Medical Malpractice in Public Healthcare Systems: An Empirical Investigation of Scheduled Damages

In the last decades, medical malpractice has been framed as one of the most critical issues for healthcare providers and health policy, holding a central role on both the policy agenda and public debate. The Law and Economics literature has devoted much attention to medical malpractice and to the investigation of the impact of malpractice reforms. Nonetheless, some reforms have been much less empirically studied as in the case of schedules, and their effects remain highly debated. The present work seeks to contribute to the study of medical malpractice and of schedules of noneconomic damages in a civil law country with a public national health system, using Italy as case study. Besides considering schedules and exploiting a quasi-experimental setting, the novelty of our contribution consists in the inclusion of the performance of the judiciary (measured as courts’ civil backlog) in the empirical analysis. The empirical analysis is twofold. First, it investigates how limiting compensations for pain and suffering through schedules impacts on the malpractice insurance market in terms of presence of private insurers and of premiums applied. Second, it examines whether, and to what extent, healthcare providers react to the implementation of this policy in terms of both levels and composition of the medical treatments offered. Our findings show that the introduction of schedules increases the presence of insurers only in inefficient courts, while it does not produce significant effects on paid premiums. Judicial inefficiency is attractive to insurers for average values of schedules penetration of the market, with an increasing positive impact of inefficiency as the territorial coverage of schedules increases. Moreover, the implementation of schedules tends to reduce the use of defensive practices on the part of clinicians, but the magnitude of this impact is ultimately determined by the actual degree of backlog of the court implementing schedules.

Prácticas defensivas, conflictos y autoridades en la frontera bonaerense.Los pagos de Magdalena y Pergamino (1752-1780)

Este trabajo ahonda en el funcionamiento de la frontera bonaerense a partir del análisis de distintas Comandancias de Fronteras, principalmente las ubicadas en los pagos de Pergamino al norte y Magdalena al sur de la jurisdicción, haciendo hincapié en la articulación generada entre las fuerzas militares regulares y los cuerpos milicianos para llevar a cabo la práctica defensiva. El recorte temporal (1752-1780) contempla desde la puesta en funcionamiento de las Comandancias hasta las reformas defensivas efectuadas por el Virrey Vértiz, que trastocaron algunos rasgos básicos de nuestro objeto de estudio. Nos interesa conocer la formación de tal frontera, las prácticas concretas que le daban vida, los sujetos sociales que emergieron en este proceso y los conflictos que protagonizaron. Seguimos las trayectorias de los Sargentos Mayores de Milicias -en especial, Diego Trillo en Pergamino y Clemente López Osornio en Magdalena- como ejemplos de una forma de autoridad local resultante de la legitimidad que proveía el ejercicio de la "defensa".

Prácticas defensivas, conflictos y autoridades en la frontera bonaerense.Los pagos de Magdalena y Pergamino (1752-1780)

Este trabajo ahonda en el funcionamiento de la frontera bonaerense a partir del análisis de distintas Comandancias de Fronteras, principalmente las ubicadas en los pagos de Pergamino al norte y Magdalena al sur de la jurisdicción, haciendo hincapié en la articulación generada entre las fuerzas militares regulares y los cuerpos milicianos para llevar a cabo la práctica defensiva. El recorte temporal (1752-1780) contempla desde la puesta en funcionamiento de las Comandancias hasta las reformas defensivas efectuadas por el Virrey Vértiz, que trastocaron algunos rasgos básicos de nuestro objeto de estudio. Nos interesa conocer la formación de tal frontera, las prácticas concretas que le daban vida, los sujetos sociales que emergieron en este proceso y los conflictos que protagonizaron. Seguimos las trayectorias de los Sargentos Mayores de Milicias -en especial, Diego Trillo en Pergamino y Clemente López Osornio en Magdalena- como ejemplos de una forma de autoridad local resultante de la legitimidad que proveía el ejercicio de la "defensa".

Prácticas defensivas, conflictos y autoridades en la frontera bonaerense.Los pagos de Magdalena y Pergamino (1752-1780)

Este trabajo ahonda en el funcionamiento de la frontera bonaerense a partir del análisis de distintas Comandancias de Fronteras, principalmente las ubicadas en los pagos de Pergamino al norte y Magdalena al sur de la jurisdicción, haciendo hincapié en la articulación generada entre las fuerzas militares regulares y los cuerpos milicianos para llevar a cabo la práctica defensiva. El recorte temporal (1752-1780) contempla desde la puesta en funcionamiento de las Comandancias hasta las reformas defensivas efectuadas por el Virrey Vértiz, que trastocaron algunos rasgos básicos de nuestro objeto de estudio. Nos interesa conocer la formación de tal frontera, las prácticas concretas que le daban vida, los sujetos sociales que emergieron en este proceso y los conflictos que protagonizaron. Seguimos las trayectorias de los Sargentos Mayores de Milicias -en especial, Diego Trillo en Pergamino y Clemente López Osornio en Magdalena- como ejemplos de una forma de autoridad local resultante de la legitimidad que proveía el ejercicio de la "defensa".

[strategies For Integration Of Health Care Practices And Sanitary Surveillance In The Context Of The Implementation Of Rede Cegonha - A Brazilian Mother And Infant Health Care Network].

Mother and infant mortality has been the scope of analysis throughout the history of public health in Brazil and various strategies to tackle the issue have been proposed to date. The Ministry of Health has been working on this and the Rede Cegonha strategy is the most recent policy in this context. Given the principle of comprehensive health care and the structure of the Unified Health System in care networks, it is necessary to ensure the integration of health care practices, among which are the sanitary surveillance actions (SSA). Considering that the integration of health care practices and SSA can contribute to reduce mother and infant mortality rates, this article is a result of qualitative research that analyzed the integration of these actions in four cities in the State of São Paulo/Brazil: Campinas, Indaiatuba, Jaguariúna and Santa Bárbara D'Oeste. The research was conducted through interviews with SSA and maternal health managers, and the data were evaluated using thematic analysis. The results converge with other studies, identifying the isolation of health care practices and SSA. The insertion of SSA in collectively-managed areas appears to be a potential strategy for health planning and implementation of actions in the context under scrutiny.

Factors associated with the prevalence of hypertension and control practices among elderly residents of São Paulo city, Brazil

The aim of this study was to analyze the prevalence of hypertension and control practices among the elderly. The survey analyzed data from 872 elderly people in São Paulo, Brazil, through a cluster sampling, stratified according to education and income. A Poisson multiple regression model checked for the existence of factors associated with hypertension. The prevalence of self-reported hypertension among the elderly was 46.9%. Variables associated with hypertension were self-rated health, alcohol consumption, gender, and hospitalization in the last year, regardless of age. The three most common measures taken to control hypertension, but only rarely, are oral medication, routine salt-free diet and physical activity. Lifestyle and socioeconomic status did not affect the practice of control, but knowledge about the importance of physical activity was higher among those older people with higher education and greater income. The research suggests that health policies that focus on primary care to encourage lifestyle changes among the elderly are necessary.

Infant feeding practices, childhood growth and obesity in adult life

A saúde infantil é amplamente afetada pelo estado nutricional. Há um interesse crescente acerca da possibilidade do estado nutricional apresentado pela criança e das práticas alimentares na primeira infância estarem relacionados à obesidade em indivíduos adultos, aumentando os riscos para complicações metabólicas. Sabe-se que estudos prospectivos possibilitam a investigação e a avaliação apropriadas de determinantes do desenvolvimento infantil. Consequentemente, o presente artigo objetivou revisar as principais evidências disponíveis a partir de estudos longitudinais sobre associações entre práticas alimentares na primeira infância, padrões de crescimento infantil e estado nutricional verificados durante a vida adulta

Harvest-ironman: heavy armature, and not its defensive secretions, protects a harvestman against a spider

Natural selection has caused prey species to evolve distinct defensive mechanisms. One of such mechanisms was the evolution of noxious or distasteful chemicals, which have appeared independently in a number of vertebrates and invertebrates. In detailed analyses of arthropod behaviour, scent gland secretions have consistently been shown to be responsible for repelling specific predators. Because using such chemicals is costly, animals with alternative cheaper defences are expected not to release such secretions when alternative options exist. In this study, we sought to determine the defensive mechanisms of the harvestman Discocyrtus invalidus, a heavy bodied species that bears a pair of repugnatorial glands. The spider Enoploctenus cyclothorax was used as the predator, and the cricket Gryllus sp. was used as a control. In a first set of experiments, the harvestmen were preyed upon significantly less than the crickets. In two other experiments, we found that harvestmen did not use their scent gland secretions to deter the predator. Moreover, results of a fourth experiment revealed that these spiders are not repelled by defensive secretions. Discocyrtus invalidus has a thick cuticle on the entire body: scanning electron micrographs revealed that only the mouth, the articulations of appendages and the tips of the legs are not covered by a hard integument. In a fifth experiment, we found that these spiders had difficulty piercing the harvestmen body. This is the first experimental evidence that a chemically defended arachnid does not use its scent gland secretions to repel a much larger predator but instead relies on its heavily built body. (c) 2010 The Association for the Study of Animal Behaviour. Published by Elsevier Ltd. All rights reserved.

Evaluation of biologic occupational risk control practices: Quality indicators development and validation

Background: There is growing demand for the adoption of qualification systems for health care practices. This study is aimed at describing the development and validation of indicators for evaluation of biologic occupational risk control programs. Methods: The study involved 3 stages: (1) setting up a research team, (2) development of indicators, and (3) validation of the indicators by a team of specialists recruited to validate each attribute of the developed indicators. The content validation method was used for the validation, and a psychometric scale was developed for the specialists` assessment. A consensus technique was used, and every attribute that obtained a Content Validity Index of at least 0.75 was approved. Results: Eight indicators were developed for the evaluation of the biologic occupational risk prevention program, with emphasis on accidents caused by sharp instruments and occupational tuberculosis prevention. The indicators included evaluation of the structure, process, and results at the prevention and biologic risk control levels. The majority of indicators achieved a favorable consensus regarding all validated attributes. Conclusion: The developed indicators were considered validated, and the method used for construction and validation proved to be effective.

Environmental management system and human resource practices: is there a link between them in four Brazilian companies?

The aim of this article is to analyze the theoretical model proposed by [Jabbour CJC, Santos FCA. Relationships between human resource dimensions and environmental management in companies: proposal of a model. Journal of Cleaner Production 2008;16(1):5 1-8.] based on the data collected in four Brazilian companies. This model investigates how the phases of the environmental management system can be linked to human resource practices in order to attain continuous improvement of a company`s environmental performance. Our aim is to contribute to a field, which has little empirical evidence. Although the interaction between the phases of the environmental management system and human resource practices is recommended by the specialized literature [Daily BE Huang S. Achieving sustainability through attention to human resource factors in environmental management. International Journal of Operations and Production Management 2001:21(12):1539-52.], the results indicate that most of the theoretical assumptions could not be confirmed in these Brazilian companies. (C) 2008 Elsevier Ltd. All rights reserved.

Variability on red blood cell transfusion practices among Brazilian neonatal intensive care units

BACKGROUND: Guidelines for red blood cell (RBC) transfusions exist; however, transfusion practices vary among centers. This study aimed to analyze transfusion practices and the impact of patients and institutional characteristics on the indications of RBC transfusions in preterm infants. STUDY DESIGN AND METHODS: RBC transfusion practices were investigated in a multicenter prospective cohort of preterm infants with a birth weight of less than 1500 g born at eight public university neonatal intensive care units of the Brazilian Network on Neonatal Research. Variables associated with any RBC transfusions were analyzed by logistic regression analysis. RESULTS: Of 952 very-low-birth-weight infants, 532 (55.9%) received at least one RBC transfusion. The percentages of transfused neonates were 48.9, 54.5, 56.0, 61.2, 56.3, 47.8, 75.4, and 44.7%, respectively, for Centers 1 through 8. The number of transfusions during the first 28 days of life was higher in Center 4 and 7 than in other centers. After 28 days, the number of transfusions decreased, except for Center 7. Multivariate logistic regression analysis showed higher likelihood of transfusion in infants with late onset sepsis (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8-4.4), intraventricular hemorrhage (OR, 9.4; 95% CI, 3.3-26.8), intubation at birth (OR, 1.7; 95% CI, 1.0-2.8), need for umbilical catheter (OR, 2.4; 95% CI, 1.3-4.4), days on mechanical ventilation (OR, 1.1; 95% CI, 1.0-1.2), oxygen therapy (OR, 1.1; 95% CI, 1.0-1.1), parenteral nutrition (OR, 1.1; 95% CI, 1.0-1.1), and birth center (p < 0.001). CONCLUSIONS: The need of RBC transfusions in very-low-birth-weight preterm infants was associated with clinical conditions and birth center. The distribution of the number of transfusions during hospital stay may be used as a measure of neonatal care quality.

Knowledges and practices of successful literacy teachers (Brazil, 1950-1980)

Significant changes have marked Brazilian education in the period focused on by this research. Aiming to understand the configurations of the teaching profession in that period, this work focuses on the issue of the school success in the area of literacy by means of an analysis of the practices of literacy teachers who were at work between the 1950s and 1980s. The research is based on life-history accounts. The study aimed at describing the various experiences of these teachers identifying the knowledges and practices that sustained their successful literacy work as well as the various factors of a social, religious, political, familiar or other nature that, in the history of each of these teachers, favoured the development of a pedagogical style of literacy particular to each one of them. Despite the peculiarities and originality of each history, the success in the literacy process, as the defining feature of the profile of the four teachers, results from two main aspects: first, the autonomy that each one managed to keep in the development of his/her teaching work, particularly in the organisation of the teaching practices that indicated greater chances of a pupil`s learning to read and write; second, their trust in the capacity of every child for learning, independently of his/her social, economic and cultural conditions. Based on this evidence it is argued that the success of the pedagogical work, particularly during the early years of schooling, lies in an ethics of the teaching work with a double implication: first, it requires the teachers` dedication to their pupils, and second, it requires respect for the work of the teacher, so that she/he can maintain her/his autonomy and inventiveness. These aspects indicate the need for reflection on teaching work and a review of current teacher education policies, particularly the policies targeted at teachers working with literacy practices.

Exposure to contaminated water: perceptions and practices in a neighborhood in the city of Manaus, Brazil

Objective. To investigate the modes of water supply and the perception concerning the problems caused by this water among residents of a neighborhood without public supply of water, settled in an area previously used as a garbage dump in the city of Manaus, Brazil. Methods. One hundred and sixty-two semi-structured household interviews were conducted. In addition, a focal group with teachers from a local public school and a meeting with residents were held. The instruments employed focused on the perception and modes of water use and on the process of exposure to chemical contaminants through water. Results. Untreated well water was used by most families. This water was considered to be ""good"" by 64.8% of the individuals interviewed. Most residents (88.3%) declared knowledge about the garbage dump. Of these, 77.6% stated that the garbage dump caused health and environmental problems. However, qualitative analysis of the responses revealed that the residents were not aware of contamination by chemical elements or of the consequences of such contamination. The activities carried out with teachers revealed that they were partially aware of the problem, but did not design interventions to address the issue. In a meeting with neighborhood residents, the presence of social activism concerning the problem was identified, but it did not extend beyond the neighborhood or reach governmental spheres. Conclusions. The study identified a situation of critical exposure that tends to be maintained as a result of misperceptions and lack of social mobilization. The dissemination of research results to teachers and residents was useful to empower subjects.