The profile of women who have experienced cesarean section and obstetric care at a public maternity hospital in Ribeirao Preto

The present paper presents the social and obstetric profile of women undergoing cesarean childbirth at a public maternity hospital in the interior of Sao Paulo state. This is a quantitative, retrospective, descriptive study performed using documental research. The collected data refer to the period between July and December 2005, and between January and June 2006. A total of 670 records were reviewed. A 23% rate of cesarean births was identified at the institution studied during the aforementioned period. The studied population was characterized as having a low level of education, living in a common-law relationship, and not having a paid occupation. The main indications for cesarean sections were iterativity and acute fetal distress. The findings revealed an emphasis on obstetric nursing in the low-risk normal childbirth scenario, considering the non-interventionist character inherent to their education and training.

The effect of noise on the voice of preschool institution educators

OBJECTIVE: To analyze the association between noise levels present in preschool institutions and vocal disorders among educators. METHODS: Cross-sectional study conducted in 2009 with 28 teachers from three preschool institutions located in the city of Sao Paulo (Southeastern Brazil). Sound pressure levels were measured according to Brazilian Technical Standards Association, with the use of a sound level meter. The averages were classified according to the levels of comfort, discomfort, and auditory damage proposed by the Pan American Health Organization. The educators underwent voice evaluation: self-assessment with visual analogue scale, auditory perceptual evaluation using the GRBAS scale, and acoustic analysis utilizing the Praat program. To analyze the association between noise and voice evaluation, descriptive statistics and the chi-square test were employed, with significance of 10% due to sample size. RESULTS: The teachers' age ranged between 21 and 56 years. The noise average was 72.7 dB, considered as damage 2. The professionals' vocal self-assessment ranked an average of 5.1 on the scale, being considered as moderate alteration. In the auditory-perceptual assessment, 74% presented vocal alteration, especially hoarseness; of these, 52% were considered mild alterations. In the acoustic assessment the majority presented fundamental frequency below the expected level. Averages for jitter, shimmer and harmonic-noise ratio showed alterations. An association between the presence of noise between the harmonics and vocal disorders was observed. CONCLUSIONS: There is an association between presence of noise between the harmonics and vocal alteration, with high noise levels. Although most teachers presented mild voice alteration, the self-evaluation showed moderate alteration, probably due to the difficulty in projection.

Tradition, Change and Variation : Past and Present Trends in Public Old-age Care

The general aim of this dissertation is to describe and analyse how public old-age care in Sweden has developed and changed during the last century. The study applies a provider perspective on how care has been planned and professionally carried out. A broader social policy perspective, studying old-age care at central/national as well as local/municipal level, is also developed. A special focus is directed at the large local variation in care and services for the elderly. The empirical base is comprised of official documents and other public sources, survey data from interviews with elderly recipients of public old-age care, and official statistics on publicly financed and controlled old-age care and services. Study I addresses the development of old-age care in Sweden during the twentieth century by studying an important occupation in this field – the supervisors and their professional roles, tasks and working conditions. Throughout, the roles of supervisors have followed the prevailing official policy on the proper way to provide care for elderly people in Sweden; from poor relief at the beginning of the 1900s, via a generous level of services in the 1960s and 1970s, to today’s restricted and economy-controlled mode of operation. Study II describes and compares two main forms of public old-age care in Sweden today, home help services and institutional care. The care-load found in home-based care was comparable to and sometimes even larger than in service-homes and other institutions, indicating that large care needs among elderly people in Sweden today can be met in their homes as well as in institutional settings. Studies III and IV analyse the local variation in public old-age care in Sweden. During the last decades there has been an overall decline in home help services. The coverage of home help for elderly people shows large differences between municipalities throughout this period, and the relative variation has increased. The local disparity seems to depend more on historical factors, e.g., previous coverage rates, than on the present municipal situation in levels of need or local economy and politics. In an introductory part the four papers are linked together by an outline of the demographic situation and the social policy model for old-age care in Sweden. Trends that have been apparent over time, e.g. professionalisation and market orientation, are traced and discussed. Conflicts between prevailing ideologies are analysed, in regards to for instance home-based and institution-based care, social and medical culture, and local and central levels of decision-making. ’Welfare municipality’, ‘path dependency’, and ‘decentralisation’ are suggested as a conceptual framework for describing the large and increasing local variations in old-age care. Finally, implications of the four studies with regard to old-age care policy and further research are discussed.

The Presidential Institution in Bulgaria, Albania and Romani: An Attempt at Comparison"

Bulgaria, Albania and Romania are all parliamentary republics with a president as head of state. Although the Albanian president is elected by Parliament, he is arguably the strongest of the three, both in terms of the powers allowed by the provisional constitution and of Mr. Berisha's political practice. The constitutional reform underway in the country will however change the status quo. In Bulgaria and Romania the presidents are elected directly by popular vote, but their powers are relatively small as compared to the democratic legitimisation implied by direct elections. Actual presidential powers should however be assessed with caution as some of them are set by law or interpretations of constitutional texts, rather than by the constitutions themselves. There is also variation in the degree to which the presidents in office have exploited their constitutional powers or taken their role as non-aligned political brokers seriously. Mr. Berisha, in particular, was in control of party politics throughout his presidency and was one of the most polarising influences on public opinion. The excessive political polarisation in all three countries has however its own logic and power. Thus Mr. Zhelev invariably supported the emergence of a political centre in Bulgaria, but this did not succeed and the policy was as damaging to his political career as the fight with would-be centrists was to Berisha's. Political practice in all three countries seems to need a presidential figure. This adds flexibility to a situation governed by hostile and mutually suspicious parties, stuck parliaments and weak or inexperienced governments. The presidents also command considerable influence on public opinion. Public opinion in Bulgaria, for example, largely supports the idea of greater power for the president, in contrast with the opinions of constitutionalists and other law-makers in the country. Under the legacy of the past, the people have a love-hate relationship with such paternalist figures. Presidents personalise politics in the public mind, but they can also become scapegoats for political failures.

Does culture affect public service motivation? Evidence of sub-national differences in Switzerland

This article explores societal culture as an antecedent of public service motivation. Culture can be a major factor in developing an institution-based theory of public service motivation. In the field of organization theory, culture is considered a fundamental factor for explaining organization behavior. But our review of the literature reveals that culture has not been fully integrated into public service motivation theory or carefully investigated in this research stream. This study starts to fill this gap in the literature by using institutionalism and social-identity theory to predict how the sub-national Germanic and Latin cultures of Switzerland, which are measured through the mother tongues of public employees and the regional locations of public offices, affect their levels of public service motivation. Our analysis centers on two large data sets of federal and municipal employees, and produces evidence that culture has a consistent impact on public service motivation. The results show that Swiss German public employees have a significantly higher level of public service motivation on the whole, while Swiss French public employees have a significantly lower level overall. Implications for theory development and future research are discussed.

Book Review: Public Service Media and Policy in Europe

Much has happened in the past fifty years, and the broadcasting system and in fact the entire media landscape have changed in many significant ways. Yet, the debate on the role of public service media and the involvement of the state in them still perseveres. It has indeed been reinvigorated due to the tectonic shifts in media production, distribution, access and consumption caused by digital technologies in general, and the Internet in particular. The gist of the debates has however curiously remained almost the same and is still focused on a set of economic arguments that call for state intervention in public media, and not unimportantly, on the various political interpretations of these economic arguments. In Europe, the debate has another essential core too, as Public Service Broadcasting (PSB) has been traditionally entrusted to serve some higher goals intrinsically related to key democratic and cultural processes. Accordingly, PSB in Western Europe has developed as the core media institution at the national level and has become deeply embedded in many facets of the nation’s economic, political, social and cultural life. Against the backdrop of PSB’s history, its vital tasks in society, as well as the dramatic changes brought about by the digitally networked environment, the question on the future of PSB and its transition into Public Service Media (PSM) is very interesting, to say the least, and highly challenging at the same time. The book by Karen Donders, Public Service Media and Policy in Europe (Palgrave, 2012), makes an essential contribution to these complex debates, and more importantly, adds some new value to an otherwise saturated discourse.

Ethnicity, Governance and the Provision of Public Goods

Ethnicity is an important institution and one that impacts on the quality of governance. This paper focuses on the behavior of ethnic groups and specifically on their impact on the provision of public goods. The paper shows that ethnic heterogeneity results in under-provision of non-excludable public goods. On the other hand, such societies associate with provision of patronage goods. The paper proposes some areas of research such the economics of ethnic institutions, empirical evidence of the role ethnic groups on public goods provision, tax compliance and institutional reforms to improve governance.

Penetrating injuries of the thorax and abdomen: Type of medical-care institution and case fatality

The purpose of this study was to determine, for penetrating injuries (gunshot, stab) of the chest/abdomen, the impact on fatality of treatment in trauma centers and shock trauma units compared with general hospitals. Medical records of all cases of penetrating injury limited to chest/abdomen and admitted to and discharged from 7 study facilities in Baltimore city 1979-1980 (n = 581) were studied: 4 general hospitals (n = 241), 2 area-wide trauma centers (n = 298), and a shock trauma unit (n = 42). Emergency center and transferred cases were not studied. Anatomical injury severity, measured by modified Injury Severity Score (mISS), was a significant prognostic factor for death, as were cardiovascular shock (SBP $\le$ 70), injury type (gunshot vs stab), and ambulance/helicopter (vs other) transport. All deaths occurred in cases with two or more prognostic factors. Unadjusted relative risks of death compared with general hospitals were 4.3 (95% confidence interval = 2.2, 8.4) for shock trauma and 0.8 (0.4, 1.7) for trauma centers. Controlling for prognostic factors by logistic regression resulted in these relative risks: shock trauma 4.0 (0.7, 22.2), and trauma centers 0.8 (0.2, 3.2). Factors significantly associated with increased risk had the following relative risks by multiple logistic regression: SBP $\le$ 70 (RR = 40.7 (11.0, 148.7)), highest mISS (42 (7.7, 227)), gunshot (8.4 (2.1, 32.6)), and ambulance/helicopter transport (17.2 (1.3, 228.1)). Controlling for age, race, and gender did not alter results significantly. Actual deaths compared with deaths predicted from a multivariable model of general-hospital cases showed 3.7 more than predicted deaths in shock trauma (SMR = 1.6 (0.8, 2.9)) and 0.7 more than predicted deaths in area-wide trauma centers (SMR = 1.05 (0.6, 1.7)). Selection bias due to exclusion of transfers and emergency center cases, and residual confounding due to insufficient injury information, may account for persistence of adjusted high case fatality in shock trauma. Studying all cases prospectively, including emergency center and transferred cases, is needed. ^

Religion, Democracy and the Public Sphere

Throughout the development and maturation of the American democratic experience, religiously inspired conduct has contributed significantly to democratically progressive political concerns such as the abolition of slavery and campaigns for civil rights, but also the encouragement and perpetuation pf anti-democratic practices such as the institution of slavery and policies of racial segregation. It may be rarely admitted, but there is no essential conceptual affinity between conduct proper to democratic political association. It may, therefore, be useful in our own political circumstances to try to determine boundaries for conduct that expresses and satisfies compatibly both religious and democratic commitments. Perhaps most Americans do recognize – if not in their own cases, at least in reference to the beliefs and actions of others – that religiously inspired conduct is neither thereby justified morally or legally nor absolved from further critical appraisal. Certainly, the history of American legal practice shows that religious belief or inspiration does not serve as acceptable legal defense for conduct charged as criminal infraction. The U.S. Constitution contains only two references to religion: the non-establishment clause prohibits governmental institutionalization of religious beliefs or liberty rights – is limited in scope and application both by other constitutional rights of individuals and by constitutionally authorized powers of government. As the U.S.S.C. has repeatedly held, individual constitutional features must be understood in a manner that harmonizes all stated and implied constitutional features, not by unbridled abstractions of selected phrases. Under the American legal system, there is no absolute or unlimited right to free exercise of religion: not everything done publicly under religious inspiration is legally permissible; what is otherwise illegal conduct is not legalized by religious inspiration. In important respects, general features of the legal boundaries concerning religiously inspired conduct in public life are reasonably clear; nevertheless, broader issues concerning further moral or ethical constraints upon religiously inspired conduct remain unresolved and rarely addressed explicitly.

Oceanic ichthyology : a treatise on the deep-sea and pelagic fishes of the world, based chiefly upon the collections made by the steamers "Blake," "Albatross," and "Fishhawk" in the northwestern Atlantic, with an atlas containing 417 figures / by George Brown Goode and Tarleton H. Bean. Pub. in connection with the National Museum and the Smithsonian institution.

v.22 (1896) text

Oceanic ichthyology : a treatise on the deep-sea and pelagic fishes of the world, based chiefly upon the collections made by the steamers "Blake," "Albatross," and "Fishhawk" in the northwestern Atlantic, with an atlas containing 417 figures / by George Brown Goode and Tarleton H. Bean. Pub. in connection with the National Museum and the Smithsonian institution.

v.22 (1896) atlas

Souvenir of Mills College and seminary illustrating principal points of interest connected with the institution.

Mode of access: Internet.

Group work in the institution : a modern challenge.

Mode of access: Internet.