Applying The Maternal Near Miss Approach For The Evaluation Of Quality Of Obstetric Care: A Worked Example From A Multicenter Surveillance Study.

To assess quality of care of women with severe maternal morbidity and to identify associated factors. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.

Variables Associated With The Performance Of Centers For Dental Specialties In Brazil.

The aim of this study was to evaluate the performance of the Centers for Dental Specialties (CDS) in the country and associations with sociodemographic indicators of the municipalities, structural variables of services and primary health care organization in the years 2004-2009. The study used secondary data from procedures performed in the CDS to the specialties of periodontics, endodontics, surgery and primary care. Bivariate analysis by χ2 test was used to test the association between the dependent variable (performance of the CDS) with the independents. Then, Poisson regression analysis was performed. With regard to the overall achievement of targets, it was observed that the majority of CDS (69.25%) performance was considered poor/regular. The independent factors associated with poor/regular performance of CDS were: municipalities belonging to the Northeast, South and Southeast regions, with lower Human Development Index (HDI), lower population density, and reduced time to deployment. HDI and population density are important for the performance of the CDS in Brazil. Similarly, the peculiarities related to less populated areas as well as regional location and time of service implementation CDS should be taken into account in the planning of these services.

Adequação de engates rápidos de aspersores como conectores de mangueira para distribuição de água em sulcos de irrigação

As a way to reduce water losses in furrow irrigation systems, used in fresh market tomato production, farmers are improperly distributing water into the field using plastic hose. The objective of this work was to study the suitability of using quick coupler sprinkler as hose connectors for water distribution in tomato plantation. The first step of the study was to assess the current hose field operation for tomato growers. Subsequently, four models of quick couplers sprinklers available in the market were tested in laboratory to determine the coefficient of resistance, the equivalent tube length, the head loss curve and the linking efficiency. As result, a structural design for hose connectors was presented using the model of coupling with the best hydraulic performance. Additionally, some technical recommendations on its use in irrigation water distribution are highlighted. Despite the requirement for additional field trials, the proposed system has potential to optimize the water use efficiency, to improve workers ergonomic conditions, and ensure good profitability to the producer.

Medalhistas de ouro nas Paraolimpiadas de Atenas 2004 : reflexões de suas trajetorias no desporto adaptado

Universidade Estadual de Campinas . Faculdade de Educação Física

A Escola Superior de Educação Fisica de Muzambinho no contexto da Educação Fisica brasileira

Universidade Estadual de Campinas . Faculdade de Educação Física