Information technology supporting healthcare and social care services

The authors are developing a pilot project for a Municipality in the North of Portugal, envisaging the definition and implementation of an e-marketplace for healthcare and social services, in order to facilitate the interaction between healthcare and social services professionals and people with special needs (or their relatives). Based on the results of a survey on user needs analysis and expectations conducted in 2011, the paper discusses the relevance and interest of such platforms and the main drivers and motivations of the population for using such services, as well as which services would motivate citizens to use the platform. The results of the study will be used to select the products and services perceived to be the most desired by the potential users. The paper thus makes three main contributions: (1) the results of the study confirm the interest and the perceived potential of such a service, from the end-users perspective; (2) the findings support the advantage of expanding this pilot project to a full scale implementation; and (3) the performed analysis improves our understanding of the relations between the characteristics of the inquired population and the perceived interest in such platforms.

The impact of the digital divide on the perceived interest of an e-Marketplace to support healthcare and social care services

In a Europe increasingly aging, it is now recognized the importance and potential of the service industry for ageing well based on information and communication technologies (ICT), as exemplified by the electronic market of social services and health care, the GuiMarket, proposed by the authors. However, this new range of services requires that individuals have advanced digital skills to fully participate in society. Based on the results of a survey made on a sample of 315 individuals, this paper discusses the importance granted GuiMarket and the intended frequency of use, concluding there is a close relationship between ICT access and use that respondents anticipate making of GuiMarket and alike services.

The impact of improvement of water supply and sanitation facilities on diarrhea and intestinal parasites: a Brazilian experience with children in two low-income urban communities

During the second half of 1986 the impact of the improvement of water supply and excreta disposal facilities on diarrheal diseases and intestinal parasitosis was studied in 254 children up to six years of age from two favelas (shanty towns) of Belo Horizonte, Brazil. The estimated incidence of diarrhea was 6.2 episodes/child year and the estimated period prevalence reached 31.0 episode days/ child/ year. The point prevalence of parasitosis was 70.7% (Ascaris lumbricoides: 55.4%, Trichuris trichiura: 19.6%, Giardia lamblia: 17.9%). The estimated prevalence of diarrhea decreased with improvement of water supply and sanitation facilities to 45% and 44% respectively, but no statistically significant impact was observed in the case of parasitosis. School education and weaning practice were found to be other important determinants of diarrhea.

Toxicological Assessment of Coated versus Uncoated Rubber Granulates Obtained from Used Tires for Use in Sport Facilities

Reuse of tire crumb in sport facilities is currently a very cost-effective waste management measure. Considering that incorporation of the waste materials in artificial turf would be facilitated if the rubber materials were already colored green, coatings were specifically developed for this purpose. This paper presents an experimental toxicological and environmental assessment aimed at comparing the obtained emissions to the environment in terms of polycyclic aromatic hydrocarbons (PAHs), heavy metals, and ecotoxicity for coated and noncoated rubber granulates. This study is a comprehensive evaluation of the major potential critical factors related with the release of all of these classes of pollutants because previous studies were not systematically performed. It was concluded that between the two types of coatings tested, one is particularly effective in reducing emissions to the environment, simultaneously meeting the requirements of adherence and color stability.

Addressing the facilities layout design problem through constraint logic programming

One of the most difficult problems that face researchers experimenting with complex systems in real world applications is the Facility Layout Design Problem. It relies with the design and location of production lines, machinery and equipment, inventory storage and shipping facilities. In this work it is intended to address this problem through the use of Constraint Logic Programming (CLP) technology. The use of Genetic Algorithms (GA) as optimisation technique in CLP environment is also an issue addressed. The approach aims the implementation of genetic algorithm operators following the CLP paradigm.

Manutenção preventiva de um edifício hospitalar

Os Hospitais, equipamentos de interesse público, são edifícios cujos desempenho e disponibilidade das suas instalações e equipamentos podem comprometer a prestação de cuidados de saúde, pelo que nestes estabelecimentos, a Manutenção Preventiva assume um papel relevante. Nesse sentido, pretendeu-se nesta dissertação definir uma estratégia específica que permita efectuar o planeamento da manutenção preventiva de um edifício hospitalar, enquanto infraestrutura para desenvolvimento da actividade clínica. Para tal, foi efectuada uma pesquisa bibliográfica, com a qual se identificaram conceitos de manutenção e requisitos a serem tidos em conta na manutenção de edifícios hospitalares. Foi efectuada uma caracterização genérica do objecto de manutenção, limitada no âmbito desta dissertação às principais componentes dos sistemas de construção e das instalações de águas e esgotos, que podem integrar um edifício hospitalar actual, atendendo às especificações e recomendações técnicas vigentes para este tipo de edifícios. Foram identificados os objectivos e requisitos de manutenção nestes edifícios, estabelecidos pelas condições de funcionamento pretendidas, pelos critérios de durabilidade exigidos pelo Dono de Obra, pelo nível de desempenho funcional requerido para as suas componentes e pelo grau de operacionalidade imposto nas suas diferentes unidades funcionais. Tendo em consideração que a criticidade de uma componente não depende só do contexto operacional da área funcional em se insere mas também das consequências que o seu estado de funcionamento pode acarretar para a unidade funcional. Foi exemplificada a análise dos modos de falha, sua criticidade e seus efeitos para hierarquização do risco associado nas componentes estudadas. As fichas exemplificativas dos planos de manutenção preventiva, que se apresentam no âmbito desta dissertação para algumas componentes básicas, integram acções e procedimentos que derivam de uma análise aos seus modos de falha e seus efeitos, bem como de recomendações técnicas exigências da regulamentação em vigor.

Riders in the storm: the professions and healthcare governance

The public sector is facing turbulent times and this also challenges the health professions who are expected to serve both the interests of the citizens and the cost-containment and austerity policies of governments. This article seeks to explore the changing role of the health professions. I introduce an approach on ‘citizen professionals’ as active players in the policy process and mediators between the state/policymakers and the citizens/patients. The aim is to highlight a transformative potential of professionalism and the connectedness with other sets of governance, like management. Empirical material from a German case study and a comparative European study serve to illustrate the arguments, drawing on policy analysis and secondary sources. The results bring the complexity of transformations and new emergent forms of professionalism into view that cannot be understood in traditional categories of conflict, exclusion and jurisdiction. Exploring the potential of the health professions to creatively respond to new challenges may reveal new opportunities for innovating healthcare policy beyond market and management.

Accounting logic and new professional in healthcare: a case study

The central place hospitals occupy in health systems transforms them into prime target of healthcare reforms. This study aims to identify current trends in organizational structure change in public hospitals and explore the role of accounting in attempts to develop controls over professionals within public hospitals. The analytical framework we proposed crosses the concept of “new professionalism” (Evetts, 2010), with the concept of “accounting logic” for controlling professionals (Broadbent and Laughlin, 1995). Looking for a more holistic overview, we developed a qualitative and exploratory study. The data were collected trough semi-structured interviews with doctors of a clinical hospital unit. Content analysis suggests that, although we cannot say that there is a complete and generalized integration of accounting information in the clinical decisions, important improvement has been made in that area. Despite the extensive literature developed on this topic, there is any empirical studies of authors are aware that allow us to realize how real doctors in reals day-to-day work integrated these trends of change in theirs clinical decisions.

Satisfação de utentes do ACES Tâmega I – Baixo Tâmega

A reforma dos cuidados de saúde primários surgiu, em 2005, com o objectivo principal de criar um novo modelo de organização dos cuidados de saúde primários mais próximo dos cidadãos e mais eficiente, tendo surgido, neste contexto, as Unidades de Saúde Familiares (USF) e, mais recentemente, as Unidades de Cuidados de Saúde Personalizados (UCSP). Importa agora determinar a avaliação que os utentes destas unidades fazem dos cuidados que lhes são prestados. O presente estudo pretende avaliar a satisfação dos utentes das UCSP e USF do Agrupamento de Centros de Saúde (ACES)Tâmega I- Baixo Tâmega e identificar os factores que a influenciam, tendo sido utilizado para tal uma versão adaptada e validada do questionário Europep. Os resultados demonstram queos utentes do ACES Tâmega I - Baixo Tâmega avaliam favoravelmente os cuidados de saúde. As dimensões com maior satisfação são a “relação e comunicação”, com destaque para o tempo dedicado pelo pessoal de enfermagem, os“recursos humanos”, com destaque para a competência, cortesia e carinho do pessoal de enfermagem e as“instalações”. Os níveis mais baixos de satisfação, embora positivos, são relativos à organização dos serviços e continuidade e cooperação. O tempo de espera na sala de espera, referente à organização dos serviços, é,entre todos, o aspecto com pior avaliação distanciando-se significativamente de todos os outros itens avaliados. Também na análise dos comentários relativos a surpresas agradáveis e desagradáveis encontradas nas unidades verifica-se que os aspectos organizacionais são os que mais desagradam os utentes e os relacionais os que mais agradam. Verifica-se que a idade, estado civil, escolaridade, utilização da unidade de saúde e tipo de unidade determinam diferenças na satisfação. Os utentes das USF recomendam mais a sua unidade de saúde e encontram-semais satisfeitos em todas as dimensões da satisfação avaliadas, sendoesta discrepância mais acentuada a nível da organização dos serviços e resposta às necessidades.

Toxicological Assessment of Coated versus Uncoated Rubber Granulates Obtained from Used Tires for Use in Sport Facilities

Reuse of tire crumb in sport facilities is currently a very cost-effective waste management measure. Considering that incorporation of the waste materials in artificial turf would be facilitated if the rubber materials were already colored green, coatings were specifically developed for this purpose. This paper presents an experimental toxicological and environmental assessment aimed at comparing the obtained emissions to the environment in terms of polycyclic aromatic hydrocarbons (PAHs), heavy metals, and ecotoxicity for coated and noncoated rubber granulates. This study is a comprehensive evaluation of the major potential critical factors related with the release of all of these classes of pollutants because previous studies were not systematically performed. It was concluded that between the two types of coatings tested, one is particularly effective in reducing emissions to the environment, simultaneously meeting the requirements of adherence and color stability.

Effect of technical parameters on dose and image quality in a computed radiography system

The discovery of X-rays was undoubtedly one of the greatest stimulus for improving the efficiency in the provision of healthcare services. The ability to view, non-invasively, inside the human body has greatly facilitated the work of professionals in diagnosis of diseases. The exclusive focus on image quality (IQ), without understanding how they are obtained, affect negatively the efficiency in diagnostic radiology. The equilibrium between the benefits and the risks are often forgotten. It is necessary to adopt optimization strategies to maximize the benefits (image quality) and minimize risk (dose to the patient) in radiological facilities. In radiology, the implementation of optimization strategies involves an understanding of images acquisition process. When a radiographer adopts a certain value of a parameter (tube potential [kVp], tube current-exposure time product [mAs] or additional filtration), it is essential to know its meaning and impact of their variation in dose and image quality. Without this, any optimization strategy will be a failure. Worldwide, data show that use of x-rays has been increasingly frequent. In Cabo Verde, we note an effort by healthcare institutions (e.g. Ministry of Health) in equipping radiological facilities and the recent installation of a telemedicine system requires purchase of new radiological equipment. In addition, the transition from screen-films to digital systems is characterized by a raise in patient exposure. Given that this transition is slower in less developed countries, as is the case of Cabo Verde, the need to adopt optimization strategies becomes increasingly necessary. This study was conducted as an attempt to answer that need. Although this work is about objective evaluation of image quality, and in medical practice the evaluation is usually subjective (visual evaluation of images by radiographer / radiologist), studies reported a correlation between these two types of evaluation (objective and subjective) [5-7] which accredits for conducting such studies. The purpose of this study is to evaluate the effect of exposure parameters (kVp and mAs) when using additional Cooper (Cu) filtration in dose and image quality in a Computed Radiography system.

Regional governance: strategies and disputes in health region management

OBJECTIVE To analyze the regional governance of the health systemin relation to management strategies and disputes.METHODOLOGICAL PROCEDURES A qualitative study with health managers from 19 municipalities in the health region of Bahia, Northeastern Brazil. Data were drawn from 17 semi-structured interviews of state, regional, and municipal health policymakers and managers; a focus group; observations of the regional interagency committee; and documents in 2012. The political-institutional and the organizational components were analyzed in the light of dialectical hermeneutics.RESULTS The regional interagency committee is the chief regional governance strategy/component and functions as a strategic tool for strengthening governance. It brings together a diversity of members responsible for decision making in the healthcare territories, who need to negotiate the allocation of funding and the distribution of facilities for common use in the region. The high turnover of health secretaries, their lack of autonomy from the local executive decisions, inadequate technical training to exercise their function, and the influence of party politics on decision making stand as obstacles to the regional interagency committee’s permeability to social demands. Funding is insufficient to enable the fulfillment of the officially integrated agreed-upon program or to boost public supply by the system, requiring that public managers procure services from the private market at values higher than the national health service price schedule (Brazilian Unified Health System Table). The study determined that “facilitators” under contract to health departments accelerated access to specialized (diagnostic, therapeutic and/or surgical) services in other municipalities by direct payment to physicians for procedure costs already covered by the Brazilian Unified Health System.CONCLUSIONS The characteristics identified a regionalized system with a conflictive pattern of governance and intermediate institutionalism. The regional interagency committee’s managerial routine needs to incorporate more democratic devices for connecting with educational institutions, devices that are more permeable to social demands relating to regional policy making.

Healthcare-associated infections: challenges to public health in Brazil

This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges.

Performance management in primary healthcare services: evidence from a field study

Health services

Institutional and matrix support and its relationship with primary healthcare

OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams.METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support – 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was “level of support” (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p < 0.20. The model was adjusted by the Hosmer-Lemeshow test.RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23).CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.