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The purpose of this paper is to investigate Portuguese hospital inpatient satisfaction.

The study was conducted at a major university hospital in Portugal. Using the IAQH-IA mailed questionnaire, data were collected over three months (March to June 2015) from patients and families. From 1,500 former inpatients, 434 participated (29 percent response rate). Using the structural equation modeling, the authors derived satisfaction models and analyzed the relationship between quality, satisfaction and patient attitudes. Inferential statistics (bivariate analysis) were used to deal with global satisfaction determinants.

The satisfaction model was confirmed using factor analysis. Results show that developing a system for delivering timely information to both patient and relatives is relevant. Communication is a fundamental aspect for patients, which to date, seems to have been neglected by hospital managers. Education and current perceived health are important global satisfaction determinants.

Hospital managers can use the authors’ findings to measure and improve operational performance.

Knowledge about patient perception and satisfaction leads to continuing improvement in healthcare quality.

The purpose of this paper is to evaluate the pathological, biochemical and redox state parameters of liver tissue in Wistar rats treated from birth to adulthood (119 days) with cafeteria diet.

During the lactation, 6 liters of Wistar rats (dam + 8 pups each) were fed one of two diets: control (CTRL; n = 3) or cafeteria (CAF; n = 3) diets and water ad libitum. After weaning, the males were placed in individual cages, receiving the same diet offered to their respective dams (CTRL or CAF; n = 18) until adulthood. The following parameters were evaluated: absolute and relative liver weight; blood, liver and feces biochemistry; liver histology; and redox state of the liver.

When assessing the relative and absolute organ weight, no significant differences were found between the groups. The Cafeteria group exhibited higher values of serum LDL-c (p = 0.008), VLDL-c (p = 0.03) and triglycerides (p = 0.01), as well as several micro and macrovacuoles of fat accumulation, higher hepatic lipid (p = 0.03) and cholesterol (p = 0.0001) levels regarding Control group. Cafeteria group showed greater expression of glutathione-s-transferase (p = 0.03) and superoxide dismutase (p = 0.005) enzymes compared to the control group. In the case of the markers of oxidative stress, there was no difference between the groups.

A simple and standardized cafeteria diet caused an accumulation of fatty acids in liver tissue, inducing a state of hepatic steatosis besides an increased expression of antioxidant enzymes.

The purpose of this study is to evaluate the nutritional effects in Wistar rats of supplementation with stand-alone saturated fatty acid (SFA) or monounsaturated fatty acid (MUFA), the replacement of SFA by MUFA and the combination of both (SFA + MUFA) over a long period of time (13 weeks).

In total, 30 Wistar rats were used and randomly assigned to receive (n = 6): control – lab chow; lard (L20%) – lab chow with added lard (20%); olive oil (O20%) – lab chow with added olive oil (20%); lard replacement with olive oil (L20% –O20%) – during six weeks lab chow with added lard (20%) replaced by lab chow with added olive oil (20%) given during the past seven weeks of the trial; lard combination with olive oil (L10% + O10%) – lab chow with added lard (10%) and olive oil (10%). Food and caloric intake, weight gain, food and energy efficiency, body mass index, bone mineral composition and blood biochemistry were evaluated.

All diets with added fatty acids showed higher energy intake (p < 0.001), weight gain (p = 0.01), accumulation of adipose tissue (p = 0.02) and food and energy efficiency (p = 0.01) compared to the control group. All groups exhibited higher levels of blood triglycerides compared to the control group (p = 0.02). In addition, the L10% + O10% group developed hyperglycemia (p < 0.001); the L group showed higher amounts of non- high density lipoprotein (HDL-c) (p = 0.04); and the L20%−O20% group exhibited high levels of the triglyceride/HDL-c ratio (p = 0.04) in relation to the control.

These results indicate that regardless of the fatty acid type, consumption in large quantities of fatty acids for long periods of time can cause obesity and dyslipidemia.

The purpose of this study is to evaluate the chemical composition of unripe banana flour from Southeast Brazil and verify its nutritional, physiological and biochemical properties in adult Wistar rats.

Analysis of soluble solids, titratable acidity, pH, moisture, ash, lipids, proteins, carbohydrate, resistant and total starch and energy was obtained. In all, 18 male Wistar rats were given different concentrations of unripe banana flour (0, 10 and 20 per cent) and these assessments were performed: feed, caloric and water intake; weight gain; coefficient of food efficiency; weight of organs; body, tibia and femur length; total mineral of bones; and biochemistry of blood, hepatic fluids and feces.

Unripe banana flour showed a potential for weight control as well as increased fecal cholesterol excretion. These results showed the potential of unripe banana flour for obesity treatment and lipid excretion. Nevertheless, plasma triacylglycerol levels increased in the animals that received the largest amount of banana flour (20 per cent w/w), possibly because of the large amount of resistant starch in the flour, indicating the need for additional studies to confirm the mechanisms responsible for this increase.

Unripe banana flour may promote beneficial health effects (such as weight control and increased elimination of cholesterol in feces); however, the large amount of resistant starch present may be responsible for an increase in blood triacyglycerol.

We present a critical literature review debating Brazilian research on social and environmental accounting (SEA). The aim of this study is to understand the role of politics in the construction of hegemonies in SEA research in Brazil. In particular, we examine the role of hegemony in relation to the co-option of SEA literature and sustainability in the Brazilian context by the logic of development for economic growth in emerging economies. The methodological approach adopts a post-structural perspective that reflects Laclau and Mouffe’s discourse theory. The study employs a hermeneutical, rhetorical approach to understand and classify 352 Brazilian research articles on SEA. We employ Brown and Fraser’s (2006) categorizations of SEA literature to help in our analysis: the business case, the stakeholder–accountability approach, and the critical case. We argue that the business case is prominent in Brazilian studies. Second-stage analysis suggests that the major themes under discussion include measurement, consulting, and descriptive approach. We argue that these themes illustrate the degree of influence of the hegemonic politics relevant to emerging economics, as these themes predominantly concern economic growth and a capitalist context. This paper discusses trends and practices in the Brazilian literature on SEA and argues that the focus means that SEA avoids critical debates of the role of capitalist logics in an emerging economy concerning sustainability. We urge the Brazilian academy to understand the implications of its reifying agenda and engage, counter-hegemonically, in a social and political agenda beyond the hegemonic support of a particular set of capitalist interests.

The purpose of this study was to evaluate the increase in sensitivity of a single risperidone administration in relation to energy intake of Wistar rats treated with cafeteria diet from birth to adulthood (119 days).

During the lactation period, six litters of Wistar rats (dam + 8 pups each litter) were fed one of the following two diets: Control (n = 3) or Cafeteria (n = 3) diets and water ad libitum. After weaning, the males were placed in individual cages, receiving the same diet offered to their respective dams (Control = 18; or Cafeteria = 18) until adulthood (119 postnatal days). The following parameters were evaluated: food and energy intake; macronutrient intake; weight gain; adipose tissue relative weight; sucrose preference; food intake after an administration of risperidone (0.1 mg/kg body weight).

The Cafeteria group showed a higher energy intake in relation to the Control group (p < 0.001). The consumption of energy beyond the individual needs can be understood as a hyperphagic condition. Also, the Cafeteria group reported greater weight gain (p = 0.048) and accumulation of adipose tissue (p < 0.001) with respect to the Control group. These results indicate that the cafeteria diet generated obesity in animals. The Cafeteria group showed reduced sucrose preference (p = 0.031), which is associated with the development of anhedonia-like behavior. In the food intake test, risperidone showed a greater sensitivity in Cafeteria animals, promoting a decrease in their energy intake in relation to the Control group that received risperidone (p = 0.040).

The cafeteria diet promoted hyperphagia, anhedonia-like behavior and obesity in animals. Acute risperidone administration showed greater sensitivity in the Cafeteria group, with a decrease in energy intake. The reported effects may be related to a downregulation of the dopaminergic system in the NAc region.

This piece of research provides an overview on supplementary education in Brazil based on the available literature.

Literature review.

In a country plenty of social and educational contrasts, student failure and high repetition rates in basic education are the main factors of supplementary education flourishing. Additional factors are the quick expansion of access at all levels of schooling and the ascension of a new lower middle class that can afford to pay for supplementary tutoring. Tutors at their homes and in small offices are still one of the most common means for students who want to overcome their difficulties and improve their knowledge and skills. However, franchising outlets have grown since the 1980s and in particular the 1986 with the winds of globalization. Their most important branches are foreign languages and preparatory courses, especially for college entrance and public servant selection examinations. This branch of business has been financially very attractive for entrepreneurs. Official data on family budget show that families spend each year a significant amount of resources, impacting the sophistication and complexity of the supplementary education market. In sum, supplementary education is a result of quality deficiencies and inequity. At the same time, it increases the lack of equity between students from different human capital backgrounds.

Main limitation is that research on supplementary education in Brazil is still recent and scarce. On the other hand, till now, no public policy has paid attention to this phenomenon.

Public policy, research, and evaluation fields must consider the phenomenon of supplementary education in Brazil as an important variable contributing to inequity and to academic performance. This chapter calls attention to the need of increasing research on this issue.

As it is more valued and easily available to relatively more privileged social groups, supplementary education in Brazil contributes to increasing education inequity.

This chapter contributes to improving knowledge on supplementary education in Brazil, and its causes and implications. This portrait of the Brazilian scenario can also be instrumental for comparative education purposes at regional and global levels.

The civil construction industry has vital importance to Brazil's economy. However, this sector is also responsible for the environmental impacts. Governments have been taking measures aiming to mitigate these impacts. Among these, the elaboration and implementation of civil construction solid waste management plans can be highlighted. However, these plans still lack standardizations and tools for their evaluation. Environmental indicators proposal for construction solid waste management plans assessment is presented to verify the adhesion of these to environmental laws, technical standards and green building certification systems recommendations.

The construction solid waste management plans of three construction works were evaluated by the proposed indicators to verify the procedures related, generating, in the end, a scale between 0 and 5. After that, plans were compared with each other.

The proposed indicators have made possible the evaluation of the environmental practices performed for three different construction works. By the proposed indicators, the environmental practices were compared to technical standards and legislation suggested procedures.

As a contribution, the evaluation proposal presented may help the construction industry as well as the public authority to evaluate the construction solid waste management plans currently elaborated, so that these can offer a quality improvement and more effective environmental measures.

Methodologies that guide the evaluation of construction solid waste management plans can be beneficial for the construction companies, which can improve the quality of the plans elaborated internally and verify the effectiveness of the plans elaborated by specialized consultancies. In general, most of the construction solid waste management plans are prepared with the purpose of only complying with the legislation, more specifically of the National Council for the Environment, Resolution 307/2002.

The purpose of this paper is to present a hybrid modelling that combines concepts and techniques for scenario building together with a Multi-criteria Decision Aid (MCDA) outranking approach. The paper presents a case to illustrate the proposed methodology.

The research method is a qualitative and quantitative mixture and it is presented as a study case. Bibliographic research is used to construct the theoretical framework. There are a number of studies that develop a sensibility analysis in MCDA modelling; however, none of them explore the robustness of the MCDA solution with use of scenarios variation.

The methodology allows the criteria that must be taken into account, according to the decision makers’ values and preferences. It is interesting to note that, depending on the scenario, different weights were applied for each criterion, and the performances of alternatives under each criterion has changed as well.

This need arises in decision problems that are susceptible to the influence of scenario variation.

This proposal was applied to a real case that has taken into account six alternatives, with a prospective analysis of three scenarios, evaluated by four criteria. The authors use prospective scenarios to choose the criterion weights and alternatives evaluation.

The purpose of this paper is to evaluate the efficiency in financial intermediation and the cost efficiency in banking service of credit unions in Brazil, based on essentially accounting variables, and to analyze the temporal evolution of the efficiency of these cooperatives.

With a sample of 315 cooperatives over the period from 2007 to 2014, this research uses a two-stage process: application of regression models with panel data to verify which variables are related to the defined outputs, with the reduction of 31 variables to 8 variables in both models; and application of the data envelopment analysis method to obtain an analysis of credit unions’ efficiency.

The results demonstrate a high level of efficiency in financial intermediation, with low variation over time, associated with a low efficiency in the banking service, in which few cooperatives have remained efficient over time. In addition, the cooperatives with highest efficiency in financial intermediation were also the most efficient in providing services.

This research has some limitations about the capacity of the proxies used to capture the real effect of the variables and assumptions of economic relations resulting in restrictions to generalize the results.

Cooperatives are usually analyzed under just one dimension. By separating the analysis into financial intermediation and banking services, cooperatives that are more efficient in each dimension can be identified, in addition to analyzing the evolution over time. The authors found that efficiency tends to be lower in banking services, and few cooperatives remain at the highest level of efficiency over time in both models.

Credit unions provide an important service in the banking and credit market. Therefore, understanding its operation and the characteristics that influence its efficiency allows a better management of the cooperatives themselves and a greater understanding of this important segment of the financial market.