An appraisal of the health planning method proposed by the Pan-American Health Organization for Latin America

A brief description of the main features of the health planning technique developed by the "Centro de Estudios del Desarrollo" (CENDES) in Venezuela, and proposed by the Pan-American Health Organization for use in Latin America, is presented. This presentation is followed by an appraisal of the planning method which includes comments both upon its positive aspects and upon its negative points. Comments are also made referring to other recent publications of the WHO/PAHO on health planning. In conclusion, the CENDES technique is considered a health planning method of great potential for use especially in underdeveloped areas, the success of its application depending upon the hability of the health planners to introduce the necessary modifications to adapt to the local circunstamces.

Notes on health care planning in Latin America and the Caribbean

Attention is called to the fact that the efforts to improve health of populations in Latin America have generally failed. The inequality in the distribution of ill-health is great. The authors accept the fact that the lack of resources available to the health sector may be a restriction towards the improvement of the situation, but they argue that a much more important issue is the misuse of such resources and their maldistribution within the health sector. The lack of integration and coordination between the health services, the conflict of public and private health systems, the under-utilization of existing services and the gap between planning and real implementation are discussed.

Proportional cancer incidence according to selected sites: comparison between residents in the City of S. Paulo, Brazil: Japanese and Brazilian/Portuguese descent

The percentual distributions of selected sites of cancer cases according to origin, sex and age are compared. Data were obtained from the Registry of Cancer of S. Paulo (School of Public Health of the University of S. Paulo, Brazil). The reference period for inhabitants of Japanese descent was 1969/78 and for those of Brazilian descent, the period was 1969/75. Standardized Proportionate Incidence Ratios (SPIR) with approximate 95% Confidence Intervals (CI) were evaluated using age specific Incidence Ratios of S. Paulo, 1973, as standards. The results agree with findings of previous works on mortality, but show different patterns according to origin. The well known fact that some sub-groups of a population may be different from the overall group is once again brought to the fore. Attention should be drawn to the differences detected for stomach, skin and prostate, in males, and for stomach, skin, cervix and uterus in females.

Propriedades psicométricas da versão portuguesa do Kansas City Cardiomyopathy Questionnaire na miocardiopatia dilatada com insuficiência cardíaca congestiva

Vários estudos demonstraram que os doentes com insuficiência cardíaca congestiva (ICC) têm um compromisso da qualidade de vida relacionada com a saúde (QVRS), tendo esta, nos últimos anos, vindo a tornar-se um endpoint primário quando se analisa o impacto do tratamento de situações crónicas como a ICC. Objectivos: Avaliar as propriedades psicométricas da versão portuguesa de um novo instrumento específico para medir a QVRS na ICC em doentes hospitalizados: o Kansas City Cardiomyopathy Questionnaire (KCCQ). População e Métodos: O KCCQ foi aplicado a uma amostra consecutiva de 193 doentes internados por ICC. Destes, 105 repetiram esta avaliação 3 meses após admissão hospitalar, não havendo eventos ocorridos durante este período de tempo. A idade era 64,4± 12,4 anos (entre 21 e 88), com 72,5% a pertencer ao sexo masculino, sendo a ICC de etiologia isquémica em 42%. Resultados: Esta versão do KCCQ foi sujeita a validação estatística semelhante à americana com a avaliação da fidelidade e validade. A fidelidade foi avaliada pela consistência interna dos domínios e dos somatórios, apresentando valores Alpha de Cronbach idênticos nos vários domínios e somatórios ( =0,50 a =0,94). A validade foi analisada pela convergência, pela sensibilidade às diferenças entre grupos e pela sensibilidade à alteração da condição clínica. Avaliou-se a validade convergente de todos os domínios relacionados com funcionalidade, pela relação verificada entre estes e uma medida de funcionalidade, a classificação da New York Heart Association (NYHA), tendo-se verificado correlações significativas (p<0,01), como medida para avaliar a funcionalidade em doentes com ICC. Efectuou-se uma análise de variância entre o domínio limitação física, os somatórios e as classes da NYHA, tendo-se encontrado diferenças estatisticamente significativas (F=23,4; F=36,4; F=37,4; p=0,0001), na capacidade de descriminação da gravidade da condição clínica. Foi realizada uma segunda avaliação em 105 doentes na consulta do 3º mês após a intervenção clínica, tendo-se observado alterações significativas nas médias dos domínios avaliados entre o internamento e a consulta (diferenças de 14,9 a 30,6 numa escala de 0-100), indicando que os domínios avaliados são sensíveis à mudança da condição clínica. A correlação interdimensões da qualidade de vida que compõe este instrumento é moderada, sugerindo dimensões independentes, apoiando a sua estrutura multifactorial e a adequabilidade desta medida para a sua avaliação. Conclusão: O KCCQ é um instrumento válido, sensível à mudança e específico para medir a QVRS numa população portuguesa com miocardiopatia dilatada e ICC. ABSTRACT - Several studies have shown that patients with congestive heart failure (CHF) have a compromised health-related quality of life (HRQL), and this, in recent years, has become a primary endpoint when considering the impact of treatment of chronic conditions such as CHF. Objectives: To evaluate the psychometric properties of the Portuguese version of a new specific instrument to measure HRQL in patients hospitalized for CHF: the Kansas City Cardiomyopathy Questionnaire (KCCQ). Methods: The KCCQ was applied to a sample of 193 consecutive patients hospitalized for CHF. Of these, 105 repeated the assessment 3 months after admission, with no events during this period. Mean age was 64.4±12.4 years (21-88), and 72.5% were 72.5% male. CHF was of ischemic etiology in 42% of cases. Results: This version of the KCCQ was subjected to statistical validation, with assessment of reliability and validity, similar to the American version. Reliability was assessed by the internal consistency of the domains and summary scores, which showed similar values of Cronbach alpha (0.50-0.94). Validity was assessed by convergence, sensitivity to differences between groups and sensitivity to changes in clinical condition. We evaluated the convergent validity of all domains related to functionality, through the relationship between them and a measure of functionality, the New York Heart Association (NYHA) classification. Significant correlations were found (p<0.01) for this measure of functionality in patients with CHF. Analysis of variance between the physical limitation domain, the summary scores and NYHA class was performed and statistically significant differences were found (F=23.4; F=36.4; F=37.4, p=0.0001) in the ability to discriminate severity of clinical condition. A second evaluation was performed on 105 patients at the 3-month follow-up outpatient appointment, and significant changes were observed in the mean scores of the domains assessed between hospital admission and the clinic appointment (differences from 14.9 to 30.6 on a scale of 0-100), indicating that the domains assessed are sensitive to changes in clinical condition. The correlation between dimensions of quality of life in the KCCQ is moderate, suggesting that the dimensions are independent, supporting the multifactorial nature of HRQL and the suitability of this measure for its evaluation. Conclusion: The KCCQ is a valid instrument, sensitive to change and a specific measure of HRQL in a population with dilated cardiomyopathy and CHF.

Microscopic analysis of "prato", "mussarela" and "mineiro" cheese sold in street markets of the City of S. Paulo, Southeastern Brazil

INTRODUCTION: Cheese should be produced from ingredients of good quality and processed under hygienic conditions. Further, cheese should be transported, stored and sold in an appropriate manner in order to avoid, among other things, the incorporation of extraneous materials (filth) of biological origin or otherwise, in contravention of the relevant food legislation. The aim of the study was to evaluate the hygienic conditions of "prato", "mussarela", and "mineiro" cheeses sold at the street food markets in the city of S. Paulo, Brazil. MATERIALS AND METHOD: Forty-seven samples of each of the three types of cheese were collected during the period from March, 1993 to February, 1994. The Latin square was used as a statistical model for sampling and random selection of the street markets from which to collect the cheese samples. The samples were analysed for the presence of extraneous matters outside for which purpose the samples were washed and filtered and inside, for which the methodology of enzymathic digestion of the sample with pancreatine, followed by filtering,was used. RESULTS AND CONCLUSION: Of the 141 samples analysed, 75.9% exhibited at least one sort of extraneous matters. For the "prato" and "mussarela" cheeses, the high number of contaminated samples was due mainly to extraneous matters present inside the cheese, whereas in the "mineiro" cheese, besides the internal filth, 100% of the samples had external filth.

Evaluation of dog population in an urban area of Southeastern Brazil

Planning control programs, for diseases such as rabies requires information on the size and structure of the dog and cat population. In order to evaluate the dog population of the urban area of Araçatuba city, S. Paulo State, Brazil, a survey was conducted using a questionnaire to interview members of households. Eighty-eight districts were visited (37,778 houses) and the interview was possible at 77.93% of these. Human population size evaluated was 113,157 inhabitants. Houses that owned animals represented 55.2%, 26,926 of the animals concerned were dogs and 5,755 were cats. Of the dogs, 56.64% were 1-4 year olds and males represented 56.2% of the total population. Dog: person ratio was estimated at 2.8 dogs to every 10 persons, almost 3 times the ratio hitherto estimated and used in the planning of rabies vaccination campaigns.

Evaluating Tsunami Impact on the Gulf of Cadiz Coast (Northeast Atlantic).

The Gulf of Cadiz coasts are exposed to tsunamis. Emergency planning tools are now taking into account this fact, especially because a series of historical occurrences were strikingly significant, having left strong evidence behind, in the mareographic records, the geological evidence or simply the memory of the populations. The study area is a strip along the Algarve coast, south Portugal, an area known to have been heavily impacted by the 1 November 1755 event. In this study we use two different tsunami scenarios generated by the rupture of two thrust faults identified in the area, corresponding to 8.1-8.3 magnitude earthquakes. Tsunami propagation and inundation computation is performed using a non-linear shallow water code with bottom friction. Numerical modeling results are presented in terms of flow depth and current velocity with maximum values of 7 m and 8 m/s for inundation depth and flow speed, respectively. These results constitute a valuable tool for local authorities, emergency and decision planners to define the priority zones where tsunami mitigation measures must be implemented and to develop tsunami-resilient communities.

Potential inundation of Lisbon downtown by a 1755-like tsunami

In this study, we present 10 m resolution tsunami flooding maps for Lisbon downtown and the Tagus estuary. To compute these maps we use the present bathymetry and topographic maps and a reasonable estimate for the maximum credible tsunami scenario. Tsunami modeling was made with a non-linear shallow water model using four levels of nested grids. The tsunami flood is discussed in terms of flow depth, run-up height and maximum inundation area. The results show that, even today, in spite of the significant morphologic changes in the city river front after the 1755 earthquake, a similar event would cause tsunami flow depths larger than one meter in a large area along the Tagus estuary and Lisbon downtown. Other areas along the estuary with a high population density would also be strongly affected. The impact of the tide on the extent of tsunami inundation is discussed, due to the large amplitude range of the tide in Lisbon, and compared with the historical descriptions of the 1755 event. The results presented here can be used to identify the potential tsunami inundation areas in Lisbon; this identification comprises a key element of the Portuguese tsunami emergency management system.

Paleomagnetic study of the Messejana Plasencia dyke (Portugal and Spain): A lower Jurassic paleopole for the Iberian plate

The only Iberian lower Jurassic palcomagnetic pole come from the "Central Atlantic Magmatic Province"-related Messejana Plasencia dyke, but the age and origin of its remanence have been a matter of discussion. With the aim of solving this uncertainty, and to go further into a better understanding of its emplacement and other possible tectonic features, a systematic paleomagnetic investigation of 40 sites (625 specimens) distributed all along the 530 kin of the Messejana Plasencia dyke has been carried out. Rock magnetic experiments indicate PSD low Ti-titanomagnetite and magnetite as the minerals carrying the NRM. The samples were mostly thermally demagnetized. Most sites exhibit a characteristic remanent component of normal polarity with the exception of two sites, where samples with reversed polarities have been observed. The paleomagnetic pole derived from a total of 35 valid sites is representative of the whole structure of the dyke, and statistically well defined, with values of PLa = 70.4 degrees N, PLo = 237.6 degrees E, K= 47.9 and A(95) = 3.5 degrees. Paleomagnetic data indicates that: (i) there is no evidence of a Cretaceous remagnetization in the dyke, as it was suggested; (ii) most of the dyke had a brief emplacement time; furthermore, two dyke intrusion events separated in time from it by at least 10,000 y have been detected; (iii) the high grouping of the VGPs directions suggests no important tectonic perturbations of the whole structure of the dyke since its intrusion time; (iv) the pole derived from this study is a good quality lower Jurassic paleopole for the Iberian plate; and (v) the Messejana Plasencia dyke paleopole for the Iberian plate is also in agreement with quality-selected European and North American lower Jurassic paleopoles and the magnetic anomalies data sets that are available for rotate them to Iberia.

Shareholder wealth creation in response to announcements of acquisitions of unlisted firms: Evidence from Spain

We investigate shareholder value creation of Spanish listed firms in response to announcements of acquisitions of unlisted companies and compare this experience to the purchase of listed firms over the period 1991–2006. Similar to foreign markets, acquirers of listed targets earn insignificant average abnormal returns, whereas acquirers of unlisted targets gain significant positive average abnormal returns. When we relate these results to company and transaction characteristics our findings diverge from those reported in the literature for other foreign markets, as our evidence suggests that the listing status effect is mainly associated with the fact that unlisted firms tend to be smaller and lesser–known firms, and thus suffer from a lack of competition in the market for corporate control. Consequently, the payment of lower premiums and the possibility of diversifying shareholders’ portfolios lead to unlisted firm acquisitions being viewed as value–orientated transactions.

Individual pension information: Recommendations for the case of Spain based on the experiences of other countries

The aim of this paper is to establish some basic guidelines to help draft the information letter sent to individual contributors should it be decided to use this model in the Spanish public pension system. With this end in mind and basing our work on the experiences of the most advanced countries in the field and the pioneering papers by Jackson (2005), Larsson et al. (2008) and Sunden (2009), we look into the concept of “individual pension information” and identify its most relevant characteristics. We then give a detailed description of two models, those in the United States and Sweden, and in particular look at how they are structured, what aspects could be improved and what their limitations are. Finally we make some recommendations of special interest for designing the model for Spain.

Desenvolvimento de um plano de manutenção preventiva na rede de distribuição de água de Lisboa

O presente relatório de estágio enquadra-se no âmbito do trabalho final de Mestrado do curso de Engenharia Civil, área de especialização em Hidráulica, do Instituto Superior de Engenharia de Lisboa, e incide na temática dos sistemas de distribuição de água. O estágio decorreu na empresa EPAL – Empresa Portuguesa das Águas Livres, S.A., e teve como objecto o desenvolvimento de um plano de manutenção preventiva para a rede de distribuição de água de Lisboa. Devido à crescente complexidade dos sistemas de abastecimento de água e à grande dispersão territorial dos diversos órgãos integrados na rede, surge a necessidade de desenvolver um sistema que permita simplificar o planeamento e a gestão das intervenções de inspecção e manutenção preventiva dos órgãos. Para esse efeito, recorreu-se a um software SIG (Sistema de Informação Geográfica) para proceder à sectorização da rede de distribuição de água em pequenos grupos (Polígonos), constituídos por um número determinado de órgãos de manobra e segurança. Esta metodologia permite organizar as intervenções em pequenos grupos e optimizar as rotinas de Inspecção diárias. No decorrer do estágio efectuou-se ainda um levantamento dos procedimentos de inspecção e manutenção dos diversos órgãos integrados na rede de distribuição de água de Lisboa, quer por acompanhamento de actividades com as equipas de inspecção, quer por recolha de recomendações junto dos fabricantes dos órgãos. Este levantamento permitiu elaborar fichas de procedimento para as actividades de inspecção e manutenção preventiva dos diversos órgãos, afim de serem usadas como referência pelos trabalhadores.

Infant mortality rates according to socioeconomic status in a Brazilian city

OBJECTIVE: Data from municipal databases can be used to plan interventions aimed at reducing inequities in health care. The objective of the study was to determine the distribution of infant mortality according to an urban geoeconomic classification using routinely collected municipal data. METHODS: All live births (total of 42,381) and infant deaths (total of 731) that occurred between 1994 and 1998 in Ribeirão Preto, Brazil, were considered. Four different geoeconomic areas were defined according to the family head's income in each administrative urban zone. RESULTS: The trends for infant mortality rate and its different components, neonatal mortality rate and post-neonatal mortality rate, decreased in Ribeirão Preto from 1994 to 1998 (chi-square for trend, p<0.05). These rates were inversely correlated with the distribution of lower salaries in the geoeconomic areas (less than 5 minimum wages per family head), in particular the post-neonatal mortality rate (chi-square for trend, p<0.05). Finally, the poor area showed a steady increase in excess infant mortality. CONCLUSIONS: The results indicate that infant mortality rates are associated with social inequality and can be monitored using municipal databases. The findings also suggest an increase in the impact of social inequality on infant health in Ribeirão Preto, especially in the poor area. The monitoring of health inequalities using municipal databases may be an increasingly more useful tool given the continuous decentralization of health management at the municipal level in Brazil.

A data-mining-based methodology for transmission expansion planning

In recent decades, all over the world, competition in the electric power sector has deeply changed the way this sector’s agents play their roles. In most countries, electric process deregulation was conducted in stages, beginning with the clients of higher voltage levels and with larger electricity consumption, and later extended to all electrical consumers. The sector liberalization and the operation of competitive electricity markets were expected to lower prices and improve quality of service, leading to greater consumer satisfaction. Transmission and distribution remain noncompetitive business areas, due to the large infrastructure investments required. However, the industry has yet to clearly establish the best business model for transmission in a competitive environment. After generation, the electricity needs to be delivered to the electrical system nodes where demand requires it, taking into consideration transmission constraints and electrical losses. If the amount of power flowing through a certain line is close to or surpasses the safety limits, then cheap but distant generation might have to be replaced by more expensive closer generation to reduce the exceeded power flows. In a congested area, the optimal price of electricity rises to the marginal cost of the local generation or to the level needed to ration demand to the amount of available electricity. Even without congestion, some power will be lost in the transmission system through heat dissipation, so prices reflect that it is more expensive to supply electricity at the far end of a heavily loaded line than close to an electric power generation. Locational marginal pricing (LMP), resulting from bidding competition, represents electrical and economical values at nodes or in areas that may provide economical indicator signals to the market agents. This article proposes a data-mining-based methodology that helps characterize zonal prices in real power transmission networks. To test our methodology, we used an LMP database from the California Independent System Operator for 2009 to identify economical zones. (CAISO is a nonprofit public benefit corporation charged with operating the majority of California’s high-voltage wholesale power grid.) To group the buses into typical classes that represent a set of buses with the approximate LMP value, we used two-step and k-means clustering algorithms. By analyzing the various LMP components, our goal was to extract knowledge to support the ISO in investment and network-expansion planning.

Extended-spectrum β-lactamases from the North of Portugal in the boundaries to Spain: emergence of high resistance to 4th generation cephalosporins

During the past 15 years, emergence and dissemination of third-generation cephalosporins resistance in nosocomial Enterobacteriaceae became a serious problem worldwide, due to the production of extended-spectrum-β-lactamases (ESBLs). The aim of this study was to investigate among the presence of ESBL-producing enterobacteria among Portuguese clinical isolates nearby Spain, to investigate the antimicrobial susceptibility patterns and to compare the two countries. The β-lactamases genes, blaTEM, blaSHV and blaCTX-M were detected by molecular methods. Among the ESBL-producing isolates it was found extraordinary levels (98.9%) of resistance to the fourth-generation cephalosporin Cefepime. These findings point to the need of reevaluate the definition of ESBL.