Allostasis and organizational excellence

Organizational excellence is critical towards the development of organizations and, considering organizations’ role in the modern world, for societies’ economic and social development. The ability of organizations to adapt and adjust to the contingencies of the change and recover the stability of organizational systems through organizations’ own dynamic process is known as allostasis. This research focuses on the relationship between allostasis and organizational excellence. Based on a sample of 205 firms from Portugal and Spain, and resorting to fuzzy-set QCA (fsQCA), this research reveals that there are different combinations (equifinality) of conditions inherent to allostasis (adaptive capacity, feedback capacity, stigmergy capacity and integration intensity) leading to sustainable high outcomes (employee satisfaction, stakeholder satisfaction and organizational performance, jointly selected as proxies for organizational excellence). The analysis also shows that organizations that match those combinations simultaneously achieve high employee satisfaction, stakeholder satisfaction and organizational performance (multifinality), which is aligned with the premises of organizational excellence. Finally, the results reveal that in the different contexts (countries) analyzed, the combinations leading to high outcomes differ, thus supporting the idea that the ability to adapt and adjust that characterizes allostasis is critical towards organizational excellence.info:eu-repo/semantics/publishedVersio

The determinants of internal audit quality

Purpose – This study aims to understand the behavior of internal auditors towards quality and analyze if some organizational and individual factors influence internal audit quality. Design/methodology/approach – The sample is constituted by Portuguese internal auditors, and the methodology includes the use of partial least squares – structuring equation model (PLS-SEM) to test the hypothesis under study. Findings – The results show that there is a negative relationship between reduced audit quality practices (RAQP) and organizational commitment and independence. The results found that time pressure positively affect RAQP. There is no evidence that perceived organizational support (POS) and risk profile are determinants of RAQP. Originality/value – This work contributes by extending the literature about the determinants of internal audit quality, but also to the practice by understanding the factors that influence the behavior of internal auditors and by making recommendations that allow an improvement of the quality of internal auditing. 研究目的 – 本研究擬瞭解內部審計師就保持內部審計質量所作出的行為，並探討是否有些組織或個人因素、會影響內部審計的質量。 研究設計/方法/理念 – 研究的樣本由葡萄牙內部審計師構成，而研究方法則包括偏最小平方法的結構方程模型 (PLS-SEM) 的使用，以測試正在研究中的假設。 研究結果 – 研究結果顯示、降低審計質量的慣常做法與組織承諾及獨立性是成負相關的; 研究結果亦顯示、時間壓力會對降低審計質量的慣常做法產生正面影響，沒有證據證實、組織支持感和風險概況是降低審計質量慣常做法的決定因素。 研究的原創性 – 本研究的貢獻為、就研究內部審計質量決定因素的文獻方面、擴展了有關的學術探討; 研究亦對內部審計作出實務方面的貢獻，因研究結果幫助我們更瞭解影響內部審計師行為的因素，而且，研究人員提出了提升內部審計質量的建議。 關鍵詞 – 內部審計質量、降低審計質量的慣常做法、組織決定因素、個人決定因素

Análise da performance do serviço nacional de saúde de Portugal continental

Classificações do JEL Classification System: P16 (Political Economy), I15 (Health and Economic Development)A necessidade de avaliação de performance tem-se vindo a estender ao setor da saúde, apesar da sensibilidade que lhe é inerente, tanto por razões de natureza política, como económica, para controlo de custos, como para ocorrer um fenómeno de empowerment dos cidadãos relativamente à sua saúde. Para colmatar esta necessidade é necessário existir um conjunto de indicadores mensuráveis e de confiança, que permita avaliar, comparar e melhorar a performance das instituições. O estudo tem como principais objetivos a análise da performance global do SNS de Portugal continental, através da análise dos 3 principais tipos de instituições que o constituem (hospitais, ULS e ARS) e a construção de um instrumento de avaliação, o Balanced Scorecard, que tenha em conta as especificidades das instituições em questão. O alvo do estudo é toda a população, ou seja, todas as instituições prestadoras de cuidados de saúde diretos à população, em Portugal continental, e que pertençam ao SNS. Os anos em estudo são 2013 e 2014. Os dados foram recolhidos nos relatórios anuais das várias instituições. Os resultados mostram que há uma grande incoerência de dados no setor da saúde, não permitindo uma análise adequada da performance das suas instituições.The need for performance evaluation has been extended to the health sector, despite the sensibility that is inherent, both for political reasons, as for economic reasons, to cost control, as to health empowerment of the citizens. To overcome this need is necessary a set of measurable and reliable indicators, in order to access, compare and improve the institutions’ performance. This study has as main objectives the analysis of the overall performance of Portugal’s mainland NHS. The 3 main types of institutions belonging to NHS were analyzed and the construction of an assessment tool, the Balanced Scorecard, was made, taking into account the institutions’ specificities. The study target is the entire population, that means, all the national direct health care providors, on the mainland, and also belonging to the NHS. The years under study are 2013 and 2014. The data was collected using the annual institution’s reports. The results show that there is great data inconsistencies in the health sector, not allowing a proper performance analysis, both of the instituions as a unit as per the entire NHS

Prevalence and serotyping of Listeria monocytogenes in Portuguese live bivalve molluscs sampled in various steps along the sanitary control process

The prevalence and contamination levels of Listeria monocytogenes were investigated in live bivalve molluscs for human consumption, collected in various steps of the commercial and sanitary circuits in the North of Portugal. Samples of di¡erent species were collected per lot before and after depuration treatment in two depuration units and further, when placed in retail markets. Listeria monocytogenes was isolated from 4% of the samples although with very low contamination levels (less than 100MPNg 1). None of the environmental (non-depurated) samples were contaminated with the food-borne pathogen. The positive samples involved depurated and commercialized samples from two lots, one in each circuit. Two serotypes (1/2a and 3b) were detected among the isolated strains. This study demonstrated the possibility of occurrence of L.monocytogenes contamination of live bivalvemolluscs along the sanitary control circuit, including at the retailmarket level. As L. monocytogenes grows well at refrigerated temperatures and in high salt matrixes such as seafood its presence in these products should not be overlooked

Characterisation of alheiras, traditional sausages produced in the North of Portugal, with respect to their microbiological safety

The objective of this study was the characterisation of alheiras, traditional Portuguese sausages, with respect to their microbiological safety. Thirty-eight lots from 17 producers were analysed. The microbiological status of the analysed product can be considered of concern in terms of food safety. Although Campylobacter spp. and Escherichia coli O157 were not detected in any sample,and Clostridium perfringens when present was not at levels of concern with reference to public health, Salmonella spp. were detected in 2 lots of industrially produced alheiras, and more than 60% of the lots analysed were contaminated with Listeria monocytogenes in concentrations higher than 100 cfu/g

Pathogenicity assessment of Shiga toxin‐producing Escherichia coli (STEC) and the public health risk posed by contamination of food with STEC

The provisional molecular approach, proposed by EFSA in 2013, for the pathogenicity assessment of Shiga toxin‐producing Escherichia coli (STEC) has been reviewed. Analysis of the confirmed reported human STEC infections in the EU/EEA (2012–2017) demonstrated that isolates positive for any of the reported Shiga toxin (Stx) subtypes (and encoding stx gene subtypes) may be associated with severe illness (defined as bloody diarrhoea (BD), haemolytic uraemic syndrome (HUS) and/or hospitalisation). Although strains positive for stx2a gene showed the highest rates, strains with all other stx subtypes, or combinations thereof, were also associated with at least one human case with a severe clinical outcome. Serogroup cannot be used as a predictor of clinical outcome and the presence of the intimin gene (eae) is not essential for severe illness. These findings are supported by the published literature, a review of which suggested there was no single or combination of virulence markers associated exclusively with severe illness. Based on available evidence, it was concluded that all STEC strains are pathogenic in humans, capable of causing at least diarrhoea and that all STEC subtypes may be associated with severe illness. Source attribution analysis, based on ‘strong evidence’ outbreak data in the EU/EEA (2012–2017), suggests that ‘bovine meat and products thereof’, ‘milk and dairy products’, ‘tap water including well water’ and ‘vegetables, fruit and products thereof’ are the main sources of STEC infections in the EU/EEA, but a ranking between these categories cannot be made as the data are insufficient. Other food commodities are also potentially associated with STEC infections but rank lower. Data gaps are identified, and are primarily caused by the lack of harmonisation in sampling strategies, sampling methods, detection and characterisation methods, data collation and reporting within the EU.info:eu-repo/semantics/publishedVersio

Guidance on date marking and related food information: part 2 (food information)

A risk‐based approach was used to develop guidance to be followed by food business operators (FBOs) when deciding on food information relating to storage conditions and/or time limits for consumption after opening a food package and thawing of frozen foods. After opening the package, contamination may occur, introducing new pathogens into the food and the intrinsic (e.g. pH and aw), extrinsic (e.g. temperature and gas atmosphere) and implicit (e.g. interactions with competing background microbiota) factors may change, affecting microbiological food safety. Setting a time limit for consumption after opening the package (secondary shelf‐life) is complex in view of the many influencing factors and information gaps. A decision tree (DT) was developed to assist FBOs in deciding whether the time limit for consumption after opening, due to safety reasons, is potentially shorter than the initial ‘best before’ or ‘use by’ date of the product in its unopened package. For products where opening the package leads to a change of the type of pathogenic microorganisms present in the food and/or factors increasing their growth compared to the unopened product, a shorter time limit for consumption after opening would be appropriate. Freezing prevents the growth of pathogens, however, most pathogenic microorganisms may survive frozen storage, recover during thawing and then grow and/or produce toxins in the food, if conditions are favourable. Moreover, additional contamination may occur from hands, contact surfaces or contamination from other foods and utensils. Good practices for thawing should, from a food safety point of view, minimise growth of and contamination by pathogens between the food being thawed and other foods and/or contact surfaces, especially when removing the food from the package during thawing. Best practices for thawing foods are presented to support FBOs.info:eu-repo/semantics/publishedVersio

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

A parish level study in the northern region of Portugal

Introduction: Diabetes and hypertension are highly prevalent conditions in Portugal. Little is known about the geographical and social patterning of these diseases, which precludes the design of targeted health policies. This study aimed to measure the geographical and socioeconomic distribution of type 2 diabetes and hypertension prevalence in the population resident in the Northern region of Portugal, for the year 2013. Material and Methods: An ecological correlation study analyzed the 2,028 parishes of the region. Prevalence data were obtained from the Regional Health Administration information system. Socioeconomic data were also obtained from this administrative database and from the 2011 national census. The association between each socioeconomic indicator and age-standardized prevalence was measured using the difference in prevalence, population attributable risk, relative inequality index, and regression coefficient. Results: The prevalence of type 2 diabetes and hypertension was 6.16% and 19.35%, respectively, and varied across parishes. These prevalences were significantly associated with low educational level, low tertiary sector weight, unemployment, and low-income rate (with prevalence differences between the most and least advantaged deciles up to 1.3% and 5.3%, respectively). Socioeconomic factors accounted for up to 20% of prevalence. Discussion: This study design did not allow us to evaluate causality and it may underestimate these diseases prevalence or its association with socioeconomic factors, but its results are in line with the evidence from other countries. Conclusion: These results emphasize the socioeconomic and geographical patterning of major diseases associated with a high mortality, and the need of health policies targeting the most deprived parishes.publishe