Health financing changes in the context of health care decentralization: the case of three Latin American countries

OBJECTIVE: The results of an evaluative longitudinal study, which identified the effects of health care decentralization on health financing in Mexico, Nicaragua and Peru are presented in this article. METHODS: The methodology had two main phases. In the first, secondary sources of data and documents were analyzed with the following variables: type of decentralization implemented, source of financing, funds for financing, providers, final use of resources, mechanisms for resource allocation. In the second phase, primary data were collected by a survey of key personnel in the health sector. RESULTS: Results of the comparative analysis are presented, showing the changes implemented in the three countries, as well as the strengths and weaknesses of each country in matters of financing and decentralization. CONCLUSIONS: The main financing changes implemented and quantitative trends with respect to the five financing indicators are presented as a methodological tool to implement corrections and adjustments in health financing.

Detection of anti-Giardia lamblia serum antibody among children of day care centers

OBJETIVES: To detect anti-Giardia lamblia serum antibodies in healthy children attending public day care centers and to assess serological tests as tools for estimating the prevalence of G. lamblia in endemic areas. METHODS: Three separate stool specimens and filter paper blood samples were collected from 147 children ranging from 0 to 6 years old. Each stool sample was processed using spontaneous sedimentation and zinc sulfate flotation methods. Blood samples were tested by indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA) for Giardia IgG. RESULTS AND CONCLUSIONS: Of 147 individuals tested, 93 (63.3%) showed Giardia cysts in their feces. Using IIF and ELISA, serum antibodies were detected in 93 (63.3%) and 100 (68%) samples , respectively. Sensitivity of IIF and ELISA was 82% and 72%, respectively. However, ELISA revealed to be less specific (39%) than IIF (70%). IIF also showed a higher concordance with microscopic examination than ELISA.

Assessment of a consultation-liaison psychiatry and psychology health care program

OBJECTIVE: To investigate the relevance of subjective criteria adopted by a psychiatry and psychology consultation-liaison service, and their suitability in the evaluation of case registries and objective results. METHODS: Semi-structured interviews were conducted and all supervisors of the university hospital service were interviewed. Routinely collected case registries were also reviewed. Standardized assessment with content analysis for each category was carried out. RESULTS: The results showed distortions in the adopted service focus (doctor-patient relationship) and consultant requests. This focus is more on consulting physician-oriented interventions than on patients. DISCUSSION: Evaluation of the relevance of service criteria could help promoting quality assessment of the services provided, mainly when objective criteria have not yet been established to assure their suitability.

Identificação das categorias mais relevantes da classificação internacional de funcionalidade, incapacidade e saúde para os terapeutas ocupacionais que exercem funções em unidades de cuidados continuados integrados

As constantes alterações das realidades sociais e epidemiológicas em associação ao envelhecimento populacional conduziram a insuficiências dos Sistemas Social e de Saúde que requerem uma reestruturação ao nível da adequação dos cuidados de saúde a prestar, pelo que, em resposta a esta necessidade foi criada a Rede Nacional de Cuidados Continuados Integrados. O presente estudo, de natureza qualitativa e carácter exploratório, tem como objectivo compreender a percepção dos Terapeutas Ocupacionais que trabalham em Unidades de Cuidados Continuados Integrados relativamente às categorias que considerem mais relevantes da Classificação Internacional da Funcionalidade, Incapacidade e Saúde, tendo sido aplicada uma entrevista a 8 profissionais a exercer funções em Unidades da Zona Norte, resultante de um processo de amostragem não probabilística e de conveniência. Como método de recolha de dados foi aplicada uma entrevista semi-estruturada, cujo guião foi construído após revisão bibliográfica, tendo por base as categorias definidas pelo modelo da Classificação Internacional da Funcionalidade, Incapacidade e Saúde e, posteriormente, analisado por um painel de peritos, tendo-se procedido à realização de uma entrevista piloto a um elemento, sem que esta contasse para a análise. A partir da análise das entrevistas realizadas procedemos à identificação das unidades de significado, tendo os conceitos sido ligados às categorias da Classificação que o representam de uma forma mais adequada, de acordo com as linking rules, tendo sido identificadas as categorias mais relevantes para os Terapeutas Ocupacionais a exercer funções em Unidades de Cuidados Continuados Integrados. Com a realização deste estudo, que pretende ser um primeiro passo para a criação de um futuro Core Set em Cuidados Continuados, foi-nos possível verificar que o maior número de categorias foram observadas no componente Actividades e Participação, tendo sido contabilizadas 70 (40,7%). Por outro lado, o componente Estruturas do corpo é o que integra menor número, contando com 19 categorias (11,05%). Assim, pensamos que a criação de um Core Set em Cuidados Continuados poderá beneficiar e facilitar a comunicação entre os profissionais destas equipas. No entanto, é importante ressalvar que a terminologia desta Classificação deverá ser utilizada de uma forma concertada com a linguagem específica da Terapia Ocupacional. Palavras-chave: Classificação Internacional da Funcionalidade, Incapacidade e Saúde, Core Set, Terapeutas Ocupacionais, Unidades de Cuidados Continuados Integrados.

Desenvolvimento de uma ferramenta colaborativa na área da gestão da informação/conhecimento para aplicação numa unidade de cuidados na comunidade

O presente projeto surgiu da necessidade de um instrumento de trabalho na área da gestão da informação / conhecimento a aplicar na Unidade de Cuidados na Comunidade dos Carvalhos (UCCC) que, pela sua estrutura de trabalho por projeto, abrange diversos grupos de utilizadores com perfis e necessidades específicas. Rapidamente assumiu maior dimensão, pois ao seu ponto de partida se conjugaram as oportunidades de utilização das tecnologias de informação na área da saúde, a divulgação da Unidade assim como a divulgação de informação sobre saúde e a interação com os utilizadores. O processo implicou a aplicação das metodologias de Investigação Ação e de Gestão de Projetos, resultando na criação e publicação de um espaço Web. Com o Content Management System (CMS) Joomla foi construído o Site UCC Carvalhos, que faculta simultaneamente informação sobre saúde, oportunidade de aconselhamento especializado e personalizado e permite a organização da documentação interna da Unidade referida. Nesta fase de início de vida do site estabeleceu-se como temáticas prioritárias a desenvolver a informação sobre a UCCC e o seu funcionamento assim como o projeto “Companhia das Barriguinhas”, mais concretamente a Preparação para o Parto e Parentalidade. O desenvolvimento deste projeto superou as expectativas de todos os elementos envolvidos, pois para além de permitir obter resposta às necessidades identificadas, permitiu também experimentar as metodologias referidas de forma integrada e aprofundar temáticas como a gestão da informação e conhecimento, o papel das tecnologias de informação e comunicação na Saúde e o papel do cidadão na utilização das mesmas no sentido de uma autonomia responsável na gestão da sua Saúde.

Probabilistic linkage in household survey on hospital care usage

OBJECTIVE: To evaluate the potential advantages and limitations of the use of the Brazilian hospital admission authorization forms database and the probabilistic record linkage methodology for the validation of reported utilization of hospital care services in household surveys. METHODS: A total of 2,288 households interviews were conducted in the county of Duque de Caxias, Brazil. Information on the occurrence of at least one hospital admission in the year preceding the interview was obtained from a total of 10,733 household members. The 130 records of household members who reported at least one hospital admission in a public hospital were linked to a hospital database with 801,587 records, using an automatic probabilistic approach combined with an extensive clerical review. RESULTS: Seventy-four (57%) of the 130 household members were identified in the hospital database. Yet only 60 subjects (46%) showed a record of hospitalization in the hospital database in the study period. Hospital admissions due to a surgery procedure were significantly more likely to have been identified in the hospital database. The low level of concordance seen in the study can be explained by the following factors: errors in the linkage process; a telescoping effect; and an incomplete record in the hospital database. CONCLUSIONS: The use of hospital administrative databases and probabilistic linkage methodology may represent a methodological alternative for the validation of reported utilization of health care services, but some strategies should be employed in order to minimize the problems related to the use of this methodology in non-ideal conditions. Ideally, a single identifier, such as a personal health insurance number, and the universal coverage of the database would be desirable.

Voluntary HIV counseling and testing during prenatal care in Brazil

OBJECTIVE: Voluntary HIV counseling and testing are provided to all Brazilian pregnant women with the purpose of reducing mother-to-child HIV transmission. The purpose of the study was to assess characteristics of HIV testing and identify factors associated with HIV counseling and testing. METHODS: A cross-sectional study was carried out comprising 1,658 mothers living in Porto Alegre, Brazil. Biological, reproductive and social variables were obtained from mothers by means of a standardized questionnaire. Being counseling about HIV testing was the dependent variable. Confidence intervals, chi-square test and hierarchical logistic model were used to determine the association between counseling and maternal variables. RESULTS: Of 1,658 mothers interviewed, 1,603 or 96.7% (95% CI: 95.7-97.5) underwent HIV testing, and 51 or 3.1% (95% CI: 2.3-4.0) were not tested. Four (0.2%) refused to undergo testing after counseling. Of 51 women not tested in this study, 30 had undergone the testing previously. Of 1,603 women tested, 630 or 39.3% (95% CI: 36.9-41.7) received counseling, 947 or 59.2% (95% CI: 56.6-61.5) did not, and 26 (1.6%) did not inform. Low income, lack of prenatal care, late beginning of prenatal care, use of rapid testing, and receiving prenatal in the public sector were variables independently associated with a lower probability of getting counseling about HIV testing. CONCLUSIONS: The study findings confirmed the high rate of prenatal HIV testing in Porto Alegre. However, women coming from less privileged social groups were less likely to receive information and benefit from counseling.

Association between child-care and acute diarrhea: a study in Portuguese children

OBJECTIVE: To quantify the influence of the type of child-care on the occurrence of acute diarrhea with special emphasis on the effect of children grouping during care. METHODS: From October 1998 to January 1999 292 children, aged 24 to 36 months, recruited using a previously assembled cohort of newborns, were evaluated. Information on the type of care and occurrence of diarrhea in the previous year was obtained from parents by telephone interview. The X² and Kruskal-Wallis tests were used to compare proportions and quantitative variables, respectively. The risk of diarrhea was estimated through the calculation of incident odds ratios (OR) and their respective 95% confidence intervals (95% CI), crude and adjusted by unconditional logistic regression. RESULTS: Using as reference category children cared individually at home, the adjusted ORs for diarrhea occurrence were 3.18, 95% CI [1.49, 6.77] for children cared in group at home, 2.28, 95% CI [0.92, 5.67] for children cared in group in day-care homes and 2.54, 95% CI [1.21, 5.33] for children cared in day-care centers. Children that changed from any other type of child-care setting to child-care centers in the year preceding the study showed a risk even higher (OR 7.65, 95% CI [3.25, 18.02]). CONCLUSIONS: Group care increases the risk of acute diarrhea whatsoever the specific setting.

DITRANS - a multi-agent system for integrated diagnosis of power transformers

This paper describes the development and the implementation of a multi-agent system for integrated diagnosis of power transformers. The system is divided in layers which contain a number of agents performing different functions. The social ability and cooperation between the agents lead to the final diagnosis and to other relevant conclusions through integrating various monitoring technologies, diagnostic methods and data sources, such as the dissolved gas analysis.

Integrated vehicle classification system

This paper presents an integrated system for vehicle classification. This system aims to classify vehicles using different approaches: 1) based on the height of the first axle and_the number of axles; 2) based on volumetric measurements and; 3) based on features extracted from the captured image of the vehicle. The system uses a laser sensor for measurements and a set of image analysis algorithms to compute some visual features. By combining different classification methods, it is shown that the system improves its accuracy and robustness, enabling its usage in more difficult environments satisfying the proposed requirements established by the Portuguese motorway contractor BRISA.

An integrated approach for distributed energy resource short term scheduling in smart grids considering realistic power system simulation

The large increase of distributed energy resources, including distributed generation, storage systems and demand response, especially in distribution networks, makes the management of the available resources a more complex and crucial process. With wind based generation gaining relevance, in terms of the generation mix, the fact that wind forecasting accuracy rapidly drops with the increase of the forecast anticipation time requires to undertake short-term and very short-term re-scheduling so the final implemented solution enables the lowest possible operation costs. This paper proposes a methodology for energy resource scheduling in smart grids, considering day ahead, hour ahead and five minutes ahead scheduling. The short-term scheduling, undertaken five minutes ahead, takes advantage of the high accuracy of the very-short term wind forecasting providing the user with more efficient scheduling solutions. The proposed method uses a Genetic Algorithm based approach for optimization that is able to cope with the hard execution time constraint of short-term scheduling. Realistic power system simulation, based on PSCAD , is used to validate the obtained solutions. The paper includes a case study with a 33 bus distribution network with high penetration of distributed energy resources implemented in PSCAD .

Particle swarm optimization applied to integrated demand response resources scheduling

The concept of demand response has a growing importance in the context of the future power systems. Demand response can be seen as a resource like distributed generation, storage, electric vehicles, etc. All these resources require the existence of an infrastructure able to give players the means to operate and use them in an efficient way. This infrastructure implements in practice the smart grid concept, and should accommodate a large number of diverse types of players in the context of a competitive business environment. In this paper, demand response is optimally scheduled jointly with other resources such as distributed generation units and the energy provided by the electricity market, minimizing the operation costs from the point of view of a virtual power player, who manages these resources and supplies the aggregated consumers. The optimal schedule is obtained using two approaches based on particle swarm optimization (with and without mutation) which are compared with a deterministic approach that is used as a reference methodology. A case study with two scenarios implemented in DemSi, a demand Response simulator developed by the authors, evidences the advantages of the use of the proposed particle swarm approaches.

The impact of night work on subjective reports of well-being: an exploratory study of health care workers from five nations

OBJECTIVE: To carry out a survey data collection from health care workers in Brazil, Croatia, Poland, Ukraine and the USA with two primary goals: (1) to provide information about which aspects of well-being are most likely to need attention when shiftwork management solutions are being developed, and (2) to explore whether nations are likely to differ with respect to the impacts of night work on the well-being of workers involved in health care work. METHODS: The respondents from each nation were sorted into night worker and non-night worker groups. Worker perceptions of being physically tired, mentally tired, and tense at the end of the workday were examined. Subjective reports of perceived felt age were also studied. For each of these four dependent variables, an ANCOVA analysis was carried out. Hours worked per week, stability of weekly work schedule, and chronological age were the covariates for these analyses. RESULTS: The results clearly support the general proposal that nations differ significantly in worker perceptions of well-being. In addition, perceptions of physical and mental tiredness at the end of the workday were higher for night workers. For the perception of being physically tired at the end of a workday, the manner and degree to which the night shift impacts the workers varies by nation. CONCLUSIONS: Additional research is needed to determine if the nation and work schedule differences observed are related to differences in job tasks, work schedule structure, off-the-job variables, and/or other worker demographic variables.

An integrated system to support electricity tariff contract definition

This paper presents an integrated system that helps both retail companies and electricity consumers on the definition of the best retail contracts and tariffs. This integrated system is composed by a Decision Support System (DSS) based on a Consumer Characterization Framework (CCF). The CCF is based on data mining techniques, applied to obtain useful knowledge about electricity consumers from large amounts of consumption data. This knowledge is acquired following an innovative and systematic approach able to identify different consumers’ classes, represented by a load profile, and its characterization using decision trees. The framework generates inputs to use in the knowledge base and in the database of the DSS. The rule sets derived from the decision trees are integrated in the knowledge base of the DSS. The load profiles together with the information about contracts and electricity prices form the database of the DSS. This DSS is able to perform the classification of different consumers, present its load profile and test different electricity tariffs and contracts. The final outputs of the DSS are a comparative economic analysis between different contracts and advice about the most economic contract to each consumer class. The presentation of the DSS is completed with an application example using a real data base of consumers from the Portuguese distribution company.

Blood glucose control in diabetes patients seen in primary health care centers

OBJECTIVE: To identify factors associated to poor glycemic control among diabetic patients seen at primary health care centers. METHODS: A cross-sectional study was carried out in a sample of 372 diabetic patients attending 32 primary health care centers in southern Brazil. Data on three hierarchical levels of health unit infrastructure, medical care and patient characteristics were collected. RESULTS: The frequency of poor glycemic control was 50.5%. Multivariate analysis (multilevel method) showed that patients with body mass indexes below 27 kg/m², patients on oral hypoglycemic agents or insulin, and patients diagnosed as diabetic over five years prior to the interview were more likely to present poor glycemic control when compared to their counterparts. CONCLUSIONS: Given the hierarchical data structuring, all associations found suggest that factors associated to hyperglycemia are related to patient-level characteristics.