"An on-going individual adjustment" : a qualitative study of midwives' experiences counselling pregnant women on physical activity in Sweden

Background: In Sweden, midwives play prominent supportive role in antenatal care by counselling and promoting healthy lifestyles. This study aimed to explore how Swedish midwives experience the counselling of pregnant women on physical activity, specifically focusing on facilitators and barriers during pregnancy. Also, addressing whether the midwives perceive that their own lifestyle and body shape may influence the content of the counselling they provide. Methods: Eight focus group discussions (FGD) were conducted with 41 midwives working in antenatal care clinics in different parts of Sweden between September 2013 and January 2014. Purposive sampling was applied to ensure a variation in age, work experience, and geographical location. The FGD were digitally recorded, transcribed verbatim, and analyzed using manifest and latent content analysis. Results: The main theme- "An on-going individual adjustment" was built on three categories: "Counselling as a challenge"; "Counselling as walking the thin ice" and "Counselling as an opportunity" reflecting the midwives on-going need to adjust their counselling depending on each woman's specific situation. Furthermore, counselling pregnant women on physical activity was experienced as complex and ambiguous, presenting challenges as well as opportunities. When midwives challenged barriers to physical activity, they risked being rejected by the pregnant women. Despite risking rejection, the midwives tried to promote increased physical activity based on their assessment of individual needs of the pregnant woman. Some participants felt that their own lifestyle and body shape might negatively influence the counselling; however, the majority of participants did not agree with this perspective. Conclusions: Counselling on physical activity during pregnancy may be a challenging task for midwives, characterized by on-going adjustments based on a pregnant woman's individual needs. Midwives strive to find individual solutions to encourage physical activity. However, to improve their counselling, midwives may benefit from further training, also organizational and financial barriers need to be addressed. Such efforts might result in improved opportunities to further support pregnant women's motivation for performance of physical activity.

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.

Coalition Formation through Motivation and Trust

Cooperation is the fundamental underpinning of multi-agent systems, allowing agents to interact to achieve their goals. Where agents are self-interested, or potentially unreliable, there must be appropriate mechanisms to cope with the uncertainty that arises. In particular, agents must manage the risk associated with interacting with others who have different objectives, or who may fail to fulfil their commitments. Previous work has utilised the notions of motivation and trust in engendering successful cooperation between self-interested agents. Motivations provide a means for representing and reasoning about agents' overall objectives, and trust offers a mechanism for modelling and reasoning about reliability, honesty, veracity and so forth. This paper extends that work to address some of its limitations. In particular, we introduce the concept of a clan: a group of agents who trust each other and have similar objectives. Clan members treat each other favourably when making private decisions about cooperation, in order to gain mutual benefit. We describe mechanisms for agents to form, maintain, and dissolve clans in accordance with their self-interested nature, along with giving details of how clan membership influences individual decision making. Finally, through some simulation experiments we illustrate the effectiveness of clan formation in addressing some of the inherent problems with cooperation among self-interested agents.

Towards Motivation-based Plan Evaluation

AI planning systems tend to be disembodied and are not situated within the environment for which plans are generated, thus losing information concerning the interaction between the system and its environment. This paper argues that such information may potentially be valuable in constraining plan formulation, and presents both an agent- and domainindependent architecture that extends the classical AI planning framework to take into account context, or the interaction between an autonomous situated planning agent and its environment. The paper describes how context constrains the goals an agent might generate, enables those goals to be prioritised, and constrains plan selection.

Choreographic exploration of physical duress: motivation for and responses to exhaustion (a project in performance)

What motivates someone to dance until they are exhausted, sweaty, boiling hot and out of breath? I myself, recalling experiences when I have danced so hard I've nearly fainted, remember how exhilarating that motivation can be. But why? Why is that at all pleasant? Of course, I had several of my own explanations, but I was also interested in doing some scientific research on exhaustion. This question was of ample depth to become the basis of my project.

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.

Implementação de sistemas de gestão integrados no setor de construção: estudo de casos brasileiros

As pressões de mercado, os programas de abertura financeira, a desregulamentação da atividade produtiva e a diminuição de barreiras protecionistas afetam significativamente a competitividade da indústria nacional. Outras mudanças, não apenas econômicas, mas sociais, políticas e tecnológicas, também pressionam as organizações a adotar novas estratégias empresariais e deixam claro que modelos de gestão tradicionais já não são mais suficientes para enfrentar estes novos desafios. Na busca de diferenciais competitivos, as empresas têm adotado sistemas de gestão da qualidade, de gestão ambiental e de gestão da saúde e segurança do trabalhador. Como forma de evidenciar a terceiros sua preocupação simultânea com estas três disciplinas, as empresas têm buscado a certificação integrada destes sistemas por meio das normas ISO 9001, ISO 14001 e OHSAS 18001. Surgem, assim, os Sistemas de Gestão Integrados (SGIs), objetos de pesquisa deste estudo. O recorte é setorial, sendo que o setor de construção foi escolhido devido a características como singularidade de seus produtos, alto impacto ambiental e alto índice de acidentes de trabalho. Com o objetivo de investigar como os SGIs foram implementados no setor de construção, foram escolhidos três casos de empresas sabidamente adotantes deste modelo de gestão. Foram analisadas as motivações, o processo de implementação e certificação do sistema, os fatores críticos de sucesso, as dificuldades encontradas e os benefícios colhidos com a adoção de SGIs. A pesquisa confirmou estudos anteriores que demonstram que a motivação, dependendo do contexto em que as empresas se inserem, pode ser por necessidade de maior competitividade, de legitimação, ou ainda, por responsabilidade ambiental de sua liderança. Os fatores críticos de sucesso são, dentre outros, comprometimento da alta administração, comunicação eficiente com as partes interessadas, disponibilidade de recursos e maturidade das equipes. As dificuldades encontradas foram a valorização excessiva de resultados econômico-financeiros, a complexidade do modelo adotado, a utilização burocrática do sistema, a falta de maturidade e preparo dos profissionais, o porte dos projetos, o perfil de competências dos profissionais e variados tipos de resistências. A adoção do SGI nas empresas estudadas esteve condicionada a situações do cenário econômico, do alto índice de terceirização verificado no setor e às dificuldades com a qualificação da mão-de-obra. Não obstante as dificuldades e os condicionantes, o SGI trouxe vários benefícios para as organizações e, um dado relevante, é que ele pode desencadear reações positivas ao longo da cadeia de valor, uma vez que as empresas adotantes de SGI passam a ser mais exigentes em relação a seus fornecedores.