Barriers and facilitators in the provision of post-abortion care at district level in central Uganda : a qualitative study focusing on task sharing between physicians and midwives

Background: Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians' and midwives' perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods: In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results: Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions: Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.

Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

BACKGROUND: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

Barriers to entry in monopoly markets: automobile distribution in Brazil

O Objetivo deste Trabalho é Analisar os Efeitos da Entrada de uma Segunda Concessionária de Automóveis em Mercados Previamente Monopolizados. para Tanto, Construiu-Se um Banco de Dados com a Localização de Concessionárias de Automóveis em Microrregiões e Características Demográficas e Econômicas Destas Microrregiões. a Partir Desse Banco de Dados e de Modelos de Escolha Binária, Foram Identificadas Variáveis que Condicionam a Existência e o Número de Concessionárias em Microrregiões. Utilizando-Se de um Modelo Adaptado de Bresnahan e Reiss (1990), Foram Estimados os Custos Fixos de Entrada de Concessionárias em Mercados Monopolizados. os Resultados Obtidos Sugerem que as Barreiras À Entrada não são Significativas, o que Aumenta a Probabilidade de que a Cláusula de Exclusividade nos Contratos de Concessão não Cause Danos À Concorrência no Mercado Brasileiro de Distribuição de Automóveis

Barriers faced by the Brazilian business community to access the United States market system

Trade history between Brazil and the United States is long and complicated but it is only in recent years that the trade balance has become more equal in terms of both imports and exports. As Brazil continues to establish its position in the world economy and expand its export market it is only natural that it seeks to increase exports to its single largest trading partner, the United States, and maintain the market share already established. In order to achieve success in these regards Brazil must have a deep understanding of the American political economy system. Part of this entails understanding barriers that must be overcome by Brazilian businesses to access United States markets, particularly the access of certain products at the industry level.

On the long run effects of barriers to trade

We study the macroeconomic effects of international trade policy by integrating a Hecksher-Ohlin trade model into an optimal-growth framework. The model predicts that a more open economy will have higher factor productivity. Furthermore, there is a "selective development trap," an additional steady state with low income, to which countries may or may not converge, depending on policy. Income at the development trap falls as trade barriers increase. Hence, cross-country differences in barriers to trade may help explain the dispersion of per-capita income observed across countries. The effects are quantified and we show that protectionism can explain a relevant fraction of TFP and long-run income differentials across countries.

Trade barriers and productivity growth: cross-industry evidence

This article investigates the impact of trade protection on the evolution of labor productivity and total factor productivity (TFP) of the Brazilian manufacturing sector. An annual panel-dataset of 16 industries for the years 1985 through 1997, a period that includes a major trade liberalization, was used. The regressions reported here are robust to openness indicator (nominal tari®s and e®ective protection rate were used), control variables and time period and suggest that barriers to trade negatively a®ects productivity growth at industry level: those sectors with lower barriers experienced higher growth. We were also able to link the observed increase of industry productivity growth after 1991 to the widespread reduction on exective protection experienced in the country in the nineties.

On the growth effects of barriers to trade

We study the macroeconomic effects of international trade policy by integrating a Hecksher-Ohlin trade model into an optimal-growth framework. The model predicts that an open economy will have higher factor productivity and faster growth. Also, under protectionist policies there may be “development traps,” or additional steady states with low income. In the last case, higher tariffs imply lower incomes, so that the large cross-country differences in barriers to trade may explain part of the huge dispersion of per capita income observed across countries. The model simulation shows that the link between trade and macroeconomic performance may be quantitatively important.

Essays on the general equilibrium effects of barriers to trade on economic growth, foreign trade and the location of economic activity in Brazil

This work presents a fully operational interstate CGE model implemented for the Brazilian economy that tries to quantify both the role of barriers to trade on economic growth and foreign trade performance and how the distribution of the economic activity may change as the country opens up to foreign trade. Among the distinctive features embedded in the model, modeling of external scale economies, port efficiency and land-maritime transport costs provides an innovative way of dealing explicitly with theoretical issues related to integrated regional systems. In order to illustrate the role played by the quality of infrastructure and geography on the country‟s foreign and interregional trade performance, a set of simulations is presented where barriers to trade are significantly reduced. The relative importance of trade policy, port efficiency and land-maritime transport costs for the country trade relations and regional growth is then detailed and quantified, considering both short run as well as long run scenarios. A final set of simulations shed some light on the effects of liberal trade policies on regional inequality, where the manufacturing sector in the state of São Paulo, taken as the core of industrial activity in the country, is subjected to different levels of external economies of scale. Short-run core-periphery effects are then traced out suggesting the prevalence of agglomeration forces over diversion forces could rather exacerbate regional inequality as import barriers are removed up to a certain level. Further removals can reverse this balance in favor of diversion forces, implying de-concentration of economic activity. In the long run, factor mobility allows a better characterization of the balance between agglomeration and diversion forces among regions. Regional dispersion effects are then clearly traced-out, suggesting horizontal liberal trade policies to benefit both the poorest regions in the country as well as the state of São Paulo. This long run dispersion pattern, on one hand seems to unravel the fragility of simple theoretical results from recent New Economic Geography models, once they get confronted with more complex spatially heterogeneous (real) systems. On the other hand, it seems to capture the literature‟s main insight: the possible role of horizontal liberal trade policies as diversion forces leading to a more homogeneous pattern of interregional economic growth.

Barriers to trade: barriers to growth

We study the cxtent to which differences in international trade policies contribute to the significant cross-country disparities in macroeconomic performance. In particular, wc concentrate on the effect of protectionism on generating differences in leveIs (of income and of measured total factor productivity), in growth rates (of output, productivity and inputs), in volatility and in trends (or development traps). We document that these rclationships are strong in cross country data, integrate a Hecksher-Ohlin mode! of international trade into the standard macroeconomic modcl to derive those rclationships analytically, and to quantify them. Our results suggest that a large fraction of the cros::; country variations can be attributed to trade policy.

Barriers to entry and development

This paper analyzes the effect of an accountability system in the Brazilian college market. For each discipline, colleges were assigned a grade that depended on the scores of their students on the ENC, an annual mandatory exam. Those grades were then disclosed to the public, giving applicants information about college quality. The system also established rewards and penalties based on the colleges’ grades. I find that the ENC had a substantial effect on different measures of college quality, such as faculty education and the proportion of full-time faculty. The detailed information from this unique dataset and the fact that the ENC started being required for different disciplines in different years allow me to control for time-specific effects, thus minimizing the bias caused by policy endogeneity. Indeed, I find strong evidence on the importance of controlling for time-specific effects: estimates of the impact of the ENC on college quality more than double when I do not take those effects into account. The ENC also affects positively the ratio between applicants and vacancies, and it decreases the faculty and the entering class sizes. The results suggest that its introduction fostered competition and favored colleges entering the market.

Energy education: breaking up the rational energy use barriers

Human development is associated directly or indirectly with the energy use, and because of this the energetic sources were dealt with in the recent past, as fully available to human necessities. The reality shows that the energy availability, considering the nonrenewable sources, is limited, and beyond that, the exploration, the processing and the use of energy impose considerable impacts on the environment. There is not a system which operates with no losses and without imposing changes to the environment. Therefore, the energy conservation incorporates the concepts and the actions applied to the research of sustainable balance between nature and the energy availability and use. Such actions can be presented both in the short term, in which the energy system is close to a collapse, or in the medium/long term, in which those responsible for the energy policies are concerned with the structure of the socioeconomic development. Such a situation requires more responsibility in the treatment of energy questions, mainly through education, which represents long-term investments. This paper discusses barriers that are present in the projects applied to energy conservation, by making clear that education is one of the best ways to transform the human behavior in for the rational use of energy. (C) 2003 Elsevier B.V. Ltd. All rights reserved.

Stages of behavior change and perceived barriers to physical activity in the elderly living in a medium size city in Brazil

The aim was to analyze the prevalence of the stages of behavior change (BCS) and the perceived barriers to physical activity in older people residents in a medium size city of São Paulo state, Brazil. Seventy-nine older people participated of the study. The BCS was assessed by the Questionnaire of Behavior Chance Stages and those on perception of barriers by the Questionnaire on Barriers to the Practice of Physical Activity in Older People (QBPPAE). Statistical analyses was comprised by the Chi-square test (p<0.05). Data showed that: a) 64,6% of the older people do not practice physical activity and only 22,8% of them have been practicing it on a regular basis for more than 6 months; b) The most perceived barriers were: "Active enough", "Too old"; "Need to rest" and; "Disease or injury"; c) The BCS seems modulate significantly the perception of barriers (p<0.05). We can conclude that: a) most of the older people are in the pre-contemplation, contemplation and preparation stages of the BCS, yet; b) gender influences almost nothing with perception of barriers and; c) the BCS interferes with the type of perceived barriers. Such conclusions support the suggestions that it is necessary to develop specific strategies for different stages of behavior change if it is to minimize the barriers. This may help to find the most effective way to change to more active lifestyle in the elderly.

Guided bone regeneration with subperiosteal implants of PTFE and hydroxyapatite physical barriers in rats

A regeneração periodontal e do rebordo ósseo utilizando barreiras físicas são procedimentos bem estabelecidos em cirurgias reconstrutivas. As características do biomaterial e o desenho da membrana empregados na regeneração tecidual guiada desempenham um papel importante na obtenção de bons resultados. O objetivo deste estudo experimental histológico foi comparar o uso de dois tipos de barreiras físicas na regeneração óssea guiada em defeitos criados na tíbia de ratos. Quinze animais foram divididos em três grupos: grupo I (barreira não-porosa de politetrafluoretileno), grupo II (blocos de hidroxiapatita de coral) e grupo III (controle que não recebeu nenhuma barreira). A análise histológica demonstrou várias quantidades de osso neoformado com ambos os tipos de barreiras. A barreira de politetrafluoretileno mostrou melhores resultados do que a hidroxiapatita. Os resultados deste estudo sugerem que a regeneração óssea pode ser conseguida com a técnica de submersão da barreira física.