Activity-based management accounting in the health care sector, with specific reference to private hospital groups in South Africa

ThesisThe health care sector, worldwide, is characterised by increasing patient loads, more complex procedures - and ever-increasing medical costs, with the cost of hospitalisation being the predominant cost factor absorbing the most resources. Leyenaar (1997: 14) maintains that the health care market has shifted from revenue to a cost focus. Increases in private hospital cost of between 13 and 15 percent at the beginning of 1999 were, according to Bisseker (1999: I), not justified, especially in the light of the healthy fmancial results achieved by many of the listed private hospital groups. Administrators of large medical aid schemes and of managed care companies are having great difficulty in explaining these increases to their members. Member contributions increased by as much as 20 percent, this despite promises that managed care would bring these costs under control (Bisseker, 1999: I ). Another problem facing South African hospitals is currencY related. Since the beginning of 1999, the Rand has lost a great deal of ground against foreign currencies, making it very expensive for hospitals to purchase any medical equipment from the overseas market. Hospitals purchase much of their technologically advanced equipment and medication from foreign countries and with the depreciating Rand, these items become even more expensive. The hospitals must bring this currencY component into their pricing policies. Another factor contributing to the recessionary climate existing in South Africa is one of medical inflation. Medical inflation rates have, over the past few years been much higher than the average inflation rate. An increased emphasis on cost management and cost contaimnent in hospitals, together with managed health care, has created an urgent need amongst health care providers for relevant, accurate, timeous and meaningful cost information (Williams, 1997: 16). In this regard Canby (1995:51) is of the opinion that by tracing healthcare activities and costs back to the events that generate and cause the cost, and by focusing on the process that drives cost, a more accurate measurement of financial information and performance is obtained. This, in tum, will enable private hospital groups to make necessary price changes only if these changes are justified by the information obtained from the new system. The health care industry may use the ABC technique, developed by manufacturing organisations to enhance their profitability, eliminate unnecessary costs and plan for change (Schuneman, 1997: I). This technique, which identifies the relationship between the activity and the source needed to complete it, can thus also be applied successfully to the medical practice. Hospital management systems may use all the components associated with ABMA to effectively control, plan, administer and monitor the activities and resources in the hospital

O impacto da promoção de ações continuadas de educação alimentar e a representação social dos alimentos na redução de sobrepeso e obesidade em adolescentes

The intake of a diet high in sugar and fat has been part a commom practice among adolescents and it increases the risk of obesity among them. Nutrition education in schools can help promote the adoption of healthy food habits. The teacher’s involvement in the process would be essential in this process, so their training and knowledge of the social representation of food by this agent is critical to the process. The aim of the study to verify the impact of intervention on nutrition in adolescents and the social representation of food by Physical Education Teacher. The specifics goals are to verify the impact of an intervention on the dietary patterns of adolescents, nutritional status, sexual maturation, stages of behavior changes for sugars, fats, fruits and vegetables; perceived consumption their fruit and vegetable intake, and talk about the food social representations with their Physical Education Teacher. Method: A qualitative and quantitative study was held in six public schools in the city of São Paulo. Between November 2010 and November 2012, 226 male and female students whose ages varied from 13 to 19 took part of the quantitative study. Weight, height, body mass index, waist circumference, stage was evaluated behavior change and food intake by semiquantitative food frequency questionnaire. The Chi-square test was used to identify the groups. Dietary patterns were identified by factorial analyzes with Varimax rotation. Mann-Whitney and Kruskal-Walliswere used to associate the evaluation of the intervention impact.Physical Education Teacher took part in the qualitative studies. Interviews about their life experiences held between March and May in 2014were used to analyze the social representation. . For the content analysis was used Bardin.. It was approved by The Comitê de Ética e Pesquisa da Universidade Federal de São Paulo. Six dietary patterns that didn’t go through any kind of change were identified during this process: junk food, healthy food, urban food, morning drinks, traditional, coffee and fat. No changes were identified in the BMI, with higher prevalence of normal weight and pubescent . An association between overweight and cardiovascular risk and also between obesity and post puberty The intervention group showed a more accurate perception concerning their vegetable intake. During the analyzes 13 theme categories came through: breastfeeding, childhood feeding, maternal care, teen eating habits, eating habits at school, adulthood eating habits, eating memory, healthy eating habits, the meaning being meals, health, part in the Project, transversal theme. The social representation of food had it focus on health, pleasure and affection. Conclusion: The educational intervention did not provide dietary changes, as the stages of behavior apparently worsened, but may reflect the better understanding of consumption. The social representation of food by the physical education teachers were introduced as aspects of health, pleasure and affection, what could compromise their pedagogical practice.O consumo de dieta rica em açúcar e gorduras tem sido uma prática frequente entre os adolescentes e aumenta o risco para obesidade. A educação alimentar na escola pode contribuir para promoção da incorporação de práticas alimentares mais saudáveis. O envolvimento do professor é essencial, assim sua capacitação e conhecimento da representação social do alimento por este agente é fundamental para o processo. O objetivo deste estudo foi verificar o impacto de intervenções em alimentação em adolescentes e a representação social do alimento pelos Professores de Educação Física. Os objetivos específicos: verificar o impacto da intervenção sobre o padrão alimentar dos adolescentes, o estado nutricional, maturação sexual, estágios de mudança de comportamento para açúcar, gorduras, frutas e vegetais; percepção de consumo pelos adolescentes quanto à ingestão de frutas e vegetais e discutir a representação social do alimento pelo Professor de Educação Física. Método: O estudo realizado foi quantitativo e qualitativo em seis Escolas Técnicas do município de São Paulo. Para o estudo quantitativo longitudinal participaram 226 adolescentes, entre 13 a 19 anos, de ambos os sexos, no período entre março a novembro de 2010 e novembro de 2012. Foi avaliado peso, altura, índice de massa corporal, circunferência de cintura, estágio de mudança de comportamento e consumo alimentar por questionário de frequência alimentar semiquantitativo. Na caracterização do grupo foi usado o Teste Qui-quadrado. Os padrões alimentares foram identificados pela análise fatorial com rotação Varimax. Nas associações para a avaliação do impacto da intervenção foram usados os testes de Mann-Whitney e Kruskal-Wallis. No estudo qualitativo participaram seis Professores de Educação Física. A representação social do alimento pelo professor foi verificada por entrevistas efetuadas entre março a maio de 2014 utilizando a História oral de vida. Para a análise de conteúdo foi utilizado Bardin. Foi aprovada pelo Comitê de Ética e Pesquisa da Universidade Federal de São Paulo sob o parecer número 522.174. Resultados: Foram identificados seis padrões alimentares (junk food, saudável, urbano, bebida matinal, tradicional, café e gorduras) que não se alteraram durante o estudo. Não foram observadas mudanças no IMC, com maior prevalência de eutróficos e púberes. Houve associação entre excesso de peso e risco cardiovascular e também entre obesidade e pós puberdade. O grupo intervenção apresentou percepção mais adequada quanto ao consumo de vegetais.Na análise das narrativas foram extraídas 13 categorias temáticas: aleitamento materno, alimentação na infância, cuidado materno, alimentação na adolescência, alimentação na escola, alimentação na fase adulta, família, memória alimentar, alimentação saudável, significado do alimento, saúde, participação no projeto, tema transversal. A representação social do alimento pelos professores focalizou na saúde, prazer e afeto. Conclusão: A intervenção educativa não propiciou mudanças nos padrões alimentares, quanto aos estágios de comportamento aparentemente pioraram, porém pode ser reflexo da melhor percepção de consumo. A representação social do alimento pelo Professor de Educação Física era conduzida por aspectos de saúde, prazer e afeto podendo interferir na sua prática pedagógica.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

Grape juice increases the BDNF levels but not alter the S100B levels in hippocampus and frontal cortex from male Wistar rats

Several studies have shown that a high consumption of vegetables and fruits is consistently associated with a low risk of oxidative stress-induced diseases, which includes some degenerative diseases such as amyotrophic lateral sclerosis, Alzheimer and Parkinson. Therefore, the objective of this study is to verify the effects of conventional and organic grape juice in the modulation of the neurotrophic factor (BDNF) and astrocytic markers protein (S100B) in hippocampus and frontal cortex of Wistar rats. In this study, 24 male Wistar rats were divided into three groups. To the first one, it was given organic purple grape juice; to the second, conventional grape juice, while the last one received only saline. After 30 days, all rats were sacrificed and hippocampus and frontal cortex were dissected. The animals that received organic and conventional grape juice showed, in frontal cortex, an elevated BNDF levels in relation to saline group. However, S100B levels did not change. These results showed that grape juices are able to modulate important marker in brain tissue, and could be an important factor to prevent brain diseases

Dos tempos e dos espacos da Educaçao Fisica

O trabalho apresenta parte dos resultados de uma pesquisa cujo objetivo foi o registro e a análise de práticas pedagógicas de Educação Física na educação da pequena infância. A investigação aconteceu em três instituições públicas de Florianópolis/Brasil, contando com extenso conjunto de observações, análise de relatórios organizados pelas professoras de Educação Física, entrevistas com estas e outros atores institucionais. Considerou também as diretrizes do município e os PPPs de cada instituição. Os dados apontam para aulas de Educação Física que intentam romper com modelos escolarizantes na Educação Infantil e que consideram, para além do tempo demarcado pelos ponteiros do relógio ou dos tradicionais encontros semanais de 45 min., as particularidades dos pequenos, a integração entre crianças de diferentes faixas-etárias, as necessidades e os projetos de trabalho de cada turma e aqueles da instituição. Nesse movimento, as aulas se misturam com os demais momentos da rotina das creches e passam também a percorrer outros espaços, como as salas de aula, o refeitório, o parque, as cercanias da instituição, bem como outros lugares da cidade, configurando novos contornos para a Educação Física voltada à pequena infância.Ponencia presentada en el Panel "Discursos y prácticas corporales".Departamento de Educación Físic

A simplified experimental model of large-for-size liver transplantation in pigs

OBJECTIVE: The ideal ratio between liver graft mass and recipient body weight for liver transplantation in small infants is unknown; however, if this ratio is over 4%, a condition called large-for-size may occur. Experimental models of large-for-size liver transplants have not been described in the literature. In addition, orthotopic liver transplantation is marked by high morbidity and mortality rates in animals due to the clamping of the venous splanchnic system. Therefore, the objective of this study was to create a porcine model of large-for-size liver transplantation with clamping of the supraceliac aorta during the anhepatic phase as an alternative to venovenous bypass. METHOD: Fourteen pigs underwent liver transplantation with whole-liver grafts without venovenous bypass and were divided into two experimental groups: the control group, in which the weights of the donors were similar to the weights of the recipients; and the large-for-size group, in which the weights of the donors were nearly 2 times the weights of the recipients. Hemodynamic data, the results of serum biochemical analyses and histological examination of the transplanted livers were collected. RESULTS: The mortality rate in both groups was 16.5% (1/7). The animals in the large-for-size group had increased serum levels of potassium, sodium, aspartate aminotransferase and alanine aminotransferase after graft reperfusion. The histological analyses revealed that there were no significant differences between the groups. CONCLUSION: This transplant method is a feasible experimental model of large-for-size liver transplantation

Genetic variants of ABC and SLC transporter genes and chronic myeloid leukaemia: impact on susceptibility and prognosis

Solute carrier (SLC) and ATP-binding cassette (ABC) transporters comprise a variety of proteins expressed on cell membranes responsible for intrusion or extrusion of substrates, respectively, including nutrients, xenobiotics, and chemotherapeutic agents. These transporters mediate the cellular disposition of tyrosine kinase inhibitors (TKIs), and their genetic variants could affect its function, potentially predisposing patients to chronic myeloid leukaemia (CML) and modulating treatment response. We explored the impact of genetic variability (single nucleotide variants—SNVs) of drug transporter genes (ABCB1, ABCG2, SLC22A1, and SLC22A5) on CML susceptibility, drug response, and BCR-ABL1 mutation status. We genotyped 10 SNVs by tetra-primers-AMRS-PCR in 198 CML patients and 404 controls, and assessed their role in CML susceptibility and prognosis. We identified five SNVs associated with CML predisposition, with some variants increasing disease risk, including TT genotype ABCB1 (rs1045642), and others showing a protective effect (GG genotype SLC22A5 rs274558). We also observed different haplotypes and genotypic profiles associated with CML predisposition. Relating to drug response impact, we found that CML patients with the CC genotype (rs2231142 ABCG2) had an increased risk of TKI resistance (six-fold). Additionally, CML patients carrying the CG genotype (rs683369 SLC22A1) presented a 4.54-fold higher risk of BCR-ABL1 mutations. Our results suggest that drug transporters’ SNVs might be involved in CML susceptibility and TKI response, and predict the risk of BCR-ABL1 mutations, highlighting the impact that SNVs could have in therapeutic selection.info:eu-repo/semantics/publishedVersio

Avaliação do dano ao DNA em ratos tratados com dieta cetogênica

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Análise qualitativa de gangliosídeos em hipocampos de ratos submetidos a isquemia cerebral transitória

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Early effects of LPS-induced neuroinflammation on the rat hippocampal glycolytic pathway

Neuroinflammation is a common feature during the development of neurological disorders and neurodegenerative diseases, where glial cells, such as microglia and astrocytes, play key roles in the activation and maintenance of inflammatory responses in the central nervous system. Neuroinflammation is now known to involve a neurometabolic shift, in addition to an increase in energy consumption. We used two approaches (in vivo and ex vivo) to evaluate the effects of lipopolysaccharide (LPS)-induced neuroinflammation on neurometabolic reprogramming, and on the modulation of the glycolytic pathway during the neuroinflammatory response. For this, we investigated inflammatory cytokines and receptors in the rat hippocampus, as well as markers of glial reactivity. Mitochondrial respirometry and the glycolytic pathway were evaluated by multiple parameters, including enzymatic activity, gene expression and regulation by protein kinases. Metabolic (e.g., metformin, 3PO, oxamic acid, fluorocitrate) and inflammatory (e.g., minocycline, MCC950, arundic acid) inhibitors were used in ex vivo hippocampal slices. The induction of early inflammatory changes by LPS (both in vivo and ex vivo) enhanced glycolytic parameters, such as glucose uptake, PFK1 activity and lactate release. This increased glucose consumption was independent of the energy expenditure for glutamate uptake, which was in fact diverted for the maintenance of the immune response. Accordingly, inhibitors of the glycolytic pathway and Krebs cycle reverted neuroinflammation (reducing IL-1β and S100B) and the changes in glycolytic parameters induced by LPS in acute hippocampal slices. Moreover, the inhibition of S100B, a protein predominantly synthesized and secreted by astrocytes, inhibition of microglia activation and abrogation of NLRP3 inflammasome assembly confirmed the role of neuroinflammation in the upregulation of glycolysis in the hippocampus. Our data indicate a neurometabolic glycolytic shift, induced by inflammatory activation, as well as a central and integrative role of astrocytes, and suggest that interference in the control of neurometabolism may be a promising strategy for downregulating neuroinflammation and consequently for diminishing negative neurological outcomes

Photobiomodulation Therapy Restores IL-10 Secretion in a Murine Model of Chronic Asthma: Relevance to the Population of CD4+CD25+Foxp3+ Cells in Lung.

It is largely known that photobiomodulation (PBM) has beneficial effects on allergic pulmonary inflammation. Our previous study showed an anti-inflammatory effect of the PBM in an acute experimental model of asthma, and we see that this mechanism is partly dependent on IL-10. However, it remains unclear whether the activation of regulatory T cells is mediated by PBM in a chronic experimental model of asthma. In this sense, the objective of this study was to verify the anti-inflammatory role of the PBM in the pulmonary inflammatory response in a chronic experimental asthma model. The protocol used for asthma induction was the administration of OVA subcutaneously (days 0 and 14) and intranasally (3 times/week, for 5 weeks). On day 50, the animals were sacrificed for the evaluation of the different parameters. The PBM used was the diode, with a wavelength of 660 nm, a power of 100 mW, and 5 J for 50 s/point, in three different application points. Our results showed that PBM decreases macrophages, neutrophils, and lymphocytes in the bronchoalveolar lavage fluid (BALF). Moreover, PBM decreased the release of cytokines by the lung, mucus, and collagen in the airways and pulmonary mechanics. When we analyzed the percentage of Treg cells in the group irradiated with laser, we verified an increase in these cells, as well as the release of IL-10 in the BALF. Therefore, we conclude that the use of PBM therapy in chronic airway inflammation attenuated the inflammatory process, as well as the pulmonary functional and structural parameters, probably due to an increase in Treg cells.post-print1951 K