Performance and financial efficiency of three dairy production systems in southern Brazil / Desempeño productivo y eficiencia financiera en tres sistemas de producción lechera en el sur de Brasil / Desempenho produtivo e a e iciência inanceira em três sistemas de produção de leite no sul do Brasil

Abstract Background: Factors such as herd composition, productivity, milk quality and technology level influence the costs and profitability of milk production. Objective: To evaluate indicators that could predict production performance and financial efficiency in three dairy production systems in southern Brazil. Methods: Monthly records of milk quality, production performance and costs from fifty dairy farms were collected. The farms were classified into grazing, semi-feedlot, or feedlot systems. Total revenues, effective operational cost, total operational cost, total cost, gross margin, net income, total cost leveling point, profitability and final milk price were calculated. Results: The feedlot system resulted in greater herd size and milk production per lactating cow (p<0.05), but greater variable costs compared to semi-feedlot and grazing systems. On the other hand, the grazing system achieved greater profitability per year. Factor II (fat and protein rates), and Factor III (herd size and productivity per area) were associated with milk price per liter paid to the farmer (p<0.05), together accounting for approximately 13% of this price. Conclusion: Dairy production systems are influenced by area, lactating cows, productive performance, productivity per area, milk quality, and use of artificial insemination as well as supplementation (concentrate and minerals). Nearly 13% of milk price can be attributed to its fat and protein content as well as herd size and productivity per area.

Resumen Antecedentes: Factores tales como composición del rebaño, productividad, calidad de la leche y nivel tecnológico pueden afectar los costos y rentabilidad de la producción lechera. Objetivo: Evaluar indicadores que puedan predecir el rendimiento productivo y eficiencia financiera en tres sistemas de producción lechera en el sur de Brasil. Métodos: Se recolectaron y analizaron registros mensuales de calidad de la leche, rendimiento productivo y costos de cincuenta granjas lecheras. Las granjas se clasificaron en tres sistemas: pastoreo, semi-confinamiento, y confinamiento. Se calcularon los ingresos totales, el costo operativo efectivo, el costo operativo total, el costo total, el margen bruto, el beneficio neto, el punto de nivelación del costo total, la rentabilidad, y el precio final de la leche. Resultados: El sistema de confinamiento presentó mayor densidad animal y producción de leche por vaca lactante (p<0,05), pero mayores costos variables en comparación con los sistemas de semi-confinamiento y pastoreo. Por otro lado, el sistema de pastoreo tuvo mayor rentabilidad por año. El Factor II (tasas de grasa y proteína) y el Factor III (tasa de ganancia y productividad por área) se asociaron al precio por litro de leche pagado al productor (p<0,05), representando juntos aproximadamente el 13% de ese precio. Conclusión: Los sistemas de producción lechera están influenciados por el área, las vacas lactantes, el rendimiento productivo, la productividad por unidad de área, la calidad de la leche y el uso de inseminación artificial, así como por la suplementación (concentrado y minerales). Casi 13% del precio de la leche se puede atribuir a su contenido de grasa y proteína, así como al tamaño de la granja y productividad por área.

Resumo Antecedentes: Fatores relacionados à composição do rebanho, produtividade, qualidade do leite e uso de tecnologias podem impactar os custos e a lucratividade da produção de leite. Objetivo: Avaliar indicadores que possam predizer a produtividade e a eficiência financeira em três sistemas de produção de leite no sul do Brasil. Métodos: Registros mensais de qualidade do leite, desempenho da produção e custos de cinquenta fazendas leiteiras foram coletados. As fazendas foram classificadas em sistemas de pastejo, semi-confinamento ou confinamento. As receitas totais, o custo operacional efetivo, o custo operacional total, o custo total, a margem bruta, o lucro líquido, o ponto de nivelamento total do custo, a lucratividade e o preço final do leite foram calculados. Resultados: O sistema de confinamento apresentou maior taxa de lotação e produção de leite por vaca lactante (p<0,05), porém maiores custos variáveis totais em relação aos sistemas de semi-confinamento e pastejo. Por outro lado, o sistema de pastejo alcançou maior rentabilidade por ano. O Fator II (taxas de gordura e proteína) e o Fator III (taxa de lotação e produtividade por área) foram associados ao preço do leite por litro pago ao produtor (p<0,05), representando juntos aproximadamente 13% desse preço. Conclusões: Os sistemas de produção leiteira foram influenciados pela área, vacas em lactação, desempenho produtivo, produtividade por área, qualidade do leite e uso de inseminação artificial, bem como pela suplementação (concentrado e minerais). Quase 13% do preço do leite pode ser atribuído ao seu teor de gordura e proteína, assim como a taxa de lotação e a produtividade por área.

Factors affecting adoption of a telemedicine device by primary care health workers in the Philippines

@#<p style="text-align: justify;"><strong>Background and Introduction.</strong> The RxBox is a telemedicine device that measures and transmits vital signs to remote experts. It has been deployed to primary care health centers (PCHC) in the Philippines serving disadvantaged populations, to decrease morbidity and mortality due to common diseases and poor access to care. Factors affecting its adoption by healthcare workers is unknown.</p><p style="text-align: justify;"><strong>Materials and Methods.</strong> The study determined social and behavioral factors that affect adoption of a telemedicine device into the clinical workflow using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. This is a mixed methods research using review of records, survey and focused group discussions.</p><p style="text-align: justify;"><strong>Results and Discussion.</strong> RxBox telemedicine devices were installed in 79 primary care health centers (PCHC) and were used a total of 15,705 times within the study period. An ordinary least squares regression analysis using the combined site and individual-level data showed that among the UTAUT parameters, only compatibility, facilitating conditions, and social factors have significant relationships with intent-to-use of the RxBox. The innovation assisted primary care health workers in their clinical responsibilities, improved the stature of their PCHC in the community, and helped in the care for patients. Training and technology support after deployment as well as encouragement by peer and champions (the PCHC physician, local government leaders) reinforced continuous use after training. Users described the experienced improvements in quality of services provided by the PCHC and the consequent benefits to their patients.</p><p style="text-align: justify;"><strong>Conclusions.</strong> These factors should be accounted for in designing strategies to reinforce health workers' attitudes and enhance support towards acceptance and use of novel telemedicine devices into clinical routine in local health centers. Lessons are immediately useful for local leaders in low- and lower middle-income countries that suffer disproportionately from unnecessary maternal deaths and mortality due to non-communicable diseases. This contributes to the body of knowledge and should bolster national-level advocacy to institute an enabling policy on telehealth Information Communication Technology (ICT) and use of Filipino innovations towards health systems strengthening. Results can be used by implementers, evaluators, and regulators of health ICT, especially in resource-poor settings. Likewise, the study can encourage more research in the field to spur more dynamic local health ICT and biomedical device industries.</p>

Analysis of Economic and Business Factors Influencing Disruptive Innovation in Telehealth / Análisis de factores económicos y empresariales que influyen la Innovación Disruptiva en Telesalud

Abstract Objective. Analysis of economic and business factors influencing disruption innovation in healthcare taking as a reference Telehealth systems and technologies. Methods. Analysis of economic and business decision factors that influence the adoption of new technologies are qualitatively analyzed using as a case example Telehealth systems. Results. Main factors for the adoption of new technologies in healthcare are identified and analyzed. Factors include new technology adoption cost, usability, perceived value, competitive systems, old systems competitive cost and performance, and type of users, between others.

Resumen Objetivo: análisis de los factores que influyen en la adopción de nuevas tecnologías en el cuidado de la salud tomando como referencia la Telesalud o el uso de las tecnologías de la información y la comunicación en la asistencia sanitaria. Métodos: el análisis de los factores de decisión económica y empresarial que influyen en la adopción de nuevas tecnologías se analiza cualitativamente utilizando como ejemplo de caso los sistemas de Telehealth. Resultados: se identifican y analizan los principales factores para la adopción de nuevas tecnologías en la atención de la salud por Telesalud. Los factores incluyen costo de adopción de nuevas tecnologías, usabilidad, valor percibido, sistemas competitivos, costos y desempeño competitivos de los sistemas actuales, y tipo de usuarios, entre otros.

Adoption of beef cattle traceability at farm level in São Paulo State, Brazil / Adoção da rastreabilidade de bovinos de corte no estado de São Paulo, Brasil

ABSTRACT: This paper aimed to identify the determinants of beef traceability adoption at farm level in São Paulo State, Brazil. A sample survey of 32 farmers who adopted the European Union certified traceability and 52 other farmers who did not adopt traceability provided data to test hypotheses on determinant factors. Three binomial logit models were used in the analysis. Results suggested that capital-intensive livestock production system, high scale production, access to specialized information and high level of human and social capital play significant role in the adoption decision.

RESUMO: O artigo tem como objetivo identificar os determinantes da adoção da rastreabilidade por pecuaristas no estado de São Paulo, Brasil. Uma amostra de 32 produtores que adotaram a certificação da rastreabilidade para a União Europeia e 52 que não adotaram a rastreabilidade forneceu dados para testar hipóteses a respeito de fatores determinantes. Três modelos logit binomial foram utilizados na análise. Os resultados sugerem que o sistema de produção pecuária intensiva, a elevada escala de produção, o acesso a informação especializada e a rede de relacionamentos desempenham papel significativo na decisão de adoção.

Padrão de incorporação de fármacos antiretrovirais pelo sistema público de saúde no Brasil / Patterns of antiretroviral therapy adoption by the Brazilian public health system

OBJETIVO: avaliar o padrão de incorporação de fármacos antiretrovirais pelo Sistema Público de Saúde no Brasil (SUS). MÉTODOS: baseando-se em trabalhos prévios publicados na literatura médica foram propostos três indicadores a serem utilizados na análise da incorporação de fármacos: intervalo conhecimento-incorporação, massa crítica de conhecimento e intervalo validação-incorporação. Utilizando-se as bases de dados do Departamento de Informática do SUS (Datasus) e do Sistema de Controle Logístico de Medicamentos (SICLOM) foram selecionados dois grupos de tecnologias farmacológicas (medicações antiretrovirais e medicações de dispensação em caráter excepcional). RESULTADOS: os medicamentos antiretrovirais analisados foram incorporados de maneira mais precoce que os medicamentos de dispensação em caráter excepcional, tanto no que se refere ao intervalo "conhecimento-incorporação" quanto ao intervalo "validação-incorporação", e apresentam uma menor "massa crítica de conhecimento" para a incorporação. CONCLUSÃO: Os medicamentos antiretrovirais têm sido incorporados de maneira mais rápida, e após a publicação de um menor número de artigos científicos, quando em comparação aos medicamentos de dispensação em caráter excepcional.

OBJECTIVE: The aim of the present scientific study is to evaluate the patterns of antiretroviral technology adoption by the Brazilian Public Health System (SUS). METHODS: Based on previous articles published in scientific medical literature, three indicators to assess antiretroviral technology adoption by SUS were proposed: knowledge-adoption interval; critical mass of knowledge; and validation-adoption interval. Using the databases from the SUS Department of Information Technology (DATASUS) and from the Brazilian Logistic Center for Medication Control (SICLOM), two pharmaceutical groups were selected (antiretroviral medications and a group of high cost medications). RESULTS: Antiretroviral medications were adopted faster than the high cost medication group when assessed on the basis of "knowledge-adoption" interval and "validation-adoption" interval. Yet, they require a lower "critical mass of knowledge" before adoption. CONCLUSION: Antiretroviral medications have been adopted faster and based on a lower number of scientific medical articles than a selected group of high cost medications.

Adoção de tecnologias de informação e comunicações nas clínicas de diálise da Bahia / Adoption of information and communication technologies in the dialysis clinics of Bahia State

O objetivo deste artigo é investigar a adoção e utilização de tecnologias de informação e comunicações nas clínicas de diálise da Bahia. Foi realizado um estudo de caso nas firmas, aplicando-se, junto aos gestores das clínicas, um questionário de pesquisa adaptado da RedeSist e da PINTEC. A amostra abrangeu as vinte empresas arroladas no CNES do Ministério da Saúde, tendo sido obtido 60 por cento de aproveitamento. As informações coletadas, de caráter quantitativo, foram analisadas a partir das distribuições de frequências das respostas dos entrevistados. Concluiu-se que o problema da adoção de tecnologias de informação e comunicações não está no acesso das clínicas de diálise às mesmas, mas sim no subaproveitamento do seu potencial econômico.

The aim of this article is to investigate the adoption and use of information and communication technologies within private dialysis clinics in Bahia State. A case study was developed with companies by applying, to clinics' managerial teams, a research questionnaire adapted from RedeSist and from PINTEC. The sample included 20 companies, listed by CNES of the Ministry of Health, and obtained a positive usage rate data of 60 percent. The collected quantitative information was analyzed by interviewees' answer frequency distribution. Conclusion indicates that the adoption of information and communication technologies by the clinics is not directly related to their access to these technologies but to the under usage of their economical potential.

Key Aspects of Using Web-based Diabetes Telemedicine Systems in Multiple Clinical Settings / 대한의료정보학회지

OBJECTIVE: Even though abundant studies and models have tried to explain and predict the adoption and use of new information systems, the research on the adoption of Diabetes Management Systems in multiple clinical settings is relatively scarce. This paper addresses this issue by outlining Georgetown University's experience with implementing its MyCareTeam diabetes telemedicine application, which is a web.based, interactive diabetes management application. METHODS: Case study is used to explore the influencial factors on web.based diabetes telemedicine systems in multiclinical setting. The experience of the Georgetown University deploying MyCareTeam system in six different geographical areas was analyzed by secondary literature review and interviews. RESULTS: This study finds several problems and possible resolutions to expand the telemedicine systems of single institution into the multiple clinical settings. The application systems must be able to transfer data from diverse medical devices and integrate with web.based diabetes management application. Therefore, the system needs to support diverse data transfer type, diverse cable, and different network environment. In addition, there is a need for more dedicated technical and operational support, to prevent frequent turnover among the overburdened nurses who currently interact remotely with telemedicine patients. CONCLUSIONS: To apply currently developed telemedicine technology into the real clinical settings, the proposed technical as well as organizational infrastructure should be established. The findings of this study will be guideline for multi.center diabetes management system in Korea.