Factors associated with lack of prenatal care in a large municipality

OBJECTIVE To analyze the factors associated with a lack of prenatal care in a large municipality in southern Brazil. METHODS In this case-control age-matched study, 716 women were evaluated; of these, 179 did not receive prenatal care and 537 received prenatal care (controls). These women were identified using the Sistema Nacional de Informação sobre Nascidos Vivos (Live Birth Information System) of Pelotas, RS, Southern Brazil, between 2009 and 2010. Multivariate analysis was performed using conditional logistic regression to estimate the odds ratios (OR). RESULTS In the final model, the variables associated with a lack of prenatal care were the level of education, particularly when it was lesser than four years [OR 4.46; 95% confidence interval (CI) 1.92;10.36], being single (OR 3.61; 95%CI 1.85;7.04), and multiparity (OR 2.89; 95%CI 1.72;4.85). The prevalence of a lack of prenatal care among administrative regions varied between 0.7% and 3.9%. CONCLUSIONS The risk factors identified must be considered when planning actions for the inclusion of women in prenatal care by both the central management and healthcare teams. These indicated the municipal areas with greater deficits in prenatal care. The reorganization of the actions to identify women with risk factors in the community can be considered to be a starting point of this process. In addition, the integration of the activities of local programs that target the mother and child is essential to constantly identify pregnant women without prenatal care.

Healthcare-associated infections: challenges to public health in Brazil

This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges.

Impact of a price-maker pumped storage hydro unit on the integration of wind energy in power systems

The increasing integration of larger amounts of wind energy into power systems raises important operational issues, such as the balance between power generation and demand. The pumped storage hydro (PSH) units are one possible solution to mitigate this problem, once they can store the excess of energy in the periods of higher generation and lower demand. However, the behaviour of a PSH unit may differ considerably from the expected in terms of wind power integration when it operates in a liberalized electricity market under a price-maker context. In this regard, this paper models and computes the optimal PSH weekly scheduling in a price-taker and price-maker scenarios, either when the PSH unit operates in standalone and integrated in a portfolio of other generation assets. Results show that the price-maker standalone PSH will integrate less wind power in comparison with the price-taker situation. Moreover, when the PSH unit is integrated in a portfolio with a base load power plant, the role of the price elasticity of demand may completely change the operational profile of the PSH unit. (C) 2014 Elsevier Ltd. All rights reserved.

Performance management in primary healthcare services: evidence from a field study

Health services

Analysis of the domain of applicability of an algorithm for a resources system selection problem for Distributed/Agile/Virtual Enterprises integration

The process of resources systems selection takes an important part in Distributed/Agile/Virtual Enterprises (D/A/V Es) integration. However, the resources systems selection is still a difficult matter to solve in a D/A/VE, as it is pointed out in this paper. Globally, we can say that the selection problem has been equated from different aspects, originating different kinds of models/algorithms to solve it. In order to assist the development of a web prototype tool (broker tool), intelligent and flexible, that integrates all the selection model activities and tools, and with the capacity to adequate to each D/A/V E project or instance (this is the major goal of our final project), we intend in this paper to show: a formulation of a kind of resources selection problem and the limitations of the algorithms proposed to solve it. We formulate a particular case of the problem as an integer programming, which is solved using simplex and branch and bound algorithms, and identify their performance limitations (in terms of processing time) based on simulation results. These limitations depend on the number of processing tasks and on the number of pre-selected resources per processing tasks, defining the domain of applicability of the algorithms for the problem studied. The limitations detected open the necessity of the application of other kind of algorithms (approximate solution algorithms) outside the domain of applicability founded for the algorithms simulated. However, for a broker tool it is very important the knowledge of algorithms limitations, in order to, based on problem features, develop and select the most suitable algorithm that guarantees a good performance.

Institutional and matrix support and its relationship with primary healthcare

OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams.METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support – 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was “level of support” (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p < 0.20. The model was adjusted by the Hosmer-Lemeshow test.RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23).CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.

Market of resources for virtual enterprise integration

Most definitions of virtual enterprise (VE) incorporate the idea of extended and collaborative outsourcing to suppliers and subcontractors in order to achieve a competitive response to market demands (Webster, Sugden, & Tayles, 2004). As suggested by several authors (Browne & Zhang, 1999; Byrne, 1993; Camarinha-Matos & Afsarmanesh, 1999; Cunha, Putnik, & Ávila, 2000; Davidow & Malone, 1992; Preiss, Goldman, & Nagel, 1996), a VE consists of a network of independent enterprises (resources providers) with reconfiguration capability in useful time, permanently aligned with the market requirements, created to take profit from a specific market opportunity, and where each participant contributes with its best practices and core competencies to the success and competitiveness of the structure as a whole. Even during the operation phase of the VE, the configuration can change, to assure business alignment with the market demands, traduced by the identification of reconfiguration opportunities and continuous readjustment or reconfiguration of the VE network, to meet unexpected situations or to keep permanent competitiveness and maximum performance (Cunha & Putnik, 2002, 2005a, 2005b).

Assessment and optimization of wind energy integration into the power systems: application to the portuguese system

The increasing integration of wind energy in power systems can be responsible for the occurrence of over-generation, especially during the off-peak periods. This paper presents a dedicated methodology to identify and quantify the occurrence of this over-generation and to evaluate some of the solutions that can be adopted to mitigate this problem. The methodology is applied to the Portuguese power system, in which the wind energy is expected to represent more than 25% of the installed capacity in a near future. The results show that the pumped-hydro units will not provide enough energy storage capacity and, therefore, wind curtailments are expected to occur in the Portuguese system. Additional energy storage devices can be implemented to offset the wind energy curtailments. However, the investment analysis performed show that they are not economically viable, due to the present high capital costs involved.

Is the electric vehicle a solution for the wind power integration in the portuguese power system?

The integration of Plug-in electric vehicles in the transportation sector has a great potential to reduce oil dependency, the GHG emissions and to contribute for the integration of renewable sources into the electricity generation mix. Portugal has a high share of wind energy, and curtailment may occur, especially during the off-peak hours with high levels of hydro generation. In this context, the electric vehicles, seen as a distributed storage system, can help to reduce the potential wind curtailments and, therefore, increase the integration of wind power into the power system. In order to assess the energy and environmental benefits of this integration, a methodology based on a unit commitment and economic dispatch is adapted and implemented. From this methodology, the thermal generation costs, the CO2 emissions and the potential wind generation curtailment are computed. Simulation results show that a 10% penetration of electric vehicles in the Portuguese fleet would increase electrical load by 3% and reduce wind curtailment by only 26%. This results from the fact that the additional generation required to supply the electric vehicles is mostly thermal. The computed CO2 emissions of the EV are 92 g CO2/kWh which become closer to those of some new ICE engines.

Integration of e-learning systems with repositories of learning objects

This paper describes a communication model to integrate repositories of programming problems with other e-Learning software components. The motivation for this work comes from the EduJudge project that aims to connect an existing repository of programming problems to learning management systems. When trying to use the existing repositories of learning objects we realized that they are mainly specialized search engines and lack features for integration with other e-Learning systems. With this model we intend to clarify the main features of a programming problem repository, in order to enable the design and development of software components that use it. The two main points of this model are the definition of programming problems as learning objects and the definition of the core functions exposed by the repository. In both cases, this model follows the existing specifications of the IMS standard and proposes extensions to deal with the special requirements of automatic evaluation and grading of programming exercises. In the definition of programming problems as learning objects we introduced a new schema for meta-data. This schema is used to represent meta-data related to automatic evaluation that cannot be conveniently represented using the standard: the type of automatic evaluation; the requirements of the evaluation engine; or the roles of different assets - tests cases, program solutions, etc. In the definition of the core functions we used two different web services flavours - SOAP and REST - and described each function as an operation for each type of interface. We describe also the data types of the arguments of each operation. These data types consist mainly on learning objects and their identifications, but include also usage reports and queries using XQuery.

Integration of repositories in Moodle

Current Learning Management Systems focus on the management of students, keeping track of their progress across all types of training activities. This type of systems lacks integration with other e-Learning systems. For instance, learning objects stored in a centralized repository are unavailable throughout an organization for potential reuse. In this paper we present the interoperability features of crimsonHex - a service oriented repository of learning objects - highlighting the use of XML languages. Its nteroperability features are compliant with the existing standards and we propose extensions to the IMS interoperability recommendation, adding new functions, formalizing an XML message interchange and providing also a REST interface. To validate the proposed extensions and its implementation in crimsonHex we designed two repository plugins for Moodle 2.0, the first of which is already implemented and is expected to be included in the next release of this popular learning management system.

Using the learning tools interoperability framework for LMS integration in service oriented architectures

The LMS plays an indisputable role in the majority of the eLearning environments. This eLearning system type is often used for presenting, solving and grading simple exercises. However, exercises from complex domains, such as computer programming, require heterogeneous systems such as evaluation engines, learning objects repositories and exercise resolution environments. The coordination of networks of such disparate systems is rather complex. This work presents a standard approach for the coordination of a network of eLearning systems supporting the resolution of exercises. The proposed approach use a pivot component embedded in the LMS with two roles: provide an exercise resolution environment and coordinate the communication between the LMS and other systems exposing their functions as web services. The integration of the pivot component with the LMS relies on the Learning Tools Interoperability. The validation of this approach is made through the integration of the component with LMSs from two vendors.

Integration of e-portfolios in learning management systems

The LMS plays a decisive role in most eLearning environments. Although they integrate many useful tools for managing eLearning activities, they must also be effectively integrated with other specialized systems typically found in an educational environment such as Repositories of Learning Objects or ePortfolio Systems. Both types of systems evolved separately but in recent years the trend is to combine them, allowing the LMS to benefit from using the ePortfolio assessment features. This paper details the most common strategies for integrating an ePortfolio system into an LMS: the data, the API and the tool integration strategies. It presents a comparative study of strategies based on the technical skills, degree of coupling, security features, batch integration, development effort, status and standardization. This study is validated through the integration of two of the most representative systems on each category - respectively Mahara and Moodle.

Herb-drug interactions among commonly used psychoactive substances by healthcare students

The concurrent use of herbs and/or nutritional supplements with psychoactive effect and prescription medications is common among college students. College students are a particularly vulnerable population, for they are under less social/familiar surveillance and seek greater independence, as well as under greater intellectual effort, stress, anxiety and depression, which predispose them to a higher consumption of psychoactive substances. Herbs, vitamins, and other dietary supplements may influence the effects of prescription and nonprescription drugs leading to adverse consequences, by increasing the potential for interactions. However, documented interactions between herbal medicinal products and prescribed drugs are rare. Objective: determine the prevalence of concomitant use of psychoactive substances among healthcare students in the Lisbon School of Health Technology, Portugal, in order to assess the risk of potential herb-drug interactions.

An Ethos Theory of Party Positions on European Integration: Poland and Beyond

Since 1989, five parliamentary elections have been the stage for the foundation and demise of political parties aspiring to govern the new democratic Polish state. The demise of the AWS before the 2001 elections after ten years of attempts to create a centre-right core party resulted in a new splintering of the right-wing, and the centre-right became again devoid of a pivotal formation. While Eurosceptic parties in average gain 8 percent of the vote, in the 2001 Polish parliamentary elections Eurosceptic parties gained around 20 percent of the vote. In Poland right-wing parties show an unusual propensity for Euroscepticism. The persistence and increased importance of nationalism in Poland, which has prevented the development of a strong Christian democratic party, effectively explains the levels of Euroscepticism on the right. After the autumn 2005 parliamentary elections the national conservative party, Law and Justice, formed a governing coalition with the national Catholic League of Polish Families, creating one of the first Eurosceptic governments. Although this work does not intend to provide a theorisation of party systems development, it shows that the context of European integration fostered nationalists’ divisiveness of, and provoked the splitting of the right the unusual propensity of parties for Euroscepticism makes Poland a paradigmatic case of the kind of conflicts over European integration emerging in Central and Eastern European party systems.