Os custos das fracturas de etiologia osteoporótica em mulheres : institucionalização na Rede Nacional de Cuidados Continuados (RNCCI) e lares de 3ª idade

RESUMO - Contexto: A osteoporose é uma doença sistémica associada à diminuição da resistência óssea que condiciona o aparecimento de fracturas por traumatismos de baixa energia as quais reduzem em muitos casos a esperança e a qualidade de vida, implicando um elevado número de horas de dedicação dos cuidadores e conduzindo, em muitos casos, à necessidade de institucionalização dos doentes. Em Portugal, ocorrem cerca de 40.000 fracturas anualmente, das quais 8.500 do fémur proximal, que se estima consumirem mais de 50 milhões de euros só em cuidados hospitalares1. Objectivo: Avaliar o impacto económico da institucionalização na Rede Nacional de Cuidados Continuados Integrados e Lares da 3ª idade por fractura de etiologia osteoporótica em mulheres no ano 2009, em Portugal. Métodos: O estudo começa por analisar sucintamente os aspectos clínicos, sociais e epidemiológicos da osteoporose, focando a perda de autonomia e qualidade de vida dos doentes vítimas deste episódio e a subsequente necessidade de institucionalização. Descrevem-se os custos associados à institucionalização na RNCCI, em Portugal, ano 2009, utilizando como fonte principal a base de dados da instituição “Gestcare CCI”, complementada com dados da literatura. Apuram-se os custos totais associados ao encaminhamento dos doentes para Lares de 3ª Idade em Portugal no ano 2009, utilizando-se informação proveniente de um painel de Delphi modificado e dados da literatura. A valorização dos recursos tem por base os preços em vigor no território nacional, expressos nos decretos-lei devidamente referenciados. Resultados: No ano 2009 em Portugal foram empregues cerca de 2,5 milhões de euros no internamento das mulheres na RNCCI, na perspectiva da sociedade, sendo cerca de 2,2 milhões atribuíveis à osteoporose (90%). Cerca de 91% dos custos totais são alocados à fractura osteoporótica da anca (2 milhões €). Para a fractura vertebral, úmero e punho os custos foram mais baixos - 7,1%, 1,3% e 1% dos custos totais da osteoporose, respectivamente. Nos Lares de 3ª idade, estimou-se a admissão de aproximadamente 14.372 doentes com fractura osteoporótica em diferentes localizações, em 2009, Portugal, com um custo que oscilou entre os 19 e os 21,6 milhões de euros. A fractura osteoporótica da anca foi a mais incidente e a que representou custos mais elevados para a Segurança Social – entre 17,5 e 19,7 milhões de euros. Considerando como referência os 52 milhões de euros gastos em 2006 no tratamento hospitalar da fractura da anca (DGS, 2006), o encaminhamento das mulheres para a RNCCI e Lares da 3ª Idade corresponde a 42% do bolo total. Assim, os resultados nacionais enquadram-se no que se encontra descrito na literatura internacional - os custos atribuíveis à hospitalização oscilaram entre 17%50 e 63%29 da despesa total da doença e das institucionalizações entre os 16%58 e os 59%51. Conclusões: Em Portugal o impacto económico da institucionalização por fractura osteoporótica, sobretudo por fractura da anca, não é desprezável e mostra que existiriam poupanças significativas se fosse possível reduzir a prevalência da doença em Portugal. Face às alterações demográficas associadas ao envelhecimento da população, é expectável que a incidência e custos com o tratamento das fracturas do colo do fémur, mais associadas à osteoporose, venham a subir nos próximos anos, pelo que o combate à doença deve ser considerada uma prioridade nacional. A decisão pela opção por determinados programas de prevenção da doença ou da comparticipação ou não de determinada terapêutica necessita contudo de ser complementada com a medição da dimensão dos benefícios terapêuticos. --- ABSTRACT - Background: Osteoporosis is a systemic disease associated with the loss off the bone strength and it is one of the major causes of low energy fractures, which in many cases reduce life hope and quality. This happens because it has associated extensive treatments and it usually carries loss of independence, implying many hours of caregivers dedication and leading, in many cases, to the institutionalization of the patients. In Portugal, about 40,000 fractures occur annually, which 8,500 are proximal femur, and that are estimated to consume over 50 million euros only in hospital care. Objective: Evaluate the economic impact of institutionalization on the Integrated Continued Care National Network (RNCCI) and Care Homes associated to osteoporotic fractures in women, in the year 2009 in Portugal. Methods: The study begins by reviewing briefly the clinical, social, and epidemiological studies of osteoporosis and osteoporotic fractures, focusing on the patient autonomy loss and life quality. The total and average costs per episode associated with the institutionalization in RNCCI are described, in Portugal, year 2009, using as main data source the application "Gestcare CCI", complemented with literature data. The total costs associated with the patients referral for the Care Homes in Portugal in 2009 is also calculated, using information from a modified Delphi panel and some literature data. The resources valuation is based on prices prevailing in Portugal. Results: In 2009, women relocation in RNCCI consumed approximately 2.5 million euros, which 2.2 million are attributable to osteoporosis (90%). About 91% of the total costs are allocated to osteoporotic hip fracture (€ 2 million). For vertebral, humerus, and wrist fracture, the associated costs were lower, 7.1%, 1.3%, and 1% of total costs of osteoporosis treatment, respectively. In Care Homes, an intake of approximately 14 372 patients with osteoporotic fracture was estimated, at a cost that is between 19 and 21.6 million euros. The osteoporotic hip fracture was the most frequent and represented higher costs for Social Security - between 17.5 and 19.7 million euros. Taking as reference the 52 million spent in 2006 with hospital treatment of hip fracture (DGS, 2006), referring women to RNCCI and Care Homes represents 42% of the total costs. The results are in accordance with the international literature - costs attributable to hospitalization ranged between 17% and 63% of total expenditure of illness and institutionalization between 16% and 59%. Conclusions: In Portugal, the economic impact of institutionalization for osteoporotic fracture, particularly for hip fracture, is not negligible. It was shown that there would be significant savings if it were possible to reduce the prevalence of the disease in Portugal. Femoral fractures were the second most frequent diagnosis in RNCCI in 2008 and 2009 (16% of all episodes recorded). The execution of RNCCI in 2008 was 75 million euros, and 2.7% consumed by hip fracture and 0.3% by wrist, humerus, and spine fractures. The average cost per episode in 2009, from the perspective of society, for hip fracture, vertebral, humerus, and wrist (or non-osteoporotic) was € 5,195, € 5,160, € 5,030, and € 4,854 respectively. Thus, considering an average cost per episode in RNCCI from January to March of 3230€, the expense related to the treatment of these patients in RNCCI in 2009 was higher. For the Care Homes, an intake of approximately 14 372 patients with osteoporotic fracture in 2009 was estimated, at a cost to Social Security that ranged from 19 to 21.6 million €. The osteoporotic hip fracture was the most frequent and it was shown to absorve higher resources from Social Security - between 17.5 and 19.7 million €. This was followed by the analysis of vertebral and humerus fracture and the results showed that these fractures have a low incidence and low proportion of institutionalization, with a significantly lower cost - only about 4.7% and 3.3% of total expenditure, respectively. With demographic changes associated to ageing, it is expected that the incidence and treatment cost of the femoral neck fractures, more commonly associated with osteoporosis, will climb in coming years, so the fight against the disease should be considered a national priority. The decision to choose a certain disease prevention program or to reimburse a certain drug not should only account about the costs, but also the benefits of it. In fact, the size and impact of this problem, makes it necessary to focus all interventions in the prevention of these episodes either by using an appropriate therapy, either through real programs for disease prevention. Once the problem is installed, we must measure the health gains associated with the patient institutionalization by conducting additional research.

Ferramentas de gestão de redes e classificação de tráfego: estudo de um caso

A gestão de redes informáticas converteu-se num fator vital para uma rede operar de forma eficiente, produtiva e lucrativa. A gestão envolve a monitorização e o controlo dos sistemas para que estes funcionam como o pretendido, ações de configuração, monitorização, reconfiguração dos componentes, são essenciais para o objetivo de melhorar o desempenho, diminuir o tempo de inatividade, melhor a segurança e efetuar contabilização. Paralelamente, a classificação de tráfego é um tema de bastante relevância em várias atividades relacionadas com as redes, tais como a previsão de QoS, segurança, monitorização, contabilização, planeamento de capacidade de backbones e deteção de invasão. A variação de determinados tipos de tráfego pode influenciar, decisões técnicas na área da gestão de redes, assim como decisões políticas e sociais. Neste trabalho pretende-se desenvolver um estudo dos vários protocolos, ferramentas de gestão e de classificação de tráfego disponíveis para apoiar a atividade de gestão. O estudo efetuado terminou com a proposta e implementação de uma solução de gestão adequado a um cenário real, bastante rico na diversidade de tecnologias e sistemas.

Segurança da Informação na Escola Pública

A função da escola é promover a aprendizagem nos jovens e estimular o acesso ao conhecimento. A utilização das TI proporciona um acesso mais rápido ao conhecimento mas, sem os mecanismos necessários, pode originar perdas e comprometer a segurança da informação. A ausência de legislação e de regulamentação que ajude na manutenção da rede informática da escola, coloca-as numa posição muito vulnerável, obrigando-as a agir individualmente de modo a suprimir esta carência. A solução passa não só pela consciencialização dos utilizadores para a necessidade de segurança, mas também pela criação de mecanismos que permitam acrescentar segurança à rede e à própria informação. Os projetos desenvolvidos pelo programa Safer Internet e pela ISECOM atuam junto da comunidade escolar, sensibilizando os utilizadores para a necessidade de segurança na Internet e nas comunicações. Por sua vez, a adoção de práticas seguras é um processo mais demorado mas exequível através da implementação de uma política de segurança da informação adaptada à realidade da escola, de acordo com a norma ISO 27001. Da recolha de opinião aos intervenientes do sistema resultaram dois documentos com a política de segurança da informação, um direcionado às escolas e outro aos utilizadores. Crê-se que a adoção destas recomendações pelas escolas pode trazer benefícios ao nível da segurança da informação.

Electricity markets modeling considering complex contracts and aggregators

All over the world, the liberalization of electricity markets, which follows different paradigms, has created new challenges for those involved in this sector. In order to respond to these challenges, electric power systems suffered a significant restructuring in its mode of operation and planning. This restructuring resulted in a considerable increase of the electric sector competitiveness. Particularly, the Ancillary Services (AS) market has been target of constant renovations in its operation mode as it is a targeted market for the trading of services, which have as main objective to ensure the operation of electric power systems with appropriate levels of stability, safety, quality, equity and competitiveness. In this way, with the increasing penetration of distributed energy resources including distributed generation, demand response, storage units and electric vehicles, it is essential to develop new smarter and hierarchical methods of operation of electric power systems. As these resources are mostly connected to the distribution network, it is important to consider the introduction of this kind of resources in AS delivery in order to achieve greater reliability and cost efficiency of electrical power systems operation. The main contribution of this work is the design and development of mechanisms and methodologies of AS market and for energy and AS joint market, considering different management entities of transmission and distribution networks. Several models developed in this work consider the most common AS in the liberalized market environment: Regulation Down; Regulation Up; Spinning Reserve and Non-Spinning Reserve. The presented models consider different rules and ways of operation, such as the division of market by network areas, which allows the congestion management of interconnections between areas; or the ancillary service cascading process, which allows the replacement of AS of superior quality by lower quality of AS, ensuring a better economic performance of the market. A major contribution of this work is the development an innovative methodology of market clearing process to be used in the energy and AS joint market, able to ensure viable and feasible solutions in markets, where there are technical constraints in the transmission network involving its division into areas or regions. The proposed method is based on the determination of Bialek topological factors and considers the contribution of the dispatch for all services of increase of generation (energy, Regulation Up, Spinning and Non-Spinning reserves) in network congestion. The use of Bialek factors in each iteration of the proposed methodology allows limiting the bids in the market while ensuring that the solution is feasible in any context of system operation. Another important contribution of this work is the model of the contribution of distributed energy resources in the ancillary services. In this way, a Virtual Power Player (VPP) is considered in order to aggregate, manage and interact with distributed energy resources. The VPP manages all the agents aggregated, being able to supply AS to the system operator, with the main purpose of participation in electricity market. In order to ensure their participation in the AS, the VPP should have a set of contracts with the agents that include a set of diversified and adapted rules to each kind of distributed resource. All methodologies developed and implemented in this work have been integrated into the MASCEM simulator, which is a simulator based on a multi-agent system that allows to study complex operation of electricity markets. In this way, the developed methodologies allow the simulator to cover more operation contexts of the present and future of the electricity market. In this way, this dissertation offers a huge contribution to the AS market simulation, based on models and mechanisms currently used in several real markets, as well as the introduction of innovative methodologies of market clearing process on the energy and AS joint market. This dissertation presents five case studies; each one consists of multiple scenarios. The first case study illustrates the application of AS market simulation considering several bids of market players. The energy and ancillary services joint market simulation is exposed in the second case study. In the third case study it is developed a comparison between the simulation of the joint market methodology, in which the player bids to the ancillary services is considered by network areas and a reference methodology. The fourth case study presents the simulation of joint market methodology based on Bialek topological distribution factors applied to transmission network with 7 buses managed by a TSO. The last case study presents a joint market model simulation which considers the aggregation of small players to a VPP, as well as complex contracts related to these entities. The case study comprises a distribution network with 33 buses managed by VPP, which comprises several kinds of distributed resources, such as photovoltaic, CHP, fuel cells, wind turbines, biomass, small hydro, municipal solid waste, demand response, and storage units.

An intelligent clustering scheme for distributed intrusion detection in vehicular cloud computing

In recent years, vehicular cloud computing (VCC) has emerged as a new technology which is being used in wide range of applications in the area of multimedia-based healthcare applications. In VCC, vehicles act as the intelligent machines which can be used to collect and transfer the healthcare data to the local, or global sites for storage, and computation purposes, as vehicles are having comparatively limited storage and computation power for handling the multimedia files. However, due to the dynamic changes in topology, and lack of centralized monitoring points, this information can be altered, or misused. These security breaches can result in disastrous consequences such as-loss of life or financial frauds. Therefore, to address these issues, a learning automata-assisted distributive intrusion detection system is designed based on clustering. Although there exist a number of applications where the proposed scheme can be applied but, we have taken multimedia-based healthcare application for illustration of the proposed scheme. In the proposed scheme, learning automata (LA) are assumed to be stationed on the vehicles which take clustering decisions intelligently and select one of the members of the group as a cluster-head. The cluster-heads then assist in efficient storage and dissemination of information through a cloud-based infrastructure. To secure the proposed scheme from malicious activities, standard cryptographic technique is used in which the auotmaton learns from the environment and takes adaptive decisions for identification of any malicious activity in the network. A reward and penalty is given by the stochastic environment where an automaton performs its actions so that it updates its action probability vector after getting the reinforcement signal from the environment. The proposed scheme was evaluated using extensive simulations on ns-2 with SUMO. The results obtained indicate that the proposed scheme yields an improvement of 10 % in detection rate of malicious nodes when compared with the existing schemes.

A Green Approach for Selfish Misbehavior Detection in 802.11-Based Wireless Networks

IEEE 802.11 is one of the most well-established and widely used standard for wireless LAN. Its Medium Access control (MAC) layer assumes that the devices adhere to the standard’s rules and timers to assure fair access and sharing of the medium. However, wireless cards driver flexibility and configurability make it possible for selfish misbehaving nodes to take advantages over the other well-behaving nodes. The existence of selfish nodes degrades the QoS for the other devices in the network and may increase their energy consumption. In this paper we propose a green solution for selfish misbehavior detection in IEEE 802.11-based wireless networks. The proposed scheme works in two phases: Global phase which detects whether the network contains selfish nodes or not, and Local phase which identifies which node or nodes within the network are selfish. Usually, the network must be frequently examined for selfish nodes during its operation since any node may act selfishly. Our solution is green in the sense that it saves the network resources as it avoids wasting the nodes energy by examining all the individual nodes of being selfish when it is not necessary. The proposed detection algorithm is evaluated using extensive OPNET simulations. The results show that the Global network metric clearly indicates the existence of a selfish node while the Local nodes metric successfully identified the selfish node(s). We also provide mathematical analysis for the selfish misbehaving and derived formulas for the successful channel access probability.

Distributed Sensing of Fluid Dynamic Phenomena with the XDense Sensor Grid Network

IEEE International Conference on Cyber Physical Systems, Networks and Applications (CPSNA'15), Hong Kong, China.

Partitioning the Network-on-Chip to Enable Virtualization on Many-Core Processors

6th International Real-Time Scheduling Open Problems Seminar (RTSOPS 2015), Lund, Sweden.

XDense: A Dense Grid Sensor Network for Distributed Feature Extraction

XXXIII Simpósio Brasileiro de Redes de Computadores e Sistemas Distribuídos (SBRC 2015). 15 to 19, May, 2015, III Workshop de Comunicação em Sistemas Embarcados Críticos. Vitória, Brasil.

Generalized Extraction of Real-Time Parameters for Homogeneous Synchronous Dataflow Graphs

23rd Euromicro International Conference on Parallel, Distributed, and Network-Based Processing (PDP 2015). 4 to 6, Mar, 2015. Turku, Finland.

Supporting NAT traversal and secure communications in a protocol implementation framework

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do Grau de Mestre em Engenharia Electrotécnica e de Computadores

Swordfish: an Autonomous Surface Vehicle for Network Centric Operations

The design and development of the swordfish autonomous surface vehicle (ASV) system is discussed. Swordfish is an ocean capable 4.5 m long catamaran designed for network centric operations (with ocean and air going vehicles and human operators). In the basic configuration, Swordfish is both a survey vehicle and a communications node with gateways for broadband, Wi-Fi and GSM transports and underwater acoustic modems. In another configuration, Swordfish mounts a docking station for the autonomous underwater vehicle Isurus from Porto University. Swordfish has an advanced control architecture for multi-vehicle operations with mixed initiative interactions (human operators are allowed to interact with the control loops).

Towards the Development of XDense, A Sensor Network for Dense Sensing

Poster in 12th European Conference on Wireless Sensor Networks (EWSN 2015). 9 to 11, Feb, 2015, pp 24-25. Porto, Portugal.

XDense: A Dense Grid Sensor Network for Distributed Feature Extraction

XXXIII Simpósio Brasileiro de Redes de Computadores e Sistemas Distribuídos (SBRC 2015), III Workshop de Comunicação em Sistemas Embarcados Críticos. Vitória, Brasil.

Co-Authorship of scientists in the energy field: an exploratory study of the ETDE World Energy Database (ETDEWEB) using Social Network Analysis

Paper presented at the 5th European Conference Economics and Management of Energy in Industry, Vilamoura, Algarve. Apr. 14-17, 2009, 11p. URL: http:// www.cenertec.pt/ecemei/