Mudanças estratégicas em organizações hospitalares: uma abordagem contextual e processual

O objetivo central do artigo consiste em verificar como ocorreu o processo de mudança estratégica em uma organização hospitalar. Analisam-se, de forma empírica, as mudanças estratégicas ocorridas nos últimos 20 anos no Hospital CBS. São identificadas as condições objetivas do setor - ambiente real, arena cognitiva - como ambiente percebido e a rede de colaboradores que dão suporte às atividades do hospital. O período de mais transformações foi o de 1991 a 1995, e as principais mudanças foram na cultura do hospital, na filosofia de trabalho dos médicos e funcionários, na forma de treinamento dos funcionários, na estrutura organizacional, nos processos e na tecnologia. Detectou-se que a coalizão dominante do hospital sofre apenas influência externa em razão das mudanças tecnológicas e que, internamente, o corpo clínico tem controle sobre o processo de tomada de decisões.

USE AND CONSEQUENCES OF PARTICIPATORY GIS IN A MEXICAN MUNICIPALITY: APPLYING A MULTILEVEL FRAMEWORK

This paper seeks to understand the use and the consequences of Participatory Geographic Information System (PGIS) in a Mexican local community. A multilevel framework was applied, mainly influenced by two theoretical lenses – structurationist view and social shaping of technology – structured in three dimensions – context, process and content – according to contextualist logic. The results of our study have brought two main contributions. The first is the refinement of the theoretical framework in order to better investigate the implementation and use of Information and Communication Technology (ICT) artifacts by local communities for social and environmental purposes. The second contribution is the extension of existing IS (Information Systems) literature on participatory practices through identification of important conditions for helping the mobilization of ICT as a tool for empowering local communities.

Ensuring dynamic strategic fit of firms that compete globally in alliances and networks: proposing the Global SNA - Strategic Network Analysis - framework

In order to sustain their competitive advantage in the current increasingly globalized and turbulent context, more and more firms are competing globally in alliances and networks that oblige them to adopt new managerial paradigms and tools. However, their strategic analyses rarely take into account the strategic implications of these alliances and networks, considering their global relational characteristics, admittedly because of a lack of adequate tools to do so. This paper contributes to research that seeks to fill this gap by proposing the Global Strategic Network Analysis - SNA - framework. Its purpose is to help firms that compete globally in alliances and networks to carry out their strategic assessments and decision-making with a view to ensuring dynamic strategic fit from both a global and relational perspective.

Reflexões para um framework da informação de custos do setor público brasileiro

O presente artigo sumariza uma proposta de framework da informação de custos para o setor público no Brasil. A proposta emergiu de contribuições promovidas pelo governo central no Brasil na realização de duas equipes de trabalho, a primeira pela comissão interministerial em 2005, e a segunda coordenada pelo Ministério da Fazenda em 2008/09. Essas contribuições foram validadas em relação às críticas veiculadas no meio acadêmico quanto às estruturas conceituais da contabilidade financeira (framework) emitidas pelo International Accounting Standards Board e Financial Accounting Standards Board, e em relação à literatura internacional de implantação de sistemas de custos no setor público. A adoção de um sistema de custos é exigida para as entidades públicas no Brasil desde 1964; entretanto, somente agora é objeto de um trabalho conduzido pelo Ministério da Fazenda para o governo federal, cujos primeiros resultados serão divulgados neste ano. O acórdão emitido pelo Tribunal de Contas da União em 2004, determinando que a legislação seja observada, tende a ampliar tal adoção. Contudo, a adoção não é suficiente, é necessária a utilização, que é função da relevância percebida da informação de custos. Sugere-se que a difusão da adoção e uso de sistemas de custos no setor público brasileiro seja feita através de uma implantação gradual, flexível, mediante a adoção do regime de competência, e baseada num framework único e comum às diversas entidades.

Capacidades dinâmicas e rituais de interação entre alta e média gerência: proposta de um framework

O presente artigo foi desenvolvido considerando situações de incerteza ambiental, em que a ordem do dia ou questão estratégica (strategic issue) é a inovação dos recursos, ou seja, transformação, renovação ou desenvolvimento de uma nova capacidade funcional (ordinária). Com o objetivo de compreender como as capacidades dinâmicas desempenham esse papel na inovação dos ativos organizacionais em tais contextos ambientais, propõe-se aqui uma perspectiva alternativa de análise a partir de uma vertente microssociológica, a qual recorre aos elementos constitutivos de rituais de interação segundo Collins (2004). Essa perspectiva oferece possibilidades de investigação da influência das conversações estratégicas, que ocorrem em meio a práticas ritualísticas de interação entre alta e média gerência, sobre o potencial de inovação das capacidades organizacionais. Para compreensão da articulação teórica realizada no trabalho, apresenta-se um framework de análise que agrega a incerteza no nível macro com variáveis comportamentais e organizacionais no nível micro, enquanto elementos mais salientes dos rituais de interação. Visando estudos futuros e melhor compreensão do framework do trabalho, são apresentadas proposições acerca das relações do modelo após o detalhamento da estrutura analítica.

Social contextual factors contributing to child and adolescent labor: an ecological analysis

OBJECTIVE: To examine the relationship between social contextual factors and child and adolescent labor. METHODS: Population-based cohort study carried out with 2,512 families living in 23 subareas of a large urban city in Brazil from 2000 to 2002. A random one-stage cluster sampling was used to select families. Data were obtained through individual household interviews using questionnaires. The annual cumulative incidence of child and adolescent labor was estimated for each district. New child and adolescent labor cases were those who had their first job over the two-year follow-up. The annual cumulative incidence of child and adolescent labor was the response variable and predictors were contextual factors such as lack of social support, social deprivation, unstructured family, perceived violence, poor school quality, poor environment conditions, and poor public services. Pearson's correlation and multiple linear regression were used to assess the associations. RESULTS: There were selected 943 families corresponding to 1,326 non-working children and adolescents aged 8 to 17 years. Lack of social support, social deprivation, perceived violence were all positively and individually associated with the annual cumulative incidence of child and adolescent labor. In the multiple linear regression model, however, only lack of social support and perceived violence in the neighborhood were positively associated to child and adolescent labor. No effect was found for poor school quality, poor environment conditions, poor public services or unstructured family. CONCLUSIONS: Poverty reduction programs can reduce the contextual factors associated with child and adolescent labor. Violence reduction programs and strengthening social support at the community level may contribute to reduce CAL.

Payment for performance in the Family Health Programme: lessons from the UK Quality and Outcomes Framework

OBJECTIVE: Payment for performance financial incentive schemes reward doctors based on the quality and the outcomes of their treatment. In Brazil, the Ministry of Health is looking to scale up its use in public hospitals and some municipalities are developing payment for performance schemes even for the Family Health Programme. In this article the Quality and Outcomes Framework used in the UK since 2004 is discussed, as well as its experience to elaborate some important lessons that Brazilian municipalities should consider before embarking on payment for performance scheme in primary care settings.

Contextual and individual indicators associated with the presence of teeth in adults

OBJECTIVE The objective of this study was to analyze whether socioeconomic conditions and the period of availability of fluoridated water are associated with the number of teeth present.METHODSThis cross-sectional study analyzed data from 1,720 adults between 20 and 59 years of age who resided in Florianópolis, SC, Southern Brazil, in 2009. The outcome investigated was the self-reported number of teeth present. The individual independent variables included gender, age range, skin color, number of years of schooling, and per capita household income. The duration of residence was used as a control variable. The contextual exposures included the period of availability of fluoridated water to the households and the socioeconomic variable for the census tracts, which was created from factor analysis of the tract’s mean income, education level, and percentage of households with treated water. Multilevel logistic regression was performed and inter-level interactions were tested.RESULTS Residents in intermediate and poorer areas and those with fluoridated water available for less time exhibited the presence of fewer teeth compared with those in better socioeconomic conditions and who had fluoridated water available for a longer period (OR = 1.02; 95%CI 1.01;1.02). There was an association between the period of availability of fluoridated water, per capita household income and number of years of education. The proportion of individuals in the poorer and less-educated stratum, which had fewer teeth present, was higher in regions where fluoridated water had been available for less time.CONCLUSIONS Poor socioeconomic conditions and a shorter period of availability of fluoridated water were associated with the probability of having fewer teeth in adulthood. Public policies aimed at reducing socioeconomic inequalities and increasing access to health services such as fluoridation of the water supply may help to reduce tooth loss in the future.

Contextual determinants of induced abortion: a panel analysis

ABSTRACT OBJECTIVE Analyze the contextual and individual characteristics that explain the differences in the induced abortion rate, temporally and territorially. METHODS We conducted an econometric analysis with panel data of the influence of public investment in health and per capita income on induced abortion as well as a measurement of the effect of social and economic factors related to the labor market and reproduction: female employment, immigration, adolescent fertility and marriage rate. The empirical exercise was conducted with a sample of 22 countries in Europe for the 2001-2009 period. RESULTS The great territorial variability of induced abortion was the result of contextual and individual socioeconomic factors. Higher levels of national income and investments in public health reduce its incidence. The following sociodemographic characteristics were also significant regressors of induced abortion: female employment, civil status, migration, and adolescent fertility. CONCLUSIONS Induced abortion responds to sociodemographic patterns, in which the characteristics of each country are essential. The individual and contextual socioeconomic inequalities impact significantly on its incidence. Further research on the relationship between economic growth, labor market, institutions and social norms is required to better understand its transnational variability and to reduce its incidence.

SPf66 vaccine trial in Brazil: conceptual framework study design and analytical approach

This paper describes the study population and the study design of the phase III field trial of the SPf66 vaccine in Brazil. Assessment of validity and precision principles necessary for the appropriate evaluation of the protective effect of the vaccine are discussed, as well as the results of the preliminary analyses of the gathered data. The analytical approach for the estimation of the protective effect of the vaccine is presented. This paper provides the conceptual framework for future publications.

The use of the Family Management Style Framework to evaluate the family management of liver transplantation in adolescence

Objective: To understand the family management experience of liver transplantation during adolescence based on the Family Management Style Framework(FMSF). Method: This is a case study that used the FMSF as theoretical framework and the hybrid model of thematic analysis as methodological reference. The case presented is from an adolescent’s family that lives in Salvador, Bahia. The data were collected through interviews with the mother and the patient charts analysis. Results: The results shows that the family defines the transplantation as threatening and there are divergence between mother and daughter related to the teen’s capabilities perception. Facing those discrepancies, the family assumes a protective posture by believing that the teen cannot take care of herself alone. The perceived consequences reflect how much the uncertainty permeates the family environment. Conclusion: It is concluded that the use of a model to evaluate the management can help professionals to direct and plan specific interventions.



Role of the hippocampus in contextual memory after classical aversive conditioning in pigeons (C. livia)

We investigated the effects of hippocampal lesions with ibotenic acid (IBO) on the memory of the sound-context-shock association during reexposure to the conditioning context. Twenty-nine adult pigeons were assigned to a non-lesioned control group (CG, N = 7), a sham-lesioned group (SG, N = 7), a hippocampus-lesioned experimental group (EG, N = 7), and to an unpaired nonlesioned group (tone-alone exposure) (NG, N = 8). All pigeons were submitted to a 20-min session in the conditioning chamber with three associations of sound (1000 Hz, 85 dB, 1 s) and shock (10 mA, 1 s). Experimental and sham lesions were performed 24 h later (EG and SG) when EG birds received three bilateral injections (anteroposterior (A), 4.5, 5.25 and 7.0) of IBO (1 µl and 1 µg/µl) and SG received one bilateral injection (A, 5.25) of PBS. The animals were reexposed to the training context 5 days after the lesion. Behavior was videotaped for 20 min and analyzed at 30-s intervals. A significantly higher percent rating of immobility was observed for CG (median, 95.1; range, 79.2 to 100.0) and SG (median, 90.0; range, 69.6 to 95.0) compared to EG (median, 11.62; range, 3.83 to 50.1) and NG (median, 7.33; range, 6.2 to 28.1) (P<0.001) in the training context. These results suggest impairment of contextual fear in birds who received lesions one day after conditioning and a role for the hippocampus in the modulation of emotional aversive memories in pigeons.

A mathematical framework for group analysis of von Willebrand factor multimeric composition following luminography

The objective of the present study was to establish a method for quantitative analysis of von Willebrand factor (vWF) multimeric composition using a mathematical framework based on curve fitting. Plasma vWF multimers from 15 healthy subjects and 13 patients with advanced pulmonary vascular disease were analyzed by Western immunoblotting followed by luminography. Quantitative analysis of luminographs was carried out by calculating the relative densities of low, intermediate and high molecular weight fractions using laser densitometry. For each densitometric peak (representing a given fraction of vWF multimers) a mean area value was obtained using data from all group subjects (patients and normal individuals) and plotted against the distance between the peak and IgM (950 kDa). Curves were constructed for each group using nonlinear fitting. Results indicated that highly accurate curves could be obtained for healthy controls and patients, with respective coefficients of determination (r²) of 0.9898 and 0.9778. Differences were observed between patients and normal subjects regarding curve shape, coefficients and the region of highest protein concentration. We conclude that the method provides accurate quantitative information on the composition of vWF multimers and may be useful for comparisons between groups and possibly treatments.