Cancelamentos de cirurgias no próprio dia

RESUMO - INTRODUÇÃO: Para garantir a qualidade e universalidade dos cuidados de Saúde, é fundamental, que os recursos disponíveis sejam bem utilizados, evitando desperdícios. Os resultados de um hospital estão diretamente ligados aos resultados do Bloco Operatório. A taxa de utilização e a taxa de cancelamentos são indicadores da atividade dos Blocos Operatórios. Realizou-se um estudo piloto no Hospital Dr. José de Almeida em Cascais. OBJECTIVO: Conhecer as taxas de cancelamento de cirurgias no próprio dia. METODOLOGIA: Estudo descritivo longitudinal, retrospectivo, quantitativo, às cirurgias agendadas, entre 1 de Janeiro e 31 de Março de 2012. Utilizou-se a estatística descritiva e a inferência estatística através de testes de independência de variáveis. RESULTADOS: 1524 cirurgias agendadas, canceladas 205, com 100 cancelamentos no próprio dia. Os resultados revelam na globalidade taxas de cancelamento (13,45%) inferiores às fornecidas pelo Ministério da Saúde em relação a 2008, 2009 e 2010, com 28,4%, 26,0% e 26,6% respectivamente. No entanto, as taxas de cancelamento no próprio dia são semelhantes 48,78% no estudo e, entre 44,1% e 50,5% nos dados do Ministério da Saúde. Os estudos internacionais consultados revelam taxas globais de 0,34% na China (Sung,2010) num hospitalar multidisciplinar e 30,3% (taxa de cancelamentos no dia) na Índia (Garg, 2009). CONCLUSÃO: A imputação do motivo de cancelamento é feita ao “serviço/ hospital” ou a “outros”, o utente apresenta uma taxa baixa de imputação do motivo de cancelamento. Foi encontrada uma relação de dependência entre as variáveis, com exceção da relação entre data do cancelamento e a especialidade cirúrgica. Assim, considera-se pertinente a realização de um estudo mais aprofundado e abrangente deste fenómeno nas instituições de saúde em Portugal.

The institutions of archaic post-modernity and their organizational and managerial consequences: The case of Portugal

The long march of modernization of the Western societies tends to be presented as following a regular sequence: societies and institutions were pre-modern, and then they were modernized, eventually becoming post-modern. Such teleology may provide an incomplete or distorted narrative of societal evolution in many parts of the world, even in the ‘post-modern heartland’ of Western Europe, with Portugal being a case in point. The concept of archaic post-modernity has been developed by a philosopher, José Gil, to show how Portuguese institutions and organizations combine elements of pre-modernity and post-modernity. The notion of an archaic post-modernity is advanced in order to provide an alternative account of the modernization process, which enriches discussion of the varieties of capitalism. Differences in historical experiences create singularities that may be considered in the analysis of culture, management and organization.

Growth Accounting: How institutions affect Portugal's Growth

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics

Credit risk of financial institutions

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Finance from the NOVA – School of Business and Economics

Tuberculosis incidence and risk factors among patients living with HIV/AIDS in public health service institutions in Brasilia, Federal District

In order to estimate the incidence of and risk factors for developing tuberculosis, the clinical charts of a retrospective cohort of 281 HIV-positive adults, who were notified to the AIDS Program of the Health Department of Brasilia in 1998, were reviewed in 2003. All the patients were treatment-naive regarding antiretroviral therapy at the time of inclusion in the cohort. Twenty-nine patients were identified as having tuberculosis at the start of the study. Thirteen incident tuberculosis cases were identified during the 60 months of follow-up, with an incidence density rate of 1.24/100 person-years. Tuberculosis incidence was highest among patients with baseline CD4+ T-lymphocyte counts < 200 cells/µl who were not using antiretroviral therapy (incidence = 5.47; 95% CI = 2.73 to 10.94). Multivariate analysis showed that baseline CD4+ T-lymphocyte counts < 200 cells/µl (adjusted hazard ratio [AHR] = 5.09; 95% CI = 1.27 to 20.37; p = 0.02) and non-use of antiretroviral therapy (AHR = 12.17; 95% CI = 2.6 to 56.90; p = 0.001) were independently associated with increased risk of tuberculosis.

Is the Lunatic Detention Act of 1917 appropriate for modern Gambia?

RESUMO: OS distúrbios mentais, neurológicos e devidos ao abuso de substâncias tem uma grande prevalência e peso em todo o Mundo. O objetivo principal deste estudo é contribuir para a melhoria dos direitos humanos das pessoas com deficiências mentais na Gâmbia, através de uma revisão e análise críticas de uma obsoleta legislação de saúde mental do País o "Lunatic Act Detention (LDA) de 1917".----- ABSTRACT: Mental, neurological, and substance use disorders are highly prevalente and burdensome worlwide. The violations of human rights directed towards people with this disorders compound the problam. This study mainly aims to contribute do the improvement of human rights of people with mental disabilities in Gambia by doing a critical review and analysis to the countries outdated mental health legislation - Lunatic Detention ct (LDA) from 1917.

Shiva's dance: Crisis, local institutions and private firms

The uneven spatial distribution of start-ups and their respective survival may reflect comparative advantages resulting from the local institutional background. For the first time, we explore this idea using Data Envelopment Analysis (DEA) to assess the relative efficiency of Portuguese municipalities in this specific context. We depart from the related literature where expenditure is perceived as a desirable input by choosing a measure of fiscal responsibility and infrastructural variables in the first stage. Comparing results for 2006 and 2010, we find that mean performance decreased substantially 1) with the effects of the Global Financial Crisis, 2) as municipal population increases and 3) as financial independence decreases. A second stage is then performed employing a double-bootstrap procedure to evaluate how the regional context outside the control of local authorities (e.g. demographic characteristics and political preferences) impacts on efficiency.

Systemic risk for financial institutions in UK

Marginal Expected Shortfall (MES) is an approach used to measure the systemic risk financial institutions face. It estimates how significantly systemic events (poor market performance, out of 1.6 times Standard Deviation borders) are expected to affect market capitalization of a particular firm. The concept was developed in the late 2000s and is widely used for cross-country comparisons of financial firms. For the purposes of generalization of this technique it is often used with market data containing non-domestic currencies for some financial firms. That may lead to results having currency noise in them as it is shown for 77 UK financial firms in our analysis between 2001 and 2014.

Who uses NHS saúde 24 hotline? Has the user changed over time?

There has been an increase in the use of telephone-based services and internet throughout the years and, therefore, the Saúde 24 Hotline has become an important service in Portugal. This service aims to screen, counsel and refer the patient in order to avoid unnecessary visits to health institutions and also to indicate the most appropriate resource according to the illness. This work has two different questions: the first one examines the determinants of satisfaction that have more influence on the overall satisfaction of the Saúde 24 Hotline users. The second one aims to analyze if the confidence level of the users is increasing over time, measured by following the recommendation. The first study was conducted on a random sample collected from June to October 2014, which was taken from the User Satisfaction Survey. The second approach includes data from January 2008 to December 2014 from the Clinical Data Base of all users who have called the Hotline. Findings suggest that the majority of users are very satisfied with the service and the variables with more impact on the overall satisfaction are commitment and availability from the nurse, adequacy of call duration and quick identification of the problem. The survey indicates that 94% of respondents follow the recommendation and on average people have called the hotline 3 times in the previous year. The results from the Clinical Database show that people who were recommended to go to the emergency room are more likely to follow the advice than the people who were recommended to book routine appointments

Under the veil of citations

Academics are often ranked on citation counts’, which is considered an adequate proxy for author's quality and reputation. This paper seeks to find what is behind a cited academic / a cited article. We constructed a rich dataset from Portuguese affiliated economists and use zero inflated negative binomial model. This procedure is appropriate for count outcomes, correcting for overdispersion and excess zeros. We also use a fixed effect poisson model to accomodate authors' unobserved heterogeneity. We analyze results in detail comparing with existing literature and making some theoretical considerations around.

Peri-intraventricular hemorrhage in newborns weighing less than 1500 grams: comparative analysis between 2 institutions

PURPOSE: This study aims to characterize the peri-intraventricular hemorrhages in the neonatal period in very low birth weight newborns in 2 institutions that provide neonatal tertiary assistance. METHOD: This was a comparative and observational study in 2 neonatal intensive care units, the Maternity Hospital of Campinas and the "Centro de Atenção Integrada à Saúde da Mulher" of the State University of Campinas, from December 01, 1998 to November 30, 1999. We examined 187 newborns for peri-intraventricular hemorrhages, using transfontanel ultrasound (76 and 11 respectively at the first and second unit), and classified them into 4 grades. We observed their gender, intrauterine growth, weight, and gestational age at birth. RESULTS: We diagnosed 34 cases of peri-intraventricular hemorrhages (13 and 21, respectively), and both groups differed as to the birth weight and the adequacy of weight to the gestational age at birth. There was no difference in the prevalence or extent of peri-intraventricular hemorrhages among cases. There was a statistically significant occurrence of lower birth weight at gestational ages of less than 30 weeks. CONCLUSIONS: The prevalence of peri-intraventricular hemorrhages in our study was compared to that reported in the world literature. Although the cases of the second institution had a smaller mean birth weight, the prevalence of peri-intraventricular hemorrhages was similar to that at the first institution, probably because in the first one, 69% of the gestational ages of the neonates with hemorrhage were less than 30 weeks as compared to 48% in the second one. We stress the importance of the ultrasonographic method for diagnosing peri-intraventricular hemorrhages in very low birth weight newborns.

Banco BPI SA financial institutions

Equity research report

Evaluación de la degradación del suelo en agroecosistemas del centro-sur de Córdoba mediante indicadores e índices. Assessment of soil degradation in agroecosystems of central-southern Córdoba by means of indicators and indices

Las actividades agropecuarias ejercen diferentes presiones sobre los recursos naturales. Esto ha llevado, en algunas áreas, a un deterioro del suelo que provoca un impacto sobre la sustentabilidad en los sistemas agropecuarios. Para evaluar la degradación del suelo se han propuesto listas de indicadores, sin embargo, se carece de una herramienta metodológica robusta, adaptada a las condiciones edafoclimáticas regionales. Además, existe una demanda de productores e instituciones interesados en orientar acciones para preservar el suelo. El objetivo de este proyecto es evaluar la degradación física, química y biológica de los suelos en agroecosistemas del centro-sur de Córdoba. Por ello se propone desarrollar una herramienta metodológica que consiste en un set de indicadores físicos, químicos y biológicos, con valores umbrales, integrados en índices de degradación, que asistan a los agentes tomadores de decisiones y productores, en la toma de decisiones respecto de la degradación del suelo. El área de trabajo será una región agrícola del centro-sur de Córdoba con más de 100 años de agricultura. La metodología comienza con la caracterización del uso del territorio y sistemas de manejo, su clasificación y la obtención de mapas base de usos y manejos, mediante sensores remotos y encuestas. Se seleccionarán sitios de muestreo mediante una metodología semi-dirigida usando un SIG, asegurando un mínimo de un punto de muestreo por unidad de mapeo. Se elegirán sitios de referencia lo más cercano a una condición natural. Los indicadores a evaluar surgen de listas propuestas en trabajos previos del grupo, seleccionados en base a criterios internacionales y a adecuados a suelos de la región. Se usarán indicadores núcleo y complementarios. Para la obtención de umbrales, se usarán por un lado valores provenientes de la bibliografía y por otro, umbrales generados a partir de la distribución estadística del indicador en suelos de referencia. Para estandarizar cada indicador se definirá una función de transformación. Luego serán ponderarán mediante análisis estadísticos mulivariados e integrados en índices de degradación física, química y biológica, y un índice general de degradación. El abordaje concluirá con el desarrollo de dos instrumentos para la toma de decisiones: uno a escala regional, que consistirá en mapas de degradación en base a unidades cartográficas ambientales, de uso del territorio y de sistemas de manejo y otro a escala predial que informará sobre la degradación del suelo de un lote en particular, en comparación con suelos de referencia. Los actores interesados contarán con herramientas robustas para la toma de decisiones respecto de la degradación del suelo tanto a escala regional como local. Agricultural activities exert different pressures on natural resources. In some areas this has led to soil degradation and has an impact on agricultural sustainability. To assess soil degradation a robust methodological tool, adapted to regional soil and climatic conditions, is lacking. In addition, there is a demand from farmers and institutions interested in direct actions to preserve the soil. The objective of this project is to assess physical, chemical and biological soil degradation in agroecosystems of Córdoba. We propose to develop a tool that consists of a set of physical, chemical and biological indicators, with threshold values, integrated in soil degradation indices. The study area is a region with more than 100 years of agriculture. The methodology begins with the characterization of land use and management systems and the obtaining of base maps by means of remote sensing and survey. Sampling sites will be selected through a semi-directed methodology using GIS, ensuring at least one sampling point by mapping unit. Reference sites will be chosen as close to a natural condition. The proposed indicators emerge from previous works of the group, selected based on international standards and appropriate for the local soils. To obtain the thresholds, we will use, by one side, values from the literature, and by the other, values generated from the statistical distribution of the indicator in the reference soils. To standardize indicators transformation functions will be defined. Indicators will be weighted by mans of multivariate analysis and integrated in soil degradation indices. The approach concluded with the development of two instruments for decision making: a regional scale one, consisting in degradation maps based on environmental, land use and management systems mapping units; and an instrument at a plot level which will report on soil degradation of a particular plot compared to reference soils.