Maternal health care professionals perspective on the provision and use of antenatal and delivery care : a qualitative descriptive study in rural Vietnam

Background. High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. Method. The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result. Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Conclusion. Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their own reproductive health. This issue should be further addressed by policy-makers. Strategies to reduce inequities in maternal health care for pregnant women are needed. The quality of client-provider interaction and management of pregnancy may be strengthened by education, human resources, re-training and provision of essential equipment.

Performance evaluation of ventilation radiators

A ventilation radiator is a combined ventilation and heat emission unit currently of interest due to its potential for increasing energy efficiency in exhaust ventilated buildings with warm water heating. This paper presents results of performance tests of several ventilation radiator models conducted under controlled laboratory conditions.   The purpose of the study was to validate results achieved by Computational Fluid Dynamics (CFD) in an earlier study and indentify possible improvements in the performance of such systems. The main focus was on heat transfer from internal convection fins, but comfort and health aspects related to ventilation rates and air temperatures were also considered.   The general results from the CFD simulations were confirmed; the heat output of ventilation radiators may be improved by at least 20 % without sacrificing ventilation efficiency or thermal comfort.   Improved thermal efficiency of ventilation radiators allows a lower supply water temperature and energy savings both for heating up and distribution of warm water in heat pumps or district heating systems. A secondary benefit is that a high ventilation rate can be maintained all year around without risk for cold draught.

The fall descriptions and health characteristics of older adults with hip fracture : a mixed methods study

Background: In light of the multifactorial etiology of fall-related hip fracture, knowledge of fall circumstances may be especially valuable when placed in the context of the health of the person who falls. We aimed to investigate the circumstances surrounding fall-related hip fractures and to describe fall circumstances in relation to participants' health and functional characteristics. Methods: The fall circumstances of 125 individuals (age >= 50 years) with hip fracture were investigated using semi-structured interviews. Data concerning participants' health (comorbidities and medications) and function (self-reported performance of mobility, balance, personal activities of daily living and physical activity, previous falls and hand grip strength) were collected via medical records, questionnaires and dynamometry. Using a mixed methods design, both data sets were analysed separately and then merged in order to provide a comprehensive description of fall events and identify eventual patterns in the data. Results: Fall circumstances were described as i) Activity at the time of the fall: Positional change (n = 24, 19%); Standing (n = 16, 13%); Walking (n = 71, 57%); Balance challenging (n = 14, 11%) and ii) Nature of the fall: Environmental (n = 32, 26%); Physiological (n = 35, 28%); Activity-related indoor (n = 8, 6%) and outdoor (n = 8, 6%); Trips and slips on snow (n = 20, 16%) and in snow-free conditions (n = 12, 10%) and Unknown (n = 10, 8%). We observed the following patterns regarding fall circumstances and participants' health: those who fell i) during positional change had the poorest functional status; ii) due to environmental reasons (indoors) had moderate physical function, but high levels of comorbidity and fall risk increasing medications; iii) in snow-free environments (outdoors) appeared to have a poorer health and functional status than other outdoor groups. Conclusions: Our findings indicate that patterns exist in relation to the falls circumstances and health characteristics of people with hip fracture which build upon that previously reported. These patterns, when verified, can provide useful information as to the ways in which fall prevention strategies can be tailored to individuals of varying levels of health and function who are at risk for falls and hip fracture.

Construção de base organizacional e suas implicações para performance corporativa: evidências da área abastecimento do Petróleo brasileiro S.A.

Esta dissertação examina algumas implicações do processo de implementação de estratégias para a performance corporativa. Este relacionamento é examinado na Área de negócios Abastecimento, da empresa Petróleo Brasileiro S.A, durante o período de 1996 e 2003. A despeito da profusão de estudos sobre estratégia empresarial, ainda há escassez de trabalhos que examinem o processo de implementação de mudanças organizacionais e suas implicações para o aprimoramento de certos indicadores de performance corporativa. Adicionalmente, tendem a prevalecer na literatura gerencial, abordagens pontuais de caráter imediatista e prescritivo, que não captam o processo de mudança organizacional e suas implicações para performance ao longo do tempo. o exame da implementação de estratégias é realizado com base em seis variáveis organizacionais extraídas da literatura existente: "comportamento da liderança"; "interação e influência"; "inovação e aprendizado"; "gestão de pessoas"; "comunicação e fluxos de conhecimento" e "estrutura organizacional". As implicações das mudanças na base organizacional para performance corporativa são examinadas a partir de dezenove indicadores, agrupados em três categorias: (i) operacionais, (ii) econômico-financeiro e (iii) segurança, meio ambiente e saúde. Esta dissertação consiste num estudo de caso individual, o qual é baseado em evidências empíricas qualitativas e quantitativas, coletadas em trabalhos de campo. A coleta dos dados baseou-se em fontes e técnicas múltiplas. Os efeitos das variáveis organizacionais que comporiam o Abastecimento, antes da criação da Área de negócio, em 1996, foram pequenos. Esses efeitos foram moderados no período entre 1996 a 2000, só apresentando impactos relevantes sobre indicadores operacionais entre 2000 e 2003, com reflexos positivos sobre o desempenho econômico, pois muitos custos foram reduzidos. Isso sugere que estratégias tecnológicas de longo prazo são um rumo robusto e consistente. As evidências sugerem que a empresa optou pela construção de uma base organizacional visando melhoria de performance no longo prazo, alinhando-se com autores que defendem essa construção como forma de fortalecer a competitividade no longo prazo. Esta dissertação contribui para o entendimento de fatores organizacionais que favorecem a implementação de estratégias e dos mecanismos que alavancam aprendizado e inovação numa empresa nacional. Este estudo conclui que a utilização de estruturas organizacionais, com o suporte da liderança e prática de baixas barreiras interfuncionais, alavancaram o aprendizado e a inovação, favorecendo resultados econômicos. Isto contradiz a proposição de autores que afirmam que reestruturação organizacional possui baixo potencial de geração de resultados, ou que enfatizam soluções de curto prazo para obtenção imediata de resultados, em detrimento da competitividade da empresa nos médio e longo prazos.

Trabalhador de enfermagem: de anjo de branco a profissional

O estudo, fundamentado nas premissas teóricas sobre relações de trabalho, em especial de algumas variáveis que integram a categoria microssocial - organização do trabalho e condições de trabalho - aliadas às contribuições da Escola Dejouriana, que analisa os temas do prazer e do sofrimento vinculados ao trabalho, procura desvendar o processo de desgaste/prazer no trabalho dentro de um hospital universitário, trazido através do discurso dos trabalhadores de enfermagem ali atuantes, buscando captar suas realizações, dificuldades, alegrias, tramas e defesas, angústias, contradições, a luta pelo poder, as vivências subjetivas, os silêncios. A presente pesquisa de caráter exploratório, por meio de um roteiro com questões fechadas e entrevistas semi-estruturadas, envolvendo trinta e seis profissionais, representantes das categorias enfermeiro, técnico de enfermagem e auxiliar de enfermagem visou apreender a realidade laboral do Hospital Universitário de Juiz de Fora, tentando delinear os contextos de trabalho vividos como positivo ou negativos, denunciando pontos na convergência trabalhador-contexto de trabalho, a partir dos quais as mudanças devam ser impulsionadas, para que se possa criar novas.estratégias, dirimir conflitos e ampliar as possibilidades de auto-realização e prazer no trabalho. As categorias de análise definidas no estudo possibilitaram uma reflexão sobre os desafios e problemas que surgem da relação trabalhador/trabalho/instituição. O conhecimento dos fatores implicados na gênese do desgaste/prazer no trabalho de enfermagem abre espaço para que estes sejam gerenciados pelos trabalhadores em proveito de sua saúde e qualidade de vida. Em suma, temos que a trajetória da enfermagem de anjo de branco a profissional tem sido marcada por preconceitos, desgaste, sofrimento e luta por espaço laboral. Abandonando a posição de saber periférico e vulnerável, assistimos atualmente o esforço dos trabalhadores de enfermagem para a construção de uma nova imagem que contempla estratégias de revalorização do estatuto profissional, controle da formação, das carreiras e dos conteúdos do trabalho para que se tornem agentes privilegiados e ativos na melhoria das condições de saúde da comunidade e propulsoras de novas idéias para o avanço da gestão nas organizações hospitalares.

Análise dos fundamentos do modelo value-based health care delivery à luz das teorias de estratégia

O setor de saúde, globalmente, apresenta problemas relacionados aos seus custos, qualidade e acesso. Porter e Teisberg (2004, 2006) propuseram modelo de gestão específico para a administração estratégica na área, o Value-Based Health Care Delivery (VBHCD). O modelo teve relativa repercussão e vem influenciando muitos atores no setor. Contudo, o modelo vem sendo aceito sem o devido questionamento de seus fundamentos e consistência com a teoria em estratégia. O presente trabalho busca, por meio de um ensaio teórico, analisar o modelo proposto à luz de paradigmas gerais da estratégia empresarial como, por exemplo, o modelo de Porter e a Visão Baseada em Recursos (RBV). Inicialmente, o artigo sintetiza as explicações teóricas do modelo porteriano clássico e da RBV. Em seguida, o VBHCD é examinado comparado a essas explicações, buscando-se relações e, eventualmente, contradições. Conclui-se que o modelo VBHCD não se alinha integralmente a nenhum corpo teórico isoladamente. Mesmo sendo proposto por Porter, parte de seus fundamentos advém, na verdade, de outras correntes teóricas. Esta abordagem integradora de teorias concorrentes, apesar de presente na literatura, ainda apresenta dificuldades e barreiras, um aspecto que não está explícito no modelo

Drinking water as a risk factor to poultry health

In the poultry industry, the use of water with adequate physical, chemical and microbiological quality it is of fundamental importance. Since many birds have access to the same water source, quality problems will affect a great number of animals. The drinking water plays an important role in the transmission of some bacterial, viral and protozoan diseases that are among the most common poultry diseases. Important factors to prevent waterborne diseases in broiler production are the protection of supply sources, water disinfection and the quality control of microbiological, chemical and physical characteristics. Water is an essential nutrient for birds and therefore quality preservation is fundamental for good herd performance. The farmer may prevent many diseases in bird flocks by controlling the quality of the ingested water, will certainly result in decreased costs and increased profit, two essential aims of animal production nowadays.

Relações interpessoais no ambiente de trabalho da equipe de enfermagem: uma ação comunicativa

The current study strives to address the interpersonal relationships of the nursing team from the perspective of the communicative action, by contributing to the health work process. It aims to analyze the interpersonal relationships of the nursing team in its work environment. This is a descriptive study with a qualitative approach. Data collection wal held from interviews, guided by a script with open questions. The study was conducted at a state hospital in the city of Natal/RN/Brazil. The research subjects were the workers of the nursing team, including nurses, nursing technicians and nursing assistants, totaling 16 subjects. The capture of information was performed in April 2012. The project was approved by the Ethics Research Committee, under CEP/UFRN protocol n. º 262/11 and Certificate of Presentation for Ethical Consideration n. º 0289.0.051.000-11. The analysis was performed from the categories that emerged from the research through a dialogue with the authors studied in the theoretical framework of the Theory of communicative action , by Jürgen Habermas, as well as The changing in the world of work, by Ricardo Antunes, and Characterization of the team , by Marina Peduzzi. The outocomes point out that the interpersonal relationship of the nursing team is very troubled, with no interaction among the individuals involved in this process, among themselves and with other health professionals. We have developed a particular concept about team, which is comprised of three essential elements: multiplicity of individuals, common objective and heterogeneity. In the studied environment, it was realized the existence of grouping teams. The interpersonal relationship of the nursing can be a facilitator or an obstacle in the workplace in such a way that causes positive or negative consequences, both to the health workers, and to the sicks. In this context, the interviewees have intensified their viewpoints with regard to the weaknesses that permeate the nursing relationship, by pointing them more frequently than the strengths. The work conditions have signaled a failing situation, which is evidenced by the constant improvisation process before the lack of human and material resources, low wages, deficit in recognizing the nursing worker, and physical and emotional wear, by creating a professional exhaustion. The devaluation of the worker also became a strong factor for this study, because it was characterized a reason of job dissatisfaction, due to the lack of valuation policies, which should be prepared by the institution or, even, they are unknown by the worker itself. The worker participation in the design of these policies has emerged as a relevant factor. The poor work conditions lead the worker to a process of professional demotivation and dissatisfaction, by causing the feeling of devaluation within its work environment. Hence, it was found in this research that the lack of communication leads to situations of inadequate interpersonal relationships, which are creators of an unsuitable environment for the performance of the nursing team

Transducer Loading Effect on the Performance of PZT-Based SHM Systems

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Administrative rationality and coping strategies in shift work

Shift work (SW) can affect worker health and productivity. Working at night, workers often accumulate fatigue and are less productive. In Brazil, laws have been drafted aiming to reduce night work and rotating shift hours. In order to slash costs, companies have been looking for new arrangements to improve productivity under these conditions. The purpose of this study was to examine management changes and their outcomes in a large glass factory located in an industrial region of Brazil. The results show that the management, seeking equal productivity among shifts, focused its efforts mainly on distributing employee expertise. The arrangement resulted in 12 different groups that combine to serve three fixed shifts. A same shift can be served by more than one group, and the members of a same group share days off on different days. There was no statistically significant productivity difference among the three shifts. The on-site examination showed that part of the production was held by the workers and transferred to the next shift in order for them to be able to meet the management's performance rate requirements. The finding shows how a Brazilian cultural trait (resistance without conflict) is used to drive coping in SW.

Influence of Excitation Signal on Impedance-based Structural Health Monitoring

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O trabalho dos assistentes sociais nos hospitais universitários Onofre Lopes (HUOL) e Hospital Ana Bezerra (HUAB) da UFRN: os desafios da formação permanente

This paper discusses the process of training social workers in the environment of University Hospitals- UH s. These hospitals provide space for professional education aiming to achieve a critical and purposeful professional performance. As environments for training, producing knowledge and providing essential services to the public, these hospitals require all members of the healthcare team to have a continued education. Understanding that training has to be a priority and conceived as constant pursuit for update through the interaction of Teaching, Researching and EPO ( Education and Public Outreach). These dimensions provide approximations and domain of theoretical and methodological, giving special importance to understanding the social reality, a sine qua non condition to the work of the Social Service professional. The main goal of the research was to comprehend how the continuous professional education of the social worker occurs and it s relation with the articulations involving Teaching, Researching and EPO, as significant elements for the job of the social workers in the Hospital Universitário Ana Bezerra and Hospital Universitário Onofre Lopes/UFRN. The research was conducted through a literature review, documentary and field inquiries with semistructured interviews including the group of 09 (nine) social workers from the aforementioned hospitals, taking as a reference the quantitative and qualitative approach to analyze mediations that stand between the subject and the social context. The results indicate that social workers in these university hospitals have their insertion beyond the care provided to patients in performance in the areas of education through preceptorship to undergraduate students and social work residents in and extension projects with low insertion in area of research. We note that there is a recognition of the importance of a continuous education, indicating that the qualification of social worker is essential in transforming their daily professional practice to better monitor, critically explain the peculiarities of public health in its everyday showing of how unequally access is provided to the users of the public health system

Spatial distribution of trachoma cases in the City of Bauru, State of São Paulo, Brazil, detected in 2006: defining key areas for improvement of health resources

Introduction: The objective of this study was to analyze the spatial behavior of the occurrence of trachoma cases detected in the City of Bauru, State of São Paulo, Brazil, in 2006 in order to use the information collected to set priority areas for optimization of health resources. Methods: the trachoma cases identified in 2006 were georeferenced. The data evaluated were: schools where the trachoma cases studied, data from the 2000 Census, census tract, type of housing, water supply conditions, distribution of income and levels of education of household heads. In the Google Earth® software and TerraView® were made descriptive spatial analysis and estimates of the Kernel. Each area was studied by interpolation of the density surfaces exposing events to facilitate to recognize the clusters. Results: of the 66 cases detected, only one (1.5%) was not a resident of the city's outskirts. A positive association was detected of trachoma cases and the percentage of heads of household with income below three minimum wages and schooling under eight years of education. Conclusions: The recognition of the spatial distribution of trachoma cases coincided with the areas of greatest social inequality in Bauru City. The micro-areas identified are those that should be prioritized in the rationalization of health resources. There is the possibility of using the trachoma cases detected as an indicator of performance of micro priority health programs.

Estudo de caso de dois acidentes do trabalho investigados com o método de árvore de causas

São apresentados dois acidentes do trabalho típicos, ocorridos em empresa de grande porte, investigados com o Método de Árvore de Causas ­ ADC, método que permite identificar o papel desempenhado por fatores gerenciais e de organização do trabalho no desencadeamento desses fenômenos. Os casos apresentados revelam a participação, na gênese dos acidentes, de fatores como designação temporária e improvisada de trabalhadores para funções e postos de trabalho, execução de tarefas deixadas à iniciativa e ao arbítrio dos trabalhadores, falta de ferramentas e de materiais apropriados à execução de tarefas e falhas na circulação de informações, entre outros. São também analisadas as indicações para o uso do método, suas potencialidades em termos de prevenção, bem como as implicações decorrentes de dificuldades de aplicação, de necessidades de treinamento e reciclagens e do dispêndio elevado de tempo para investigação de cada acidente.

Morbidity-mortality and performance evaluation of Brahman calves from in vitro embryo production

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)