O modelo de transporte de doentes não urgentes : estudo do caso Hospital Geral de Santo António

RESUMO - Contexto: A avaliação das práticas de um hospital na utilização do transporte não urgente, mais concretamente, a análise do procedimento utilizado nas respectivas requisições de transporte não urgente, por patologia, da estrutura de custos por tipo de transporte e sua validação em termos de conformidade para respectivo pagamento. Objectivos: Os objectivos deste trabalho são a i) avaliação da adequação das práticas do transporte não urgente, do Hospital Geral de Santo António (HGSA) do Centro Hospitalar do Porto (CHP), ao normativo legal em vigor, ii) do grau de conformidade das requisições de transporte analisadas com os critérios clínicos estabelecidos, iii) mensurar os custos de transporte programado na estrutura hospitalar e avaliar a dimensão dos transportes injustificados/inadequados, no orçamento do HGSA. Metodologia: A partir da análise do normativo legal do transporte não urgente e do Regulamento Interno do HGSA, foram criadas duas matrizes, feita uma análise comparativa entre as mesmas, com o objectivo de permitir aferir do grau de conformidade do Regulamento face ao normativo legal. De 560 requisições de transporte e de 525 facturas de transporte não urgente, foi realizada uma comparação do grau de adequação das práticas do HGSA face ao estabelecido legal e clinicamente. Na vertente da análise do grau de conformidade do Regulamento face ao normativo legal foram os dois documentos comparados de acordo com os requisitos estabelecidos na Lei, tendo sido definidas as seguintes variáveis para as seguintes situações: i) situações abrangidas pelo transporte não urgente, taxa de conformidade situações abrangidas (TCSA) ii) justificações clinicas para o direito a tal tipo de transporte, taxa de conformidade justificações clinicas (TCJC) tendo, posteriormente, sido definida e calculada uma taxa global de conformidade (TCG). Na vertente do grau de adequação entre os critérios clínicos definidos e a sua aplicação prática bem como da definição da dimensão dos custos e sua representatividade no transporte injustificado/inadequado foram, para a primeira questão, criadas quatro variáveis, Transporte Justificado (TJ), Transporte Justificado mas não o meio utilizado (TJnm), Transporte Justificado mas sem sustentação clínica (TJssc) e Transporte Não Justificado (TNJ) e para a segunda questão três variáveis, o Transporte em Ambulância (TA), o Transporte em Táxi (TT) e o Transporte Publico ou Próprio (TP). Resultados: Conclui-se do presente estudo que o Regulamento Interno do CHP tem, nas duas situações em análise, um grau elevado de conformidade com o respectivo normativo legal, de acordo com a Taxa de Conformidade Global (80%). Também é possível concluir na adequação dos critérios clínicos definidos à sua aplicação prática que os mesmos se adequam em 85,7% das situações analisadas, ou seja, em 85,7% das vezes o transporte estava justificado, sendo que em 38% das vezes o transporte estava integralmente justificado, em 49% das vezes estava justificado mas não o meio utilizado e em 14% encontrava-se justificado mas sem a sustentação clinica devida. No que respeita ao tipo de transporte utilizado dos transportes justificados, 90 % foi realizado em ambulância, 8% em táxi e 2% em transporte publico ou próprio e dos transportes não justificados 92,5% foi realizado em ambulância, 2,5% em táxi e 5% em transporte publico ou próprio. No que concerne à causa clínica, nos transportes justificados, 53,3% deve-se a problemas do aparelho locomotor, 25% a alterações neurológicas, 16,3% a patologias que condicionam incapacidade funcional em repouso ou para a actividade mínima diária, 4,6% a transplante renal, 0,4% a Hemodiálise/Diálise e 0,4% a casos sociais e nos transportes injustificados, 69,2% deveu-se a alterações neurológicas e 30,8% a problemas do aparelho locomotor. O custo do transporte injustificado ascendeu a 304.172,50 € enquanto o do transporte inadequado ascendeu a 187.263 €.

Dengue: clinical forms and risk groups in a high incidence city in the southeastern region of Brazil

INTRODUCTION: The article describes the epidemiologic profile of dengue cases in Vitória, the capital of Espírito Santo, Brazil, from 2000 to 2009, aimed at identifying risk groups regarding the incidence and severity of the disease. METHODS: Confirmed cases of dengue among city residents during ten years were classified as dengue fever, dengue hemorrhagic fever, dengue shock syndrome and dengue with complications, and analyzed according to sex, age, race-color and education. RESULTS: The proportion of dengue cases was highest among women aged 20 to 29 years-old and similar between whites and blacks. A gradual decrease occurred in the percentage of dengue cases in the population aged 15 years-old or more, in the historical series of 10 years, and a growing increase in individuals less than 15 years-old, showing statistical significance. The fatality rate ranged from zero to 0.3% for all forms of dengue and from 0.2% to 18.2% for severe forms. CONCLUSIONS: The profile of those affected by the disease in the municipality is similar to those affected in Brazil. The increasing number of cases in individuals under 15 years-old corroborates the results of recent studies in other Brazilian municipalities.

Anti-Toxocara antibodies detected in children attending elementary school in Vitoria, State of Espírito Santo, Brazil: prevalence and associated factors

INTRODUCTION: The aim of this study was to evaluate the frequency of anti-Toxocara antibodies in serum from 7-year-old children attending elementary school in Vitória-ES, Brazil and to correlate these antibodies with socio-demographic factors, the presence of intestinal helminths, blood eosinophil numbers, past history of allergy or asthma, and clinical manifestations of helminth infections. METHODS: The detection of anti-Toxocara antibodies was performed using an ELISA (Cellabs Pty Ltd)on serum from 391 children who had already been examined by fecal examination and blood cell counts. Data from clinical and physical examinations were obtained for all children. RESULTS: The prevalence of anti-Toxocara antibodies was 51.6%, with no gender differences. No significant differences were observed between positive serology and the presence or absence of intestinal worms (60.3 and 51.7%, respectively; p = 0.286). The only variables significantly related to positive serology were onycophagy and the use of unfiltered water. Although eosinophilia (blood eosinophil count higher than 600/mm³) was significantly related to the presence of a positive ELISA result, this significance disappeared when we considered only children without worms or without a past history of allergy or asthma. No clinical symptoms related to Toxocara infection were observed. CONCLUSIONS: There is a high prevalence of anti-Toxocara antibodies in children attending elementary schools in Vitória, which may be partially related to cross-reactivity with intestinal helminths or to a high frequency of infection with a small number of Toxocara eggs.

Utopia III or an Ambiguous Humanist Utopia for the Second Millenium

Portuguese literature does not have many examples of successful and renowned utopias, though the considerable amount of published utopias written in foreign languages and translated to Portuguese language being quite relevant. However, in the last quarter of the twentieth century, almost at the eve of the second millennium an important Portuguese utopia was published: Utopia III, written by Pina Martins (1998). This long novel is structured as being the sequel of More’s Utopia, presenting the history and actual status of the mother of all literary utopias. The question at the basis of the whole novel is, “What would More’s Utopia be like today?” The main goal of this text will be to presente a literary analysis of Utopia III, focusing on the humanist principles and their adaptation to contemporary society, the search for a harmonious relationship between city and nature, the defence of a Portuguese identity and the appeal to a humanist renewal.

Is there space to build one more transshipment terminal within Portuguese territory?

NSBE - UNL

It takes more than soccer to make Argentinians, Brazilians, Chileans and Mexicans happy

Double Degree in Economics from the NOVA - School of Business and Economics and Insper

Are basic schools more effective than secondary schools?

The present essay focuses on the effectiveness of Portuguese public schools’ provision of 7th, 8th and 9th grades, using data from the Portuguese Ministry of Education and Science for 2009/10, 2010/11 and 2011/12. At least two school types offer these grades: Basic and Secondary. Based on previous findings, a production function is estimated for 9th grade students in the regular academic track, including a variable that indicates the specific school type attended by each student. After concluding that Basic Schools add more value, some explanations are presented as well as recommendations and possible further research.

O processo de dádiva de sangue do dador de primeira vez no Hospital do Espírito Santo - Évora, EPE : satisfação e retorno para a dádiva seguinte

RESUMO - Introdução: Com este trabalho, pretendeu-se averiguar em que medida a satisfação no processo de dádiva de sangue afeta o regresso dos dadores que doam pela primeira vez na vida, ou que se apresentaram pela primeira vez no Serviço de sangue do HESE. Material e métodos: Estudo observacional transversal descritivo. Dos dadores com uma única inscrição no período de 2011 a 2012 inclusive, (531+541 dadores) foram retirados os que entretanto completaram 66 anos (idade limite para a dádiva); os que não tinham contacto telefónico válido; e os que tinham morada fora do Distrito de Évora. Os dadores restantes (327 + 330 dadores), foram então inquiridos através de um questionário efetuado telefonicamente para determinar as causas de não regresso. Resultados: Obtiveram-se 360 respostas válidas ao questionário, correspondentes a 50% da amostra com um IC de 95%. Apesar de estar amplamente demonstrado que a satisfação na dádiva contribui decisivamente para o retorno à dádiva seguinte, apenas 12% da amostra referiu não regressar por algum motivo de insatisfação decorrente do processo de dádiva. Evidentemente, o mérito destes resultados é devido à equipa do Serviço de Imunohemoterapia do HESE. Porém uma outra realidade fica aqui patente, os dadores de primeira vez estão a decrescer há vários anos, e destes, os que regressam são cada vez menos. A manter-se esta tendência, a taxa de renovação da bolsa de dadores poderá tornar-se insuficiente para a manutenção da atual bolsa de dadores. Se o HESE conseguisse recuperar para a dádiva metade da amostra de dadores de primeira vez que não regressam, a sua autonomia em termos de consumo de sangue sairia reforçada, com o incremento de proveitos financeiros consequente. Conclusão: Este trabalho concretiza os objetivos a que se propôs, nomeadamente o de produzir conhecimento útil e de suporte à decisão no âmbito da administração hospitalar. O HESE tem agora ao seu dispor, a caraterização dos dadores de primeira vez e a descrição de como se está a processar a renovação da sua bolsa de dadores.

Spatial analysis of new cases of leprosy in the State of Espírito Santo, Brazil, between 2004 and 2009

INTRODUCTION: Leprosy in Brazil is a public health issue, and there are many regions in the State of Espírito Santo with high endemic incidence levels of leprosy, characterizing this state as a priority for leprosy programs. The aim of this study was to determine the spatial distribution of coefficients of new cases of leprosy in the State of Espírito Santo, Brazil. METHODS: We conducted a descriptive and ecologic study based on the spatial distribution of leprosy in the State of Espírito Santo between 2004 and 2009. Data were gathered from the available records of the Espírito Santo State Health Secretary. The global and local Bayesian empirical methods were used to produce an estimate of leprosy risk, smoothing the fluctuation effects of the detection coefficients. RESULTS: The study resulted in a coefficient adjustment of new cases in 10 towns that changed their classification, among which, 2 went from low to medium, 4 from medium to high, 3 from high to very high, and 1 from very high to hyper-endemic. An average variation of 1.02, fluctuating between 0 and 12.39 cases/100,000 inhabitants, was found in a comparative calculation between the Local Ebest value and the average coefficient of new leprosy cases in the State of Espírito Santo. CONCLUSIONS: The spatial analysis of leprosy favors the establishment of control strategies with a better cost-benefit relationship since it reveals specific and priority regions, thereby enabling the development of actions that can interfere in the transmission chain.

How to increase and attract more tourists into Kenya throught experiental marketing

This marketing plan project is a culmination of extensive strategies with the use of experiential marketing to address issues confronting the Kenyan tourism industry in order to have a sustainable tourism sector. Following the terrorist attack carried out by Islamist militants’ belonging to al-Shabaab terrorist organization on Nairobi’s Westgate shopping mall in September 2013, tourist forecast has gone down sharply with an average of 20% fall in tourists’ arrivals which is likely to have an impact on the tourism sector in Kenya. Even before the deadly attack on Westgate, the most lethal attack by Islamist terrorists in 15 years in Kenya, the government through the Kenya tourist board had announced that in 2013 tourist arrivals were down by 12%, at 495,978, according to an October 2013 report by Bloomberg. Tourism revenues were also down by 7.4%, over FY12/13 (July-June) to reach KES96.24bn, according to a September 2013 report on the local Capital FM website. Beyond 2013, much will depend on how quickly the Kenya tourist board can regain control of the situation. The Kenyan government believes that the Westgate mall attack was a 'one-off' incident, with a low probability of a similar event happening again over the short term period. Germany, United States, United Kingdom, Australia, Italy, France and Canada continue to be the key source market however; the Kenya tourist board can make continued growth stronger from new emerging markets in order to increase new arrivals into the country. The marketing plan outlines the objectives to be implemented and provides the implementation strategy, activity plans, monitoring and evaluation plans, financial requirements projections and proposes a new structure of experiential marketing. A number of regional forces are identified that will impact tourism into the country including global, social and economic forces, emerging trends in visitor motivations and behavior, emerging forces in experiential marketing. A major component of the strategy identifies target markets for Kenya to commensurate with the level of resources that will be available for marketing and promotion, in keeping with the forces and trends identified and the nature of the Kenya tourism environment. The agreed upon target market segments are: generic/mass travel, experiential travel, creative travel, adventure seeking travel, senior/extended/long stay travel, and business related travel. The strategy phases the development of the target markets over the years of the marketing strategies in order to yield the best opportunity for results. A core activity in developing a marketing strategy is determining the nature of experiences Kenya offers in tourism. The strategy’s experience development process will continue to develop within the context of the products identified which will be promoted regionally: culture/heritage, nature, community-based. Each county in the country has a significant number of attractions and experiences and the challenge of the country is to bring these together in a creative and innovative way in order to encourage tourists to visit more than one county in Kenya.

Malignancies in HIV/AIDS patients attending an outpatient clinic in Vitória, State of Espírito Santo, Brazil

INTRODUCTION: The present study investigated cancer prevalence and associated factors among HIV-infected individuals attending an AIDS outpatient clinic in Vitória, State of Espírito Santo, Brazil. METHODS: A sectional study was conducted among HIV infected adults attending an AIDS outpatient clinic in Vitória, State of Espírito Santo, Brazil. Demographic, epidemiological and clinical data were abstracted from medical records, including cancer diagnoses; nadir and current CD4 cell count, HIV viral load, time on antiretroviral treatment (ART), type of ART and smoking status. RESULTS: A total of 730 (91.3%) patients were included in the study. Median age was 44.0 [interquartile range (IQR): 35-50.3] years; median time since HIV diagnosis was 5.5 years (IQR: 2-10); 60% were male; and 59% were white. Thirty (4.1%) cases of cancer were identified of which 16 (53%) were AIDS defining cancers and 14 (47%) were non-AIDS defining malignancies. Patients diagnosed with cancer presented higher chance of being tobacco users [OR 2.2 (95% CI: 1.04-6.24)]; having nadir CD4 ≤200 cells/mm³ [OR 3.0 (95% CI: 1.19-7.81)] and higher lethality [OR 13,3 (95% CI: 4,57-38,72)]. CONCLUSIONS: These results corroborate the importance of screening for and prevention of non-AIDS defining cancers focus in HIV-infected population, as these cancers presented with similar frequency as AIDS defining cancers.

First description of autochthonous canine visceral leishmaniasis in the metropolitan region of Vitória, State of Espírito Santo, Brazil

INTRODUCTION: We investigated autochthonous canine visceral leishmaniasis (CVL) in the metropolitan region of Vitória (MRV), an area in which a human case was previously reported. METHODS: Serological, parasitological, and molecular tests were performed in 201 dogs. RESULTS: Twenty-six (13%) and 12 (6%) dogs were identified as positive using in-house enzyme-linked immunosorbent assay (ELISA) and rK39 tests, respectively. Two dogs had a positive culture for Leishmania chagasi, and 4 were polymerase chain reaction (PCR)-positive for Leishmania spp. One positive dog belonged to the aforementioned patient. CONCLUSIONS: Although the responsible vector was not found, our results provide evidence of autochthonous CVL in the MRV, a non-endemic area for VL.

The good, the bad and the ugly: The fall and resolution of Banco Espírito Santo

This case study – and accompanying teaching note – briefly describes the history of the Espírito Santo family, a banking dynasty who led one of Portugal’s leading economic and financial groups, along with its “crown jewel”, Banco Espírito Santo. It chronicles how the corporate governance issues at BES allowed the family to exploit the bank, its shareholders and its customers, so as to support its unprofitable non-financial businesses. This left the bank in a poor financial situation, which deteriorated beyond control, leaving regulators – whose actions are also analysed here – with no alternative, amidst a severe liquidity crisis, but to apply a resolution measure, pinning large losses on junior bondholders and shareholders before recapitalising the bank.

Espírito Santo Saúde: The bidding war

This case study describes the current situation of Espírito Santo Saúde, which involved an eventful takeover process. The company initially went public on February 2014 and later that year, due to the financial situation of its holdings it had to be sold. The bidding war began in August 2014, after Ángeles announced the first offer. Other participants who also pitched bids include José de Mello Saúde, UnitedHealth and Fosun. Furthermore, the potential projects Espírito Santo Saúde was considering implementing prior to the sale and the current situation of the healthcare industry in Portugal, will also be analysed.