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.

Advances and challenges in oral health after a decade of the “Smiling Brazil” Program

ABSTRACT OBJECTIVE To analyze oral health work changes in primary health care after Brazil’s National Oral Health Policy Guidelines were released. METHODS A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. RESULTS Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people’s participation and social control; and intersectorial actions. CONCLUSIONS Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

Validation of an instrument to evaluate health promotion at schools

ABSTRACT OBJECTIVE To validate an instrument designed to assess health promotion in the school environment. METHODS A questionnaire, based on guidelines from the World Health Organization and in line with the Brazilian school health context, was developed to validate the research instrument. There were 60 items in the instrument that included 40 questions for the school manager and 20 items with direct observations made by the interviewer. The items’ content validation was performed using the Delphi technique, with the instrument being applied in 53 schools from two medium-sized cities in the South region of Brazil. Reliability (Cronbach’s alpha and split-half) and validity (principal component analysis) analyses were performed. RESULTS The final instrument remained composed of 28 items, distributed into three dimensions: pedagogical, structural and relational. The resulting components showed good factorial loads (> 0.4) and acceptable reliability (> 0.6) for most items. The pedagogical dimension identifies educational activities regarding drugs and sexuality, violence and prejudice, auto care and peace and quality of life. The structural dimension is comprised of access, sanitary structure, and conservation and equipment. The relational dimension includes relationships within the school and with the community. CONCLUSIONS The proposed instrument presents satisfactory validity and reliability values, which include aspects relevant to promote health in schools. Its use allows the description of the health promotion conditions to which students from each educational institution are exposed. Because this instrument includes items directly observed by the investigator, it should only be used during periods when there are full and regular activities at the school in question.

Promoting adverse drug reaction reporting: comparison of different approaches

ABSTRACT OBJECTIVE To describe different approaches to promote adverse drug reaction reporting among health care professionals, determining their cost-effectiveness. METHODS We analyzed and compared several approaches taken by the Northern Pharmacovigilance Centre (Portugal) to promote adverse drug reaction reporting. Approaches were compared regarding the number and relevance of adverse drug reaction reports obtained and costs involved. Costs by report were estimated by adding the initial costs and the running costs of each intervention. These costs were divided by the number of reports obtained with each intervention, to assess its cost-effectiveness. RESULTS All the approaches seem to have increased the number of adverse drug reaction reports. We noted the biggest increase with protocols (321 reports, costing 1.96 € each), followed by first educational approach (265 reports, 20.31 €/report) and by the hyperlink approach (136 reports, 15.59 €/report). Regarding the severity of adverse drug reactions, protocols were the most efficient approach, costing 2.29 €/report, followed by hyperlinks (30.28 €/report, having no running costs). Concerning unexpected adverse drug reactions, the best result was obtained with protocols (5.12 €/report), followed by first educational approach (38.79 €/report). CONCLUSIONS We recommend implementing protocols in other pharmacovigilance centers. They seem to be the most efficient intervention, allowing receiving adverse drug reactions reports at lower costs. The increase applied not only to the total number of reports, but also to the severity, unexpectedness and high degree of causality attributed to the adverse drug reactions. Still, hyperlinks have the advantage of not involving running costs, showing the second best performance in cost per adverse drug reactions report.

Use of the Brazilian People’s Pharmacy Program by older adults

ABSTRACT OBJECTIVE To assess the prevalence and factors associated with the use of the expanded Brazilian People’s Pharmacy Program among older adults and the reasons for not using it. METHODS In this population-based cross-sectional study conducted in the urban area of Pelotas, RS, Southern Brazil, we evaluated 1,305 older adults (aged 60 years or over) who had used medication in the last 15 days. Independent variables were socioeconomic factors, economic status, household income in minimum wages, educational attainment in years of schooling and occupational status. Demographic variables were sex, age, marital status, and self-reported skin color/race. Poisson regression was employed to analyze the factors associated with the use of the program. RESULTS The prevalence of use was 57.0% whilst the prevalence of knowledge of the program was 87.0%. In individuals aged 80 years or over, use of the program was 41.0%. As to the origin of the prescriptions used by older adults, 46.0% were from the Brazilian Unified Health System. The main reasons for not using the program were: difficulty in getting prescriptions, medication shortage, and ignorance about the medications offered and about the program. Higher age, lower income, presence of chronic diseases, and use of four or more medications were associated with use of the program. CONCLUSIONS It is necessary to expand the knowledge and use of the Brazilian People’s Pharmacy Program, especially among older adults, and to improve the dissemination of its list of medications to users and physicians. Thus it will be possible to reduce spending on long-term medications, which are especially important for this population.

Educational application of remote experimentation for mobile devices

In this article the authors describe the application development RExMobile and the importance of remote experimentation via mobile devices, especially smartphones simple, beyond the space provided for this application in education. The article deals the creation, software and hardware that provide an interactive and dynamic way to attract more students to use these experiments remote, serving as support to teachers to science teaching from its initial series. The ease and availability of smartphones, even these students of basic education, permits the reach of new users and in different places. Thus, the practice of remote experimentation in mobile devices enables new spaces for access and interaction. Are used for developing software free or low cost, HTML5 and jQuery Mobile framework, that enable the creation of pages compatible with different mobile operating systems such as iOS, Android, Windows Phone, some Symbian, among others. Also are demonstrated patterns layouts that allow greater accessibility.

Inclusion of children identified as having special educational needs (SEN) within the Austrian compulsory educational system

Este artigo pretende descrever vários aspetos da segregação, integração e inclusão dentro do sistema educativo obrigatório austríaco. Após uma introdução que contém definições e um resumo internacional, será brevemente descrito o sistema educativo da Áustria. Subsequentemente, três temas de interesse serão debatidos. Primeiro será caracterizada a situação atual referente à inclusão de crianças com necessidades educativas especiais. Esta situação difere bastante entre estados federais. Serão descritos os desenvolvimentos que conduziram à situação atual. Em segundo serão apresentados estudos empíricos recentes relativos ao movimento austríaco que almeja a inclusão. Em terceiro e a título exemplificativo serão apresentados em detalhe alguns desenvolvimentos recentes, alguns planos e visões futuras de três estados federais austríacos.

EduMCA: an approach to Educational Mobile Content Adaptation

As the variety of mobile devices connected to the Internet growts there is a correponding increase in the need to deliver content tailored to their heterogeneous characteristics. At the same time, we watch to the increase of e-learning in universities through the adoption of electronic platforms and standards. Not surprisingly, the concept of mLearning (Mobile Learning) appeared in recent years decreasing the limitation of learning location with the mobility of general portable devices. However, this large number and variety of Web-enabled devices poses several challenges for Web content creators who want to automatic get the delivery context and adapt the content to the client mobile devices. In this paper we analyze several approaches to defining delivery context and present an architecture for deliver uniform mLearning content to mobile devices denominated eduMCA - Educational Mobile Content Adaptation. With the eduMCA system the Web authors will not need to create specialized pages for each kind of device, since the content is automatically transformed to adapt to any mobile device capabilities from WAP to XHTML MP-compliant devices.

Seqins: a sequencing tool for educational resources

The teaching-learning process is increasingly focused on the combination of the paradigms “learning by viewing” and “learning by doing.” In this context, educational resources, either expository or evaluative, play a pivotal role. Both types of resources are interdependent and their sequencing would create a richer educational experience to the end user. However, there is a lack of tools that support sequencing essentially due to the fact that existing specifications are complex. The Seqins is a sequencing tool of digital resources that has a fairly simple sequencing model. The tool communicates through the IMS LTI specification with a plethora of e-learning systems such as learning management systems, repositories, authoring and evaluation systems. In order to validate Seqins we integrate it in an e-learning Ensemble framework instance for the computer programming learning.

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.

Sequencing educational resources with Seqins

Existing adaptive educational hypermedia systems have been using learning resources sequencing approaches in order to enrich the learning experience. In this context, educational resources, either expository or evaluative, play a central role. However, there is a lack of tools that support sequencing essentially due to the fact that existing specifications are complex. This paper presents Seqins as a sequencing tool of digital educational resources. Seqins includes a simple and flexible sequencing model that will foster heterogeneous students to learn at different rhythms. The tool communicates through the IMS Learning Tools Interoperability specification with a plethora of e-learning systems such as learning management systems, repositories, authoring and automatic evaluation systems. In order to validate Seqins we integrate it in an e-learning Ensemble framework instance for the computer programming learning domain.

Meta-analysis of gender and science research - Country report - Portugal

In Portugal, especially starting in the 1970s, women’s studies had implications on the emergency of the concept of gender and the feminist criticism to the prevailing models about differences between sexes. Until then, women had been absent from scientific research both as subject and as object. Feminism brought more reflexivity to the scientific thinking. After the 25th of April 1974, because of the consequent political openness, several innovating themes of research emerged, together with new concepts and fields of study. However, as far as gender and science relationship is concerned, such studies especially concentrate on higher education institutions. The feminist thinking seems to have two main objectives: to give women visibility, on the one hand, and to denunciate men’s domain in the several fields of knowledge. In 1977, the “Feminine Commission” is created and since then it has been publishing studies on women’s condition and contributing to the enhancement of the reflection of female condition at all levels. In the 1980s, the growing feminisation of tertiary education (both of students and academics), favoured the development of women’s studies, especially on their condition within universities with a special focus on the glass ceiling, despite the lack of statistical data by gender, thus making difficult the analysis of women integration in several sectors, namely in educational and scientific research activities. Other agglutinating themes are family, social and legal condition, work, education, and feminine intervention on political and social movements. In the 1990s, Women Studies are institutionalised in the academic context with the creation of the first Master in Women Studies in the Universidade Aberta (Open University), in Lisbon. In 1999, the first Portuguese journal of women studies is created – “Faces de Eva”. Seminars, conferences, thesis, journals, and projects on women’s studies are more and more common. However, results and publications are not so divulgated as they should be, because of lack of comprehensive and coordinated databases. 2. Analysis by topics 2.1. Horizontal and vertical segregation Research questions It is one of the main areas of research in Portugal. Essentially two issues have been considered: - The analysis of vertical gender segregation in educational and professional fields, having reflexes on women professional career progression with special attention to men’s power in control positions and the glass ceiling. - The analysis of horizontal segregation, special in higher education (teaching and research) where women have less visibility than men, and the under-representation of women in technology and technological careers. Research in this area mainly focuses on description, showing the under-representation of women in certain scientific areas and senior positions. Nevertheless, the studies that analyze horizontal segregation in the field of education adopt a more analytical approach which focuses on the analysis of the mechanisms of reproduction of gender stereotypes, especially socialisation, influencing educational and career choices. 1

ESEIG Mobile: an m-learning approach in a superior school

In recent years, mobile learning has emerged as an educational approach to decrease the limitation of learning location and adapt the teaching-learning process to all type of students. However, the large number and variety of Web-enabled devices poses challenges for Web content creators who want to automatic get the delivery context and adapt the content to mobile devices. This paper studies several approaches to adapt the learning content to mobile phones. It presents an architecture for deliver uniform m-Learning content to students in a higher School. The system development is organized in two phases: firstly enabling the educational content to mobile devices and then adapting it to all the heterogeneous mobile platforms. With this approach, Web authors will not need to create specialized pages for each kind of device, since the content is automatically transformed to adapt to any mobile device capabilities from WAP to XHTML MP-compliant devices.

Philodryas patagoniensis bite and local envenoming

A 5-year-old boy bitten by a specimen of Philodryas patagoniensis, a colubrid snake currently classified as nonvenomous, developed signs of local envenoming characterized by swelling and warmth on the bitten limb. This is the first time that local envenoming following Philodryas patagoniensis bite is recognized. Based on the clinical findings and misidentification of the snake, the patient was treated as a victim of Bothrops bite, having received unnecessarily the specific antivenom. Educational efforts to make doctors and health workers capable to identify correctly venomous snakes are necessary, to avoid inappropriate indication of antivenom and decrease the risk of its potentially harmful untoward effects. Examination of the bite site can be useful to the differential diagnosis between pit viper and colubrid bites.

Determinants of frailty: the added value of assessing medication

This study aims to analyze which determinants predict frailty in general and each frailty domain (physical, psychological, and social), considering the integral conceptual model of frailty, and particularly to examine the contribution of medication in this prediction. A cross-sectional study was designed using a non-probabilistic sample of 252 community-dwelling elderly from three Portuguese cities. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator. The amount and type of different daily-consumed medication were also examined. Hierarchical regression analysis were conducted. The mean age of the participants was 79.2 years (±7.3), and most of them were women (75.8%), widowed (55.6%) and with a low educational level (0–4 years: 63.9%). In this study, determinants explained 46% of the variance of total frailty, and 39.8, 25.3, and 27.7% of physical, psychological, and social frailty respectively. Age, gender, income, death of a loved one in the past year, lifestyle, satisfaction with living environment and self-reported comorbidity predicted total frailty, while each frailty domain was associated with a different set of determinants. The number of daily-consumed drugs was independently associated with physical frailty, and the consumption of medication for the cardiovascular system and for the blood and blood-forming organs explained part of the variance of total and physical frailty. The adverse effects of polymedication and its direct link with the level of comorbidities could explain the independent contribution of the amount of prescribed drugs to frailty prediction. On the other hand, findings in regard to medication type provide further evidence of the association of frailty with cardiovascular risk. In the present study, a significant part of frailty was predicted, and the different contributions of each determinant to frailty domains highlight the relevance of the integral model of frailty. The added value of a simple assessment of medication was considerable, and it should be taken into account for effective identification of frailty.