: análise sísmica de uma barragem de abóbadas múltiplas

Trabalho Final de Mestrado elaborado no Laboratório Nacional de Engenharia Civil (LNEC) para a obtenção do grau de Mestre em Engenharia Civil pelo Instituto Superior de Engenharia de Lisboa no âmbito do protocolo de cooperação entre o ISEL e o LNEC

Analysis of Forest Fires by means of Pseudo Phase Plane and Multidimensional Scaling Methods

Forest fires dynamics is often characterized by the absence of a characteristic length-scale, long range correlations in space and time, and long memory, which are features also associated with fractional order systems. In this paper a public domain forest fires catalogue, containing information of events for Portugal, covering the period from 1980 up to 2012, is tackled. The events are modelled as time series of Dirac impulses with amplitude proportional to the burnt area. The time series are viewed as the system output and are interpreted as a manifestation of the system dynamics. In the first phase we use the pseudo phase plane (PPP) technique to describe forest fires dynamics. In the second phase we use multidimensional scaling (MDS) visualization tools. The PPP allows the representation of forest fires dynamics in two-dimensional space, by taking time series representative of the phenomena. The MDS approach generates maps where objects that are perceived to be similar to each other are placed on the map forming clusters. The results are analysed in order to extract relationships among the data and to better understand forest fires behaviour.

Dynamic Analysis and Pattern Visualization of Forest Fires

This paper analyses forest fires in the perspective of dynamical systems. Forest fires exhibit complex correlations in size, space and time, revealing features often present in complex systems, such as the absence of a characteristic length-scale, or the emergence of long range correlations and persistent memory. This study addresses a public domain forest fires catalogue, containing information of events for Portugal, during the period from 1980 up to 2012. The data is analysed in an annual basis, modelling the occurrences as sequences of Dirac impulses with amplitude proportional to the burnt area. First, we consider mutual information to correlate annual patterns. We use visualization trees, generated by hierarchical clustering algorithms, in order to compare and to extract relationships among the data. Second, we adopt the Multidimensional Scaling (MDS) visualization tool. MDS generates maps where each object corresponds to a point. Objects that are perceived to be similar to each other are placed on the map forming clusters. The results are analysed in order to extract relationships among the data and to identify forest fire patterns.

Simulation of offshore wind system with three-level converters: HVDC power transmission in cloud scope

This paper is on a simulation for offshore wind systems in deep water under cloud scope. The system is equipped with a permanent magnet synchronous generator and a full-power three-level converter, converting the electric energy at variable frequency in one at constant frequency. The control strategies for the three-level are based on proportional integral controllers. The electric energy is injected through a HVDC transmission submarine cable into the grid. The drive train is modeled by a three-mass model taking into account the resistant stiffness torque, structure and tower in the deep water due to the moving surface elevation. Conclusions are taken on the influence of the moving surface on the energy conversion. © IFIP International Federation for Information Processing 2015.

Parametric analog signal amplification applied to nanoscale cmos wireless digital transceivers

Thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the subject of Electrical and Computer Engineering by the Universidade Nova de Lisboa,Faculdade de Ciências e Tecnologia

Water-contact patterns and risk factors for Schistosoma mansoni infection in a rural village of Northeast Brazil

Schistosomiasis mansoni in the Serrano village, municipality of Cururupu, state of Maranhão, Brazil, is a widely spread disease. The PECE (Program for the Control of Schistosomiasis), undertaken since 1979 has reduced the prevalence of S. mansoni infection and the hepatosplenic form of the disease. Nevertheless piped water is available in 84% of the households, prevalence remains above 20%. In order to identify other risk factors responsible for the persistence of high prevalence levels, a cross-sectional survey was carried out in a systematic sample of 294 people of varying ages. Socioeconomic, environmental and demographic variables, and water contact patterns were investigated. Fecal samples were collected and analyzed by the Kato-Katz technique. Prevalence of S. mansoni infection was 24.1%, higher among males (35.5%) and between 10-19 years of age (36.6%). The risk factors identified in the univariable analysis were water contacts for vegetable extraction (Risk Ratio - RR = 2.92), crossing streams (RR = 2.55), bathing (RR = 2.35), fishing (RR = 2.19), hunting (RR = 2.17), cattle breeding (RR = 2.04), manioc culture (RR = 1.90) and leisure (RR = 1.56). After controlling for confounding variables by proportional hazards model the risks remained higher for males, vegetable extraction, bathing in rivers and water contact in rivers or in periodically inundated parts of riverine woodland (swamplands)

EPIDEMIOLOGICAL SURVEY ON CANINE POPULATION WITH THE USE OF IMMUNOLEISH SKIN TEST IN ENDEMIC AREAS OF HUMAN AMERICAN CUTANEOUS LEISHMANIASIS IN THE STATE OF RIO DE JANEIRO, BRAZIL

A survey for canine tegumentary leishmaniasis (CTL) has been carried out between 1986 and 1993 in seven endemic localities for American cutaneous leishmaniasis in the State of Rio de Janeiro. 270 dogs have been examined for their clinical aspects, the development of delayed hypersensitivity (DHS) with Immunoleish antigen and with immunofluorescent antibody research of IgG (IF). 28.2% of them had ulcer lesions and 3.3% had scars. The lesions consisted of single (39.5%) and mucocutaneous lesions (31.6%), multiple cutaneous (25.0%) and mucocutaneous lesions associated with cutaneous ulcers (4.0%). Twelve (15.8%) isolates from biopsies were analyzed by zimodeme and schizodeme and identified as L. (V.) braziliensis. The overall prevalence of canine infection that was evaluated with the skin test was of 40.5% and with IF it was of 25.5%. Both tests showed a high positive rate with relation to the animals with mucosal lesions, as in the case of human mucocutaneous leishmaniasis. The comparison of the two tests showed the skin test to have a better performance although there was no statistical difference (p>0.05) between them. The proportional sensitivity and specificity was of 84.0% and 74.0%, respectively. The Immunoleish skin test and IF are useful tools to be employed in CTL field epidemiological surveys.

HEART ANEURYSM IN CHAGAS' DISEASE

This prospective study on 41 autopsy collected human hearts concerns the "apical" lesion in Chagas' disease. Previous report did not show a correlation between lesion frequency and heart weight then discarding a vascular factor in its pathogenesis. The present paper involves other variables besides the heart weight to evaluate the relative coronary insufficiency. Distinct colored gel (green and red) injected through the capillary beds of both coronary arteries defined the extent of both vessels before separating the atria and removing the sub-epicardium fat. The Right Ventricle (RV) and Left Ventricle (LV) free walls furnished the RV/LV mass ratio. The myocardium mass colored green (right coronary artery - RC) and the whole Ventricular Weight (VW) determined the RC/VW mass ratio. The heart weight plus these mass ratios, graded and added, composed a score inversely proportional to the myocardium irrigation condition. It intended to be a more sensitive morphologic evaluation of the relative ischaemia to correlate to the apical lesion. This study showed a right deviation for the relative accumulated frequency of lesions plotted as a score function and a significant difference for higher scores in hearts with aneurysm. It suggests a ischaemic factor intervening in the apical lesion pathogenesis in Chagas' cardiopathy.

Distribuições de eventos extremos e telecomunicações

As distribuições de Lei de Potência (PL Power Laws), tais como a lei de Pareto e a lei de Zipf são distribuições estatísticas cujos tamanhos dos eventos são inversamente proporcionais à sua frequência. Estas leis de potência são caracterizadas pelas suas longas caudas. Segundo Vilfredo Pareto (1896), engenheiro, cientista, sociólogo e economista italiano, autor da Lei de Pareto, 80% das consequências advêm de 20% das causas. Segundo o mesmo, grande parte da economia mundial segue uma determinada distribuição, onde 80% da riqueza mundial é detida por 20% da população ou 80% da poluição mundial é feita por 20% dos países. Estas percentagens podem oscilar nos intervalos [75-85] e [15-25]. A mesma percentagem poderá ser aplicada à gestão de tempo, onde apenas 20% do tempo dedicado a determinado assunto produzirá cerca de 80% dos resultados obtidos. A lei de Pareto, também designada de regra 80/20, tem aplicações nas várias ciências e no mundo físico, nomeadamente na biodiversidade. O número de ocorrências de fenómenos extremos, aliados ao impacto nas redes de telecomunicações nas situações de catástrofe, no apoio imediato às populações e numa fase posterior de reconstrução, têm preocupado cada vez mais as autoridades oficiais de protecção civil e as operadoras de telecomunicações. O objectivo é o de preparar e adaptarem as suas estruturas para proporcionar uma resposta eficaz a estes episódios. Neste trabalho estuda-se o comportamento de vários fenómenos extremos (eventos críticos) e aproximam-se os dados por uma distribuição de Pareto (Lei de Pareto) ou lei de potência. No final, especula-se sobre a influência dos eventos críticos na utilização das redes móveis. É fundamental que as redes móveis estejam preparadas para lidar com as repercussões de fenómenos deste tipo.

The interrogation of witnesses abroad in execution of a european investigation order: an examination from eyes of the defence

European Master Human Rights and Democratisation