Estudo das potencialidades e dificuldades para a constituição de um cluster hospitalar no concelho de Cascais

Para efeitos de obtenção do grau de Mestre em Sociologia, na área de especialização em Sociologia Económica e das Organizações na Faculdade de Ciências Sociais e Humanas na Universidade Nova de Lisboa, a aluna realizou um estágio na Câmara Municipal de Cascais (CMC) no período de 26-11-07 a 26-05-08 em regime de tempo integral. A aluna foi aceite para estagiar como investigadora no Departamento de Planeamento Estratégico, a fim de elaborar um projecto visando tirar o maior partido social, económico e tecnológico do novo Hospital de Cascais. Uma vez discutidas e analisadas as motivações da CMC, foi proposta pela aluna a realização de um estudo das potencialidades e dificuldades nas áreas Empresarial, da Saúde e da I&D em Cascais, para a criação de um cluster hospitalar. O estudo compreendeu um levantamento dos serviços necessários ao funcionamento hospitalar e normalmente adquiridos em outsourcing, bem como dos regimes de aquisições; do potencial empresarial para esses serviços residente no Concelho; e dos centros de investigação e universidades localizados nas proximidades geográficas de Cascais com áreas de estudos de interesse para o futuro cluster hospitalar. Analisados os resultados e avaliados os pontos fortes e fracos em cada uma destas dimensões, o estudo conclui com uma proposta de plano para dinamizar e organizar um futuro Cluster Hospitalar de Cascais.In order to obtain her Master degree in Sociology, specializing in Economic Sociology and Sociology of Organizations, the student took a full-time training post with the Municipal Government of Cascais (Câmara Municipal de Cascais - CMC), from November 11 2007 to May 26 2008. She trained as a researcher in the Department of Strategic Planning, aiming to design a project to take as much advantage as possible of the building of a new hospital in the municipality. Once discussed and analyzed CMC’s motivations, the student proposed to undertake a study of the potential and the obstacles posed by the Enterprise, Health and R&D areas in Cascais for the creation of an hospital cluster. The study undertook a survey of the services needed for the working of an hospital and usually outsourced, as well as of the outsourcing regimes, of the resident enterprise potential for those services in the municipality; and of R&D centres and universities in the neighbourhood of Cascais doing research in areas that are relevant for a future hospital cluster. After the research results were analyzed and the strengths and weaknesses in all the above dimensions were assessed, the study concludes with a proposal of a plan to foster and organize a future Cascais Hospital Cluster

Responsabilidade Social no Setor da Saúde: Representações, Valores, Motivações e Instrumentos

Buscámos ao longo deste estudo identificar os valores éticos, as motivações e as lógicas de justificação acionadas pelos atores do setor da saúde e do setor autárquico em torno da Responsabilidade Social das Empresas (RSE), através da análise dos discursos, dos programas e das redes de stakheolders implementadas. Os resultados mostraram que existem diversidade, divergências e equilíbrios variáveis entre os discursos de diferentes atores e programas, nomeadamente entre os que privilegiam interpretações instrumentais e estratégicas da RS, associadas a lógicas de justificação industrial e de renome, e os que se pautam por interpretações éticas e idealistas, associadas a lógicas de justificação cívica. Essa diversidade de orientações valorativas face à RSE torna-a um campo potencialmente controverso, e pode constituir um obstáculo a graus mais elevados de consolidação das redes em clusters, cuja ampliação na área da saúde necessitará de envolver trabalho de consensualização pelos atores organizacionais entre si, com os seus stakeholders internos e externos, e com os atores político-administrativos, especialmente as autarquias locais, que a desenvolver-se constituirá um objeto pertinente para futura investigação sociológica.This study aimed to identify the ethical values, motivations and justification logics enacted by actors in the healthcare and the local administration sectors concerning Corporate Social Responsibility (CSR), through the analysis of their discourses, programmes and stakeholder networks implemented. The results highlight there is variety divergence and variable equilibria across the discourses of different actors and programmes, namely between those favouring instrumental and strategic interpretations of CSR, which are associated with industrial and renown justification logics, and those abiding by ethical and idealistic interpretations, which are associated with civic justification logics. Such diversity of value orientations in the face of CSR makes this a potentially controversial field, and it may hinder reaching higher levels of network consolidation into clusters. Its widening in the healthcare sector will therefore require consensus-making labour by the corporate actors among themselves, with their internal and external stakeholders, and with political and administrative actors, mainly local councils. To the extent that it develops, such labour will provide a relevant subject for further sociological research

The discourses and the controversies on the technical military and technical police cooperation among Portugal, Brazil and Angola

O presente artigo propõe‑se analisar a atividade de cooperação técnico‑militar e técnico‑policial, com base nos fundamentos de análise da sociologia pragmática. Acreditamos que o estudo dos objetivos que os diferentes atores atribuem à cooperação constitui um elemento‑base para a compreensão da referida cooperação no espaço lusófono. Ao contrário de autores como (Moreira, 2001), tentaremos enquadrar o nosso estudo na transformação do sistema capitalista do Estado‑Providência, pelo facto de acreditarmos que as alterações nos moldes como os atores realizam os seus julgamentos, principalmente no sector da Segurança, poderão compreender uma estratégia muito mais vasta, relacionada à legitimação do estado‑providência e à sobrevivência do próprio sistema capitalista.RECORREU‑SE à metodologia de análise compreensiva e a um conjunto de técnicas qualitativas de análise de dados, pelo facto de pretendemos analisar materiais densos no que concerne à sua subjetividade. A grelha taxonómica de (Boltanski & Thèvenot, 1991) servirá de suporte ao estudo que pretendemos desenvolver, visto colocar ao nosso dispor um conjunto de ferramentas para análise das lógicas de justificação formuladas pelos atores, quando estes se encontram em situações de controvérsia pública POSTO isto, sublinhamos que este estudo tem a pertinência científica de contribuir para a compreensão dos moldes como os diferentes atores do sector da Segurança formulam os julgamentos quando são confrontados. A par disto, apresenta a pertinência prática de dar a conhecer como as instituições de Segurança gerem as diferentes lógicas de julgamento e ainda de que forma conseguem reunir os consensos e formalizar os compromissos. IMPORTA, precisamente, tentarmos perceber se a reunião de consensos depende ou não da articulação das diferentes lógicas, sob a alçada de um princípio superior de bem comum e, em caso afirmativo, como isto ocorre

Dinâmicas de (investig)ação em contextos de promoção da língua portuguesa: a presença do CIDTFF na rede Camões, I.P.

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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

A TEORIA ATOR-REDE COMO REFERENCIAL TEÓRICO-METODOLÓGICO EM PESQUISAS EM SAÚDE E ENFERMAGEM

Objetivo: reflexionar sobre la Teoría Actor-Red como referencial teórico-metodológico en la investigación en salud y enfermería. Método: estudio del tipo reflexivo, que utilizo los principios y conceptos de la Teoría Actor-Red como referencial teórico-metodológico. Resultados: la referida Teoría puede ser operacionalizada a partir de la cartografía de controversias como su método, siendo este definido por los movimientos: 1) buscar una puerta de entrada en la red; 2) identificar a los portavoces; 3) acceder a los dispositivos de inscripción; 4) mapear las asociaciones entre los actantes. Se constituye como un conjunto de técnicas para explorar y ver polémicas y controversias, observando y cartografiando el debate social, especialmente, pero no exclusivamente, en torno a los problemas técnico-científicos. Así, en el ámbito de la salud y enfermería, más precisamente en el ambiente de prácticas complejas donde los enfermeros y las tecnologías de la salud operan, la Teoría Actor-Red ha emergido como un referencial teórico-metodológico de relevante notoriedad. Su aplicación puede contribuir al entendimiento de las innovaciones y sus influencias para la colectividad a partir de asociaciones establecidas entre los actores, siguiendo sus pasos, sin fraccionar sus vidas, sin hacer recortes aislados, siguiendo lo que sucede en red y lo que está interconectado, interfiriendo y sufriendo interferencias. Conclusión: por creer que el conocimiento es un producto social o efecto de una red de actores humanos y no humanos, y no algo producido por medio de la operación de un método científico privilegiado, la Teoría Actor-Red se presenta como un referencial teórico-metodológico prometedor para los ambientes controvertidos de las áreas de la salud y enfermería

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit