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- A análise do modelo organizativo dos Cuidados de Saúde Primários no ACeS de OeirasPublication . Martins, Paula Cristina Garcia; Machado, Maria do CéuO início da reforma dos cuidados de saúde primários aconteceu em 2005, com o Programa do XVII Governo Constitucional, que tinha como objetivo “atribuir uma particular relevância à reestruturação dos centros de saúde, pela proximidade ao cidadão e pelo contributo que dão à melhoria dos níveis de vida dos Portugueses. ” (Decreto-Lei n.º 88, 2005, p. 3606) Em 2006, surgiram as Unidades de Saúde Familiar (USF) como o primeiro movimento da reforma. As USF são unidades funcionais com autonomia administrativa, técnica e funcional que se organizaram de forma voluntária, que visam a prestação de serviços de qualidade e de proximidade, baseando-se numa nova forma de organizar a acessibilidade do utente à saúde. Em 2008 foram criados os Agrupamentos de Centros de Saúde (ACeS), segundo movimento da reforma. Os ACeS têm como objetivos a eficiência e economia de escala, aplicados à agregação de recursos e das estruturas de gestão. Estes agrupamentos passaram a ser constituídos por diversas unidades funcionais, entre elas as USF e as Unidades de Cuidados de Saúde Personalizados (UCSP).Através da realização de um estudo de caso no ACeS de Oeiras, observaram-se os resultados de seis dos indicadores comuns contratualizados pelas USF e pelas UCSP, entre 2009 e 2011, com o objetivo de compreender as novas formas de organização. Estes indicadores representam quatro áreas: o acesso, o desempenho assistencial, a satisfação e o desempenho económico. O estudo permitiu concluir que as USF obtiveram melhores resultados no triénio em análise, e que as UCSP levaram mais tempo a adaptar-se aos sistemas de informação e à nova forma organizativa, mas no último ano em análise (2011), os seus resultados melhoraram.
- Analysis of conservation priorities of Iberoamerican cattle based on autosomal microsatellite markersPublication . Ginja, Catarina; Gama, Luís T.; Cortes, Óscar; Delgado, Juan Vicente; Dunner, Susana; García, David; Landi, Vincenzo; Martín-Burriel, Inmaculada; Martínez-Martínez, Amparo; Penedo, M. Cecília T.; Rodellar, Clementina; Zaragoza, Pilar; Cañon, Javier; BioBovis ConsortiumBackground: Determining the value of livestock breeds is essential to define conservation priorities, manage genetic diversity and allocate funds. Within- and between-breed genetic diversity need to be assessed to preserve the highest intra-specific variability. Information on genetic diversity and risk status is still lacking for many Creole cattle breeds from the Americas, despite their distinct evolutionary trajectories and adaptation to extreme environmental conditions. Methods: A comprehensive genetic analysis of 67 Iberoamerican cattle breeds was carried out with 19 FAOrecommended microsatellites to assess conservation priorities. Contributions to global diversity were investigated using alternative methods, with different weights given to the within- and between-breed components of genetic diversity. Information on Iberoamerican plus 15 worldwide cattle breeds was used to investigate the contribution of geographical breed groups to global genetic diversity. Results: Overall, Creole cattle breeds showed a high level of genetic diversity with the highest level found in breeds admixed with zebu cattle, which were clearly differentiated from all other breeds. Within-breed kinships revealed seven highly inbred Creole breeds for which measures are needed to avoid further genetic erosion. However, if contribution to heterozygosity was the only criterion considered, some of these breeds had the lowest priority for conservation decisions. The Weitzman approach prioritized highly differentiated breeds, such as Guabalá, Romosinuano, Cr. Patagonico, Siboney and Caracú, while kinship-based methods prioritized mainly zebu-related breeds. With the combined approaches, breed ranking depended on the weights given to the within- and between-breed components of diversity. Overall, the Creole groups of breeds were generally assigned a higher priority for conservation than the European groups of breeds. Conclusions: Conservation priorities differed significantly according to the weight given to within- and betweenbreed genetic diversity. Thus, when establishing conservation programs, it is necessary to also take into account other features. Creole cattle and local isolated breeds retain a high level of genetic diversity. The development of sustainable breeding and crossbreeding programs for Creole breeds, and the added value resulting from their products should be taken into consideration to ensure their long-term survival.