A critical look at the Portuguese public-private partnerships in healthcare

The pre-conceived idea that contracts in a public-private partnership (PPP) regime, in healthcare or in any other economic sector, are, as a rule, ruinous and appealing for only a share of the stakeholders, lacks a solid basis that confirms it. This idea, outset and nurtured by the media, has been instigating the distrust of the users who, in turn, demand a more rigorous and efficient utilisation of public resources. Being Portugal in the top of countries that resort to PPPs, it is urgent to inquire if its respective contracts originated an inefficient and ineffective management of resources. It is precisely this discussion that we address in this paper, focusing our efforts in the Portuguese healthcare sector.

Water utilities performance analysis in developing countries: On an adequate model for universal access

The results of the analysis of water utility performance studies based on data envelopment analysis (DEA) can be very sensitive to the methodological approach and the variables employed. This study investigates approaches and variables for developing countries in order to identify an adequate model for universal access. Three models were developed and compared. The first used traditional variables, the second considered the quality of service variables, and the last are expanded on the second by incorporating the realization of the human right to water into efficiency estimation. Methodological approaches comprising the variable returns to scale DEA (most common for developing countries) and slack-based directional distance function (employed in this study) were also compared. The case study of 77 Brazilian water utilities suggests that a model that incorporates the objective of universal access in the efficiency estimation changes substantialy utility efficiency scores. Therefore, utilities that make investments to reach the universal access can be penalized since traditional models incorporate the expenses, but fail to capture the results. The research conclusions suggest that approaches and variable choices are likely to impact on the analysis results, misrepresenting them regardless of the purpose for using DEA in the study.

Monitoring inequality in water access: Challenges for the 2030 Agenda for Sustainable Development

The diffusion of the indicators for monitoring sustainable development goals (SDG) has conceptual and symbolic uses far beyond their instrumental uses. Despite its value in dismantling social and economic inequalities, the goal regarding guaranteed of water and sanitation for all did not specify any indicators for this purpose. This research contributes to the discussions on the best way to monitor inequality in access to water by the SDG. Inequality measures established in other areas of study and specific to the access to water were analyzed as their applicability for this purpose. Our study finds that current United Nations strategy does not allow for robust conclusions and does not respect some economical axioms. Furthermore, we show the potentialities and inconveniences of the most important metrics, but it can be concluded that if the objective is merely to measure inequality and communicate easily, the concentration index is the most appropriate measure. These results may contribute to a more refined discussion of how the SDGs can measures progress towards equality in water access and provides information to guide governments agendas for equality in water access.

2016 update of the Portuguese recommendations for the use of biological therapies in children and adolescents with Juvenile Idiopathic Arthritis

OBJECTIVE

To provide evidence-based guidance for the rational and safe prescription of biological therapies in children and adolescents with juvenile idiopathic arthritis (JIAs) considering the latest available evidence and the new licensed biologics.

METHODS

Rheumatologists and Pediatricians with expertise in Pediatric Rheumatology updated the recommendations endorsed by the Portuguese Society of Rheumatology and the Portuguese Society of Pediatrics based on published evidence and expert opinion. The level of agreement with final propositions was voted using an online survey.

RESULTS

In total, 20 recommendations to guide the use of biological therapy in children and adolescents with JIAs are issued, comprising 4 general principles and 16 specific recommendations. A consensus was achieved regarding the eligibility and response criteria, maintenance of biological therapy, and procedures in case of non-response, for each JIA category. Specific recommendations concerning safety procedures were also updated.

CONCLUSIONS

These recommendations take into account the specificities of each JIA category and are intended to continuously improve the management of JIA patients.

Life cycle assessment of a packaging waste recycling system in Portugal

Life Cycle Assessment (LCA) has been used to assess the environmental impacts associated with an activity or product life cycle. It has also been applied to assess the environmental performance related to waste management activities. This study analyses the packaging waste management system of a local public authority in Portugal. The operations of selective and refuse collection, sorting, recycling, landfilling and incineration of packaging waste were considered. The packaging waste management system in operation in 2010, which we called "Baseline" scenario, was compared with two hypothetical scenarios where all the packaging waste that was selectively collected in 2010 would undergo the refuse collection system and would be sent directly to incineration (called "Incineration" scenario) or to landfill ("Landfill" scenario). Overall, the results show that the "Baseline" scenario is more environmentally sound than the hypothetical scenarios.

On evaluating health centers groups in Lisbon and Tagus Valley: efficiency, equity and quality

Background

Bearing in mind the increasing health expenses and their weight in the Portuguese gross domestic product, it is of the utmost importance to evaluate the performance of Primary Health Care providers taking into account both efficiency, quality and equity. This paper aims to contribute to a better understanding of the performance of Primary Health Care by measuring it in a Portuguese region (Lisbon and Tagus Valley) and identifying best practices. It also intends to evaluate the quality and equity provided.

Methods

For the purpose of measuring the efficiency of the health care centers (ACES) the non-parametric full frontier technique of data envelopment analysis (DEA) was adopted. The recent partial frontier method of order-m was also used to estimate the influence of exogenous variables on the efficiency of the ACES. The horizontal equity was investigated by applying the non-parametric Kruskal-Wallis test with multiple comparisons. Moreover, the quality of service was analyzed by using the ratio between the complaints and the total activity of the ACES.

Results

On the whole, a significant level of inefficiency was observed, although there was a general improvement in efficiency between 2009 and 2010. It was found that nursing was the service with the lowest scores. Concerning the horizontal equity, the analysis showed that there is no evidence of relevant disparities between the different subregions(NUTS III). Concerning the exogenous variables, the purchasing power, the percentage of patients aged 65 years old or older and the population size affect the efficiency negatively.

Conclusions

This research shows that better usage of the available resources and the creation of a learning network and dissemination of best practices will contribute to improvements in the efficiency of the ACES while maintaining or even improving quality and equity. It was also proved that the market structure does matter when efficiency measurement is addressed.

Thimerosal exposure (from tetanus-diphtheria vaccine) during pregnancy and neurodevelopment of breastfed infants at 6 months

AIM

We studied the effect on neurodevelopment of infants who are exposed to thimerosal in tetanus-diphtheria (Td) vaccines during pregnancy.

METHODS

We compared Gesell Developmental Schedules (GDS) of exclusive breastfed infants at 6 months born to mothers who received Td (1 to 3 doses) against those who were born to mothers who did not take such vaccines.

RESULTS

Compared with the group of infants not exposed to ethylmercury in utero, the infants of exposed mothers showed no significant difference in neurodevelopment delays. Although there was a significant correlation between hair-Hg of mothers and hair-Hg of neonates (Spearman r = 0.353; p = 0.0011), there was no significant correlation between the level of in utero exposure to ethylmercury in Td vaccines and neonate's hair-Hg concentrations (Spearman r = 0.060; p = 0.5922). However, regression analysis showed that GDS at 6 months was significantly associated with total mercury concentration of neonate's hair but was not sensitive to the number of vaccines taken by the mother.

CONCLUSION

Early neurodevelopment of exclusively breastfed infants is sensitive to in utero exposure to mercury, but maternal thimerosal exposure in tetanus-diphtheria vaccines per se cannot portend clinical neurodevelopment delays measured by GDS at 6 months.

Taxonomic and phylogenetic relationships between neotropical species of ticks from genus Amblyomma (Acari: Ixodidae) inferred from second internal transcribed spacer sequences of rDNA

The accurate specific identification of ticks is essential for the study, control and prevention of tick-borne diseases. Herein, we determined ribosomal nucleotide sequences of the second internal transcribed spacer (ITS2) of 15 Neotropical hard tick species of the genus Amblyomma Koch found in Brazil. Most of the studied ticks accidentally parasite humans and potentially act as vectors of zoonoses. Lengths of the ITS2 sequences ranged from 956 to 1,207 bp, whereas GC content varied from 62.4 to 66.9%. A matrix of ITS2 divergence was calculated with the ITS2 sequence data obtained showing divergence levels varying from 1.5 to 28.8%. The analysis indicated that this molecular marker can be useful for Amblyomma-specific identification. Phylogenetic inferences based on the ITS2 sequences were used to assess some issues in subgenus taxonomy.

Application of performance indicators in water utilities management--a case-study in Portugal

This paper presents some issues concerning water supply systems assessment through performance indicators, based upon research work recently carried out in Portugal about water utilities. A proposal of 50 performance indicators divided into five different groups is presented here, namely structural indicators, operational indicators, water and service quality indicators, personnel indicators and economic indicators. These indicators were associated with a hierarchical structure of knowledge or development according to different levels: basic level, development level and strategic level. The performance indicators, structure, their implementation and assessment methodology and examples of some indicators, use concerning the characterisation or assessment of a water utility are also presented in the paper.