International Science Index
A Settlement Strategy for Health Facilities in Emerging Countries: A Case Study in Brazil
A settlement strategy is to anticipate and respond the needs of existing and future communities through the provision of primary health care facilities in marginalized areas. Access to a health care network is important to improving healthcare coverage, often lacking, in developing countries. The study explores that a good sanitary system strategy of rural contexts brings advantages to an existing settlement: improving transport, communication, water and social facilities. The objective of this paper is to define a possible methodology to implement primary health care facilities in disadvantaged areas of emerging countries. In this research, we analyze the case study of Lauro de Freitas, a municipality in the Brazilian state of Bahia, part of the Metropolitan Region of Salvador, with an area of 57,662 km²
and 194.641 inhabitants. The health localization system in Lauro de Freitas is an integrated process that involves not only geographical aspects, but also a set of factors: population density, epidemiological data, allocation of services, road networks, and more. Data were collected also using semi-structured interviews and questionnaires to the local population. Synthesized data suggest that moving away from the coast where there is the greatest concentration of population and services, a network of primary health care facilities is able to improve the living conditions of small-dispersed communities. Based on the health service needs of populations, we have developed a methodological approach that is particularly useful in rural and remote contexts in emerging countries.
IOT Based Process Model for Heart Monitoring Process
Connecting health services with technology has a huge demand as people health situations are becoming worse day by day. In fact, engaging new technologies such as Internet of Things (IOT) into the medical services can enhance the patient care services. Specifically, patients suffering from chronic diseases such as cardiac patients need a special care and monitoring. In reality, some efforts were previously taken to automate and improve the patient monitoring systems. However, the previous efforts have some limitations and lack the real-time feature needed for chronic kind of diseases. In this paper, an improved process model for patient monitoring system specialized for cardiac patients is presented. A survey was distributed and interviews were conducted to gather the needed requirements to improve the cardiac patient monitoring system. Business Process Model and Notation (BPMN) language was used to model the proposed process. In fact, the proposed system uses the IOT Technology to assist doctors to remotely monitor and follow-up with their heart patients in real-time. In order to validate the effectiveness of the proposed solution, simulation analysis was performed using Bizagi Modeler tool. Analysis results show performance improvements in the heart monitoring process. For the future, authors suggest enhancing the proposed system to cover all the chronic diseases.
Adverse Drug Reactions Monitoring in the Northern Region of Zambia
The Copperbelt University Health Services (CBUHS) was designated by the Zambia Medicines Regulatory Authority (ZAMRA), formally the Pharmaceutical Regulatory Authority (PRA) as a regional pharmacovigilance centre to carryout activities of drug safety monitoring in four provinces in Zambia. CBUHS’s mandate included stimulating the reporting of adverse drug reactions (ADRs), as well as collecting and collating ADR reports from health institutions in the four provinces. This report covers the researchers’ experiences from May 2008 to September, 2016. The main objectives are 1) to monitor ADRs in the Zambian population, 2) to disseminate information to all health professionals in the region advising that the CBU health was a centre for reporting ADRs in the region, 3) to monitor polypharmacy as well as the benefit-risk profile of medicines, 4) to generate independent, evidence based recommendations on the safety of medicines, 5) to support ZAMRA in formulating safety related regulatory decisions for medicines, and 6) to communicate findings with all key stakeholders. The methodology involved monthly visits, beginning in early May 2008 to September, 2016, by the CBUHS to health institutions in the programme areas. Activities included holding discussions with health workers, distribution of ADR forms and collection of ADRs reports. These reports, once collected, were documented and assessed at the CBUHS. A report was then prepared for ZAMRA on quarterly basis. At ZAMRA, serious ADRs were noted and recommendations made to the Ministry of Health of the Republic of Zambia. The results show that 2,600 ADRs reports were received at the pharmacovigilance regional centre. Most of the ADRs reports that received were due to antiretroviral drugs, as well as a few from anti-malarial drugs like Artemether/Lumefantrine – Coartem®. Three hundred and twelve ADRs were entered in the Uppsala Monitoring Centre WHO Vigiflow for further analysis. It was concluded that in general, 2008-16 were exciting years for the pharmacovigilance group at CBUHS. From a very tentative beginning, a lot of strides were made and contacts established with healthcare facilities in the region. The researchers were encouraged by the support received from the Copperbelt University management, the motivation provided by ZAMRA and most importantly the enthusiasm of health workers in all the health care facilities visited. As a centre for drug safety in Zambia, the results show it achieves its objectives for monitoring ADRs, Pharmacovigilance (drug safety monitoring), and activities of monitoring ADRs as well as preventing them. However, the centre faces critical challenges caused by erratic funding that prevents the smooth running of the programme.
Knowledge and Attitude: Challenges for Continuing Education in Health
One of the great challenges presented in educational practice is how to ensure the students not only acquire knowledge of training courses throughout their academic life, but also how to apply it in their current professional activities. Consequently, aiming to incite changes in the education system of healthcare professionals noticed the inadequacy of the training providers to solve the social problems related to health, the education related to these procedures should initiate in the earliest years of process. Following that idea, there is another question that needs an answer: If the change in the education should start sooner, in the period of basic training of healthcare professionals, what guidelines should a permanent education program incorporate to promote changes in an already established system? For this reason, the objective of this paper is to present different views of the teaching-learning process, with the purpose of better understanding the behavior adopted by healthcare professionals, through bibliographic study. The conclusion was that more than imparting knowledge to the individual, a larger approach is necessary on permanent education programs concerning the performance of professional health services in order to foment significant changes in education.
Nutrition Program Planning Based on Local Resources in Urban Fringe Areas of a Developing Country
Obesity prevalence and severe malnutrition in Indonesia has increased from 2007 to 2013. The utilization of local resources in nutritional program planning can be used to program efficiency and to reach the goal. The aim of this research is to plan a nutrition program based on local resources for urban fringe areas in a developing country. This research used a qualitative approach, with a focus on local resources including social capital, social system, cultural system. The study was conducted in Mijen, Central Java, as one of the urban fringe areas in Indonesia. Purposive and snowball sampling techniques are used to determine participants. A total of 16 participants took part in the study. Observation, interviews, focus group discussion, SWOT analysis, brainstorming and Miles and Huberman models were used to analyze the data. We have identified several local resources, such as the contributions from nutrition cadres, social organizations, social financial resources, as well as the cultural system and social system. The outstanding contribution of nutrition cadres is the participation and creativity to improve nutritional status. In addition, social organizations, like the role of the integrated health center for children (Pos Pelayanan Terpadu), can be engaged in the nutrition program planning. This center is supported by House of Nutrition to assist in nutrition program planning, and provide social support to families, neighbors and communities as social capitals. The study also reported that cultural systems that show appreciation for well-nourished children are a better way to improve the problem of balanced nutrition. Social systems such as teamwork and mutual cooperation can also be a potential resource to support nutritional programs and overcome associated problems. The impact of development in urban areas such as the introduction of more green areas which improve the perceived status of local people, as well as new health services facilitated by people and companies, can also be resources to support nutrition programs. Local resources in urban fringe areas can be used in the planning of nutrition programs. The expansion of partnership with all stakeholders, empowering the community through optimizing the roles of nutrition care centers for children as our recommendation with regard to nutrition program planning.
PRENACEL: Development and Evaluation of an M-Health Strategy to Improve Prenatal Care in Brazil
The quality of prenatal care is key to reduce maternal morbidity and mortality. Communication between the health service and users can stimulate prevention and care. M-health has been an important and low cost strategy to health education. The PRENACEL programme (prenatal in the cell phone) was developed. It consists of a programme of information via SMS from the 20th week of pregnancy up to 12th week after delivery. Messages were about prenatal care, birth, contraception and breastfeeding. Communication of the pregnant woman asking questions about their health was possible. The objective of this study was to evaluate the implementation of PRENACEL as a useful complement to the standard prenatal care. Twenty health clinics were selected and randomized by cluster, 10 as the intervention group and 10 as the control group. In the intervention group, women and their partner were invited to participate. The control group received the standard prenatal care. All women were interviewed in the immediate post-partum and in the 12th and 24th week post-partum. Most women were married, had more than 8 years of schooling and visit the clinic more than 6 times during prenatal care. The intervention group presented lowest percentage of higher economic participants (5.6%), less single mothers and no drug user. It also presented more prenatal care visits than the control group and it was less likely to present Severe Acute Maternal Mortality when compared to control group as well as higher percentage of partners (75.4%) was present at the birth compared to control group. Although the study is still being carried out, preliminary data are showing positive results of the compliance of women to prenatal care.
Youth Friendly Health Services for Rural Thai Teenagers
Young people today has sexual activities differing from those of earlier generations, in that teenagers are likely to have multiple partners, and are frequently in short-term relationships or with partners that are not well known to them. The proportion of teenage mothers in Thailand has increased. Young people were not specifically addressed during the overall very successful HIV-prevention campaigns. Because of this missed opportunity, they are still unaware of the risk of unsafe sexual behavior. Aims: To describe the reproductive health care services in perspectives of rural Thai teenagers Methods: This survey was one part of a mixed method approach taken using survey and focus groups with 439 teenagers aged 12-18 years in 5 villages, Udon Thani, Thailand. The standard questionnaire survey had been used for collecting data. The numeric data was checked and analyzed by using descriptive statistics. Results: Most teenager respondents stated that they do not know where sexual reproductive health services provided for them. Most teenagers felt difficult to access and talk with health staff about sexual related issues. They stated that discussing, or consulting with health providers might not be safe. Teenagers might lose opportunities to access and get advice from health care services. The mean knowledge score of contraception and condom reproductive was 6.34 from a total score 11. Most teenagers especially girls expressed a need for counseling services and reported a need for telephone services. Conclusions: The need of appropriate information focusing on sexual relationships and contraception should be designed to help young people make wise decisions and there should be set health care services for Thai teenagers to make sure that teenagers could access easily. Health care providers need to be trained to improve their knowledge, attitudes and skills in reproductive health care practices for Thai teenagers.
Community‐Based Participatory Research in Elderly Health Care of Paisanee Ramintra 65 Community, Bangkok, Thailand
In order to address the social factors of elderly health care, researcher and community members have turned to more inclusive and participatory approaches to research and interventions. One such approach, community-based participatory research (CBPR) in public health, has received increased attention as the academic and public health communities struggle to address the persistent problems of disparities in the use of health care and health outcomes for several over the past decade. As Thailand becomes an ageing society, health services and proper care systems specifically for the elderly group need to be prepared and well established. The purpose of this assignment was to study the health problems and was to explore the process of community participation in elderly health care. Participants in this study were member of elderly group of Paisanee Ramintra 65 community in Bangkok, Thailand. The results indicated two important components of community participation process in elderly health care: 1) a process to develop community participation in elderly health care, and 2) outcomes resulting from such process. The development of community participation consisted of four processes. As for the outcomes of the community participation development process, they consisted of elderly in the community got jointly and formulated a group, which strengthened the project because of collaborative supervision among themselves. Moreover, inactive health care services have changed to being energetic and focus on health promotion rather than medical achievement and elderly association of community can perform health care activities for chronically illness through the achievement of this development; consequently, they increasingly gained access to physical, cognitive, and social activity.
Health Expenditure and its Place in Economy: The Case of Turkey
While health is a source of prosperity for individuals, it is also one of the most important determinants of economic growth for a country. Health, by increasing the productivity of labor, contributes to economic growth. Therefore, countries should give the necessary emphasis to health services. The primary aim of this study is to analyze the changes occurring in health services in Turkey by examining the developments in the sector. In this scope, the second aim of the study is to reveal the place of health expenditures in the Turkish economy. As a result of the analysis in the dataset, in which the 1999-2013 periods is considered, it was determined that some increase in health expenditures took place and that the increase in the share of health expenditures in GDP was too small. Furthermore, analysis of the results points out that in financing health expenditures, the public sector is prominent compared to the private sector.
Service Blueprint for Improving Clinical Guideline Adherence via Mobile Health Technology
Background: To improve the delivery of paediatric
healthcare in low resource settings, Community Health Workers
(CHW) have been provided with a paper-based set of protocols
known as Community Case Management (CCM). Yet research has
shown that CHW adherence to CCM guidelines is poor, ultimately
impacting health service delivery. Digitising the CCM guidelines via
mobile technology is argued in extant literature to improve CHW
adherence. However, little research exist which outlines how (a) this
process can be digitised and (b) adherence could be improved as a
result. Aim: To explore how an electronic mobile version of CCM
(eCCM) can overcome issues associated with the paper-based CCM
protocol (inadequate adherence to guidelines) vis-à-vis service
blueprinting. This service blueprint will outline how (a) the CCM
process can be digitised using mobile Clinical Decision Support
Systems software to support clinical decision-making and (b)
adherence can be improved as a result. Method: Development of a
single service blueprint for a standalone application which visually
depicts the service processes (eCCM) when supporting the CHWs,
using an application known as Supporting LIFE (SL eCCM app) as
an exemplar. Results: A service blueprint is developed which
illustrates how the SL eCCM app can be utilised by CHWs to assist
with the delivery of healthcare services to children. Leveraging
smartphone technologies can (a) provide CHWs with just-in-time
data to assist with their decision making at the point-of-care and (b)
improve CHW adherence to CCM guidelines. Conclusions: The
development of the eCCM opens up opportunities for the CHWs to
leverage the inherent benefit of mobile devices to assist them with
health service delivery in rural settings. To ensure that benefits are
achieved, it is imperative to comprehend the functionality and form
of the eCCM service process. By creating such a service blueprint for
an eCCM approach, CHWs are provided with a clear picture
regarding the role of the eCCM solution, often resulting in buy-in
from the end-users.
Designing a Patient Monitoring System Using Cloud and Semantic Web Technologies
Moving into a new era of healthcare, new tools and
devices are developed to extend and improve health services, such as
remote patient monitoring and risk prevention. In this concept,
Internet of Things (IoT) and Cloud Computing present great
advantages by providing remote and efficient services, as well as
cooperation between patients, clinicians, researchers and other health
professionals. This paper focuses on patients suffering from bipolar
disorder, a brain disorder that belongs to a group of conditions
called affective disorders, which is characterized by great mood
swings. We exploit the advantages of Semantic Web and Cloud
Technologies to develop a patient monitoring system to support
clinicians. Based on intelligently filtering of evidence-knowledge and
individual-specific information we aim to provide treatment
notifications and recommended function tests at appropriate times or
concluding into alerts for serious mood changes and patient’s nonresponse
to treatment. We propose an architecture as the back-end
part of a cloud platform for IoT, intertwining intelligence devices
with patients’ daily routine and clinicians’ support.
Fetal and Infant Mortality in Botucatu City, São Paulo State, Brazil: Evaluation of Maternal - Infant Health Care
In Brazil, neonatal mortality rate is considered
incompatible with the country development conditions, and has been
a Public Health concern. Reduction in infant mortality rates has also
been part of the Millennium Development Goals, a commitment
made by countries, members of the Organization of United Nations
(OUN), including Brazil. Fetal mortality rate is considered a highly
sensitive indicator of health care quality. Suitable actions, such as
good quality and access to health services may contribute positively
towards reduction in these fetal and neonatal rates. With appropriate
antenatal follow-up and health care during gestation and delivery,
some death causes could be reduced or even prevented by means of
early diagnosis and intervention, as well as changes in risk factors
and interventions. Objectives: To study the quality of maternal and
infant health care based on fetal and neonatal mortality, as well as the
possible actions to prevent those deaths in Botucatu (Brazil).
Methods: Classification of prevention according to the International
Classification of Diseases and the modified Wigglesworth´s
classification. In order to evaluate adequacy, indicators of quality of
antenatal and delivery care were established by the authors. Results:
Considering fetal deaths, 56.7% of them occurred before delivery,
which reveals possible shortcomings in antenatal care, and 38.2% of
them were a result of intra- labor changes, which could be prevented
or reduced by adequate obstetric management. These findings were
different from those in the group of early neonatal deaths which were
also studied. Adequacy of health services showed that antenatal and
childbirth care was appropriate for 24% and 33.3% of pregnant
women, respectively, which corroborates the results of prevention.
These results revealed that shortcomings in obstetric and antenatal
care could be the causes of deaths in the study. Early and late
neonatal deaths have similar characteristics: 76% could be prevented
or reduced mainly by adequate newborn care (52.9%) and adequate
health care for gestational women (11.7%). When adequacy of care
was evaluated, childbirth and newborn care was adequate in 25.8%
and antenatal care was adequate in 16.1%. In conclusion, direct
relationship was found between adequacy and quality of care
rendered to pregnant women and newborns, and fetal and infant
mortality. Moreover, our findings highlight that deaths could be
prevented by an adequate obstetric and neonatal management.
Culture Dimensions of Information Systems Security in Saudi Arabia National Health Services
The study of organisations’ information security
cultures has attracted scholars as well as healthcare services industry
to research the topic and find appropriate tools and approaches to
develop a positive culture. The vast majority of studies in Saudi
national health services are on the use of technology to protect and
secure health services information. On the other hand, there is a lack
of research on the role and impact of an organisation’s cultural
dimensions on information security. This research investigated and
analysed the role and impact of cultural dimensions on information
security in Saudi Arabia health service. Hypotheses were tested and
two surveys were carried out in order to collect data and information
from three major hospitals in Saudi Arabia (SA). The first survey
identified the main cultural-dimension problems in SA health
services and developed an initial information security culture
framework model. The second survey evaluated and tested the
developed framework model to test its usefulness, reliability and
applicability. The model is based on human behaviour theory, where
the individual’s attitude is the key element of the individual’s
intention to behave as well as of his or her actual behaviour. The
research identified a set of cultural and sub-cultural dimensions in SA
health information security and services.
The Impact of Web Based Education on Cancer Patients’ Clinical Outcomes
Cancer is a widespread disease in the world and is the third reason of deaths among the chronic diseases. Educating patients and caregivers has a vital role for empowering them in managing disease and treatment's symptoms. Informing of the patients about their disease and treatment process decreases patient's distress and decisional conflicts, improves wellbeing of them, increase success of the treatment and survival. In this era, technological education methods are used for patients that have different chronic disease. Many studies indicated that especially web based patient education such as chronic obstructive lung disease; heart failure is more effective than printed materials. Web based education provide easiness to patients while they are reaching health services. It also has more advantages because of it decreases health cost and requirement of staff. It is thought that web based education may be beneficial method for cancer patient's empowerment in coping with the disease's symptoms. The aim of the study is evaluate the effectiveness of web based education for cancer patients' clinical outcomes.
Everyday Life in the City of Kyzylorda and Almaty in the 20-30-s of the XX Century (State Health Services)
The relevance of the study of everyday life in Almaty
and Kyzylorda are associated with the emergence of the modern
trends in historiography and socializing areas of government reform.
The relevance is due to the fact that in the early twentieth century
Kyzylorda and Almaty began to develop as a city and this period has
a special place in the life of the state. An interesting aspect of the
everyday life of the inhabitants of the new city, which was built in the
era of Stalin's Five-Year Plans, can be examined through the eyes of
the Soviet people living in a specific environment, reflecting the life
of the citizens. The study of industrialization of the Soviet Union and
the attention paid to new developments in the first five years of
everyday aspects as the impact of the modernization of the 1930s was
one of the decisive factors in the lives of residents. Among these
factors, we would like to highlight the medical field, which is the
basis of all human life, specifically focusing on the state of medicine
in Alma-Ata in the first 20-30-years of the twentieth century, and
analyze the different aspects of human life, determining the quality of
medical care to the population during this period.
What Do Young People Seeking Professional Help Want and Expect From Therapy?
Client expectations and preferences about therapy
represent an important area of investigation as research shows they
are linked to engagement in therapy and therapy outcomes. Studies
examining young people-s expectations and preferences of therapy
remain a neglected area of research. The present study explored what
expectations and preferences young people seeking professional help
held regarding: their role as a client, their therapist-s role, their
therapeutic outcomes, and the processes of therapy. Gender and age
differences were also examined. Participants included 188 young
people aged 12-25 who completed a survey while attending their
initial session at a youth mental health service. Data were analysed
using quantitative methods. Results found the young people held
significantly more pessimistic expectations around therapy when
compared to what they had wanted therapy to be like. Few age and
gender differences were found. Results highlight the importance of a
collaborative therapy approach when working with young people.
Chronic Patients- Prescription Refill Intentions
Environment today is featured with aging population,
increasing prevalence of chronic disease and complex of medical
treatment. Safe use of pharmaceutics relied very much on the efforts
made by both the health- related organizations and as well as the
government agencies. As far as the specialization concern in providing
health services to the patients, the government actively issued and
implemented the divisions of medical treatment and pharmaceutical to
improve the quality of care and to reduce medication errors and ensure
public health. Pharmaceutical sub-sector policy has been implemented
for 13 years. This study attempts to explore the factors that affect the
patients- behavior intention of refilling a prescription from a NHIB
pharmacy. Samples were those patients refilling their prescriptions
with the case NHIB pharmacies. A self-administered questionnaire
was used to collect respondents- information while the patients or
family members visit the pharmacy for the refilling. 1,200
questionnaires were dispatched in 37 pharmacies that randomly
selected from Pingtung City, Dongkang, Chaozhou, Hengchun areas.
732 responses were gained with 604 valid samples for further analyses.
Results of data analyses indicated that respondents- attitude,
subjective norm, perceived behavior control and behavior intentions
toward refilling behavior varied from some demographic variables to
another. This research also suggested adding actual behavior, either by
a self-report or observed, into the research.
Brain Drain of Doctors; Causes and Consequences in Pakistan
Pakistani doctors (MBBS) are emigrating towards developed countries for professional adjustments. This study aims to highlight causes and consequences of doctors- brain drain from Pakistan. Primary data was collected from Mayo Hospital, Lahore by interviewing doctors (n=100) through systematic random sampling technique. It found that various socio-economic and political conditions are working as push and pull factors for brain drain of doctors in Pakistan. Majority of doctors (83%) declared poor remunerations and professional infrastructure of health department as push factor of doctors- brain drain. 81% claimed that continuous instability in political situation and threats of terrorism are responsible for emigration of doctors. 84% respondents considered fewer opportunities of further studies responsible for their emigration. Brain drain of doctors is affecting health sector-s policies / programs, standard doctor-patient ratios and quality of health services badly.
Personal Health Assistance Service Expert System (PHASES)
In this paper the authors present the framework of a
system for assisting users through counseling on personal health, the
Personal Health Assistance Service Expert System (PHASES).
Personal health assistance systems need Personal Health Records
(PHR), which support wellness activities, improve the understanding
of personal health issues, enable access to data from providers of
health services, strengthen health promotion, and in the end improve
the health of the population. This is especially important in societies
where the health costs increase at a higher rate than the overall
economy. The most important elements of a healthy lifestyle are
related to food (such as balanced nutrition and diets), activities for
body fitness (such as walking, sports, fitness programs), and other
medical treatments (such as massage, prescriptions of drugs). The
PHASES framework uses an ontology of food, which includes
nutritional facts, an expert system keeping track of personal health
data that are matched with medical treatments, and a comprehensive
data transfer between patients and the system.
Telemedicine and Medical Informatics: The Global Approach
Telemedicine is brought to life by contemporary changes of our world and summarizes the entire range of services that are at the crossroad of traditional healthcare and information technology. It is believed that eHealth can help in solving critical issues of rising costs, care for ageing and housebound population, staff shortage. It is a feasible tool to provide routine as well as specialized health service as it has the potential to improve both the access to and the standard of care. eHealth is no more an optional choice. It has already made quite a way but it still remains a fantastic challenge for the future requiring cooperation and coordination at all possible levels. The strategic objectives of this paper are: 1. To start with an attempt to clarify the mass of terms used nowadays; 2. To answer the question “Who needs eHealth"; 3. To focus on the necessity of bridging telemedicine and medical (health) informatics as well as on the dual relationship between them; as well as 4. To underline the need of networking in understanding, developing and implementing eHealth.
To Design Holistic Health Service Systems on the Internet
There are different kinds of online systems on the Internet for people who need support and develop new knowledge. Online communities and Ask the Expert systems are two such systems. In the health care area, the number of users of these systems has increased at a rapid pace. Interactions with medical trained experts take place online, and people with concerns about similar health problems come together to share experiences and advice. The systems are also used as storages and browsed for health information. Over the years, studies have been conducted of the usage of the different systems. However, in what ways the systems can be used together to enhance learning has not been explored. This paper presents results from a study of online health-communities and an Ask the Expert system for people who suffer from overweight. Differences and similarities in regards to posted issues and replies are discussed, and suggestions for a new holistic design of the two systems are presented.
Total Quality Management: The Socio- Demographic and Operational-Financial Determinants for Users- Perception of the Services Quality
The aim of this paper is to know the sociodemographic
and operational-financial determinants of the services
quality perceived by users of the national health services. Through
the use of an inquiry conducted by the Ministry of Health,
comprehending 16.936 interviews in 2006, we intend to find out if
there is any characteristic that determines the 2006 inquiry results.
With the revision of the literature we also want to know if the
operational-financial results have implications in hospitals users-
perception on the quality of the received services. In order to achieve
our main goals we will make use of the regression analysis to find out
the possible dimensions that determine those results.