How Were Conflicts of Interest Handled?

Conflicts of interest were potentially great but they were minimized by the great conviction from both Doctors and Health Ministry that something had to be done to improve data on perinatal health. To decrease the number of hospitals where deliveries took place, to concentrate doctors, nurses and equipment, to define staff and to acquire equipment and to train nurses and paediatricians was the way. One the point of view of cost-effectiveness, centralization of expensive technologies, and development of expertise concentrating cases in a same centre - Surgery, VLBW, etc- and lowering mortality rates and get better outcomes were clear health gains. In 1989 after the political decision of closing small maternities the committee return to villages and cities to explain to political local power and people, the decision, which kind of care they will have in the future, why and expected gains. Level I hospitals and Health Centers stop to have deliveries; Health Centers were given a great responsibility: the follow up of the most part of the normal pregnancies by GP. There was no economic pressure because the National Health Service is free, there are no economic incentives for obstetrical or neonatal care, hospitals are financed through ICD, hospital level is defined according to both delivery and newborn care. In 1989 the rule was “No results can be obtained without the interested and responsible participation of all – institutions and people”. At that time the emphasis was on training. There are geographic influences on regionalization for example for islands and inner and far geographic areas. Also we would like to emphasize the influence of demographics on regionalization. As birth rate continues to decrease the hospitals left open 20 years ago with more than 1500 deliveries have to be closed now because the number of deliveries decreased. It was much more difficult and unacceptable to close some few maternities now than 20 years ago. All the difference was that at that time reasons were explained and now it was a Minister order. Other fearful events are the opening of private hospitals, the lowering gross national income, the economic difficulties and financial problems.

Importância da Inseminação Artificial na Terapêutica da Infertilidade

Introdução: Desde há vários anos que a inseminação intra-uterina intra-conjugal (IAC), com ou sem estimulação ovárica, vem sido usada no tratamento da infertilidade. No entanto, o seu uso permanece controverso. Material e métodos: Efectuou-se uma análise retrospectiva (1997-1999) de 114 ciclos de IAC com estimulação ovárica controlada em 66 casais, com o objectivo de determinar a eficácia da IAC e identificar variáveis significativas predictíveis do seu sucesso. Analisou-se o protocolo de estimulação, taxa de gravidez, resultado da gravidez e complicações da terapêutica. Resultados: A taxa de gravidez foi de 10,5% por ciclo e de 18% por casal, sendo a taxa de gravidez múltipla de 25% e a de aborto 0%. Metade de todas as gravidezes resultantes ocorreram no primeiro ciclo de IAC. A análise estatística identificou duas variáveis significativas: número de folículos e duração da infertilidade. Baixas doses de FSH parecem prevenir a gravidez múltipla e o síndrome de hiperestimulação ovárica. Conclusão: Concluímos que uma selecção criteriosa das pacientes associada a estimulação ovárica adequada é fundamental para o sucesso da IAC e que esta técnica constitui um tratamento eficaz para algumas formas de infertilidade.

The Support Role in Clinical Supervision of Nursing Students: Determinant in the Development of Emotional Skills

The problematic situation faced by clients, associated to the processes of health and disease, is expressed through emotions that nursing students have to deal with in the course of care and their formative experiences in clinical teaching. Students have learning needs not only to manage emotions in the context of customer care, but also in terms of their own internal world, emotional conflicts, emotional stress and burn-out. With the present literature review, we intend to explore existing evidence regarding the ways in which the nurse supervisor's support towards nursing students potentiates the development of their competences for the performance of emotional labour. These skills prove to be the key in the ability to manage the emotionally intense situations of care practice and the support function of the nursing supervisor contributes to the development of such competences.