Regional governance: strategies and disputes in health region management

OBJECTIVE To analyze the regional governance of the health systemin relation to management strategies and disputes.METHODOLOGICAL PROCEDURES A qualitative study with health managers from 19 municipalities in the health region of Bahia, Northeastern Brazil. Data were drawn from 17 semi-structured interviews of state, regional, and municipal health policymakers and managers; a focus group; observations of the regional interagency committee; and documents in 2012. The political-institutional and the organizational components were analyzed in the light of dialectical hermeneutics.RESULTS The regional interagency committee is the chief regional governance strategy/component and functions as a strategic tool for strengthening governance. It brings together a diversity of members responsible for decision making in the healthcare territories, who need to negotiate the allocation of funding and the distribution of facilities for common use in the region. The high turnover of health secretaries, their lack of autonomy from the local executive decisions, inadequate technical training to exercise their function, and the influence of party politics on decision making stand as obstacles to the regional interagency committee’s permeability to social demands. Funding is insufficient to enable the fulfillment of the officially integrated agreed-upon program or to boost public supply by the system, requiring that public managers procure services from the private market at values higher than the national health service price schedule (Brazilian Unified Health System Table). The study determined that “facilitators” under contract to health departments accelerated access to specialized (diagnostic, therapeutic and/or surgical) services in other municipalities by direct payment to physicians for procedure costs already covered by the Brazilian Unified Health System.CONCLUSIONS The characteristics identified a regionalized system with a conflictive pattern of governance and intermediate institutionalism. The regional interagency committee’s managerial routine needs to incorporate more democratic devices for connecting with educational institutions, devices that are more permeable to social demands relating to regional policy making.

Performance evaluation of hospitals that provide care in the public health system, Brazil

OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System.METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction.RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed.CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

Prealbumina, precalicreína e protrombina na forma hepatesplênica da esquistossomose: catabolismo aumentado de proteínas da coagulação?

No plasma de 20 doentes portadores da forma hepatesplênica da esquistossomose mansônica, assim como no de 18 indivíduos normais, foram avaliados pré-albumina, precalicreína (atividade amidolítica) e protrombina-antígeno. Os valores da concentração plasmática de pré-albumina obtidos no grupo controle permitiram que se estabelecesse um intervalo de referência (0,5 — 99,5%) de 97 — 389 mg/I. Valores anormalmente diminuídos de pré-albumina encontrados em 2 dos doentes indicaram nestes uma disfunção hepatocítica de síntese protêica. Nos 18 doentes restantes a média da pré-albumina (232 ± 13 mg/l) não diferiu (p > 0,05) da do grupo controle (243 ± 11 mg/l) enquanto as médias da atividade de pró-calicreina (34 ± 1 μKat/l) e protrombina (81 ± 3,0 mg/l) estavam significativamente diminuídos no grupo de esquistossomóticos (p < 0,01). Estes dados não excluem a possibilidade da pré-calicreina ou da protrombina-antígeno serem marcadores de síntese protêica pelo hepatócito mais sensíveis que a pré-albumina; se entretanto a concentração plasmática normal desta proteína indicar preservação desta função, a diminuição de fatores de coagulação poderá ser secundária a um "turnover" aumentado dos fatores de coagulação na forma hepatesplênica da esquistossomose.

Gestão de instalações eléctricas para optimização do desempenho, eficiência e qualidade de energia em grandes edifícios com integração de Miniprodução

As alterações climáticas e as emissões de CO2 são questões que suscitam a nível internacional e nacional o desenvolvimento de estratégias que atenuem os seus impactes. A Eficiência Energética (EE) é essencial para que num futuro próximo não haja impactes significativos no meio ambiente devido a elevado e ineficiente consumo energético. A União Europeia (UE) e Portugal têm desenvolvido políticas e programas que estimulam a eficiência energética, bem como a diminuição de gases com efeito de estufa (GEE) e a promoção da utilização de fontes de energia renovável. Por outro lado vivemos numa sociedade que passa cerca de 80% do seu tempo em edifícios e, nestes, é consumida 40% da energia mundial. Com uma dependência energética superior a 80%, Portugal tem vindo a apostar, nos últimos anos, em fontes de energia renovável. Esta aposta serve como substituição de fontes, mas não leva directamente à redução de consumos. A redução da factura de energia só pode ser atingida com uma maior eficiência energética e melhores práticas de gestão de energia em edifícios, transportes e industria. Esta dissertação centra-se especificamente num conjunto de edifícios públicos, património municipal da autarquia de Matosinhos, cujo modelo de fornecimento da energia eléctrica é passível de análise crítica no sentido de uma optimização radical ao nível da concepção da rede e exploração, com consequente redução de custos ao nível da facturação. Esta nova metodologia de exploração e gestão de sistemas eléctricos incidirá na criação de um “campus” energético autárquico resultante do novo layout da rede e respectivo fornecimento de energia a partir da rede de distribuição pública. O estudo permitirá fornecer ferramentas fundamentais para a gestão municipal e empresarial ao nível da sustentabilidade energética nos edifícios públicos com abrangência aos serviços empresariais. De referir que a gestão das instalações eléctricas para optimização do desempenho, eficiência e qualidade de energia é aplicável aos 308 municípios nacionais com relevância para as empresas que apresentam consumos significativos nos seus edifícios. Enquanto funcionário da Câmara Municipal de Matosinhos, este município foi uma escolha natural como referência, na análise da relação existente entre a administração local e a gestão da energia. Para ajudar à análise foi efectuado um benchmarketing a cinco edifícios municipais: Edifício dos Paços do Concelho, Biblioteca Municipal Florbela Espanca, Palacete Visconde Trevões, ex-Edifício dos SMAS e Edifício do ex-Tribunal, visando potenciar a correcta gestão de energia destes edifícios por parte das entidades que os gerem, perante novas oportunidades de melhoria e soluções encontradas. Como contributo às metas impostas pela Directiva 2009/28/CE para 2020, a qual prevê uma redução de 20% no consumo final de energia através da eficiência energética, a incorporação de 20% de energia renovável no consumo energético global e a consequente redução em 20% da emissão de GEE, é apresentado um estudo ao nível de um parque fotovoltaico com a componente técnica e económica.

Gestão e retenção de repatriados: um estudo empírico em empresas portuguesas

Este estudo pretende compreender como uma amostra de empresas portuguesas gere os seus expatriados/repatriados. Especificamente, explora o papel das práticas de GRH de apoio à expatriação/repatriação. Este objectivo orientou o trabalho de pesquisa para a compreensão do papel que as empresas têm na gestão da expatriação (i.e. antes, durante e depois) e consequentes efeitos na retenção/turnover do repatriado.

Retaining repatriates: an exploratory study in portuguese companies

This study aims to understand the factors which may explain the retention of repatriates from companies acting within Portugal. These factors can be related either to the individual, or to the work, to the organisation or to non-working contexts. Eight companies located in Portugal have participated in this study. Several semi-structured interviews were done to 16 organizational representatives and to 28 repatriates. The obtained results show that the repatriates’ retention on the visited companies may be influenced by several categories of factors. We can conclude that it is (1) the good relation with the leadership, (2) the recognition of the performed job but, also (3) the seniority, (4) the age and the (5) depressed national job market. These are the major factors that emerge as relevant factors for the retention. Hence, there is not only one category of explaining determining factors for the retention decision, but there are several. These findings will be discussed in detail and implications and suggestions for future research will be proposed as well.

Comunicação organizacional eficaz e tecnologias da informação e da comunicação

Tese de Doutoramento em Sociologia da Comunicação

Dificuldades encontradas no processo de internacionalização: estudo nas PME de mobiliário nos concelhos de Paços de Ferreira e Paredes

Dissertação de Mestrado apresentada ao Instituto Superior de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Auditoria, sob orientação do Mestre Adalmiro Álvaro Malheiro de Castro Andrade Pereira

Paleoclimatic and paleobiological correlations by mammal faunas from Southern America and SW Europe

Proceedings of the 1" R.C.A.N.S. Congress, Lisboa, October 1992

Role of SPARC in Bone Remodeling and Cancer‐Related Bone Metastasis

There is a growing socioeconomic recognition that clinical bone diseases such as bone infections, bone tumors and osteoporotic bone loss mainly associated with ageing, are major issues in today0s society. SPARC (secreted protein, acidic and rich in cysteine), a matricellular glycoprotein, may be a promising therapeutic target for preventing or treating bone‐related diseases. In fact, SPARC is associated with tissue remodeling, repair, development, cell turnover, bone mineralization and may also participate in growth and progression of tumors, namely cancer‐related bone metastasis. Yet, the function of SPARC in such biological processes is poorly understood and controversial. The main objective of this work is to review the current knowledge related to the activity of SPARC in bone remodeling, tumorigenesis, and bone metastasis. Progress in understanding SPARC biology may provide novel strategies for bone regeneration and the development of anti‐angiogenic, anti‐proliferative, or counter‐adhesive treatments specifically against bone metastasis.

Catalytic activity of a benzoyl hydrazone based dimeric dicopper(II) complex in catechol and alcohol oxidation reactions

The benzoyl hydrazone based dimeric dicopper(II) complex [Cu2(R)(CH3O)(NO3)]2(CH3O)2 (R-Cu2+), recently reported by us, catalyzes the aerobic oxidation of catechols (catechol (S1), 3,5- itertiarybutylcatechol (S2) and 3-nitrocatechol (S3)) to the corresponding quinones (catecholase like activity), as shown by UV–Vis absorption spectroscopy in methanol/HEPES buffer (pH 8.2) medium at 25 C. The highest activity is observed for the substituted catechol (S2) with the electron donor tertiary butyl group, resulting in a turnover frequency (TOF) value of 1.13 103 h1. The complex R-Cu2+ also exhibits a good catalytic activity in the oxidation (without added solvent) of 1-phenylethanol to acetophenone by But OOH under low power (10 W) microwave (MW) irradiation. 2014 Elsevier B.V. All rights reserved.

Greener Selective Cycloalkane Oxidations with Hydrogen Peroxide Catalyzed by Copper-5-(4-pyridyl)tetrazolate Metal-Organic Frameworks

Microwave assisted synthesis of the Cu(I) compound [Cu(µ4-4-ptz)]n [1, 4-ptz = 5-(4-pyridyl)tetrazolate] has been performed by employing a relatively easy method and within a shorter period of time compared to its sister compounds. The syntheses of the Cu(II) compounds [Cu3(µ3-4-ptz)4(µ2-N3)2(DMF)2]n∙(DMF)2n (2) and [Cu(µ2-4-ptz)2(H2O)2]n (3) using a similar method were reported previously by us. MOFs 1-3 revealed high catalytic activity toward oxidation of cyclic alkanes (cyclopentane, -hexane and -octane) with aqueous hydrogen peroxide, under very mild conditions (at room temperature), without any added solvent or additive. The most efficient system (2/H2O2) showed, for the oxidation of cyclohexane, a turnover number (TON) of 396 (TOF of 40 h−1), with an overall product yield (cyclohexanol and cyclohexanone) of 40% relative to the substrate. Moreover, the heterogeneous catalytic systems 1–3 allowed an easy catalyst recovery and reuse, at least for four consecutive cycles, maintaining ca. 90% of the initial high activity and concomitant high selectivity.

Hydrogenating activity of Pt/zeolite catalysts focusing acid support and metal dispersion influence

Toluene hydrogenation was studied over catalysts based on Pt supported on large pore zeolites (HUSY and HBEA) with different metal/acid ratios. Acidity of zeolites was assessed by pyridine adsorption followed by FTIR showing only small changes before and after Pt introduction. Metal dispersion was determined by H2–O2 titration and verified by a linear correlation with the intensity of Pt0–CO band obtained by in situ FTIR. It was also observed that the electronic properties of Pt0 clusters were similar for the different catalysts. Catalytic tests showed rapid catalyst deactivation with an activity loss of 80–95% after 60 min of reaction. The turnover frequency of fresh catalysts depended both on metal dispersion and the support. For the same support, it changed by a 1.7-fold (HBEA) and 4.0-fold (HUSY) showing that toluene hydrogenation is structure-sensitive, i.e. hydrogenating activity is not a unique function of accessible metal. This was proposed to be due to the contribution to the overall activity of the hydrogenation of adsorbed toluene on acid sites via hydrogen spillover. Taking into account the role of zeolite acidity, the catalysts series were compared by the activity per total adsorbing sites which was observed to increase steadily with nPt/(nPt + nA). An increase of the accessible Pt atoms leads to an increase on the amount of spilled over hydrogen available in acid sites therefore increasing the overall activity. Pt/HBEA catalysts were found to be more active per total adsorbing site than Pt/HUSY which is proposed to be due to an augmentation in the efficiency of spilled over hydrogen diffusion related to the proximity between Pt clusters and acid sites. The intervention of Lewis acid sites in a greater extent than that measured by pyridine adsorption may also contribute to this higher activity of Pt/HBEA catalysts. These results reinforce the importance of model reactions as a closer perspective to the relevant catalyst properties in reaction conditions.

Determinantes da estrutura de capitais do setor do calçado em Portugal

Dissertação de Mestrado apresentado ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Contabilidade e Finanças, sob orientação de Mestre Adalmiro Álvaro Malheiro de Castro Andrade Pereira

Projecto de sistema de fixação de punções para quinadoras hidráulicas

Mestrado em Engenharia Mecânica - Construções Mecânicas