O impacto (custo) das LMELT decorrente de acidentes de trabalho numa organização de saúde

RESUMO - A morbilidade associada às lesões músculoesqueléticas ligadas ao trabalho (LMELT) origina uma elevada perda de produtividade (absentismo e presentismo) em organizações de saúde, o que induz um substantivo impacto (custo) económico. Nesse contexto, os profissionais de saúde, como grupo vulnerável à ocorrência de LMELT, nomeadamente aqueles que mobilizam os doentes diariamente, apresentam elevadas taxas de acidentes de trabalho com absentismo. Considerando a importância do capital humano em saúde e tendo em conta o contexto actual de contenção da despesa no sector da saúde português, o despiste de situações de perda de produtividade e seu impacto económico em instituições de saúde, assume um papel fundamental na gestão dessas organizações. O presente estudo teve como objetivo avaliar o impacto (custo) das LMELT por acidente de trabalho em enfermeiros e assistentes operacionais do CMRA durante o período de 2009 a 2013. Partindo da identificação dos acidentes de trabalho (AT) ocorridos nestes grupos profissionais entre 2009 e 2013, da lesão musculoesquelética resultante e do absentismo registado os participantes no estudo responderam aos itens da escala WQL-8 e SPS-6, para se determinar também os níveis de presentismo. Este estudo adotou a metodologia do capital humano para estimar os custos indiretos ou perda de produtividade das LMELT. Constatou-se que são as transferências a maior causa das LMELT, com uma sintomatologia mais prevalente na região lombar. Existe perda de produtividade nesta instituição entre 2009 e 2013 com um custo total estimado em 222.015,98€, absentismo e presentismo, sendo a Distração Evitada a dimensão que apresenta maiores valores.

Desperdício de medicamentos em ambiente hospitalar : identificação dos pontos críticos no circuito, impacto no consumo de recursos e estratégias de controlo

RESUMO - Numa época de constrangimento orçamental, os hospitais do SNS vêm-se na obrigação de melhorar a eficiência de utilização dos recursos disponíveis, por forma a contribuir para o seu equilíbrio financeiro. Cabe a cada prestador analisar a sua posição, avaliar as suas oportunidades e adoptar estratégias que a curto, médio ou longo prazo se traduzam numa efetiva melhoria na eficiência. A análise e o controlo do desperdício associado à prestação de cuidados de saúde apresentam-se, globalmente, como uma dessas oportunidades. Neste trabalho são exploradas oportunidades de redução de desperdício em medicamentos, numa perspectiva meramente operacional, a nível das funções desempenhadas pelos Serviços Farmacêuticos (SF). No hospital em estudo acompanhou-se as diferentes linhas de produção dos SF, nomeadamente as tarefas envolvidas no processo de Distribuição Individual Diária em Dose Unitária, na distribuição de medicamentos para o Serviço de Urgências (SU) e na preparação de citotóxicos e imunomoduladores para o Hospital de Dia de Oncologia. Durante o ano de 2013, os SF devolveram aos fornecedores 0,07% e abateram 0,05% da despesa em medicamentos. A análise dos erros de medicação registados reflete o tipo de distribuição adotado para a maioria dos serviços de internamento do hospital. As melhorias encontradas a este nível passam pelo reforço de recursos humanos a desempenhar as tarefas de dispensa de medicamentos mas também pela implementação de uma cultura de registo de erros e acidentes, baseada no sistema de informação, para que se consiga quantificar o desperdício associado e agir com vista à optimização do circuito. A relação entre o método de distribuição adotado para o SU e a utilização do medicamento neste serviço foi apenas investigada para os medicamentos de registo individual de administração. Foi determinado um índice de eficiência de utilização de 67,7%, entre o dispensado e o administrado. Às discrepâncias encontradas está associado um custo de 32 229,6 € para o ano de 2013. Constatou-se também que, a nível do consumo de citotóxicos e imunomoduladores houve, durante o mês de abril de 2013, um índice de desperdício médio de 14,7%, entre o prescrito e o consumido, que se traduziu num custo do desperdício mensal de 13 070,9 €. Com base no desperdício mensal estimou-se que o desperdício anual associado à manipulação de citotóxicos e imunomoduladores deverá corresponder a 5,5% da despesa anual do serviço com estes medicamentos. Não obstante as limitações encontradas durantes o trabalho, e parte do desperdício apurado ser inevitável, demonstrou-se que o desperdício em medicamentos pode traduzir-se numa fatia não negligenciável mas controlável da despesa do hospital em estudo. No seguimento do seu conhecimento, a sua contenção pode ter um impacto na redução de despesa a curto-médio prazo, sem a necessidade de racionamento da utilização de medicamentos e sem alterar os padrões de qualidade assistencial exigidos pela tutela e pelos doentes. Por último, são apresentadas recomendações para a redução do desperdício em medicamentos, adequadas a cada uma das dimensões analisadas.

Caracterização dos beneficiários do Programa De volta para casa de Belo Horizonte/MG/Brasil quanto à autonomia e comportamento social

RESUMO: INTRODUÇÃO E OBJETIVOS: Trata-se de estudo transversal descritivo, em etapa única, cujo objetivo foi traçar o perfil dos beneficiários do Programa De volta para casa (PVC), munícipes de Belo Horizonte / Minas Gerais / Brasil, quanto ás habilidades de vida independente (autonomia) e comportamento social. MÉTODO: O universo inicial de beneficiários era de 210, em julho de 2013, data de aprovação do protocolo. Por questões operacionais, o público-alvo considerado e estudado foi de 121 beneficiários. Foram utilizados como instrumentos as escalas Independent Living Skills Survey (ILSS) e Social Behavior Scale (SBS). Foi feita a análise estatística dos dados e os resultados foram analisados à luz do paradigma emergente de produção social da saúde. RESULTADOS: Considerando o total válido estudado de 121 beneficiários, os resultados revelaram que 82,4% apresentam diagnóstico de esquizofrenia e 62% eram do sexo masculino. Apresentaram média de idade de 57,9 anos e tempo médio de internação psiquiátrica antes de inserção no programa de 30,9 anos. Quanto à autonomia, os resultados da ILSS revelaram uma média global de 1,6 sendo que os melhores índices foram alcançados nos subitens Cuidados pessoais (2,69), Alimentação (2,53), Saúde (2,07) e os piores índices foram encontrados nos subitens Emprego (0,47), Lazer (0,86) e Preparo e armazenamento de alimentos (0,98). Quanto aos problemas no comportamento social, os resultados da SBS revelaram uma média global de 0,69 sendo que as áreas de maiores dificuldade foram: Rir ou falar sozinho (40,5%), Incoerência da fala (29%), Auto-cuidado precário e Pouca atividade (ambas com 25,6% cada). As áreas de menores dificuldades, ainda quanto à SBS, foram: Idéias suicidas 92,4%), Comportamento sexual inapropriado (7,4%) e Depressão (9,9%). CONCLUSÃO: Concluiu-se que o perfil dos beneficiários do PVC, quanto à autonomia e aos problemas de comportamento social, aponta para médias relativamente baixas. O desafio para o enfrentamento desta questão deverá considerar estratégias múltiplas de ação à luz do paradigma emergente de saúde e da reabilitação psicossocial que priorize o empoderamento e protagonismo do beneficiário. É necessário o desenvolvimento de outros estudos que ampliem o evidenciamento desta clientela no que tange às suas reais necessidades e potencialidades para que se possa efetivar o ajuste necessário para a legitimação do programa enquanto ação efetivo-eficaz de promoção de saúde.-------------ABSTRACT: descriptive cross-sectional study in a single stage was conducted to investigate independent living skills and social behavior profile of beneficiaries of Programa De Volta para casa (PVC) who live in Belo Horizonte/Minas Gerais/Brazil. METHODS: The target population included a total of 210 individuals in july 2013, when the study was approved by the ethics committees. Because of operational reasons only 121 individuals were evaluated. Data were collected using the Independent Living Skills Survey (ILSS) and the Social Behavior Scale (SBS). Statistical results were analyzed considering as a reference framework both the emerging paradigm of social health production. RESULTS: Considering a sample of 121 individuals, results revealed that 82.4% were diagnosed with schizophrenia, and 62% were male. The mean age was 57.9 years and the mean stay in the psychiatric hospital prior to PVC was 30.9 years. Independent living skills measured by ILSS revealed a global mean of 1.6, and the best scores were in the following subscales: personal care (2.69), feeding (2.53) and health (2.07). On the other hand, the worst scores were in the following subscales: employment (0.47), leisure (0.86) and food preparation (0.98). Impairment of social functioning measured by SBS revealed a global mean of 0.69, and the best scores were in the following subscales: laughing and talking by itself (40.5%), conversation: incoherence (29%), appearance and personal hygiene (25.6%), and idleness (25.6%). The worst scores were in the following subscales: suicidal ideations (92.4%), improper sexual behavior (7.4%), and depression (9.9%). CONCLUSION: It was concluded that the profile of PVC beneficiaries, regarding their autonomy and their problems of social behavior, points to a relatively low average. The challenge of facing this issue should consider multiple strategies of intervention that prioritizes the empowerment and leadership of the beneficiaries, based on the emerging paradigm of health and psychosocial rehabilitation as a reference framework. The development of other studies that expand the evidencing of this target population with respect to their real needs and capabilities in order to carry out the necessary adjustments for the legitimacy of the program as effective health promotion action is required.

Business continuity management at Banif: Defining and selecting recovery strategies

This project aims to delineate recovery strategies for a Portuguese Bank, as a way to increase its preparedness towards unexpected disruptive events, thus avoiding an operational crisis escalation. For this purpose, Business Continuity material was studied, a risk assessment performed, a business impact analysis executed and new strategic framework for selecting strategies adopted. In the end, a set of recovery strategies were chosen that better represented the Bank’s appetite for risk, and recommendations given for future improvements.

Assessment of integration of the leprosy program into primary health care in Aracaju, state of Sergipe, Brazil

INTRODUCTION: The aim of this study was to assess the epidemiological and operational characteristics of the Leprosy Program before and after its integration into the Primary healthcare Services of the municipality of Aracaju-Sergipe, Brazil. METHODS: Data were drawn from the national database. The study periods were divided into preintegration (1996-2000) and postintegration (2001-2007). Annual rates of epidemiological detection were calculated. Frequency data on clinico-epidemiological variables of cases detected and treated for the two periods were compared using the Chi-squared (χ2) test adopting a 5% level of significance. RESULTS: Rates of detection overall, and in subjects younger than 15 years, were greater for the postintegration period and were higher than rates recorded for Brazil as a whole during the same periods. A total of 780 and 1,469 cases were registered during the preintegration and postintegration periods, respectively. Observations for the postintegration period were as follows: I) a higher proportion of cases with disability grade assessed at diagnosis, with increase of 60.9% to 78.8% (p < 0.001), and at end of treatment, from 41.4% to 44.4% (p < 0.023); II) an increase in proportion of cases detected by contact examination, from 2.1% to 4.1% (p < 0.001); and III) a lower level of treatment default with a decrease from 5.64 to 3.35 (p < 0.008). Only 34% of cases registered from 2001 to 2007 were examined. CONCLUSIONS: The shift observed in rates of detection overall, and in subjects younger than 15 years, during the postintegration period indicate an increased level of health care access. The fall in number of patients abandoning treatment indicates greater adherence to treatment. However, previous shortcomings in key actions, pivotal to attaining the outcomes and impact envisaged for the program, persisted in the postintegration period.

Portugal

In 2014, the wind energy sector achieved a maturity status within the Portuguese power system. While it still experienced some additional capacity deployment (222 MW), after 15 years of intense deployment Portugal reached 4, 953 MW of installed wind power capacity by the end of 2014. Wind power represents 25% (considering only mainland Portugal) of the total operational capacity and 42% of renewable energy capacity in the country. In 2014, Portuguese wind parks produced 12.1 TWh maintaining a wind energy contribution of 24% of the annually electricity consumption. This high wind penetration was influenced by the favorable wind conditions observed in the first three months of the year over central and northern regions of mainland Portugal that also correspond to the largest concentration of installed wind capacity.

A intervenção dos orgãos de polícia criminal em sede de julgamento

Currently, Portugal assumes itself as a democratic rule of substantive law State, sustained by a legal system seeking the right balance between the guarantee of fundamental rights and freedoms constitutional foreseen in Portugal’s Fundamental Law and criminal persecution. The architecture of the penal code lies with, roughly speaking, a accusatory basic structure, “deliberately attached to one of the most remarkable achievements of the civilizational democratic progress, and by obedience to the constitutional commandment”, in balance with the official investigation principle, valid both for the purpose of prosecution and trial. Regarding the principle of non self-incrimination - nemo tenetur se ipsum accusare, briefly defined as the defendant’s right of not being obliged to contribute to the self-incrimination, it should be stressed that there isn’t an explicit consecration in the Portuguese Constitution, being commonly accepted in an implicit constitutional prediction and deriving from other constitutional rights and principles, first and foremost, the meaning and scope of the concept of democratic rule of Law State, embedded in the Fundamental Law, and in the guidelines of the constitutional principles of human person dignity, freedom of action and the presumption of innocence. In any case, about the (in) applicability of the principle of the prohibition of self-incrimination to the Criminal Police Bodies in the trial hearing in Court, and sharing an idea of Guedes Valente, the truth is that the exercise of criminal action must tread a transparent path and non-compliant with methods to obtain evidence that violate the law, the public order or in violation of democratic principles and loyalty (Guedes Valente, 2013, p. 484). Within the framework of the penal process relating to the trial, which is assumed as the true phase of the process, the witness represents a relevant figure for the administration of criminal justice, for the testimonial proof is, in the idea of Othmar Jauernig, the worst proof of evidence, but also being the most frequent (Jauernig, 1998, p. 289). As coadjutant of the Public Prosecutor and, in specific cases, the investigating judge, the Criminal Police Bodies are invested with high responsibility, being "the arms and eyes of Judicial Authorities in pursuing the criminal investigation..." which has as ultimate goal the fulfillment of the Law pursuing the defense of society" (Guedes Valente, 2013, p. 485). It is in this context and as a witness that, throughout operational career, the Criminal Police Bodies are required to be at the trial hearing and clarify the Court with its view about the facts relating to occurrences of criminal context, thus contributing very significantly and, in some cases, decisively for the proper administration of the portuguese criminal justice. With regards to the intervention of Criminal Police Bodies in the trial hearing in Court, it’s important that they pay attention to a set of standards concerning the preparation of the testimony, the very provision of the testimony and, also, to its conclusion. Be emphasized that these guidelines may become crucial for the quality of the police testimony at the trial hearing, thus leading to an improvement of the enforcement of justice system. In this vein, while preparing the testimony, the Criminal Police Bodies must present itself in court with proper clothing, to read before and carefully the case files, to debate the facts being judged with other Criminal Police Bodies and prepare potential questions. Later, while giving his testimony during the trial, the Criminal Police Bodies must, summing up, to take the oath in a convincing manner, to feel comfortable, to start well by convincingly answering the first question, keep an attitude of serenity, to adopt an attitude of collaboration, to avoid the reading of documents, to demonstrate deference and seriousness before the judicial operators, to use simple and objective language, to adopt a fluent speech, to use nonverbal language correctly, to avoid spontaneity responding only to what is asked, to report only the truth, to avoid hesitations and contradictions, to be impartial and to maintain eye contact with the judge. Finally, at the conclusion of the testimony, the Criminal Police Bodies should rise in a smooth manner, avoiding to show relief, resentment or satisfaction, leaving a credible and professional image and, without much formality, requesting the judge permission to leave the courtroom. As final note, it’s important to stress that "The intervention of the Police Criminal Bodies in the trial hearing in Court” encloses itself on a theme of crucial importance not only for members of the Police and Security Forces, who must welcome this subject with the utmost seriousness and professionalism, but also for the proper administration of the criminal justice system in Portugal.

Concordance between expected and observed bacilloscopy results of clinical forms of leprosy: a 6-year retrospective study in Recife, State of Pernambuco, Brazil

INTRODUCTION: Operational classification of leprosy based on the number of skin lesions was conceived to screen patients presenting severe forms of the disease to enable their reception of a more intense multidrug regimen without having to undergo lymph smear testing. We evaluated the concordance between operational classification and bacilloscopy to define multibacillary and paucibacillary leprosy. METHODS: We selected 1,213 records of individuals with leprosy, who were untreated (new cases) and admitted to a dermatology clinic in Recife, Brazil, from 2000 to 2005, and who underwent bacteriological examination at diagnosis for ratification of the operational classification. RESULTS: Compared to bacilloscopy, operational classification demonstrated 88.6% sensitivity, 76.9% specificity, a positive predictive value of 61.8%, and a negative predictive value of 94.1%, with 80% accuracy and a moderate kappa index. Among the bacilloscopy-negative cases, 23% had more than 5 skin lesions. Additionally, 11% of the bacilloscopy-positive cases had up to 5 lesions, which would have led to multibacillary cases being treated as paucibacillary leprosy if the operational classification had not been confirmed by bacilloscopy. CONCLUSIONS: Operational classification has limitations that are more obvious in borderline cases, suggesting that in these cases, lymph smear testing is advisable to enable the selection of true multibacillary cases for more intense treatment, thereby contributing to minimization of resistant strain selection and possible relapse.

Potential M&A between TIM Brazil and Oi S.A: The irreversible force of Telecommunications convergence

The intrinsic forces of market aiming for telecom industry convergence has arrived to Brazil. This case presents real characters, a sequence of events and other public information that has been impacting two corporations studied in this case. TIM Brazil and Oi S.A, two top players in the Brazilian telecom industry mobile and fixed segment respectively. While a merge between the two of them looks perfect and simple in an operational perspective due to its vertical complementarity, bring to them opportunities to win over a bundle offer (multi service package) that will consolidate their market predominance. Macroeconomic and internal corporate contrasts between these companies’ environment might signal that an impulsive could have a high price to pay in the future.

Construction sector: Need for strategic reorientation

The construction sector in Portugal declined sharply over the past 10 years. The current crisis can wiped out the entire industry. Can the industry survive? What lessons can we learn? What can be done to revive the sector? These are questions this study intends to answer. By analyzing the best practices of the industry and of the largest construction companies in Portugal, as well as the difficulties and constrains that they all faced, I found that retrenchment (operational costs and selling assets) are the main measures companies resort to, and that strategic reorientation is essential to turnaround. I found that internationalization is a key driver on strategic reorientation and diversification and concentration are complementary strategies that can enforce and strengthen the main one.

Zon-Optimus merger: Case study

The present Work Project was performed as a Case Study, analysing the merger between Zon, a leading Portuguese Pay TV operator and Optimus, the third largest mobile company in Portugal. The Case Study was developed with the purpose of understanding the value creation of the Zon-Optimus merger, being analysed the: (i) industry trends, (ii) parties’ contribution, (iii) pre-merger events, (iv) merger rationale, (v) deal structure and valuation, (vi) competition authority decision and (vii) competitive advantages and future strategy. Was also attached a Teaching Note where synergies, implied valuations, exchange ratios, shareholder agreements, swot analysis, among others, were duly analysed.

Strategic design of There App’s business model: From product to multi-sided platform

The following work project illustrates the strategic issues There App, a mobile application, faces regarding the opportunity to expand from its current state as a product to a multisided platform. Initially, a market analysis is performed to identify the ideal customer groups to be integrated in the platform. Strategic design issues are then discussed on how to best match its value proposition with the identified market opportunity. Suggestions on how the company should organize its resources and operational processes to best deliver on its value proposition complete the work.

Leprosy and pregnancy in the State of Para: an epidemiological perspective

Introduction A few older publications describe leprosy associated with pregnancy, a situation that has been linked to leprosy exacerbation. This study aimed to describe the detection rate of this association in the State of Pará by county and Integration Region (IR) from 2007 to 2009 via an analysis of sociodemographic, epidemiological and operational indices. Methods This was a descriptive study using information generated by the SINAN. The Detection Coefficient of the Leprosy and Pregnancy Association (DCLP) epidemiological index was constructed to help interpret the endemicity parameters. The disease was considered hyperendemic when greater than two cases per 10,000 inhabitants were identified. Results During the study period, 149 associations were detected, with 14 hyperendemic counties: seven in 2007, five in 2008 and two in 2009. The Carajás Integrated Region displayed the highest DCLP index in the period. Eldorado dos Carajás had the single highest DCLP index (5.7/10,000 inhabitants, 2008), whereas the DCLP index in Conceição do Araguaia was very high in all three years. However, most counties displayed low or medium DCLP indices. The annual averages were 0.31 DCLP (2007), bass; 0.30 (2008), bass and 0.19 (2009), bass. The average DCLP index was 0.26, which is considered low. Three clusters of medium endemicity were identified by the average DCLP in the study period. Conclusions The analyses indicated that the surveillance program is still unsatisfactory in Pará. The interpretation of the endemicity parameters enabled qualitative and quantitative analyses to determine the epidemiological panorama of this association. The identification of high endemicity requires further clarification.

Overcoming the “European Paradox”: The role of Regional Innovation Systems (RIS) in translating R&D investments into economic and employment growth

The emergence of the so-called “European Paradox” shows that R&D investment is not maximally effective and that increasing the scale of public R&D expenditures is not sufficient to generate employment and sustained economic growth. Increasing Governmental R&D Investment is far from being a “panacea” for stagnant growth. It is worth noting that Government R&D Investment does not have a statistically significant impact on employment, indicating the need to assess the trade-offs of policies that could lead to significant increases in government expenditure. Surprisingly, Governmental R&D Employment does not contribute to “mass-market” employment, despite its quite important role in reducing Youth-Unemployment. Despite the negative side-effects of Governmental R&D Employment on both GVA and GDP, University R&D Employment appears to have a quite important role in reducing Unemployment, especially Youth-Unemployment, while it also does not have a downside in terms of economic growth. Technological Capacity enhancement is the most effective instrument for reducing Unemployment and is a policy without any downside regarding sustainable economical development. In terms of wider policy implications, the results reinforce the idea that European Commission Research and Innovation policies must be restructured, shifting from a transnational framework to a more localised, measurable and operational approach.

Cabelte restructuring by OxyCapital

This case study describes OxyCapital’s intervention in Cabelte’s operational and financial restructuring. Despite Cabelte’s strong debt burden, OxyCapital believed that the Group’s financial difficulties were temporary and that it had growth potential if the said restructuring would be implemented. Hence, while striving for an operational turnaround, OxyCapital managed to reach an agreement among not only the several banks but also the Group’s shareholder for the financial restructuring. The transaction included the acquisition of a majority stake on the Group’s share capital and of a significant part of Cabelte’s bank debt by OxyCapital’s Corporate Restructuring Fund.