Sustentabilidade financeira do sistema de saúde português: O papel do setor privado

O Sistema de Saúde no seu modelo atual apresenta uma série de fragilidades de caracter financeiro e constrangimentos na capacidade de resposta exacerbados durante a recente pandemia COVID-19, aos que se associam outros desafios para a sustentabilidade financeira nomeadamente a transição demográfica, a transição epidemiológica, e a inovação tecnológica. Atendendo as características do Sistema de Saúde português, uma estratégia para abordar as ameaças a sustentabilidade financeira é o desenvolvimento de estratégias de colaboração entre os diferentes setores que integram o sistema. Com o objetivo de analisar o papel do setor privado de prestação de cuidados de saúde na sustentabilidade financeira do Sistema de Saúde, e explorar modelos de integração, foi efetuado um estudo exploratório, de carater qualitativo com implementação de uma análise indutiva aos dados obtidos de entrevistas semiestruturadas aplicadas a uma amostra de peritos selecionados através da amostragem por conveniência, em que os resultados foram analisados utilizando a metodologia de Gioia.Como principais resultados salienta-se que o sistema de saúde em Portugal está caracterizado pela fragmentação do financiamento, da prestação de serviços de saúde, e segmentação da cobertura. Constatou-se que o desenvolvimento de estratégias de colaboração entre o setor público e o setor privado da saúde constitui um fator crítico de sucesso que depende da redefinição do modelo de integração, carece da implementação de critérios de avaliação da qualidade, eficiência, acesso e de resultados semelhantes para todos os intervenientes, assim como da redefinição de modelos de financiamento com responsabilidade partilhada e idealmente com a introdução do value-based healthcare.The Portuguese health system has shown a series of financial constraints and conditioned capacity of response related to accessibility and coverage exacerbated during the recent COVID-19 pandemic, to which are associated other challenges for financial sustainability, namely changes in demographic and epidemiologic pattern and the increasing cost of technological innovation. Considering the Portuguese health system characteristics, a strategy to address the threats to financial sustainability is the development of collaboration strategies between the different stakeholders. With the aim of analyze the role of the private health care sector in the financial sustainability of the Portuguese Health System, and to explore models of integration of the private sector with the public sector for the provision of health care, an exploratory qualitative study was carried out, based on the implementation of an inductive analysis of data obtained from semi-structured interviews applied to a sample of experts, the results were analyzed using Gioia’s methodology. As main results, it should be noted that the health system in Portugal is characterized by the fragmentation of funding and in the provision of health services. It was observed that the development of collaboration strategies between the public and private health sectors is a critical success factor that depends on the redefinition of the integration model, lacks the implementation of criteria for evaluating quality, efficiency, access and similar results for all stakeholders, as well as the redefinition of funding models with shared responsibility and ideally with the introduction of value-based healthcare

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Tailoring of structures and permeation properties of asymmetric nanocomposite cellulose acetate/silver membranes

Cellulose acetate (CA)-silver (Ag) nanocomposite asymmetric membranes were prepared via the wet-phase inversion method by dispersing polyvinylpirrolydone-protected Ag nanoparticles in the membrane casting solutions of different compositions. Silver nanoparticles were synthesized ex situ and added to the casting solution as a concentrated aqueous colloidal dispersion. The effects of the dispersion addition on the structure and on the selective permeation properties of the membranes were studied by comparing the nanocomposites with the silver-free materials. The casting solution composition played an important role in the adequate dispersion of the silver nanoparticles in the membrane. Incorporation of nanoscale silver and the final silver content resulted in structural changes leading to an increase in the hydraulic permeability and molecular weight cut-off of the nanocomposite membranes. (c) 2014 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2015, 132, 41796

Associations between physical status and training load in women soccer players

This study aimed to analyze the variations of fitness status, as well as test the relationships between accumulated training load and fitness changes in women soccer players. This study followed an observational analytic cohort design. Observations were conducted over 23 consecutive weeks (from the preseason to the midseason). Twenty-two women soccer players from the same first Portuguese league team (22.7 ± 5.21 years old) took part in the study. The fitness assessment included anthropometry, hip adductor and abductor strength, vertical jump, change of direction, linear speed, repeated sprint ability, and the Yo-Yo intermittent recovery test. The training load was monitored daily using session rating of perceived exertion (s-RPE). A one-way repeated ANOVA revealed no significant differences for any of the variables analyzed across the three moments of fitness assessments (p > 0.05). The t-test also revealed no differences in the training load across the moments of the season (t = 1.216; p = 0.235). No significant correlations were found between fitness levels and accumulated training load (range: r = 0.023 to −0.447; p > 0.05). This study revealed no differences in the fitness status during the analyzed season, and the fitness status had no significant relationship with accumulated training load.Fundação para a Ciência e Tecnologia | Ref. UIDB / 50008/2020Ministerio de Economía y Competitividad | Ref. PGC2018-098742-B-C3

Ecoeficiência e ecogestão no setor do azeite: uma avaliação do ciclo de vida

A União Europeia (UE) é a principal região produtora de azeite a níve11 mundial, com Portugal a ocupar a quarta posição, depois da Espanha, Itália e Grécia. O azeite tem, por isso, uma grande importância nos países da bacia Mediterrânica, não apenas devido à riqueza e herança cultural associada a este produto, mas também à sua enorme relevância na economia, na criação de emprego, no combate à desertificação e na manutenção das populações rurais. Apesar da importância económica e social deste produto alimentar de excecional valor nutricional, a sua produção envolve aspetos ambientais que não devem nem podem ser negligenciados. Ao longo das etapas da cadeia produtiva do azeite, desde o cu~tivo e da produção de azeitona até ao consumo final do produto, ocorrem consumos de recursos mássicos e energéticos, bem como a produção de resíduos gasososJ líquidos e sólidos com impactes e consequências negativas nos ecossistemas. Estes impactes variam ,em função das práticas e das técnicas utilizadas nas diferentes etapas, da região, do país, das características locais das explorações e ainda dos modelos de gestão. As condições sodoeconómicas, o clima ,e os aspetos culturais têm também influência nos impactes gerados.info:eu-repo/semantics/publishedVersio

A conversão do sertão capelas e a governamentalidade nas Minas Gerais The conversion of the hinterland chapels and governamentalidade in the Minas Gerais

O artigo trata da instituição das capelas no território das Minas Gerais, considerando a sua significação política e a sua relação com o enquadramento social da população. Procura-se avaliar essa prática de poder, desde a fundação pelos patronos coloniais até o reconhecimento eclesiástico e régio. Observando-se os laços políticos na segunda metade do século XVIII, verifica-se ainda que as capelas, mecanismos de poder senhorial e de normalização dos súditos, tinham um papel fundamental na governamentalidade do Estado, especialmente nas fronteiras.<br>This paper is concerned with the establishment of chapels in Minas Gerais, taking into account its political meaning and its relationship with the social fitting of the population. Power practices are evaluated, since foundations of the chapels by colonial sponsors to their ecclesiastical and royal admissions. Considering political bonds on the second half of the eighteen century, one verifies that chapels - a way of power of owners and subject regulation - had a fundamental role in the government, mainly at frontiers