The importance of environmental sustainability in public procurement of medical devices in health care sector

The aim of this thesis was to examine the role of environmental sustainability in the procurement of medical devices in health care sector. Current literature is mainly focused on other product groups and medical devices have been left without sufficient attention. Nevertheless, EU has recently developed green public procurement criteria for medical devices (EU GPP criteria for health care EEE) in order to support and offer guidelines for purchasers in hospitals. In this study, the criteria were used as a framework in order to examine the most significant environmental aspects for medical devices. The empirical research was executed in Finnish public hospitals with mixed method approach; quantitative data was collected by a survey and qualitative data was collected by interviews held for procurement specialists. The focus was on understanding the importance of environmental sustainability in the procurement of medical devices and which environmentally sustainable features would be the most significant. Of interest was also the medical device supplier view and how they could take environmental sustainability into consideration.

Partnering Strategies for Fitness Evaluation in a Pyramidal Evolutionary Algorithm

This paper combines the idea of a hierarchical distributed genetic algorithm with different inter-agent partnering strategies. Cascading clusters of sub-populations are built from bottom up, with higher-level sub-populations optimising larger parts of the problem. Hence higher-level sub-populations search a larger search space with a lower resolution whilst lower-level sub-populations search a smaller search space with a higher resolution. The effects of different partner selection schemes for (sub-)fitness evaluation purposes are examined for two multiple-choice optimisation problems. It is shown that random partnering strategies perform best by providing better sampling and more diversity.

Estimation of whole body muscle, adipose/fat mass, validation in health and during weight loss. Development of prediction equations using MRI as reference method

Background: Body composition is affected by diseases, and affects responses to medical treatments, dosage of medicines, etc., while an abnormal body composition contributes to the causation of many chronic diseases. While we have reliable biochemical tests for certain nutritional parameters of body composition, such as iron or iodine status, and we have harnessed nuclear physics to estimate the body’s content of trace elements, the very basic quantification of body fat content and muscle mass remains highly problematic. Both body fat and muscle mass are vitally important, as they have opposing influences on chronic disease, but they have seldom been estimated as part of population health surveillance. Instead, most national surveys have merely reported BMI and waist, or sometimes the waist/hip ratio; these indices are convenient but do not have any specific biological meaning. Anthropometry offers a practical and inexpensive method for muscle and fat estimation in clinical and epidemiological settings; however, its use is imperfect due to many limitations, such as a shortage of reference data, misuse of terminology, unclear assumptions, and the absence of properly validated anthropometric equations. To date, anthropometric methods are not sensitive enough to detect muscle and fat loss. Aims: The aim of this thesis is to estimate Adipose/fat and muscle mass in health disease and during weight loss through; 1. evaluating and critiquing the literature, to identify the best-published prediction equations for adipose/fat and muscle mass estimation; 2. to derive and validate adipose tissue and muscle mass prediction equations; and 3.to evaluate the prediction equations along with anthropometric indices and the best equations retrieved from the literature in health, metabolic illness and during weight loss. Methods: a Systematic review using Cochrane Review method was used for reviewing muscle mass estimation papers that used MRI as the reference method. Fat mass estimation papers were critically reviewed. Mixed ethnic, age and body mass data that underwent whole body magnetic resonance imaging to quantify adipose tissue and muscle mass (dependent variable) and anthropometry (independent variable) were used in the derivation/validation analysis. Multiple regression and Bland-Altman plot were applied to evaluate the prediction equations. To determine how well the equations identify metabolic illness, English and Scottish health surveys were studied. Statistical analysis using multiple regression and binary logistic regression were applied to assess model fit and associations. Also, populations were divided into quintiles and relative risk was analysed. Finally, the prediction equations were evaluated by applying them to a pilot study of 10 subjects who underwent whole-body MRI, anthropometric measurements and muscle strength before and after weight loss to determine how well the equations identify adipose/fat mass and muscle mass change. Results: The estimation of fat mass has serious problems. Despite advances in technology and science, prediction equations for the estimation of fat mass depend on limited historical reference data and remain dependent upon assumptions that have not yet been properly validated for different population groups. Muscle mass does not have the same conceptual problems; however, its measurement is still problematic and reference data are scarce. The derivation and validation analysis in this thesis was satisfactory, compared to prediction equations in the literature they were similar or even better. Applying the prediction equations in metabolic illness and during weight loss presented an understanding on how well the equations identify metabolic illness showing significant associations with diabetes, hypertension, HbA1c and blood pressure. And moderate to high correlations with MRI-measured adipose tissue and muscle mass before and after weight loss. Conclusion: Adipose tissue mass and to an extent muscle mass can now be estimated for many purposes as population or groups means. However, these equations must not be used for assessing fatness and categorising individuals. Further exploration in different populations and health surveys would be valuable.

Representativeness, legitimacy and power in public involvement in health-care management

Public participation in health-service management is an increasingly prominent policy internationally. Frequently, though, academic studies have found it marginalized by health professionals who, keen to retain control over decision-making, undermine the legitimacy of involved members of the public, in particular by questioning their representativeness. This paper examines this negotiation of representative legitimacy between staff and involved users by drawing on a qualitative study of service-user involvement in pilot cancer-genetics services recently introduced in England, using interviews, participant observation and documentary analysis. In contrast to the findings of much of the literature, health professionals identified some degree of representative legitimacy in the contributions made by users. However, the ways in which staff and users constructed representativeness diverged significantly. Where staff valued the identities of users as biomedical and lay subjects, users themselves described the legitimacy of their contribution in more expansive terms of knowledge and citizenship. My analysis seeks to show how disputes over representativeness relate not just to a struggle for power according to contrasting group interests, but also to a substantive divergence in understanding of the nature of representativeness in the context of state-orchestrated efforts to increase public participation. This divergence might suggest problems with the enactment of such aspirations in practice; alternatively, however, contestation of representative legitimacy might be understood as reflecting ambiguities in policy-level objectives for participation, which secure implementation by accommodating the divergent constructions of those charged with putting initiatives into practice.

The socioeconomic gradient in health: The role of intra-household resource allocation

This paper aims to analyse the impact of different household financial regimes on the health status of males and females in a number of European countries. Using the EU-SILC 2010 on intra-household sharing of resources, we find that each member of the couple is worse off if his/her partner has most decision-making responsibilities. Additionally, the presence of children in the household plays a role in the effect that household financial regimens exert on individual self-assessed health, especially among females. We conclude that family arrangements regarding resource allocation and decision-making have important consequences and should be given some attention in the task of identifying individuals predisposed to health problems.

Transdiscipline and research in health: Science, society and decision making

Significant advances in science should be given to addressing the needs of society and the historical context of the territories. Although technological developments that began with modernity and the industrial revolution allowed human beings to control the resources of nature to put to your service without limits, it is clear that the crisis of the prevailing development models manifest themselves in many ways but with three common denominators: environmental degradation, social injustice and extreme poverty. Consequently, today should not be possible to think a breakthrough in the development of science without addressing global environmental problems and the deep social injustices that increase at all scales under the gaze, impassively in many occasions, of formal science.

Retinal Macroglial Responses in Health and Disease

Due to their permanent and close proximity to neurons, glial cells perform essential tasks for the normal physiology of the retina. Astrocytes andM¨uller cells (retinal macroglia) provide physical support to neurons and supplement them with several metabolites and growth factors.Macroglia are involved in maintaining the homeostasis of extracellular ions and neurotransmitters, are essential for information processing in neural circuits, participate in retinal glucose metabolism and in removing metabolic waste products, regulate local blood flow, induce the blood-retinal barrier (BRB), play fundamental roles in local immune response, and protect neurons from oxidative damage. In response to polyetiological insults, glia cells react with a process called reactive gliosis, seeking to maintain retinal homeostasis. When malfunctioning, macroglial cells can become primary pathogenic elements. A reactive gliosis has been described in different retinal pathologies, including age-related macular degeneration (AMD), diabetes, glaucoma, retinal detachment, or retinitis pigmentosa. A better understanding of the dual, neuroprotective, or cytotoxic effect of macroglial involvement in retinal pathologies would help in treating the physiopathology of these diseases.The extensive participation of the macroglia in retinal diseases points to these cells as innovative targets for new drug therapies.

Ethical-moral courses of action and active citizenship in health students

Abstract Introduction: The practice of active citizenship, ethical-moral courses of action and civic, moral and ethics education are essentials for ethical decision making in health. Objetive: To determine if gender influences students’ ethical- moral course of action. Methods: Descriptive study with a non-probabilistic sample of 85 students enrolled in the 1st cycle of the health degree. Results: Of the participants surveyed 61.2% were found to say that action should take into account their moral principles, with ethical/ moral subjectivism prevailing; 44.7% consider that one should “Do what will have the best consequences for the greatest number of people”, with the principle of utilitarianism being significant; 55.3% think that “An action is ethically good” if “It is in accordance with morality”, thereby highlighting subjectivism/relativism; 45.9% believe that “ethical-moral values” “are relative and vary from society to society” agreeing with relativism as an explanatory principle for action. Males showed a greater tendency to support their decision-making with the principle of objectivism, (Fischer=.010). Conclusion: The results suggest that students’ ethical-moral education is required to promote an ethical-moral course of action in their professional practice. Thus, universities with their health courses should be at the forefront of this education, making their graduates ambassadors/interveners of a way of knowing and of being as well as promoters of the dignity of the citizen of the modern world.

Balance evaluation in haemophilic preadolescent patients using Nintendo Wii Balance Board®

Introduction: Alterations in the musculoskeletal system, especially in the lower limbs, limit physical activity and affect balance and walking. Postural impairments in haemophilic preteens could increase the risk of bleeding events and deteriorate the physical condition, promoting the progression of haemophilic arthropathy. Aim: This study aims to evaluate static postural balance in haemophilic children, assessed by means of the Wii Balance Board® (WBB). Methods: Nineteen children with haemophilia and 19 without haemophilia aged 9-10 years, have participated in this study. Postural balance was assessed by performing four tests, each one lasting 15 s: bipodal eyes open (BEO), bipodal eyes closed (BEC), monopodal dominant leg (MD) and monopodal non-dominant leg (MND). Two balance indices, standard deviation of amplitude (SDA) and standard deviation of velocity (SDV) were calculated in the anterior-posterior (AP) and medial-lateral (ML) directions. Results: Index values were higher in haemophilic group and the differences were statistically significant (P < 0.05) in only six (SDAAP in BEO, BEC and MD conditions, SDAML in BEO, SDVAP in BEO and SDVML in MND condition) of 16 parameters analysed. Conclusion: Tests performed indicate a poorer static postural balance in the haemophilic cohort compared to the control group. Accordingly, physiotherapy programmes, physical activity and sports should be designed to improve the postural balance with the aim of preventing joint deterioration and improving quality of life. © 2016 John Wiley & Sons Ltd.

MEF2C: expression, regulation and interaction with target genes in health and diseases

Tese de doutoramento, Ciências Biomédicas, Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 2015

Reliability of Tethered Swimming Evaluation in Age Group Swimmers

The aim of the present study was to examine the reliability of tethered swimming in the evaluation of age group swimmers. The sample was composed of 8 male national level swimmers with at least 4 years of experience in competitive swimming. Each swimmer performed two 30 second maximal intensity tethered swimming tests, on separate days. Individual force-time curves were registered to assess maximum force, mean force and the mean impulse of force. Both consistency and reliability were very strong, with Cronbach’s Alpha values ranging from 0.970 to 0.995. All the applied metrics presented a very high agreement between tests, with the mean impulse of force presenting the highest. These results indicate that tethered swimming can be used to evaluate age group swimmers. Furthermore, better comprehension of the swimmers ability to effectively exert force in the water can be obtained using the impulse of force. Key words: swimming, training and testing, propulsive force, front crawl.

Sugarcane herbicide leaching risk evaluation in Guarany Aquifer.

he region of Ribeirão Preto, São Paulo State, Brazil, is located over recharge area of the Guarany aquifer, the most important source of groundwater in the South Central region of the country. This region is also the most important sugarcane producing area of the country which produces a large amount of the ethanol. This study was conducted to determine the potential risk of herbicide groundwater contamination. The leaching risk potential of herbicides to groundwater was conducted using the weather simulator ?Weather Generator? (WGEN) coupled with the model ?Chemical Movement Trough Layered Soils? (CMLS94). The following herbicides were evaluated in clayey and sandy soils (Typic Haplorthox and Typic Quartzipsamment soils) found in the region: ametryn (N-ethyl-N\'-(1- methylethyl)-6-(methylthio)-1,3,5-triazine-2,4-diamine), atrazine (6-chloro-N-ethyl-N\'-(1-methylethyl)-1,3,5-triazine- 2,4-diamine), clomazone (2-[(2-chlorophenyl)methyl]-4,4-dimethyl-3-isoxazolidinone), diuron (3,4-dichlorophenyl)- N,N-dimethylurea), halosulfuron (3-chloro-5-[(4,6-dimethoxy-2-pyrimidinyl)amino]carbonyl], hexazinone (3- cyclohexyl-6-(dimethylamino)-1-methyl-1,3,5-triazine-2,4 (1H,3H)-dione), imazapic ((±)-2-[4,5-dihydro-4-methyl-4- (1-methylethyl)-5-oxo-1H-imidazol-2-yl]-5-methyl-3-pyridinecarboxylic acid), imazapyr ((±)-2-[4,5-dihydro-4-methyl- 4-(1-methylethyl)-5-oxo-1H-imidazol-2-yl]-3-pyridinecarboxylic acid), MCPA (4-chloro-2-methylphenoxy)acetic acid), metribuzin (4-amino-6-(1,1-dimethylethyl)-3-(methylthio)-1,2,4-triazin-5(4H)-one), MSMA (Amonosodium salt of MAA), paraquat (1,1\'-dimethyl-4,4\'-bipyridinium ion), pendimethalin (N-(1-ethylpropyl)-3,4-dimethyl-2,6- dinitrobenzenamine), picloram (4-amino-3,5,6-trichloro-2-pyridinecarboxylic acid), simazine (6-chloro-N,N\'-diethyl- 1,3,5-triazine-2,4-diamine), sulfentrazone [N-[2,4-dichloro-5-[4-(difluoromethyl)-4,5-dihydro-3-methyl-5-oxo-1H- 1,2,4-triazol-1-yl]phenyl]methanesulfonamide], and tebuthiuron [N-[5-(1,1-dimethylethyl)-1,3,4-thiadiazol-2-yl]-N,N\'- dimethylurea]. Results obtained by our simulation study have shown that the herbicides picloram, tebuthiuron, and metribuzin have the highest leaching potential, in either sandy or clayey soils, with picloram reaching the root zone of sugarcane at 0.6m in less than 150 days.