Public-private partnerships in health care services: Do they outperform public hospitals regarding quality and access? Evidence from Portugal

Public-private partnerships (PPPs) are widely spread long-term arrangements between governments and strategic private partner(s). One of their objectives is to reduce the financial pressure on the public treasury with regard to new investments. PPPs have been employed within the health care sector which, in turn, carries a huge social burden. In Portugal, for instance, PPPs in health care concern bundling hospital infrastructure and clinical services management. Notwithstanding the need to ensure sustainability and efficient use of hospital resources, it is clearly compulsory to guarantee that patients receive appropriate and timely care, with maximum security, and equitable manner. Still, little or even no attention has been paid in the literature to the clinical response capacity of PPP hospitals and to the populism arguing that these entities have a lower social performance than typical public hospitals. This study uses robust benchmarking methodologies alongside recent data about Portuguese hospitals (FY2012-FY2017) to demystify this idea and to demonstrate that, actually, PPP hospitals can deliver health care services with social performance levels at least as good as public hospitals.info:eu-repo/semantics/publishedVersio

Public-private partnerships in health care services: Do they outperform public hospitals regarding quality and access? Evidence from Portugal

Public-private partnerships (PPPs) are widely spread long-term arrangements between governments and strategic private partner(s). One of their objectives is to reduce the financial pressure on the public treasury with regard to new investments. PPPs have been employed within the health care sector which, in turn, carries a huge social burden. In Portugal, for instance, PPPs in health care concern bundling hospital infrastructure and clinical services management. Notwithstanding the need to ensure sustainability and efficient use of hospital resources, it is clearly compulsory to guarantee that patients receive appropriate and timely care, with maximum security, and equitable manner. Still, little or even no attention has been paid in the literature to the clinical response capacity of PPP hospitals and to the populism arguing that these entities have a lower social performance than typical public hospitals. This study uses robust benchmarking methodologies alongside recent data about Portuguese hospitals (FY2012-FY2017) to demystify this idea and to demonstrate that, actually, PPP hospitals can deliver health care services with social performance levels at least as good as public hospitals.info:eu-repo/semantics/publishedVersio

Magnetic Resonance Image In The Diagnosis And Evaluation Of Extra-prostatic Extension And Involvement Of Seminal Vesicles Of Prostate Cancer: A Systematic Review Of Literature And Meta-analysis.

Systematic review of literature and meta-analysis to evaluate the results of magnetic resonance image 1.5T with endorectal coil in the diagnosis and evaluation of extra-prostatic extension and involvement of seminal vesicles of prostate cancer, compared to the histopathological results of the radical prostatectomy specimen. It was conducted a systematic review of literature and meta-analyses of all studies data published after 2008. In those studies, the patients with prostate cancer with indication to radical prostatectomy were submitted to magnetic resonance image (MRI) at pre-operatory period and the results were compared to those of histopathological studies after the surgery. The selected terms for research included prostate cancer, magnetic resonance, radical prostatectomy, and prostate cancer diagnosis, in the databases EMBASE, LILACS, PUBMED/MEDLINE and Cochrane Library. The data were collected using a specific qualitative instrument and the meta-analysis data were presented in the forest plot graphics, homogeneity test and sROC curves and funnel plot. A total of seven studies were included, with a total of 603 patients. Among these studies, six evaluated the value of MRI for the detection of prostate cancer, and the median sensitivity of meta-analysis was 0.6 and specificity 0.58, but with heterogeneity among the studies. Three studies evaluated extra-prostatic extension with a median sensitivity of 0.49, specificity 0.82 and heterogeneity only for sensitivity. Three studies evaluated invasion of seminal vesicles, with median sensitivity of 0.45 and specificity 0.96, with heterogeneity in both analysis. Magnetic resonance of 1.5T with endocoil showed low values of sensitivity and specificity for the diagnosis and staging of prostate cancer. The reviewed studies showed a significant heterogeneity among them. The best observed result was MRI specificity for invasion of seminal vesicles. More studies are necessary to evaluate new techniques and parameters before recommending the routine use of MRI in clinical practice.39215516

Development of a first-contact protocol to guide assessment of adult patients in rehabilitation services networks

OBJECTIVE: This paper describes the development of the Protocol for Identification of Problems for Rehabilitation (PLPR), a tool to standardize collection of functional information based on the International Classification of Functioning, Disability and Health (ICF). DEVELOPMENT OF THE PROTOCOL: The PLPR was developed for use during the initial contact with adult patients within a public network of rehabilitation services. Steps to develop the protocol included: survey of the ICF codes most used by clinical professionals; compilation of data from functional instruments; development and pilot testing of a preliminary version in the service settings; discussion with professionals and development of the final version. The final version includes: user identification; social and health information; brief functional description (BFD); summary of the BFD; and PLPR results. Further testing of the final version will be conducted. CONCLUSIONS: The protocol standardizes the first contact between the user and the rehabilitation service. Systematic use of the protocol could also help to create a functional database that would allow comparisons between rehabilitation services and countries over time

Agroecologia para Escola Guarany Karaí Kuerí Renda

A presente pesquisa relaciona ou problemas socioambientais na aldeia Sapucaí, através da escola indígena Karaí Kuery Renda tomando em considerações as construções etnoagroecológicas. Aplicou-se como metodologia observação de campo, registros com fotos e desenhos elaborados por crianças. Como objetivos empíricos de longo alcance, visou-se a integração das famílias dos estudantes na comunidade escolar. A prática realizada na escola registrou a concepção dos alunos sobre sua aldeia, visando fundamentar construções de documentos pedagógicos com sentido agroecológico. A partir deste trabalho podem ser formados multiplicadores agroecológicos, de forma a favorecer o desenvolvimento cultural, político, econômico e ambiental. O levantamento de práticas já existentes pela comunidade, somado ás novas propostas criadas no que condiz a agroecologia, pode vir a ser importante para aliar a proposta de junção do conhecimento tradicional da comunidade referida, com projetos pedagógicos e ambientais.Eje A5: Sistemas de conocimientoFacultad de Ciencias Agrarias y Forestale

Agroecologia para Escola Guarany Karaí Kuerí Renda

A presente pesquisa relaciona ou problemas socioambientais na aldeia Sapucaí, através da escola indígena Karaí Kuery Renda tomando em considerações as construções etnoagroecológicas. Aplicou-se como metodologia observação de campo, registros com fotos e desenhos elaborados por crianças. Como objetivos empíricos de longo alcance, visou-se a integração das famílias dos estudantes na comunidade escolar. A prática realizada na escola registrou a concepção dos alunos sobre sua aldeia, visando fundamentar construções de documentos pedagógicos com sentido agroecológico. A partir deste trabalho podem ser formados multiplicadores agroecológicos, de forma a favorecer o desenvolvimento cultural, político, econômico e ambiental. O levantamento de práticas já existentes pela comunidade, somado ás novas propostas criadas no que condiz a agroecologia, pode vir a ser importante para aliar a proposta de junção do conhecimento tradicional da comunidade referida, com projetos pedagógicos e ambientais.Eje A5: Sistemas de conocimientoFacultad de Ciencias Agrarias y Forestale

Agroecologia para Escola Guarany Karaí Kuerí Renda

A presente pesquisa relaciona ou problemas socioambientais na aldeia Sapucaí, através da escola indígena Karaí Kuery Renda tomando em considerações as construções etnoagroecológicas. Aplicou-se como metodologia observação de campo, registros com fotos e desenhos elaborados por crianças. Como objetivos empíricos de longo alcance, visou-se a integração das famílias dos estudantes na comunidade escolar. A prática realizada na escola registrou a concepção dos alunos sobre sua aldeia, visando fundamentar construções de documentos pedagógicos com sentido agroecológico. A partir deste trabalho podem ser formados multiplicadores agroecológicos, de forma a favorecer o desenvolvimento cultural, político, econômico e ambiental. O levantamento de práticas já existentes pela comunidade, somado ás novas propostas criadas no que condiz a agroecologia, pode vir a ser importante para aliar a proposta de junção do conhecimento tradicional da comunidade referida, com projetos pedagógicos e ambientais.Eje A5: Sistemas de conocimientoFacultad de Ciencias Agrarias y Forestale

Nonequilibrium Green's function theory for transport and gain properties of quantum cascade structures

The transport and gain properties of quantum cascade (QC) structures are investigated using a nonequilibrium Green's function (NGF) theory which includes quantum effects beyond a Boltzmann transport description. In the NGF theory, we include interface roughness, impurity, and electron-phonon scattering processes within a self-consistent Born approximation, and electron-electron scattering in a mean-field approximation. With this theory we obtain a description of the nonequilibrium stationary state of QC structures under an applied bias, and hence we determine transport properties, such as the current-voltage characteristic of these structures. We define two contributions to the current, one contribution driven by the scattering-free part of the Hamiltonian, and the other driven by the scattering Hamiltonian. We find that the dominant part of the current in these structures, in contrast to simple superlattice structures, is governed mainly by the scattering Hamiltonian. In addition, by considering the linear response of the stationary state of the structure to an applied optical field, we determine the linear susceptibility, and hence the gain or absorption spectra of the structure. A comparison of the spectra obtained from the more rigorous NGF theory with simpler models shows that the spectra tend to be offset to higher values in the simpler theories.Comment: 44 pages, 16 figures, appearing in Physical Review B Dec 200

Effect of raw sugar cane bagasse on performance and ingestive behavior of beef cattle

Avaliou-se o efeito da utilização do bagaço de cana-de-açúcar in natura (BIN), obtido por dois métodos de extração do açúcar, moagem convencional ou difusão, como fonte de fibra em dietas que continham bagaço tratado sob pressão e vapor (BTPV), como principal fonte de volumoso sobre o desempenho e o comportamento ingestivo de bovinos confinados. Para avaliação do desempenho, foram utilizados 84 machos não castrados das raças Nelore, Canchim e Holandesa, com média de peso inicial de 270kg, distribuídos em delineamento de blocos ao acaso. Para a avaliação do comportamento ingestivo, foram utilizados quatro garrotes da raça Nelore, em delineamento de quadrado latino 4 x 4. Os tratamentos consistiram na substituição do BTPV pelo BIN na matéria seca, constituindo as dietas experimentais: 5% BIN moagem convencional; 5% BIN difusão, 10% BIN difusão e 15% BIN difusão. O consumo de MS foi menor no tratamento com 15% de BIN obtido por difusão (BINdif), em relação ao teor de inclusão de 10%. Não houve diferença (P>0,05) entre os tratamentos para ganho diário de peso, conversão alimentar e peso vivo final entre os tratamentos. Os tempos despendidos com as atividades de ruminação (minutos/kg de MS) e mastigação (minutos/kg de MS ou de FDN) foram maiores (P<0,05) no tratamento com 15% de BINdif na dieta. O BINdif pode ser utilizado como fonte de fibra íntegra em até 15% da MS da dieta sem prejudicar o desempenho dos animais.This study was conducted to evaluate effects of replacing steam pressure treated sugar cane bagasse by two types of raw sugar cane bagasse extracted through grinding or diffusion, on performance and ingestive behavior of beef cattle. Eighty four young bulls (Nelore, Canchim and Holstein) with 270kg of body weight at the beginning of the experiment were used in a randomized block design. Ingestive behavior was evaluated using four Nelore young bulls in a 4 x 4 Latin square design. Treatments were the direct substitution of steam pressure treated sugarcane bagasse by raw bagasse (RB), corresponding to the experimental treatments: 5% RB from grinding; 5% RB from diffusion; 10% RB from diffusion and 15% RB from diffusion. Dry matter intake was lower in treatment with 15% of bagasse obtained by diffusion (BINdif) in comparison to 10% BINdif. There were no differences (P>0.05) among treatments for average daily gain, feed conversion and final live weight. Ruminating time (minutes/kg of DM) and chewing time (minutes/kg of DM or NDF) was greater (P>0.05) when BINdif was added at 15% level to diets. BINdif can be added up to 15% of the dietary DM with no detrimental effect on beef cattle performance

Reduced nerve injury-induced neuropathic pain in kinin B1 receptor knock-out mice

Injury to peripheral nerves often results in a persistent neuropathic pain condition that is characterized by spontaneous pain, allodynia, and hyperalgesia. Nerve injury is accompanied by a local inflammatory reaction in which nerve-associated and immune cells release several pronociceptive mediators. Kinin B1 receptors are rarely expressed in nontraumatized tissues, but they can be expressed after tissue injury. Because B1 receptors mediate chronic inflammatory painful processes, we studied their participation in neuropathic pain using receptor gene-deleted mice. In the absence of neuropathy, we found no difference in the paw-withdrawal responses to thermal or mechanical stimulation between B1 receptor knock-out mice and 129/J wild-type mice. Partial ligation of the sciatic nerve in the wild-type mouse produced a profound and long-lasting decrease in thermal and mechanical thresholds in the paw ipsilateral to nerve lesion. Threshold changed neither in the sham-operated animals nor in the paw contralateral to lesion. Ablation of the gene for the B1 receptor resulted in a significant reduction in early stages of mechanical allodynia and thermal hyperalgesia. Furthermore, systemic treatment with the B1 selective receptor antagonist des-Arg9-[Leu8]-bradykinin reduced the established mechanical allodynia observed 7-28 d after nerve lesion in wild-type mice. Partial sciatic nerve ligation induced an upregulation in B1 receptor mRNA in ipsilateral paw, sciatic nerve, and spinal cord of wild-type mice. Together, kinin B1 receptor activation seems to be essential to neuropathic pain development, suggesting that an oral-selective B1 receptor antagonist might have therapeutic potential in the management of chronic pain