As ações de controle da tuberculose na atenção primária à saúde: a visão do doente

Tuberculosis is a disease of great impact on the world context today. In Brazil, the disease management was directed to the Primary Health Care, due to the determination of the Ministry of Health to decentralize health actions for primary care. Thus, since the actions of diagnosis, treatment and control of the disease should happen in this context, however, there are still many barriers that may hinder the realization of these determinations. This study aims to analyze the development of tuberculosis control activities conducted in the services of primary health care from the patient's vision. This is a descriptive, cross-sectional and quantitative study. The population consists of 517 tuberculosis patients treated in units of Primary Health Care in the city of Natal-RN; the sample consists of 93 TB patients. The collect instrument is structured, based in The Primary Care Assessment Tool (PCAT), validated in Brazil and adapted to assess attention to TB in Brazil, with modifications. This instrument was divided into blocks: the first one describes the socio-demographic information of patients with TB and the second one describes the health services working in control, diagnosis and treatment of TB, and includes issues related to the dimensions of primary care: access, bond, services, coordination of care, guidance to the community and family focus. For quantitative analysis, were built indicators for each item of the instrument. The response patterns are followed according to the Likert scale, which was assigned a value between one and five meant that the degree of preference relation (or agreement) of the statements. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. The results indicate that 62.37% of patients are male, 27.96% aged 41 to 50 years old, and 34.41% unemployed, with low education and low family income. It was found that the reference hospital services are the front door to the patient (59.14%), and are also the local diagnosis of the disease (72.04%). On access, the conditions satisfactory found are: the number of times the patients need to pick up the health care issue, the marking and the facility to get a consultancy in the HS, assistance provided without harm to the individual's attendance labor and facilities related to the proximity between the residence and services; were considered unsatisfactory conditions related to travel to the HS, and on hours and days of operation of services. As for the cast of services were satisfactory and regular actions related to the request for examination to become viable in the first HS, the availability of pot to perform smear and medicines for the treatment, as well as consultations control and receiving information about the disease and the treatment performed; it is considered unsatisfactory the performance of the home care for patients with TB by the HS that acts as a front door, for implementation of the Directly Observed Treatment (DOT), home visits during treatment, the provision of transportation allowance to the patient and the existence of groups for TB patients. Regarding the coordination of care, resulted in regular the action of referring the patient to other HS to obtain examinations, and as unsatisfactory referral to obtain medications. The relationship bond between patient and health team were considered satisfactory in the majority or regular. As for the family and community focus, is satisfactory only the indicator relating to questions from professionals to the patient about the existence of respiratory symptoms in the family. It is considered that there is need for greater commitment from government entities to the incentives required to TB control, as well as the availability of necessary inputs and training of human resources working in the PHC in the ongoing quest to strengthen primary care, as a place of broader host needs to contact the user with the actions and health professionals. It is recommended the adoption of management mechanisms possible to expand the capacity of the health PHC, promoting the service delivery to the user and ensuring attention to population health.

Utilização do Balanced Scorecard na gestão pública : um estudo de caso na Polícia Militar do Estado do Rio Grande do Norte

This dissertation deals with the use of the Balanced Scorecard (BSC) in the Military Police of Rio Grande do Norte (PMRN), an organization of service delivery in the area of public safety. For this purpose we sought refuge in the company's own documents, which presented the mission, vision and strategic objectives, which are items essential to the development of the instrument and its prospects. With the general objective of developing the BSC to PMRN, fitting into the methodology in a single case study, that from the desk study and according to their development, we established the classification of goals to the generic models and the BSC then adjusted according to public understanding of the corporation presented by professionals in the process of collection and in-depth interviews. Thus emerged the strategy map PMRN, based on the presentation of the causes and effects between the strategic objectives of each perspective, the value proposition to customers, internal processes needed to meet this value proposition and intangible assets, which are the basis to execute these processes

Egressos na avaliação da qualidade de um curso: o caso da Engenharia de Produção da UFRN

This thesis aims at analyzing the perspective of graduates perceived quality of an undergraduate course in order to contribute to continuous improvement. In order to achieve the proposed objectives, we performed a literature search, seeking together the work surrounding this issue, with the intent to update the concepts discussed today on the subject studied, they are: quality management, quality in higher education institutions and the system national assessment of higher education - Sinaes. The methodology is characterized as a case study, quantitative, and the object of study is composed of students who graduated from Production Engineering, Federal University of Rio Grande do Norte, which includes students who graduated from 2002 to 2010; data collection was done through the survey instrument, questionnaire, available online through SurveyMonkey interface, data analysis was done by means of descriptive statistics and multivariate analysis, including factor analysis. The proposed survey instrument consists of questions nineteen and twenty statements that address the central theme of this dissertation. The results show the identification of four latent factors (obtained by exploratory factor analysis), through two perspectives, the analysis of perception and importance, the results were similar in terms of the variable factors. The first factor was related to the support given to students, a factor known to support two extra class, the third factor related aspects of the library, and finalizing the evaluation and approached a factor of 4 facilities. Through research it was concluded that this study presents several points to be improved by the management team, and recommended to continue to evaluate the perceptions of graduates, seeking continuous improvement in service delivery by the university

O impacto dos custos não-gerenciáveis na determinação das tarifas de energia elétrica: um estudo nas companhias distribuidoras do nordeste que tiveram revisão tarifária nos exercícios de 2003 e 2004

This work presents results derived from a study related to impact on non-controllable costs in the determination of energy taxes. This is done analyzing tax review practiced by concessionaries responsible for the distribution of electrical energy located in the Northeastern Region of Brazil, between 2003 and 2004. This Region was chosen as a study area due to the researcher s expectation in congregating companies that deliver services to markets that have similar social-economical profiles. A brief explanation related to the restructuring of the electrical sector in Brazil is presented, pointing out that there was privatization of the great majority of these companies. The study also points out the definition of regulating rules in service delivery process. The components of taxes that are practiced by these companies aimed at final consumers, as well as the market as a whole and the revision process that is executed by Agência Nacional de Energia Elétrica ANEEL for the definition of these taxes are demonstrated in the research. A brief historical of the concessionaires that were focus of the research is presented, totaling five companies. Some data used by ANEEL in the tax review process was analyzed as well as data on components of approved taxes. It is concluded that as a media 47, 49% of the components of taxes in the researched companies correspond to the non-controllable costs. These is done considering previous classification by ANEEL in the tax review process. Although, if it is considered that these companies since 2006, by the means of participation in energy auctions are able to negotiate energy prices for their own needs, it is concluded that these concession contracts guarantee the delivery of the service to the costumer in the total tribute. The percentage of non-controllable costs is 16, 27% average of the tax. This means, amongst other information, that the government has a great deal of responsibility in the formation of price practiced by these companies and its target markets

The variability and predictors of quality of AIDS care services in Brazil

Background: Since establishing universal free access to antiretroviral therapy in 1996, the Brazilian Health System has increased the number of centers providing HIV/AIDS outpatient care from 33 to 540. There had been no formal monitoring of the quality of these services until a survey of 336 AIDS health centers across 7 Brazilian states was undertaken in 2002. Managers of the services were asked to assess their clinics according to parameters of service inputs and service delivery processes. This report analyzes the survey results and identifies predictors of the overall quality of service delivery.Methods: The survey involved completion of a multiple-choice questionnaire comprising 107 parameters of service inputs and processes of delivering care, with responses assessed according to their likely impact on service quality using a 3-point scale. K-means clustering was used to group these services according to their scored responses. Logistic regression analysis was performed to identify predictors of high service quality.Results: The questionnaire was completed by 95.8% (322) of the managers of the sites surveyed. Most sites scored about 50% of the benchmark expectation. K-means clustering analysis identified four quality levels within which services could be grouped: 76 services (24%) were classed as level 1 (best), 53 (16%) as level 2 (medium), 113 (35%) as level 3 (poor), and 80 (25%) as level 4 (very poor). Parameters of service delivery processes were more important than those relating to service inputs for determining the quality classification. Predictors of quality services included larger care sites, specialization for HIV/AIDS, and location within large municipalities.Conclusion: The survey demonstrated highly variable levels of HIV/AIDS service quality across the sites. Many sites were found to have deficiencies in the processes of service delivery processes that could benefit from quality improvement initiatives. These findings could have implications for how HIV/AIDS services are planned in Brazil to achieve quality standards, such as for where service sites should be located, their size and staffing requirements. A set of service delivery indicators has been identified that could be used for routine monitoring of HIV/AIDS service delivery for HIV/AIDS in Brazil (and potentially in other similar settings).

High expectations, varying outcomes: Decentralization and participation in Brazil, Japan, Russia and Sweden

In the past 20 years, decentralization has been proposed as a strategy for enhancing public participation. Aid-providing organizations, such as the World Bank, stimulated decentralization processes in several countries in the hope that this would promote civic empowerment, diminish corruption, enhance efficiency, and improve public service delivery. This assumption forms the basis for a comparative analysis into the relation between decentralization and participation at the local level in Brazil, Japan, Russia and Sweden. A multi-level regression analysis using the data of the Democracy and Local Governance Project was undertaken in order to test the 'one size fits all' and the 'diversity in development' hypotheses. The results show that the second hypothesis was corroborated. Perceived autonomy had a different impact on openness to participation depending on the country considered; in one country (Japan), perceived autonomy diminished public officials' willingness to be open to public participation.

Structural change and productivity growth, 20 years later: old problems, new opportunities

Includes bibliography

e-Government architectures, technical and political situation in Latin America

Includes bibliography

Trade in services in Latin America and the Caribbean: an analysis of recent trends

Includes bibliography

Structural change and productivity growth 20 years later: old problems, new opportunities. Summary

Includes bibliography

Governo eletrônico, democracia digital e comunicação pública: a presença do poder judiciário na internet

Pós-graduação em Comunicação - FAAC

A gestão nas unidades básicas de saúde no município de São Paulo: a percepção dos trabalhadores

Pós-graduação em Serviço Social - FCHS

Rural governance and livelihoods systems diversification in the Western Balkans: comparative case studies of Bosnia and Herzegovina, Montenegro and Serbia

Agriculture is still important for socio-economic development in rural areas of Bosnia, Montenegro and Serbia (BMS). However, for sustainable rural development rural economies should be diversified so attention should be paid also to off-farm and non-farm income-generating activities. Agricultural and rural development (ARD) processes and farm activity diversification initiatives should be well governed. The ultimate objective of this work is to explore linkages between ARD governance and rural livelihoods diversification in BMS. The thesis is based on an extended secondary data analysis and surveys. Questionnaires for ARD governance and coordination were sent via email to public, civil society and international organizations. Concerning rural livelihood diversification, the field questionnaire surveys were carried out in three rural regions of BMS. Results show that local rural livelihoods are increasingly diversified but a significant share of households are still engaged in agriculture. Diversification strategies have a chance to succeed taking into consideration the three rural regions’ assets. However, rural households have to tackle many problems for developing new income-generating activities such as the lack of financial resources. Weak business skills are also a limiting factor. Fully exploiting rural economy diversification potential in BMS requires many interventions including improving rural governance, enhancing service delivery in rural areas, upgrading rural people’s human capital, strengthening rural social capital and improving physical capital, access of the rural population to finance as well as creating a favourable and enabling legal and legislative environment fostering diversification. Governance and coordination of ARD policy design, implementation and evaluation is still challenging in the three Balkan countries and this has repercussions also on the pace of rural livelihoods diversification. Therefore, there is a strong and urgent need for mobilization of all rural stakeholders and actors through appropriate governance arrangements in order to foster rural livelihoods diversification and quality of life improvement.

Comparing expectations and experiences of care for sexually transmitted infections in general practice: a qualitative study

Background A key aim of England's National Strategy for Sexual Health is to extend high-quality sexual health services in primary care. Objectives To explore the expectations and experiences of men and women who initially presented at their general practice with a suspected sexually transmitted infection in order to identify areas where change could improve service delivery. Methods Semi-structured interviews were carried out in six general practices and two genitourinary medicine (GUM) clinics in Brent primary care trust (London) and Bristol (southwest England). Patients within general practice, and GUM patients who had initially attended general practice were eligible to participate. Interview transcripts were analysed using thematic analysis. Results 49 patients (29 women, 20 men) were interviewed. Patients approaching their GP practice typically expected written referral or in-house care, but this expectation was often not met. Absence of formal referral, lack of information and perceived avoidance of sexual health matters by practitioners were commonly cited as reasons for disappointment. However, a dedicated service within general practice met expectations well. Conclusion Purchasers and providers of all general practice services should ensure that any patient consulting in primary care with a suspected sexually transmitted infection can either receive appropriate care there, or a formal and supported referral to a specialised GUM clinic or primary care service.

Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey

Cardiac rehabilitation (CR) programmes support patients to achieve professionally recommended cardiovascular prevention targets and thus good clinical status and improved quality of life and prognosis. Information on CR service delivery in Europe is sketchy.