Effect of facilitation of local maternal-and-newborn stakeholder groups on neonatal mortality : cluster-randomized controlled trial

BACKGROUND: Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. METHODS AND FINDINGS: In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]). CONCLUSIONS: A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44599712. Please see later in the article for the Editors' Summary.

Self-reported conflict management competence among nursing students on the point of graduating and registered nurses with professional experience

Objective: It has been shown that specific competence is necessary for preventing and managing conflicts in healthcare settings. The aim of this descriptive and correlation study was to investigate and compare the self-reported conflict management competence (CMC) of nursing students who were on the point of graduating (NSPGs), and the CMC of registered nurses (RNs) with professional experience. Methods: The data collection, which consisted of soliciting answers to items measuring CMC in the Nurse Professional Competence (NPC) Scale, was performed as a purposive selection of 11 higher education institutions (HEIs) in Sweden. Three CMC items from the NPC Scale were answered by a total of 569 nursing students who were on the point of graduating and 227 RN registered nurses with professional experience. Results: No significant differences between NSPGs and RNs were found, and both groups showed a similar score pattern, with the lowest score for the item: “How do you perceive your ability to develop the group and strengthen competence in conflict management and problem-solving, based on knowledge of group dynamics?”. RNs with long professional experience (>24 months) rated their overall CMC as significantly better than RNs with short (<24 months) professional experience did (p = .05). NSPGs who had experience of international studies during their nursing education reported higher CMC, compared with those who did not have this experience (p = .03). RNs who reported a high degree of utilisation of CMC during the previous month scored higher regarding self-reported overall CMC (p < .0001). Conclusions: Experience of international studies during nursing education, or long professional experience, resulted in higher self-reported CMC. Hence, the CMC items in the NPC Scale can be suitable for identifying self-reported conflict management competence among NSPGs and RNs

Aplicando métodos de solução de problemas em tarefas de interpretação de rochas

A Engenharia de Conhecimento (Knowledge Engineering - KE) atual considera o desenvolvimento de Sistemas Baseados em Conhecimento (Knowledge- Based Systems - KBSs) como um processo de modelagem baseado em modelos de conhecimento reusáveis. A noção de Métodos de Solução de Problemas (Problem- Solving Methods - PSMs) desempenha um importante papel neste cenário de pesquisa, pois representa o conhecimento inferencial de KBSs em um formalismo explícito. Não menos importante, PSMs também facilitam a compreensão do processo de raciocínio desenvolvido por humanos. PSMs são descritos em um formalismo abstrato e independente de implementação, facilitando a análise do conhecimento inferencial que muitas vezes é obscurecido em grandes bases de conhecimento. Desta forma, este trabalho discute a noção de PSMs, avaliando os problemas de pesquisa envolvidos no processo de desenvolvimento e especificação de um método, como também analisando as possibilidades de aplicação de PSMs. O trabalho apresenta a descrição e análise de um estudo de caso sobre o processo de desenvolvimento, especificação e aplicação de um PSM Interpretação de Rochas. As tarefas de interpretação de rochas são desenvolvidas por petrógrafos especialistas e correspondem a um importante passo na caracterização de rochasreservatório de petróleo e definição de técnicas de exploração, permitindo que companhias de petróleo reduzam custos de exploração normalmente muito elevados. Para suportar o desenvolvimento de KBSs neste domínio de aplicação, foram desenvolvidos dois PSMs novos: o PSM Interpretação de Rochas e o PSM Interpretação de Ambientes Diagenéticos. Tais métodos foram especificados a partir de uma análise da perícia em Petrografia Sedimentar, como também a partir de modelos de conhecimento e dados desenvolvidos durante o projeto PetroGrapher. O PSM Interpretação de Rochas e o PSM Interpretação de Ambientes Diagenéticos são especificados conceitualmente em termos de competência, especificação operacional e requisitos/suposições. Tais definições detalham os componentes centrais de um esquema de raciocínio para interpretação de rochas. Este esquema é empregado como um modelo de compreensão e análise do processo de raciocínio requerido para orientar o desenvolvimento de uma arquitetura de raciocínio para interpretação de rochas. Esta arquitetura é descrita em termos de requisitos de armazenamento e manipulação de dados e conhecimento, permitindo projetar e construir um algoritmo de inferência simbólico para uma aplicação de bancos de dados inteligentes denominada PetroGrapher.

Ensaio sobre o agente racional: esparadrapos para um paciente terminal?

The Rational Agent model have been a foundational basis for theoretical models such as Economics, Management Science, Artificial Intelligence and Game Theory, mainly by the ¿maximization under constraints¿ principle, e.g. the ¿Expected Utility Models¿, among them, the Subjective Expected Utility (SEU) Theory, from Savage, placed as most influence player over theoretical models we¿ve seen nowadays, even though many other developments have been done, indeed also in non-expected utility theories field. Having the ¿full rationality¿ assumption, going for a less idealistic sight ¿bounded rationality¿ of Simon, or for classical anomalies studies, such as the ¿heuristics and bias¿ analysis by Kahneman e Tversky, ¿Prospect Theory¿ also by Kahneman & Tversky, or Thaler¿s Anomalies, and many others, what we can see now is that Rational Agent Model is a ¿Management by Exceptions¿ example, as for each new anomalies¿s presentation, in sequence, a ¿problem solving¿ development is needed. This work is a theoretical essay, which tries to understand: 1) The rational model as a ¿set of exceptions¿; 2) The actual situation unfeasibility, since once an anomalie is identified, we need it¿s specific solution developed, and since the number of anomalies increases every year, making strongly difficult to manage rational model; 3) That behaviors judged as ¿irrationals¿ or deviated, by the Rational Model, are truly not; 4) That¿s the right moment to emerge a Theory including mental processes used in decision making; and 5) The presentation of an alternative model, based on some cognitive and experimental psychology analysis, such as conscious and uncounscious processes, cognition, intuition, analogy-making, abstract roles, and others. Finally, we present conclusions and future research, that claims for deeper studies in this work¿s themes, for mathematical modelling, and studies about a rational analysis and cognitive models possible integration. .

Applying negotiation skills in the design of public policies: analysis of the city of São Paulo’s invoice program

The author argues that by applying problem-solving negotiation skills in the design of public policies, public administrators benefit from more effective and wide-ranging outcomes in the realization of their goals. In order to demonstrate this idea, the author analyzes how negotiation skills – such as identifying key actors and their interests, recognizing hardbargaining tactics and changing the players, knowing your best alternative, creating value and building trust – permeated and contributed to the success of the City of São Paulo’s Invoice Program (“Programa Nota Fiscal Paulistana”), a public policy aimed at combating tax evasion of service tax in the City of São Paulo.

Graphical constraints: a graphical user interface for constraint problems

A constraint satisfaction problem is a classical artificial intelligence paradigm characterized by a set of variables (each variable with an associated domain of possible values), and a set of constraints that specify relations among subsets of these variables. Solutions are assignments of values to all variables that satisfy all the constraints. Many real world problems may be modelled by means of constraints. The range of problems that can use this representation is very diverse and embraces areas like resource allocation, scheduling, timetabling or vehicle routing. Constraint programming is a form of declarative programming in the sense that instead of specifying a sequence of steps to execute, it relies on properties of the solutions to be found, which are explicitly defined by constraints. The idea of constraint programming is to solve problems by stating constraints which must be satisfied by the solutions. Constraint programming is based on specialized constraint solvers that take advantage of constraints to search for solutions. The success and popularity of complex problem solving tools can be greatly enhanced by the availability of friendly user interfaces. User interfaces cover two fundamental areas: receiving information from the user and communicating it to the system; and getting information from the system and deliver it to the user. Despite its potential impact, adequate user interfaces are uncommon in constraint programming in general. The main goal of this project is to develop a graphical user interface that allows to, intuitively, represent constraint satisfaction problems. The idea is to visually represent the variables of the problem, their domains and the problem constraints and enable the user to interact with an adequate constraint solver to process the constraints and compute the solutions. Moreover, the graphical interface should be capable of configure the solver’s parameters and present solutions in an appealing interactive way. As a proof of concept, the developed application – GraphicalConstraints – focus on continuous constraint programming, which deals with real valued variables and numerical constraints (equations and inequalities). RealPaver, a state-of-the-art solver in continuous domains, was used in the application. The graphical interface supports all stages of constraint processing, from the design of the constraint network to the presentation of the end feasible space solutions as 2D or 3D boxes.

Avaliação de efetividade do centro de reabilitação de adultos - CRA/NATAL/RN

Public services with an emphasis on rehabilitation treatment of disabled people, as established law, have aimed to ensure quality and equity assistance in a rehabilitation way to the segment highlighted. As for people with physical disabilities, the Unified Health System (hereby SUS) through the directive GM/ MS No. 818 of 2001, requires the creation of hierarchical and regionalized services networks at different levels of complexity to ensure appropriate assistance. This study whose title is Evaluation of effectiveness of the Adult Rehabilitation Center in Rn: elements for a discussion aimed to evaluate the effectiveness of rehabilitation services that institution, reference in the State of Rio Grande do Norte, has directed its patients, more specifically those who have had a stroke and therefore are disabled ones. From the standpoint of methodological conduction, it was prioritized a qualitative and empirical theoretical research which was carried out from the following courses: literature references with authors who are the themes pertaining to rehabilitation, inclusion, public policy evaluation, health policy and disability; documentary research through Regulation of Technical Procedures, files, records, informative booklets that were of great importance to the knowledge of the institution, as well as its functioning and dynamics of field research that was materialized with the managers, rehabilitation staff and Center s users, through the application of semi-structured interviews as a tool for data collection. The information obtained was analyzed from the critical analysis of discourse. As a result, it was identified some technical, administrative and financial difficulties which have obliterated the effectiveness of services provided, such as: lack of many professionals to meet existing demand, poor quality of equipment and the physical structure, limits on autonomy management as a result of dependence along with the SESAP/RN; besides the excessive bureaucratization in the administrative processes compromising Center s problem-solving needs. However, in the narratives of managers, rehabilitation staff of patients, despite the difficulties, treatment made by Centre has effectiveness to the extent that has been contributing even in a limited way to improve their quality of life

Navegando nas ondas dos saberes do ser: uma conversa com a sexualidade à luz da corporeidade.

This study aimed to provide a continuing education towards raising teachers for reflection and effective sexual education within the school environment as a possible route of self-education and training of teachers of elementary school. More specifically aim to facilitate through the Continuing Education to discuss the knowledge of the body and knowledge of human sexuality, presenting them as core knowledge in the integral formation of individuals and promote discussion of a Human-centered education Teaching in a vocational training and human .In this sense, we dialogue with the human teaching preconized by Arroyo (2002, 2004) along with the humanization (hominization) of the individuals through education, under Freire´s perspective of the being more (2003) as well as his ideas, Pineau´s (2003) and Josso´s (2004) about the educational practice understanding as a way to build up the autonomy of the individuals who we intend to educate. We defend the inclusion of the body as an essential learning element according to the principles of corporeity presented by Assman (2001), whose comprehension is that every learning experience has a corporal inscription. Furthermore, the knowledge about human sexuality cannot be excluded from this process since the sexuality is inherent of individuals and is constructed and reconstructed during their existence. Our view of the world and of man is supported by the knowledge of the complexity (Morim, 2004) trying to surpass the mechanist view that sees them through the duality view, fragmenting them. For the discussion and construction of knowledge that search for the confluence of these knowledges about the being and the educational practice, aiming at the individual integral formation starting from the process of self-formation/self-knowledge, we´ve directed our research-action-formation having as compass the theoretical-methodological postulate of the research-action (Barbier, 2002; Morin, 2004; Thiollent, 2004) because it makes the participation of all the involved people in the process of resolution or surpassing of problem solving possible. We´ve used the continuing formation as a way of access for data collection, applying a questionnaire with open questions for the ones involved in the research. Based on the findings it´s been possible to infer that for the teaching formation it is necessary the inclusion of the Human sexuality and corporeity theme, so that the teacher can surpass the biological view of sexuality and also the expansion of the mechanist view of the body. To do so, we suggest that the teaching formation happens supported by the teaching capacitation and formation according to Maturana (2004), bringing teaching knowledges (Tardiff, 2002), which contribute effectively for the responsibility to educate people for life.

O projeto politico pedagógico de enfermagem e o sistema único de saúde: a visão de discentes

This research aims to analyze, in the view of students, the pedagogic project of undergraduate nursing course, of UFRN, and its articulation with the SUS, in an attempt to understand the issues that permeate the teaching and learning of nursing. This is a qualitative study that used the focus group technique as a tool to collect empirical data. There were three meetings, where we had the collaboration of 23 graduating students from the eighth period of the semester 2009.1. For the analysis of information, we use a theoretical framework based on curriculum guidelines and basic principles of the SUS, making the analogy of the results with the metaphor of Greek mythology, Ariadne's thread, in dialogue with authors who discuss education as a transformative practice. Thus, the texture of the yarn was built of five thematic fields: joint the pedagogic project with the SUS; the teaching/service and theory/practice relation; interdisciplinarity or transdisciplinarity; didactic/methodological and relational approaches; and co-participation of students in the pedagogic project. According to the discussions, we find many difficulties in the teaching and learning process of undergraduate nursing in UFRN to strengthen the SUS, including: dislocation of educational institutions with services, professionals, managers and community; dichotomy between theory and practice; reality of services as a learning field and working process in health; posture adopted by professionals, teachers and other subjects included in the process of health education; decontextualization and fragmentation of teaching with the practice in health and nursing; excessive use of very illustrative methodologies, but little problem-solving; difficult and precarious situation in the relations between teachers and between teachers/students, regarding the acceptance of differences; absence of participation of students in the evaluation process and conduct of the educational project in progress. In this sense, we understand the need an auto-reflexive act of teaching and conducting collective pedagogical course with a view to achieving the SUS. Thus, it is necessary to support practices motivated by the polyphonic dialogue and the exercise of symbiosis and autopoiesis of subjects/actors jointly responsible for the ongoing process of learning for life.

Reinternações psiquiátricas no Rio Grande do Norte: implicações e impacto das novas estratégias de atenção à saúde mental

The Brazilian Psychiatric Reform based on the desinstitucionalization of the assistance, translated to the emphasis on community/territorial treatment and in the social inclusion of the mental suffering, promoted advances in the psychiatric restructuring. In the Rio Grande do Norte (RN), we can enumerate as advances of the Brazilian Psychiatric Reform the expansion of the mental health care chain and the implementation of some strategies that, together, aims to further the psychosocial attention of the individual with psych suffering and to reduce the indices of psychiatrics readmissions in the state. In the current Brazilian‟s mental health situation we were interesting in answered the following question: what the impact of the substitutes services‟ extension in the revolving door phenomenon? This search aims to analyze the revolving door phenomenon occurrences based on the news strategies of mental health care in the Rio Grande do Norte. This is a descriptive-exploratory study with a qualitative approach, oriented by the theoretical framework of critical-dialectical approach about the Brazilian Psychiatric Reform and using the thematic oral history as method of information collects. The search was realized on the Hospital João Machado (HJM), estate reference in psychiatric treatment, and the participants was 20 professionals that work on it. The collection of information had started after the approval of the UFRN Research Ethics Committee with the opinion number 216/2011 and CAAE number 0021.0.051.000-11 and was realized using the direct observation and semi-structured interview. The study‟s results were categorized in two categories and five subcategories of analysis. CATEGORY 1) Current situation of the mental health care chain in the RN, with the subcategories: 1.1 Impact of the new services of mental health care in the revolving door phenomenon in the RN; 1.2 Implications of the new services of mental health care in assisting user to the HJM; 1.3 Issues the permeate the mental health care chain in the RN. CATEORY 2) Main causes of the revolving door phenomenon in HJM, with the categories: 2.1 Family problems; 2.2 Lack of assistance after discharge from psychiatric hospital. In summary, we conclude that the extension of the mental health care chain contributed for the reduction of the psychiatrics re-hospitalization‟s indices in RN. However, we realized that territorial services of mental health care are not the only responsible for the revolving door phenomenon. Factors as family problems and the disarticulation of the assistance after the discharge from hospital influence on the perpetuation of hospitalizations and re-hospitalizations in the local scenario. To study the revolving door phenomenon that occur in the psychiatrics‟ assistance considering the news strategies of mental health care allowed us to approach the advances and challenges brought by the RPb and by the desinstitucionatization in the state, indicating the need for further discussions and problem-solving strategies of psychosocial care.

Ensino do processo de enfermagem: visão dos discentes de graduação de Natal/RN

The nursing process (NP) it s the systematized way of offering humanized care with the objective of reaching the expected results. The concern of the health and education institutions of elaborating implementation strategies of it is growing. The objective of this research was to know the vision of the senior students of the nursing graduation courses from Natal/RN, about the teaching of the NP. It s about a descriptive and exploratory study of the qualitative and quantitative type, done in five teaching institutions of the undergraduate nursing course of the municipality of Natal- RN in 2011. The research was composed by 48 students of the last 2 years of the nursing course. The gathering of the data was done through an online survey with open and closed questions via SurveyMonkey. For the quantitative data it was used the descriptive statistics from Microsoft Office Excel and for the qualitative data the Content Analysis of Bardin. The results pointed a predominance of female students (81,25%) with an age between 21- 39 years old (75,00%) and in the last year of the course (62,50%). As the opinion of the students about the NP two categories emerged: 1) Nursing Process as grounded method in scientific knowledge and established in two stages; 2) Nursing Assistance Quality, with two subcategories: Nursing Process as Nursing Practice and Nursing Process as instrument of improvement of the aid quality and promotion of well-being. In relation to the tuition of the NP the students (45,83%) said that the knowledge on the subject of the instructor was good; 81,25% reported that the professors use a traditional teaching methodology with the problem solving components and 45,83% answered that is addressed in specific disciplines in an isolated way starting from the professional line. The phase of NP that the nursing students have more difficulties of learning and implementing, being mentioned 22 times (29,70%). In relation to the student s difficulties, in the fields of supervised internships, in applying the NP it was stated for 83,50% that the barriers were related to the non implementation of the practice, overwork and the lack of trust of the nurse in the NP. The teaching-care strategies described as the internship fields were: the training of nurses to be able to contribute with the University in the implementation of the service and teaching; and the need of the universities to focus, continuously throughout the course, the NP with the involvement and incentive of the instructors in this process. These results show that the NP for the nursing students is a work methodology of the profession that needs to be implemented effectively in the practical reality for its teaching to turn effective and for the future professionals to be able to bring real contributions in the achievement of systematized actions trying to improve the assistance quality and the nursing actions. It is expected that this study could help bringing some strategies to facilitate the merging between theory and practice in teaching the NP and stimulate a discussion about the topic at the Nursing Schools where the research was held together with the coordinators, instructors and students

A estratégia didática de resolução de problemas na formação de professores de química

In this work it is presented a research developed in the initial training of teachers of the chemistry graduation course at the Universidade Federal do Rio Grande do Norte (UFRN). The intervention was realized in two classes in the context of a discipline in the curricular structure with nineteen undergraduate students of chemistry. The study utilizes characteristics of the qualitative approach and uses observation, questionnaires, interviews and examination papers. The experiment involved a sequence of activities fundamented on the Problem Solving (PS) teaching strategy to approach chemical concepts. The proposal was planned and organized according to the theoretical presupposition of the work developed by the authors of the Science Education in PS, of teaching experience and from the initial hypotheses of the research. The goal was that the future teachers could experience the strategy and advance to the new meanings. The themes addressed in the activities were the difference between exercises and problems, exercises turning into problems, the steps of problem solving and some implications of the teaching strategy for the work of the teacher. The results showed evidence that through a process of collective reflection, and from the difficulties experienced in the strategy practice, the undergraduates are introduced to new perspectives of reflection and action of teaching practice, and understanding some benefits of innovative proposals for the teaching of chemistry. It also showed that, although this theme is approached, in some moments of the graduation, the future teachers don‟t know when or how to realize activities in this perspective. From the aspects that rose in research we highlighted the difficulties in the problem solving steps, the use of the strategy in school and the knowledge and skills of the teacher for planning activities in Problem Solving

Cooperação em sagüis comuns callithrix jacchus: condições e restrições

The cooperative behavior is no longer a dilemma for the theory of evolution, since there are models that explain the evolution of this behavior by means of natural selection at the individual level. However, there have been few studies on the proximal factors that interfere with cooperative behavior. In the study of the influence of cognition on cooperation, many authors have been interested in situations in which individuals decide whether to act cooperatively and select partners with different qualities to cooperate. Of the factors studied, we highlight the need for understanding the apparatus and communication between partners to the occurrence of cooperation. Recently, highlight is the proposal that the ability to cooperate would be greater in species with cooperative breeding system. Thus, the common marmoset (Callithrix jacchus) is a New World monkey which stands as a valuable species for this type of study because it presents cooperative actions in nature, such as sharing food and protection of the community territory. Our experiment investigated whether common marmosets unrelated females (n = 6) were able to cooperate using an electrical and a mechanical apparatus, if this cooperation is a byproduct of individual actions or involve social attention, if it occurs inter-individual variation in the use of devices and formation of roles (producer / scrounger) in dyads. We use the number of rewards obtained by animals (Ratio of Correct Pulls) as indicators of cooperation and glances for partners (Ratio of Correct Glances) as indicators of social attention and communication. The results indicate that the type of apparatus was not a constraint for the occurrence of cooperation between the marmosets, but still has not been verified formation of roles in the dyads. The performance of animals in the two devices showed a large variation in the learning time, not having relationship with the performance in the tests phase. In both devices the level of social glances at control phases were casually correlated with any other phase, but the data showed that there was not social attention, that is, the monkeys realized that they gave food to the partners, but the partners did