Las empresas sociales del estado y el derecho fundamental a la salud. Estudio de caso hospital simón bolívar E.S.E (2002-2014)

El presente trabajo busca hacer un análisis sobre los arreglos institucionales introducidos con la ley 100 de 1993 a las Empresas Sociales del Estado (ESE), y cómo estos han afectado la prestación del servicio de salud y la garantía del derecho; para lo cual se escoge como ejemplo el Hospital Simón Bolívar E.S.E de Bogotá durante los años 2002 a 2014. Se explica como con la implementación de la descentralización, el modelo de aseguramiento y la autonomía financiera se afectó la prestación del servicio de salud, teniendo en cuenta la introducción de un eslabón dentro del sistema de salud: las Empresas Promotoras de Salud (EPS).

Esplenopatias cirúrgicas em cães, estudo retrospetivo num hospital de referência na área da Grande Lisboa

As esplenopatias são doenças comuns em canídeos que tanto podem estar associadas com doenças benignas com excelente prognóstico, como doenças com alto grau de malignidade com elevada taxa de mortalidade. O objetivo do presente trabalho foi caracterizar a população de canídeos esplenectomizados num hospital de referência na área da grande Lisboa. A população foi constituída por 73 indivíduos da espécie Canis familiaris sujeitos a esplenectomia total ou parcial. A população foi analisada e distribuída segundo vários parâmetros, como o a raça, o sexo, a idade, o diagnóstico pré-cirúrgico, o diagnóstico histopatológico, o hematócrito pré cirúrgico e por fim a sobrevida. Da análise total de canídeos, observou-se que, a maioria dos canídeos esplenectomizados eram do género masculino, de raça indeterminada e com uma média de 10 anos de idade. Constatou-se que cerca de metade dos canídeos esplenectomizados sobreviveram após um ano da cirurgia e que o diagnóstico histopatológico mais comum foi o hemangiossarcoma, seguido do hematoma esplénico. Através dos testes estatísticos conclui-se que o hematócrito não apresenta qualquer relação com a sobrevida dos animais, embora possa estar relacionado com o diagnóstico histopatológico. Este estudo visou ainda uma caracterização detalhada dos canídeos diagnosticados com hemangiossarcoma. Os animais mais afectados nesta amostra, eram do género masculino com 9anos de idade e eram da raça Boxer e Labrador. Confirmou-se ainda que esta é uma doença com mau prognóstico, apresentando uma taxa de mortalidade de 80%.

O processo de acreditação hospitalar na perspectiva de profissionais de saúde de um hospital privado em Macapá - Estudo de caso

A acreditação hospitalar é um método de avaliação dos recursos institucionais, voluntário e periódico, que busca garantir a qualidade da assistência prestada, através da padronização, organização e segurança nos processos de trabalho. A certificação hospitalar é um reconhecimento da Organização Nacional de Acreditação - ONA que garante alto nível de prestação de serviço em todos os setores de uma organização de saúde, introduzindo a gestão da qualidade como ferramenta permanente de aprimoramento institucional. Destacam-se como uns de seus objetivos, a busca contínua pela qualidade nos cuidados aos pacientes, proporcionando um ambiente livre de riscos para todos aqueles que circulam na instituição de saúde, abrangendo todos os seus serviços e segmentos existentes. O caminho para a implantação bem sucedida de um programa baseado nos padrões exigidos pelo Manual Brasileiro de Acreditação - MBA da ONA passa pela estruturação de um processo educativo permanente e abrangente, que contemple todo o quadro funcional, desde o operacional até a alta administração da instituição, compartilhando princípios, metas e objetivos a serem alcançados. O presente trabalho tem como objetivo analisar cultura de melhoria contínua de gestão da qualidade na perspectiva de profissionais de saúde de um hospital privado em Macapá, sendo classificada como um estudo quanti-qualitativo, de abordagem descritiva exploratória. A pesquisa foi desenvolvido com 198 profissionais de saúde alocados nas seguintes categorias: liderança, equipe multiprofissional, equipe técnica e administrativo/apoio, por meio de aplicação de questionário.

Uptake of a free coronary heart disease risk screening programme in community pharmacy: the Healthy Heart Assessment service

Introduction Health promotion (HP) aims to enhance good health while preventing ill-health at three levels of activity; primary (preventative), secondary (diagnostic) and tertiary (management).1 It can range from simple provision of health education to ongoing support, but the effectiveness of HP is ultimately dependent on its ability to influence change. HP as part of the Community Pharmacy Contract (CPC) aims to increase public knowledge and target ‘hard-to-reach’ individuals by focusing mainly on primary and tertiary HP. The CPC does not include screening programmes (secondary HP) as a service. Coronary heart disease (CHD) is a significant cause of morbidity and mortality in the UK. While there is evidence to support the effectiveness of some community pharmacy HP strategies in CHD, there is paucity of research in relation to screening services.2 Against this background, Alliance Pharmacy introduced a free CHD risk screening programme to provide tailored HP advice as part of a participant–pharmacist consultation. The aim of this study is to report on the CHD risk levels of participants and to provide a qualitative indication of consultation outcomes. Methods Case records for 12 733 people who accessed a free CHD risk screening service between August 2004 and April 2006 offered at 217 community pharmacies were obtained. The service involved initial self-completion of the Healthy Heart Assessment (HHA) form and measurement of height, weight, body mass index, blood pressure, total cholesterol and highdensity lipoprotein levels by pharmacists to calculate CHD risk.3 Action taken by pharmacists (lifestyle advice, statin recommendation or general practitioner (GP) referral) and qualitative statements of advice were recorded, and a copy provided to the participants. The service did not include follow-up of participants. All participants consented to taking part in evaluations of the service. Ethical committee scrutiny was not required for this service development evaluation. Results Case records for 10 035 participants (3658 male) were evaluable; 5730 (57%) were at low CHD risk (<15%); 3636 (36%) at moderate-to-high CHD risk (≥15%); and 669 (7%) had existing heart disease. A significantly higher proportion of male (48% versus 30% female) participants were at moderate- to-high risk of CHD (chi-square test; P < 0.005). A range of outcomes resulted from consultations. Lifestyle advice was provided irrespective of participants’ CHD risk or existing disease. In the moderate-to-high-risk group, of which 52% received prescribed medication, lifestyle advice was recorded for 62%, 16% were referred and 34% were advised to have a re-assessment. Statin recommendations were made in 1% of all cases. There was evidence of supportive and motivational statements in the advice recorded. Discussion Pharmacists were able to identify individuals’ level of CHD risk and provide them with bespoke advice. Identification of at-risk participants did not automatically result in referrals or statin recommendation. One-third of those accessing the screening service had moderate-to-high risk of CHD, a significantly higher proportion of whom were men. It is not known whether these individuals had been previously exposed to HP but presumably by accessing this service they may have contemplated change. As effectiveness of HP advice will depend among other factors on ability to influence change, future consultations may need to explore patients’ attitude towards change in relation to the Trans Theoretical Model4 to better tailor HP advice. The high uptake of the service by those at moderate-to-high CHD risk indicates a need for this type of screening programme in community pharmacy, perhaps specifically to reach men who access medical services less.

The unpatriotism of the economic constitution? Rights to free movement and their impact on national and European identity

Abstract: Instead of the political reading of the EU Constitution adopted by advocates of constitutional patriotism, this article examines the European economic constitution. The four single market freedoms can be used by the Court of Justice to strike down Member State laws which represent deeply held aspects of national cultural identity. The article examines whether the court does in fact act in this way and proceeds to argue that the issue of identity protection does not stop with the court. In those policy areas where the court is more interventionist, and its case-law is perceived as an identity threat, one is likely to find binding Treaty-based derogations. Where, in contrast, the effect of the court's case-law poses less of a threat, one is more likely to see non-binding declarations. The article examines a number of policy areas in which specific cultural derogations and declarations are to be found, including abortion, property acquisition, football and alcohol control.

Recovering potential: factors associated with success in engaging challenging students with alternative pre-16 provision

The study focuses on a group of young people for whom conventional school placements had broken down and were attending vocational courses at an FE college while still of compulsory school age. The students had been excluded by, or had failed to attend, their schools or had achieved at very low levels in the academic curriculum. Over half successfully completed the vocational course at college. Many factors conventionally regarded as predictors for poor educational outcomes were not associated with completion and non-completion. For example, students who had been excluded, who had statements of special educational needs and had been involved with the criminal justice system were as likely to complete their courses as other students. However, students who had very poor attendance records at school also tended to drop out of college. The results suggest that the increased flexibility, guidance and elements of work-related learning promised in current 14 - 19 developments may help meet the needs of this group of students.

The effect of free Ca2+ on the heat stability and other characteristics of low-heat skim milk powder

Low-heat skim milk powder (SMP), reconstituted to 25% total solids, was found to have poor heat stability. This could be improved by reducing the free Ca2+ concentration to 1.14 mm, or lower, by the addition of either Amberlite IR-120 ion-exchange resin in its sodium form or tri-sodium citrate in skim milk prior to evaporation and spray drying. Reduction in Ca2+ concentration was accompanied by increases in pH, particle size, and kinematic viscosity, and by a reduction in zeta-potential and changes in colour. In-container sterilisation of the reconstituted powder increased particle size, zeta-potential, kinematic viscosity and a* and b* values. However. Ca2+ concentration, pH and whiteness decreased. This study elucidated the importance of Ca2+ concentration and pH on heat stability of low-heat SMP, suggesting that Ca2+ concentration and pH in bulk milk are useful indicators for ensuring that spray dried milk powder has good heat stability. (C) 2009 Elsevier Ltd. All rights reserved.

Attitudes of rural branch managers in Madhya Pradesh, India, toward their role as providers of financial services to the poor

Discussions on banking reforms to reduce financial exclusion have referred little to possible attitudinal constraints, on the part of staff at both branch and institutional levels, inhibiting the provision of financial services to the poor. The research project, funded by the ESCOR (now Social Science Research) Small Grants Committee, has focused on this aspect of financial exclusion. The research commenced in May 2001 and was completed in April 2002. Profiles of the rural bank branch managers, including personal background, professional background and workplace, are presented. Attitudes of managers toward aspects of their work environment and the rural poor are examined, using results from both quantitative and qualitative analysis. Finally, the emerging policy implications are discussed. These include bank reforms to address human resource management, the work environment, intermediate bank management and organization, and the client interface.

Truth commissions: a barrier to the provision of judicial assistance?

Truth commissions and criminal trials have come to be perceived as complementary transitional justice mechanisms. However, where effective prosecutions are dependent on the exchange of information and transfer of suspects between states under existing mutual legal assistance and extradition arrangements, the operation of a truth commission in the state of territoriality may act as an obstacle to international cooperation. At the same time, requests for assistance from a third state pursuing prosecutions may impact negatively on the truth commission process in the requested state by inhibiting those reluctant to become involved in criminal proceedings from offering testimony. This article demonstrates a practical discord between these bodies when they operate in different states and questions whether they can truly be considered “complementary”.

Changes in fat, fat-free mass and body water in human normal pregnancy

Measurements of body weight, total body water and total body potassium (40K) were made serially on three occasions during pregnancy and once post partum in 27 normal pregnant women. Skinfold thickness and fat cell diameter were also measured. A model of body composition was formulated to permit the estimation of changes in fat, lean tissue and water content of the maternal body. Total maternal body fat increased during pregnancy, reaching a peak towards the end of the second trimester before diminishing. Serial measurements of fat cell diameter showed poor correlation, whilst total body fat calculated from skinfold thickness correlated well with our estimated values for total body fat in pregnancy.

In search of the aim of the free movement of persons provisions: has the Court of Justice missed the point?

The Court of Justice has, over the years, often been vilified for exceeding the limits of its jurisdiction by interpreting the provisions of Community legislation in a way not seem originally envisaged by its drafters. A recent example of this approach was a cluster of cases in the context of the free movement of workers and the freedom of establishment (Ritter-Coulais and its progeny), where the Court included within the scope of those provisions situations which, arguably, did not present a sufficient link with their (economic) aim. In particular, in that case law the Court accepted that the mere exercise of free movement for the purpose of taking up residence in the territory of another Member State whilst continuing to exercise an economic activity in the State of origin, suffices for bringing a Member State national within the scope of Articles 39 and 43 EC. It is argued that the most plausible explanation for this approach is that the Court now wishes to re-read the economic fundamental freedoms in such a way as to include within their scope all economically active Union citizens, irrespective of whether their situation presents a sufficient link with the exercise of an economic activity in a cross-border context. It is suggested that this approach is problematic for a number of reasons. It is, therefore, concluded that the Court should revert to its orthodox approach, according to which only situations that involve Union citizens who have moved between Member States for the purpose of taking up an economic activity should be included within the scope of the market freedoms.

Redefining the outer boundaries of EU Law: the Zambrano, McCarthy and Dereci trilogy

In its three recent rulings in the cases of Zambrano, McCarthy, and Dereci, the Court appears to have been determined to redefine the external boundaries of EU law, in cases involving the family reunification rights of Union citizens.These three judgments can be read as an indication that for Article 20 TFEU to apply, there is no longer a requirement of a cross-border element on the facts of the case, and that it is sufficient if the contested national measure has the effect of ‘depriving citizens of the Union of the genuine enjoyment of the substance’ of their rights (the ‘Zambrano principle’).The cases can, at the same time, also be read as a confirmation that the free movement provisions do – still – require a cross-border element and, in particular, the exercise of inter-State movement, in order to apply. Though the result in these cases has not been entirely unexpected, especially in the aftermath of the Rottmann ruling, it is rather problematic in that, although it is obvious that the Court wishes to redraw the line dividing the national and EU spheres of competence, it does not make it entirely clear where this line now lies and leaves many essential questions unanswered, which will obviously require some time to be resolved. EU lawyers are consequently, once more, left with having to decipher as best as they can the real intentions of the Court in this new line of case-law, which has been further complicated by the fact that what the Court seems to have given with one hand in Zambrano (and before that in Rottmann), has taken it back to a large extent through its rulings in McCarthy and Dereci, which appear to confine the former two cases to their own exceptional facts.6 Moreover, the ‘reverse discrimination Pandora’s box’, the opening of which appears to have been the real target of these references, remains untouched: instead of providing a direct solution to this problem, the Court has chosen to – once again – broaden the scope of the Treaty provisions in order to include within it as many situations as possible and, thus, prevent the emergence of this type of differential treatment on a case-by-case basis.As will be explained, nonetheless, this is by no means an appropriate solution to the reverse discrimination conundrum.