External quality assessment in the voluntary counseling and testing centers in the Brazilian Amazon using dried tube specimens: results of an effectiveness evaluation

INTRODUCTION : In 2011, the Brazilian Ministry of Health rolled out a program for the external quality assessment of rapid human immunodeficiency virus (HIV) tests using the dried tube specimen (DTS) method (EQA-RT/DTS-HIV). Our objective was to evaluate the implementation of this program at 71 voluntary counseling and testing centers (VCTCs) in the Brazilian Legal Amazonian area one year after its introduction. METHODS : Quantitative and qualitative study that analyzed secondary data and interviews with healthcare workers (HCWs) (n=39) and VCTC coordinators (n=32) were performed. The assessment used 18 key indicators to evaluate the three dimensions of the program's logical framework: structure, process, and result. Each indicator was scored from 1-4, and the aggregate results corresponding to the dimensions were expressed as proportions. The results were compared to the perceptions of the HCWs and coordinators regarding the EQA-RT/DTS-HIV program. RESULTS: The aggregate scores for the three dimensions of structure, process, and result were 91.7%, 78.6%, and 95%, respectively. The lowest score in each dimension corresponded to a different indicator: access to Quali-TR online system 39% (structure), registration in Quali-TR online system 38.7% (process), and VCTC completed the full process in the program's first round 63.4% (result). Approximately 36% of the HCWs and 52% of the coordinators reported enhanced trust in the program for its rapid HIV testing performance. CONCLUSIONS: All three program dimensions exhibited satisfactory results (>75%). Nevertheless, the study findings highlight the need to improve certain program components. Additionally, long-term follow-ups is needed to provide a more thorough picture of the process for external quality assessment.

The use of the Nursing Activities Score in clinical settings: an integrative review

ABSTRACT Objective analyze how studies have approached the results obtained from the application of the Nursing Activities Score (NAS) based on Donabedian’s model of healthcare organization and delivery. Method CINAHL and PubMed databases were searched for papers published between 2003 and March 2015. Results 36 articles that met the inclusion criteria were reviewed and double-coded by three independent coders and analyzed based on the three elements of Donabedian’s health care quality framework: structure, process and outcome. The most frequently addressed, but not always tested, variables were those that fell into the structure category. Conclusion variables that fell into the process category were used less frequently. Beside NAS, the most frequently used variables in the outcome category were mortality and length of stay. However, no study used a quality framework for healthcare or NAS to evaluate costs, and it is recommended that further research should explore this approach.

Genetic Structure of Triatoma sordida (Hemiptera: Reduviidae) Domestic Populations from Bolivia: Application on Control Interventions

The genetic population of Triatoma sordida group 1, a secondary vector of Chagas disease in Bolivia, was studied by multi-locus enzyme electrophoresis. A total of 253 nymphal and adult specimens collected from seven neighbouring localities in the Velasco Province, Department of Santa Cruz, were processed. The relatively low genetic variability was confirmed for this species (rate of polymorphism: 0.20). The absence of genetic disequilibrium detected within the seven localities was demonstrated. A geographical structuration appears between localities with distances greater than 20 km apart. Although T. sordida presents a relatively reduced dispersive capacity, its panmictic unit is wider than compared with T. infestans. Genetic distances between T. sordida populations were correlated with geographic distance. Gene flow between geographic populations of T. sordida provides an efficient framework for effective vigilance and control protocols.

Climate governance in an international system under conservative hegemony: the role of major powers

In the last five years, climate change has been established as a central civilizational driver of our time. As a result of this development, the most diversified social processes - as well as the fields of science which study them - have had their dynamics altered. In International Relations, this double challenge could be explained as follows: 1) in empirical terms, climate change imposes a deepening of cooperation levels on the international community, considering the global common character of the atmosphere; and 2) to International Relations as a discipline, climate change demands from the scientific community a conceptual review of the categories designed to approach the development of global climate governance. The goal of this article is to discuss in both conceptual and empirical terms the structure of global climate change governance, through an exploratory research, aiming at identifying the key elements that allow understanding its dynamics. To do so, we rely on the concept of climate powers. This discussion is grounded in the following framework: we now live in an international system under conservative hegemony that is unable to properly respond to the problems of interdependence, among which - and mainly -, the climate issue.

Changes in the ways of life of farmers in the northwest of Portugal after 1980

ABSTRACT This study analyzes the changes from 1980s in the lifestyles of families of pluriactive and exclusively agricultural farmers in the northwest of Portugal caused by the income arising from the migration of at least one member of the family to another country in the European Union and the narrowing of the labor and consumer markets among the villages, towns and cities. The theoretical framework used to analyze the changes in the way of life of the pluriactive farmers was based on Giddens' theory of structuration, which denies both the absolute determinism of the structure on the subject and the freedom of unrestrained action of these same subjects. The study was carried out with the application of a survey to 78 farmers, divided into "pluriactive" and "exclusively agricultural" farmers. The findings pointed out to a greater aquisition of modes of urban life by pluriactive farmers compared with the exclusively agricultural farmers and showed a generational bias in this process of acculturation.

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.

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.

Evaluation of maternal and neonatal hospital care: quality index of completeness

OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System.METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country.RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country.CONCLUSIONS The index of completeness proved to be of great value for monitoring the maternal and neonatal hospital care of Brazilian Unified Health System and indicated that the quality of health care was unsatisfactory. However, its application does not replace specific evaluations.

Genetic structure of Neisseria meningitidis serogroup C epidemic strains in South Brazil

In the present study we report the results of an analysis, based on serotyping, multilocus enzyme electrophoresis (MEE), and ribotyping of N. meningitidis serogroup C strains isolated from patients with meningococcal disease (MD) in Rio Grande do Sul (RS) and Santa Catarina (SC) States, Brazil, as the Center of Epidemiology Control of Ministry of Health detected an increasing of MD cases due to this serogroup in the last two years (1992-1993). We have demonstrated that the MD due to N.meningitidis serogroup C strains in RS and SC States occurring in the last 4 years were caused mainly by one clone of strains (ET 40), with isolates indistinguishable by serogroup, serotype, subtype and even by ribotyping. One small number of cases that were not due to an ET 40 strains, represent closely related clones that probably are new lineages generated from the ET 40 clone referred as ET 11A complex. We have also analyzed N.meningitidis serogroup C strains isolated in the greater São Paulo in 1976 as representative of the first post epidemic year in that region. The ribotyping method, as well as MEE, could provide useful information about the clonal characteristics of those isolates and also of strains isolated in south Brazil. The strains from 1976 have more similarity with the actual endemic than epidemic strains, by the ribotyping, sulfonamide sensitivity, and MEE results. In conclusion, serotyping with monoclonal antibodies (C:2b:P1.3), MEE (ET 11 and ET 11A complex), and ribotyping by using ClaI restriction enzyme (Rb2), were useful to characterize these epidemic strains of N.meningitidis related to the increased incidence of MD in different States of south Brazil. It is mostly probable that these N.meningitidis serogroup C strains have poor or no genetic corelation with 1971-1975 epidemic serogroup C strains. The genetic similarity of members of the ET 11 and ET 11A complex were confirmed by the ribotyping method by using three restriction endonucleases.

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.