Análise de custo de um programa de prevenção de internação para idosos no ambiente da saúde suplementar

Esta tese realiza uma análise de custo de um programa de prevenção de internação hospitalar para idosos (acima de 65 anos), no ambiente da saúde suplementar. Trata-se um programa voltado para idosos considerados de risco, de acordo com um questionário que avalia a probabilidade de risco de internação hospitalar. Indivíduos de risco são convidados a participar do programa, quando se estabelecem dois grupos: um que aceita a intervenção do programa (Grupo Bem Viver) e outro que recusa (Grupo Recusa). A intervenção do programa está voltada para o acompanhamento domiciliar, com equipe multidisciplinar, que se efetiva de acordo com uma estratificação, segundo a avaliação da dependência funcional para os indivíduos. Essa estratificação funcional divide os idosos do programa em cinco grupos distintos, denominados grupos funcionais. Indivíduos que recusam a intervenção mantêm a assistência com cuidado usual. A análise de custo é uma avaliação econômica parcial que estabelece uma comparação da utilização de serviços de saúde entre os dois grupos de idosos: um sob intervenção, grupo Bem Viver, e outro em cuidado usual, grupo Recusa. Esta análise foi realizada para um período dividido em 12 meses antes do evento (intervenção ou recusa) e 12 meses após o evento. Levantou-se a utilização de serviços de saúde de acordo com os indicadores de consultas, exames, procedimentos ambulatoriais, internações e consultas hospitalares. O custo do programa foi incluído também na análise final. Comparações foram estabelecidas entre os grupos no padrão de utilização, considerando-se os períodos antes e depois do evento. Os grupos funcionais foram analisados dentro da perspectiva da utilização para os mesmos períodos. Os resultados demonstraram que o grupo com adesão tem um grande percentual de indivíduos com dependência funcional, sugerindo que existe uma seleção adversa na aceitação do programa, quando indivíduos de maior risco têm adesão. Para o grupo sob intervenção, ocorreu um aumento da utilização com os serviços de saúde no conjunto de consultas, exames e procedimentos ambulatoriais, havendo diminuição com o custo unitário das internações hospitalares e consultas hospitalares. O grupo que recusa tem discreto aumento para o conjunto de consultas, exames e procedimentos ambulatoriais e um grande percentual de aumento para as internações (+40.2%) e consultas hospitalares (34.3%). Este resultado para internações foi analisado também através da transformação logarítmica, com uso da função inversa para a base de cálculo. Nesta aplicação estatística foi confirmado esse resultado para o padrão de utilização de internações. Na análise final, que incluiu o custo do programa propriamente dito, foi apresentada uma hipótese de avaliação para o grupo Bem Viver, sem a intervenção do programa. Desta maneira, realizou-se uma projeção para a utilização do grupo Bem Viver, a partir dos percentuais atingidos pelo grupo Recusa.

Using participant or non-participant observation to explain information behaviour

Cooper, J., Lewis, R. & Urquhart, C. (2004). Using participant or non-participant observation to explain information behaviour. Information Research, 9(4). Retrieved August 3, 2006 from http://informationr.net/ir/9-4/paper184.html Sponsorship: AHRC (Cooper).

Memoria-proyecto Unidad de Hospitalización “A” de cirugía ortopédica y rehabilitación neurológica

Este Trabajo Fin de Máster (TFM) propone la elaboración de una memoria proyecto de la unidad de hospitalización A de un centro monográfico de Cirugía Ortopédica y Traumatología (COT) integrado en un hospital general de nivel terciario. Se trata de una memoria con carácter retrospectivo que abarca desde Enero de 2013 hasta Diciembre de 2015. Una memoria que recoge un análisis de la situación junto con todos los aspectos de la nueva organización de la unidad y con propuestas de mejora futuras. Se realiza un análisis externo del modelo organizativo del sistema sanitario regional, del hospital general, de su centro monográfico de COT y de la unidad la cual está integrada en el mismo. El análisis interno ha supuesto una descripción pormenorizada de la unidad, tanto de espacio físico y recursos materiales como de recursos humanos y actividad asistencial junto con los cambios realizados en este periodo y las necesidades que se objetivan para los próximos años y que formarán el eje principal de la parte del proyecto de la presente memoria. Tras ambos análisis se realiza una matriz DAFO, método de ordenación de la información en cuatro categorías básicas: Debilidad, Amenaza, Fortaleza y Oportunidad, a partir del cual se iniciará un proceso de identificación de propuestas de mejora de cara a plantear acciones que se deberían poner en marcha para aprovechar las oportunidades detectadas y permitieran prepararse contra las amenazas teniendo conciencia de las debilidades y fortalezas.

A importância da qualidade de vida na Saúde Oral dos idosos

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

Context-aware real-time assistant architecture for pervasive healthcare

The aging population in many countries brings into focus rising healthcare costs and pressure on conventional healthcare services. Pervasive healthcare has emerged as a viable solution capable of providing a technology-driven approach to alleviate such problems by allowing healthcare to move from the hospital-centred care to self-care, mobile care, and at-home care. The state-of-the-art studies in this field, however, lack a systematic approach for providing comprehensive pervasive healthcare solutions from data collection to data interpretation and from data analysis to data delivery. In this thesis we introduce a Context-aware Real-time Assistant (CARA) architecture that integrates novel approaches with state-of-the-art technology solutions to provide a full-scale pervasive healthcare solution with the emphasis on context awareness to help maintaining the well-being of elderly people. CARA collects information about and around the individual in a home environment, and enables accurately recognition and continuously monitoring activities of daily living. It employs an innovative reasoning engine to provide accurate real-time interpretation of the context and current situation assessment. Being mindful of the use of the system for sensitive personal applications, CARA includes several mechanisms to make the sophisticated intelligent components as transparent and accountable as possible, it also includes a novel cloud-based component for more effective data analysis. To deliver the automated real-time services, CARA supports interactive video and medical sensor based remote consultation. Our proposal has been validated in three application domains that are rich in pervasive contexts and real-time scenarios: (i) Mobile-based Activity Recognition, (ii) Intelligent Healthcare Decision Support Systems and (iii) Home-based Remote Monitoring Systems.

Numeracy skills for nurses: revision and review

Introduces a revision and working examples of the numeracy skills key to the role of nurses working with older people in nursing and residential homes.

El contexto y el centro residencial para las personas adultos mayores en Colombia y España. La empresa social una alternativa para el bienestar

La protección a los adultos o personas mayores se ha convertido en una política de Estado, esto debido al creciente registro de vulneración de los derechos de los mismos. Por lo tanto, conocer estas políticas gubernamentales y sociales que se encuentran vigentes, también el actual sistema de seguridad social y su cobertura para ésta población tanto en España y Colombia, así como su contexto legal y social, además de identificar los espacios donde un adulto mayor encuentra la alternativa de vivir y compartir sus años longevos, ya sea en los llamados hogares geriátricos, residencias o centros de atención a mayores, como también el papel que las empresas solidarias juegan en la oferta y demanda de un mercado donde el segmento del adulto mayor de acuerdo a las necesidades en este contexto, genera mayores demandas de productos y profesionales especializados con sentido social. Este tejido de relaciones en pro del Bienestar hacía el adulto mayor, conlleva a presentar los resultados parciales de una investigación realizada en hogares o residencias para personas mayores ubicados en Ávila, Madrid y Santiago de Cali.

The L Pack: Addressing the Sexual Health Needs of Young Lesbians

Concerns about the sexual health of women who identify as other than heterosexual have been highlighted in numerous research reports, yet access to information, advice and services remains limited within Northern Ireland. In response to this, a group of young women have produced a sexual health resource (‘‘The L Pack’’) specifically for those who identify as lesbian or bisexual. This article discusses the issue of lesbian sexual health and the rationale for the production of The L Pack. Drawing upon discussions with the young women involved and the various partners, it outlines the participatory process of producing information for young women by young women, the meaning and value of this and the nature of learning for all involved. Illustrating feminist and related principles through practice examples, the article outlines how the project moved from a focus on individual learning to one where the young women involved gained the knowledge, skills and confidence to take their learning to their peers and others.

Young Women’s Positive and Negative Perceptions of Self in Northern Ireland

This paper represents analysis of one aspect of a larger research project examining the everyday lives and experiences of young women in Northern Ireland. As an introductory exercise within focus groups, 48 young women considered and discussed the good and not so good things about being a young woman in Northern Ireland. Through these accounts many issues emerged, some in direct contrast and contradiction to one another. The area focused upon for the purpose of this paper is the body, particularly with regard to body image (self-expression versus pressure) and becoming a woman (growing up versus menarche). The aim is to illustrate that what young women cite as being potentially positive aspects of growing up or being a young woman often have negative experiences and implications attached to them. In light of the advancements made by young women in Northern Irish society, an opening of opportunities and their awareness of the persistence of gendered messages regarding their bodies, many young women are of the belief that such messages have less impact upon them today and that gender is a barrier that can be overcome. It is illustrated and argued here, however, that dominant cultural messages regarding women’s bodies are more subtle, confusing and perhaps pervasive than they ever have been. As a consequence, this has created more pressure and confusion for young women and tensions exist in terms of young women’s beliefs and their actions. In light of these research findings, this paper considers practice implications for those working with and for young women.

Possible futures for social work with children and families in Australia, the United Kingdom and the United States

There has been considerable interest in recent years in comparing the operation of social work services to children and families internationally, particularly between Australia, the United Kingdom and the United States. Reviewing the respective policy environments and drawing on recent research experience in these three nations the author speculates as to how such services may be placed to respond to a converging agenda to tackle the high social and economic costs of social exclusion. It is argued that a conspiracy of circumstances have led child and family social work away from its more general child welfare objectives of the past and created consolidation of functions in relation to child protection work. This has left services ill prepared to play a central role within a new and resurgent child welfare agenda.

The Impact of Engagement Processes on the First Appointment Attendance Rate at a Regional Outpatient Psychological Trauma Service.

The effectiveness of simple measures to increase attendance at first appointments is briefly reviewed. The Family Trauma Centre’s remit and pre-study engagement process are described. The perceived idiosyncratic aspects of inviting people suffering from psychological trauma to attend a clinical service are noted as contributory factors in initially tolerating a high first appointment DNA rate. Three new initial engagement processes are then described and results of their application to 30 referrals in total are presented. The overwhelming finding is that paying close attention to any of the three initial engagement processes significantly increases first appointment attendance. Based on these findings the Centre developed a new initial engagement protocol.. The principle that services should pay more attention to their engagement processes than on the characteristics of their client groups when seeking to reduce first appointment DNA rates is supported.

Do environmental and task characteristics matter in the control of externalized local public services? Unveiling the relevance of party characteristics and citizens’ offstage voice

Purpose: The purpose of this paper is to investigate the mechanisms adopted by cities to control the provision of externalized public services and to explore the determinants of such control choices.

Design/methodology/approach: The paper presents the results of a multiple case study based on the experiences of three cities and three public services (transport, solid waste collection and home care services for the elderly), where control mechanisms and their possible antecedents were analyzed.

Findings: The results show that the control models found in the cases analyzed do not correspond to the "pure" patterns described in the private sector literature and that the factors identified by management control contributions do not seem to be exhaustive in explaining the configuration of control systems in the public sector. While environmental and task characteristics only partially explain the adoption of certain configurations of control, the features of the control systems seem to be rather influenced by variables that are related to party characteristics.

Originality/value: The paper shows that the combinations of control mechanisms are more multifaceted than those presented in the literature, and that the factors identified in the private sector literature do not seem to explain comprehensively the configuration of control systems in the public sector. © Emerald Group Publishing Limited.

Upholding the convention on the rights of the child: a quandary in cyberspace

Put in place to protect the rights of the child, the Convention on the Rights of the Child is a set of non-negotiable standards. A core principle underpinning the Convention is the child's right to participate fully in social arenas and to access sources of social support without excessive interference. Juxtaposing this is the right of the child to be shielded from harm, abuse and exploitation. Over the past several decades the Internet has emerged as a fast and easily accessible medium for people to connect and communicate. While the Internet provides children with a source of support through chat rooms, online communities and social networking sites, just as equally it can expose vulnerable children to predatory and deviant individuals exacerbating the potential for harm. Upholding the Convention in cyberspace is a challenge. The Internet is not owned or regulated by any governing body and accountability is difficult to enforce. This article discusses some of the difficulties of upholding the Convention online and provides recommendations for policy-makers to protect children as they participate in cyberspace.