The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006]

Background: In 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality and improving maternal health by 2015.Objective: To evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality.Methods: Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage), with p < 0.05.Results: Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births). The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal mortality.Conclusions: This safe motherhood referral system was a good strategy in reducing perinatal mortality and direct causes of maternal mortality and decreasing the overall rate of C-sections.

Cooperação e apoio técnico entre estado e municípios: a experiência do programa articuladores da atenção básica em São Paulo

Com os processos de regionalização no final dos anos 1990, os estados iniciam um resgate de seu papel político para enfrentamento da fragmentação do sistema público de saúde. Nesse processo, as secretarias estaduais de saúde, representadas pelo Conselho Nacional de Secretários de Saúde, passam a redefinir as funções do Estado junto à Atenção Básica. Na histórica atuação da Secretária de Estado da Saúde de São Paulo (SES-SP) na atenção primária, uma das marcas refere-se à expertise profissional nesse campo, que com o processo de municipalização migrou para os municípios, especialmente os de maior porte, ou redefiniu suas áreas de atuação no interior da própria SES-SP, em áreas como a vigilância epidemiológica e sanitária, a de avaliação e controle, entre outras. Esse capital humano foi em parte resgatado a partir de 2009, com o Programa Articuladores de Atenção Básica. O Programa representa uma política de apoio da SES-SP para os municípios, priorizando aqueles com população inferior a 100 mil habitantes, com o objetivo de auxiliar os gestores municipais na qualificação dos serviços de Atenção Básica e fortalecer esse nível de atenção no sistema público de saúde. Toma como objeto de trabalho o reconhecimento de prioridades de saúde locais e dos obstáculos para a melhoria da atenção à saúde, na construção conjunta de estratégias e alternativas de enfrentamento dos problemas identificados. Este artigo apresenta o processo de implantação desse Programa, bem como alguns resultados referentes às principais frentes de atuação desses profissionais na busca da qualificação da atenção básica no estado.

Development of an open case-based decision-support system for diagnosis in oral pathology

Making diagnoses in oral pathology are often difficult and confusing in dental practice, especially for the lessexperienced dental student. One of the most promising areas in bioinformatics is computer-aided diagnosis, where a computer system is capable of imitating human reasoning ability and provides diagnoses with an accuracy approaching that of expert professionals. This type of system could be an alternative tool for assisting dental students to overcome the difficulties of the oral pathology learning process. This could allow students to define variables and information, important to improving the decision-making performance. However, no current open data management system has been integrated with an artificial intelligence system in a user-friendly environment. Such a system could also be used as an education tool to help students perform diagnoses. The aim of the present study was to develop and test an open case-based decisionsupport system.Methods: An open decision-support system based on Bayes' theorem connected to a relational database was developed using the C++ programming language. The software was tested in the computerisation of a surgical pathology service and in simulating the diagnosis of 43 known cases of oral bone disease. The simulation was performed after the system was initially filled with data from 401 cases of oral bone disease.Results: the system allowed the authors to construct and to manage a pathology database, and to simulate diagnoses using the variables from the database.Conclusion: Combining a relational database and an open decision-support system in the same user-friendly environment proved effective in simulating diagnoses based on information from an updated database.

A tool to simplify the management of homogeneous and heterogeneous grids

To simplify computer management, several system administrators are adopting advanced techniques to manage software configuration on grids, but the tight coupling between hardware and software makes every PC an individual managed entity, lowering the scalability and increasing the costs to manage hundreds or thousands of PCs. This paper discusses the feasibility of a distributed virtual machine environment, named Flexlab: a new approach for computer management that combines virtualization and distributed system architectures as the basis of a management system. Flexlab is able to extend the coverage of a computer management solution beyond client operating system limitations and also offers a convenient hardware abstraction, decoupling software and hardware, simplifying computer management. The results obtained in this work indicate that FlexLab is able to overcome the limitations imposed by the coupling between software and hardware, simplifying the management of homogeneous and heterogeneous grids. © 2009 IEEE.

The Owner Share scheduler for a distributed system

In large distributed systems, where shared resources are owned by distinct entities, there is a need to reflect resource ownership in resource allocation. An appropriate resource management system should guarantee that resource's owners have access to a share of resources proportional to the share they provide. In order to achieve that some policies can be used for revoking access to resources currently used by other users. In this paper, a scheduling policy based in the concept of distributed ownership is introduced called Owner Share Enforcement Policy (OSEP). OSEP goal is to guarantee that owner do not have their jobs postponed for longer periods of time. We evaluate the results achieved with the application of this policy using metrics that describe policy violation, loss of capacity, policy cost and user satisfaction in environments with and without job checkpointing. We also evaluate and compare the OSEP policy with the Fair-Share policy, and from these results it is possible to capture the trade-offs from different ways to achieve fairness based on the user satisfaction. © 2009 IEEE.

The Brazilian Seismographic Integrated Systems (BRASIS): Infrastructure and data management

In geophysics and seismology, raw data need to be processed to generate useful information that can be turned into knowledge by researchers. The number of sensors that are acquiring raw data is increasing rapidly. Without good data management systems, more time can be spent in querying and preparing datasets for analyses than in acquiring raw data. Also, a lot of good quality data acquired at great effort can be lost forever if they are not correctly stored. Local and international cooperation will probably be reduced, and a lot of data will never become scientific knowledge. For this reason, the Seismological Laboratory of the Institute of Astronomy, Geophysics and Atmospheric Sciences at the University of São Paulo (IAG-USP) has concentrated fully on its data management system. This report describes the efforts of the IAG-USP to set up a seismology data management system to facilitate local and international cooperation. © 2011 by the Istituto Nazionale di Geofisica e Vulcanologia. All rights reserved.

Uso do AHP na avaliação do desempenho do sistema de gestão da qualidade, meio ambiente e segurança e saúde ocupacional integrados

The paper analyses the application of the AHP method together with the attach A of ISO 9004:2000 in order to evaluate the performance of two industrial organizations, both possessing quality management systems with ISO 9001:2000 certifications, based on the specific requirements of quality, environment, occupational health and management systems. The evaluated organizations were a government-owned company from the science and technology sector that works in the nuclear area, and a private company that works in the automotive and railroad area. The open software Web-Hipre version 1.22 from Helsinki University of Technology, Finland, was used. The results demonstrated that the AHP method together with the attach A of ISO 9004:2000 is adequate to evaluate organizational performances. Both organizations presented similar performance levels.

Phosphorus and potassium budget in the soil-plant system in crop rotations under no-till

Soil management and crop rotations can affect P and K budget in soil, decreasing losses, and increasing fertilizer use efficiency. The P and K budget in the soil-plant system at depths up to 60. cm was studied for different soil managements and crop rotations under no-till for three years in Botucatu, São Paulo, Brazil. The investigated crop rotations were: triticale (X Triticosecale) and sunflower (Helianthus annuus) cropped in autumn-winter; pearl millet (Pennisetum glaucum), forage sorghum (Sorghum bicolor), and Sunn hemp (Crotalaria juncea) were grown in the spring, as well as an additional treatment with chiseling followed by a fallow period; and soybean (Glycini max, L., Merril) was cropped in the summer. Each year triticale and sunflower were grown in plots and pearl millet, forage sorghum, Sunn hemp and of chisel/fallow in sub-plots. The triticale/millet rotation led to the largest decrease in available P within the 0-0.60. m layer of the soil profile and the largest K increase within the 0-0.05. m layer. Potassium mobility in the soil profile and the increases in the available K content in the 0.40-0.60. m layer were independent of the management system. Crop rotations with or without chiseling are not effective in preventing soil P losses. There is considerable K leaching below 0.60. m, but chiseling and the use of high K accumulating plants as triticale results in lower K losses. © 2012 Elsevier B.V.

Influence of Agroforestry and Traditional Management of Maize (Zea mays L.) on Soil Fertility

The aim of the work was to evaluate soil nutrient concentration at 0-5, 5-10, and 10-20 cm in maize (Zea mays L.) grown in sequence with black oats (Avena strigosa Schreb.) under Leucaena diversifolia alley cropping agroforestry system (AFS) and traditional management system/sole crop (without trees-TS), following a randomized block design. The experiment was carried out at the Brazilian Association of Biodynamic Agriculture, in Botucatu, São Paulo, Brazil. The treatments were: control (C), chemical fertilizer (F), biomass of L. diversifolia alley cropping (B), and biomass of L. diversifolia alley cropping + chemical fertilizer (B+F). After 2 yr, it was observed that pH, organic matter, and nutrient content had a tendency to show higher values in the treatments biomass+fertilizer, biomass, and fertilizer application, in both systems. Higher values in pH, organic matter, phosphorus, potassium, calcium, magnesium, sum of bases, cation exchange capacity, percentage base saturation, boron, copper, and manganese tended to occur in the agroforestry system. © 2013 Copyright Taylor and Francis Group, LLC.

Cadeia de reciclagem das baterias veiculares: estudo da gestão de um fluxo logístico reverso para os pequenos fabricantes

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Diretrizes para planejamento e implementação de sistema de gestão integrada em empresas da construção civil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação do nível de maturidade de empresas automotivas

Pós-graduação em Engenharia Mecânica - FEG

Desenvolvimento de um sistema de laudos histopatológicos baseado na plataforma microsoft .net 2.0

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Proposta de método para avaliação do sistema de gestão da qualidade, meio ambiente, segurança e saúde ocupacional integrados

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Ações da vigilância alimentar e nutricional em serviços de atenção básica à saúde de Botucatu-SP e município pertencentes à DRS VI

Pós-graduação em Alimentos e Nutrição - FCFAR