Public-private partnership in the Portuguese health sector.

Since 2001, in Portugal, constant reforms in hospital management have accompanied the transformations in the management models applied to public administration, intending to ensure a higher quality of services and, simultaneously, a more significant economic efficiency. This study aims to analyse, for the period between 2012 and 2021, the economic and financial results (value-for-money) of the PPP model, compared with the public management hospitals (PMH). It used a mixed research approach based on multiple case studies and archival research. As the main results, it was found that: i) the PPP model, applied to the health sector, appears to be advantageous, not only regarding the economic and financial results but also concerning the quality of service provision; and ii) despite the value-for-money generated by the PPP model, the lower operating costs and the superior performance in comparison with PMH, the government has permanently opted to revert from a PPP model to a PMH model. This study concluded that the hospital management model is instead seen as an instrumentalised political instrument than a management tool that could generate savings for the taxpayers. Several practical implications are presented.

Perceived Quality and Users' Satisfaction with Public-Private Partnerships in Health Sector.

In Portugal, the government has accepted private management within public hospitals since 1996. The objectives of the state were to ensure more efficiency in resource management and maintain or increase the service quality provided to the users. Four public hospitals have been managed with a public-private partnership (PPP) approach. This study aimed to empirically analyse the degree of satisfaction of the Portuguese population regarding the service quality provided by PPP and Public Management Hospitals (PMH) within a structural equation model, and verify if people's literacy level, age, education, and income moderate their opinions. The study used 2077 valid questionnaire responses applied in the four regions served by the eight hospitals. The results show that the users of the PPP hospitals are more satisfied than those from PMH with statistical significance. Literacy level moderates the relationship between perceived quality and users' satisfaction, and education moderates the same relationship only in the context of PPP hospitals. More educated people with a high literacy level are more demanding, both regarding PPP and PMH hospitals. Nevertheless, the results are very beneficial to the PPP model; thus, improved decision-making regarding contract renewal might help policymakers consider the findings of this paper.

Multidimensional assessment of anxiety through the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA): From dimensionality to response prediction across emotional contexts.

The assessment of mal-adaptive anxiety is crucial, considering the associated personal, economic, and societal burden. The State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) is a self-report instrument developed to provide multidimensional anxiety assessment in four dimensions: trait-cognitive, trait-somatic, state-cognitive and state-somatic. This research aimed to extend STICSA's psychometric studies through the assessment of its dimensionality, reliability, measurement invariance and nomological validity in the Portuguese population. Additionally, the predictive validity of STICSA-Trait was also evaluated, through the analysis of the relationship between self-reported trait anxiety and both the subjective and the psychophysiological response across distinct emotional situations. Similarly to previous studies, results supported both a four-factor and two separated bi-factor structures. Measurement invariance across sex groups was also supported, and good nomological validity was observed. Moreover, STICSA trait-cognitive dimension was associated with differences in self-reported arousal between groups of high/low anxiety, whereas STICSA trait-somatic dimension was related to differences in both the subjective and psychophysiological response. Together, these results support STICSA as a useful instrument for a broader anxiety assessment, crucial for an informed diagnosis and practice.

On the Impact of the Data Acquisition Protocol on ECG Biometric Identification.

Electrocardiographic (ECG) signals have been used for clinical purposes for a long time. Notwithstanding, they may also be used as the input for a biometric identification system. Several studies, as well as some prototypes, are already based on this principle. One of the methods already used for biometric identification relies on a measure of similarity based on the Kolmogorov Complexity, called the Normalized Relative Compression (NRC)-this approach evaluates the similarity between two ECG segments without the need to delineate the signal wave. This methodology is the basis of the present work. We have collected a dataset of ECG signals from twenty participants on two different sessions, making use of three different kits simultaneously-one of them using dry electrodes, placed on their fingers; the other two using wet sensors placed on their wrists and chests. The aim of this work was to study the influence of the ECG protocol collection, regarding the biometric identification system's performance. Several variables in the data acquisition are not controllable, so some of them will be inspected to understand their influence in the system. Movement, data collection point, time interval between train and test datasets and ECG segment duration are examples of variables that may affect the system, and they are studied in this paper. Through this study, it was concluded that this biometric identification system needs at least 10 s of data to guarantee that the system learns the essential information. It was also observed that "off-the-person" data acquisition led to a better performance over time, when compared to "on-the-person" places.

Multimodal Emotion Evaluation: A Physiological Model for Cost-Effective Emotion Classification.

Emotional responses are associated with distinct body alterations and are crucial to foster adaptive responses, well-being, and survival. Emotion identification may improve peoples' emotion regulation strategies and interaction with multiple life contexts. Several studies have investigated emotion classification systems, but most of them are based on the analysis of only one, a few, or isolated physiological signals. Understanding how informative the individual signals are and how their combination works would allow to develop more cost-effective, informative, and objective systems for emotion detection, processing, and interpretation. In the present work, electrocardiogram, electromyogram, and electrodermal activity were processed in order to find a physiological model of emotions. Both a unimodal and a multimodal approach were used to analyze what signal, or combination of signals, may better describe an emotional response, using a sample of 55 healthy subjects. The method was divided in: (1) signal preprocessing; (2) feature extraction; (3) classification using random forest and neural networks. Results suggest that the electrocardiogram (ECG) signal is the most effective for emotion classification. Yet, the combination of all signals provides the best emotion identification performance, with all signals providing crucial information for the system. This physiological model of emotions has important research and clinical implications, by providing valuable information about the value and weight of physiological signals for emotional classification, which can critically drive effective evaluation, monitoring and intervention, regarding emotional processing and regulation, considering multiple contexts.

Reunification in foster care: Influences on decision-making.

An important goal of out of home care is to prepare the family and child for reunification. Practitioners are often required to make the decision whether to reunify a foster child with their biological family. This study examines this complex reunification decision in Portugal. Using the Judgments and Decisions Processes in Context model, the authors presented to Portuguese child protection workers and higher education students (n = 400) a case vignette of a child in foster care in which reunification is considered. The vignette consider two scenarios related to the child's wish to go back or not to her biological family, each one presented to half of both samples. The study examined judgments regarding physical and emotional risk and the decision on whether to reunify the child with their biological family, and analyzed the associations of case characteristics, the decision-making context, and the child's wishes regarding reunification with the participants' judgments and decisions. We have used a randomized factorial survey within a quantitative approach and we have performed descriptive, inferential and content analysis of data. The findings indicate that a large majority of professionals and students recommended that the child remain with their foster family, though both groups recommended reunification more frequently when the child wished to return to their biological family. A comparison with findings from other countries suggests that country context can be an important factor that leads to different outcomes. Implications for both practice and research are presented.

Características y desarrollo del acogimiento familiar en dos países con fuerte tradición de acogimiento residencial: España y Portugal / Characteristics and Development of Foster Care in Two Countries with a Strong Tradition of Residential Care: Spain and Portugal

Los procesos de acogimiento familiar que se producen en cada país dependen de factores históricos y culturales que dan lugar a grandes diferencias internacionales. A pesar de que las comparativas internacionales ofrecen un medio de intercambio de experiencias, lo que permite el aprendizaje mutuo y la transferencia de buenas prácticas, a menudo encontramos enormes barreras para su realización debido, entre otros factores, al limitado acceso a los datos sobre la práctica de la protección infantil. Frente a estas limitaciones, este artículo ofrece una investigación comparativa realizada en España y Portugal, cuyo objetivo ha sido la evaluación del acogimiento familiar en dos países donde la investigación en el ámbito de la protección infantil ha sido tradicionalmente desatendida. Sobre una muestra de 357 casos en España y 289 en Portugal, se realizó un estudio del perfil de características de los niños acogidos, las familias de origen y los acogedores, así como de los procesos de acogida en ambos países. La comparativa reveló importantes diferencias relacionadas con la mayor edad al inicio del acogimiento de los niños en España; el perfil de los acogedores, con edades más avanzadas, un bajo nivel educativo y llevando a cabo acogidas de más de un niño simultáneamente en Portugal. El estudio comparado nos ha permitido identificar áreas que requieren mayor atención en ambos países, como la renovación generacional del banco de acogedores en Portugal o la necesidad de acelerar los procesos de toma de decisiones para la entrada en acogimiento familiar en España. Se pretende que este artículo sirva de aliento para la recogida de datos y comparación con otros países iberoamericanos.

Fostering processes that occur in each country depend on historical and cultural factors that give rise to large international differences. Despite the fact that international comparisons offer a way of exchanging experiences, allowing mutual learning and transfer of good practice, we often encounter major barriers for its completion due to limited access to data on child protection practice, among other factors. Given these limitations, this article provides a comparative study conducted in Spain and Portugal. The aim is the evaluation of family foster care interventions in two countries where research in the field of child protection has traditionally been neglected. The profile of foster children, families of origin and foster families, as well as the features of the fostering processes were studied in a sample of 357 cases in Spain and 289 in Portugal. The comparison revealed significant differences related to the older age of Spanish foster children at the beginning of the foster placement. The profile of foster carers revealed older age, low educational level and frequent situations of multiple placements in Portugal. The comparative study has identified areas that require further attention in both countries, such as the generational shift of foster carers in Portugal or the need to speed up the decision-making processes for entry into a family foster placement in Spain. This article intends to be an encouragement for data collection and comparison in other Latin American countries.