Prevalência da colonização vaginal e anorretal por estreptococo do grupo B em gestantes do terceiro trimestre

OBJETIVOS: estudar a prevalência da colonização por estreptococo do grupo B em gestantes do terceiro trimestre, atendidas em um hospital regional, e avaliar a associação da colonização com as variáveis maternas demográficas e clínicas. MÉTODOS: no período de 8 de outubro de 2002 a 26 de março de 2003, foi realizado um estudo transversal (de prevalência) com 309 gestantes no terceiro trimestre. Amostras de secreção vaginal e anorretal foram coletadas e testadas para identificação presuntiva do estreptococo do grupo B. Foram incluídas as gestantes com gestação maior ou igual a 36 semanas datadas por ultra-sonografia e excluídas as que se recusaram a participar, as em uso de antibioticoterapia e as que haviam sido submetidas a exame ginecológico pelo período mínimo de 24 horas antes da coleta. As gestantes foram caracterizadas por variáveis demográficas (raça, idade, grau de escolaridade, renda familiar e número de gestações) e clínicas (idade gestacional, ocorrência de infecção urinária durante a gestação atual, ruptura prematura de membranas e tempo de bolsa rota, febre materna intraparto, corioamnionite, líquido amniótico com mecônio, via de parto utilizada, febre materna pós-parto e endometrite). RESULTADOS: das gestantes, 46 estavam colonizadas pelo estreptococo do grupo B, sendo que 26 (56,5%) tiveram a cultura vaginal positiva, 8 (17,4%) a cultura anorretal positiva e 12 (26,5%) tiveram tanto a cultura vaginal como a retal positivas. Nenhuma das variáveis analisadas neste estudo foi estatisticamente significativa quanto à colonização pelo estreptococo do grupo B. Os resultados obtidos foram submetidos à análise bivariada pelo teste do chi2 e teste exato de Fisher quando apropriado. CONCLUSÃO: a taxa de prevalência da colonização vaginal e anorretal pelo estreptococo do grupo B em gestantes no terceiro trimestre, foi de 14,9%. Não houve associação entre fatores de risco (primigestação, idade materna inferior a 20 anos e nível sócio econômico baixo) e a prevalência da infecção.

Public and Private Sector Decision Makers Within the Rail Baltica Growth Corridor

Transport volumes have increased and will continue to increase in European Union. Even though the growth has not been equal between different transport modes. Most of the growth has been faced on road transport. European Union aims to balance the unbalanced market shares between the modes by gaining and supporting the competitiveness of railway and waterway transport. In EU railway transportation is seen as solution to increase safety in traffic and decrease the environmental impacts of transportation. The aim of this research is to figure out how it is possible to decrease the environmental impacts by the technology already in use. Main focus of this research is in intermodality and combining the road and railway transportation. This study aims also to figure out demands and expectations towards new Rail Baltica railway route connecting Tallinn and Berlin. The research is conducted by performing a literature review about decreasing environmental impacts and combining road and rail transport. Another viewpoint is taken from the possible effects of tourism to the passenger transport on rails. Knowledge gained by literature review is deepened by additional internet questionnaire study and expert interview study. In decreasing the environmental impacts of transportation electric trains are definitely the best option providing that the electricity is generated from renewable or carbon dioxide free sources. Decrease of environmental impacts has been reached also with acceptance of larger road transport vehicles. According to interviewed passenger transport experts, the whole route from Tallinn to Berlin may not be convenient to be used in passenger transport, just because the route is too long.. In EU freight is transported mainly with semi-trailer combinations, and that is why it could be logical if huckepack trains would be used on Rail Baltica. Huckepack train allows semi-trailers to be transported on rails with time efficient loading-unloading process. Overall, Rail Baltica project is experienced as a future-oriented one and new railway alignment is seen as great alternative option for transport modes using fossil fuels.

Relação entre os níveis séricos do hormônio anti-Mulleriano, inibina B, estradiol e hormônio folículo estimulante no terceiro dia e o status folicular ovariano

OBJETIVO: examinar a hipótese de que o nível sérico do hormônio anti-Mülleriano (HAM) reflete o status folicular ovariano. MÉTODOS: Desenho: estudo prospectivo. Pacientes: foram incluídas 101 candidatas à FIV-TE submetidas à estimulação ovariana controlada com agonista de GnRH e FSH. Depois de atingir a supressão da hipófise e antes da administração de FSH (dia basal), os níveis séricos de HAM, inibina B e FSH foram avaliados. O número de folículos antrais foi determinado pela ultra-sonografia (dia basal) (folículo antral precoce; 3-10 mm). RESULTADOS: as médias do nível sérico de HAM, inhibina B, E2, P4 e FSH (dia basal) foram 3,4±0,14 ng/mL, 89±4,8 pg/mL, 34±2,7 pg/mL, 0,22±0,23 ng/mL e 6,6±0,1 mUI/mL, respectivamente, e a média do número de folículos antrais precoces foi 17±0,39. O nível sérico do HAM foi negativamente correlacionado com a idade (r= -0,19, p<0,04) e positivamente correlacionado com o número de folículos antrais precoces (r=0,65, p<0,0001), mas isto não se aplicou aos níveis séricos de inibina B, E2 e FSH. CONCLUSÕES: esse dado demonstra a associação do HAM com a quantidade de folículo antral, sendo aquele, portanto, um provável biomarcador do status folicular ovariano.

Comparação dos padrões da frequência cardíaca fetal no segundo e terceiro trimestres da gestação

OBJETIVO: comparar os padrões da frequência cardíaca fetal (FCF) do segundo e terceiro trimestres da gestação. MÉTODOS: estudo prospectivo, comparativo, realizado no período de Janeiro de 2008 e Julho de 2009 com os seguintes critérios de inclusão: gestação única, feto vivo, ausência de intercorrências clínicas ou obstétricas, ausência de malformação fetal, com idade gestacional entre 24 e 27 semanas (segundo trimestre - 2ºT) ou entre 36 e 40 semanas (terceiro trimestre - 3ºT). Foram realizados os exames de cardiotocografia computadorizada (Sistema 8002 - Sonicaid) por período de 30 minutos e o perfil biofísico fetal. O Sistema 8002 analisa o traçado da FCF em períodos de 3,75 segundos (1/16 de minuto). Em cada período, a duração média dos intervalos de tempo entre sucessivos batimentos cardíacos fetais foi avaliada e mensurada em milisegundos (ms). A FCF média foi calculada em cada período, e também as diferenças entre períodos adjacentes. Os parâmetros incluíram: FCF basal, acelerações transitórias, duração dos episódios de alta variação, duração dos episódios de baixa variação e variação de curto prazo. Os resultados foram analisados pelos testes t de Student, teste do qui-quadrado e teste exato de Fischer. Foi adotado nível de significância de 0,05. RESULTADOS: dezoito gestações de 2ºT foram comparadas com 25 gestações de 3ºT. Houve diferença significativa nos parâmetros da FCF avaliada pela cardiotocografia computadorizada quando comparados os fetos de 2ºT e os de 3ºT em relação aos seguintes resultados: média da FCF basal (143,8 bpm versus 134,0 bpm, p=0,009), média do número de acelerações transitórias >10 bpm (3,7 versus 8,4, p<0,001) e >15 bpm (0,9 bpm versus 5,4 bpm, p<0,001), duração média dos episódios de alta variação (8,4 min x 15,4 min, p=0,008) e média da variação de curto prazo (8,0 ms versus10,9 ms, p=0,01). Em todos os exames o perfil biofísico fetal apresentou resultado normal. CONCLUSÕES: o presente estudo constata diferenças significativas nos padrões avaliados entre gestações de segundo e terceiro trimestres, e indica a influência da maturação do sistema nervoso autonômico na regulação da FCF.

Increasing the percentage of vaginal birth in the private sector in Brazil through the redesign of care model

OBJETIVO: Implantar um novo modelo de cuidado ao parto e reduzir o percentual de cesarianas entre as gestantes da UNIMED Jaboticabal.MÉTODOS: Estudo descritivo desenvolvido em uma instituição do interior paulista, que teve início em 2012 e propôs o redesenho do modelo de cuidado ao parto com a revisão de todo o processo assistencial por meio da Ciência da Melhoria Contínua. Para medir os resultados das mudanças, foram selecionados nove indicadores e suas respectivas metas.RESULTADOS: O indicador de partos vaginais atingiu a meta de 40%, após sete meses do início da intervenção. Este indicador entre as gestantes do SUS atingiu 66%. A taxa de mortalidade perinatal decresceu 25% comparando-se 2012 a 2014 e a taxa de prematuridade foi de 3/100 nascidos vivos em 2014. O percentual de gestantes da UNIMED com 6 ou mais consultas de pré-natal atingiu 95%. Em relação aos custos hospitalares per capita referentes à assistência ao parto, notou-se um decréscimo de 27%, quando comparados os anos de 2012 e 2013. Tal queda não se sustentou e o custo hospitalar per capita, em 2014, retornou aos mesmos patamares de 2012. A remuneração dos obstetras registrou um acréscimo de 72%, se comparados os anos de 2012, 2013 e 2014. Houve queda de 61% dos custos com a unidade de terapia intensiva (UTI) neonatal, comparando os anos de 2012 e 2013. A taxa de admissão em UTI neonatal acompanhou a redução dos custos e foi de 55%, se comparados os anos de 2012 a 2014, entre as gestantes da UNIMED. Não houve o alcance da meta de 80% de participação das gestantes nos cursos de preparação para o nascimento. A porcentagem de gestantes satisfeitas e muito satisfeitas com a assistência ao parto atingiu 86%.CONCLUSÃO: Este projeto atingiu seus objetivos, reduzindo o percentual de cesarianas entre as gestantes da UNIMED Jaboticabal, e constituiu-se em um exemplo concreto da realização do triplo objetivo em saúde: melhorar a experiência dos envolvidos e os resultados de saúde de populações e indivíduos e realizar estas duas tarefas com menor custo, eliminando desperdícios assistenciais.

Service innovation development and knowledge integration practices - a comparative case study on KIBS sector

Academic research on services and innovations on services has significantly grown during recent years. So far research concerning management of knowledge intensive work on service development activities is very limited. The objective of this study was to examine knowledge integration practices that support service innovation development and to the best of knowledge such studies have not been previously published in academic literature. In the theoretical part of the study a review of state‐of‐the‐art literature was conducted, research gap was indicated and a framework for analysis was built. In the empirical part an explorative comparative multi‐case study was carried out in KIBS sector. Four companies were selected and four service development projects were inspected. The service development activities and knowledge integration practices were identified. The cases were carefully compared and results formed. The empirical results indicated that service innovation development is partly linear and partly incremental flow of activities where knowledge integration practices have important role supporting the planning and execution of tasks. Knowledge integration practices supporting planning and workshops are close interaction, interpretation, project planning and sequencing of work tasks. The identified knowledge integration practices supporting building service solution were careful role and competence management, routines and common knowledge. The main implication is that to manage knowledge intensive service innovation development a firm should carefully develop and choose relevant knowledge integration practices to support the service development activities.

Logistics of North-West Russia and Rail Baltica: Standpoints of Private Sector

The main aims of the present report are to describe the current state of railway transport in Russia, and to gather standpoints of Russian private transportation logistics sector towards the development of new railway connection called Rail Baltica Growth Corridor, connecting North-West Russia with Germany through the Baltic States and Poland. North-West Russia plays important role not only in Russian logistics, but also wider European markets as in container sea ports handling is approx. 2.5 mill. TEU p.a. and handling volume in all terminals is above 190 million tons p.a. The whole transportation logistics sector is shortly described as an operational environment for railways – this is done through technical and economic angles. Transportation development is always going in line with economics of the country, so the analysis on economical development is also presented. Logistics integration of the country is strongly influenced by its engagement in the international trade. Although, raw material handling at sea ports and container transports (imports) are blossoming, domestic transportation market is barely growing (in long-term perspective). Thus, recent entrance of Russia into World Trade Organization (WTO) is analyzed theme in this research, as the WTO is an important regulator of the foreign trade and enabler of volume growth in foreign trade related transportation logistics. However, WTO membership can influence negatively the development of Russia’s own industry and its volumes (these have been uncompetitive in global markets for decades). Data gathering in empirical part was accomplished by semi-structured case study interviews among North-West Russian logistics sector actors (private). These were conducted during years 2012-2013, and research compiles findings out of ten case company interviews. Although, there was no sea port involved in the study, most of the interviewed companies relied in European Logistics within significant parts in short sea shipping and truck combined transportation chains (in Russian part also using railways). As the results of the study, it could be concluded that Rail Baltica is seen as possible transport corridor in most of the interviewed companies, if there is enough cargo available. However, interviewees are a bit sceptical, because major and large-scale infrastructural improvements are needed. Delivery time, frequency and price level are three main factors influencing the attractiveness of Rail Baltica route. Price level is the most important feature, but if RB can offer other advantages such as higher frequency, shorter lead times or more developed set of value-added services, then some flexibility is possible for the price level. Environmental issues are not the main criteria of today, but are recognized and discussed among customers. Great uncertainty exists among respondents e.g. on forthcoming sulphur oxide ban on Baltic Sea shipping (whether or not it is going to be implemented in Russia). Rather surprisingly, transportation routes to Eastern Europe and Mediterranean area are having higher value and price space than those to Germany/Central Europe. Border crossing operations (traction monopoly at rails and customs), gauge widths as well as unclear decision-making processes (in Russia), are named as hindering factors. Performance standards for European connected logistics among Russian logistics sector representatives are less demanding as compared to neighbourhood countries belonging to EU.

Exploring the value creation in service ecosystem context: the case of the information technology sector

This thesis examines customer value creation in a service ecosystem context. The objective of this thesis is to develop a comprehensive view of value creation processes in a service ecosystem context and an understanding on the roles of the stakeholders involved in these processes, focusing on the information technology industry. The novelty of the two central concepts of this thesis, systemic customer value and service ecosystem, as well as the gap in the literature of empirical research on value creation in an ecosystem-level, opened an interesting research topic. The empirical study is conducted as a single case analysis, utilizing Group Decision Support System (GDSS) and also Analytic Hierarchy Process (AHP). The findings suggest that customer value is created by a complex combination of interactions among different actors of the ecosystem. Thus, value is not created by a single offering directed to the customer, but by an integration of services from different parts of the ecosystem as well as the active participation of customer in this process.

National Library of Finland as Service Centre for libraries, archives, museums and other public sector organisations

Kristiina Hormia-Poutasen esitys KOBV-konferenssissa Berliinissä, Saksassa kesäkuussa 2013.

Mapping the Value Network Potential in Cross-sector Collaboration: Case welfare Services for Elderly in Finland

Value network has been studied greatly in the academic research, but a tool for value network mapping is missing. The objective of this study was to design a tool (process) for value network mapping in cross-sector collaboration. Furthermore, the study addressed a future perspective of collaboration, aiming to map the value network potential. During the study was investigated and pondered how to get the full potential of collaboration, by creating new value in collaboration process. These actions are parts of mapping process proposed in the study. The implementation and testing of the mapping process were realized through a case study of cross-sector collaboration in welfare services for elderly in the Eastern Finland. Key representatives in elderly care from public, private and third sectors were interviewed and a workshop with experts from every sector was also conducted in this regard. The value network mapping process designed in this study consists of specific steps that help managers and experts to understand how to get a complex value network map and how to enhance it. Furthermore, it make easier the understanding of how new value can be created in collaboration process. The map can be used in order to motivate participants to be engaged with responsibility in collaboration and to be fully committed in their interactions. It can be also used as a motivator tool for those organizations that intend to engage in collaboration process. Additionally, value network map is a starting point in many value network analyses. Furthermore, the enhanced value network map can be used as a performance measurement tool in cross-sector collaboration.

Accounting for competition, governance and accountability during institutional change in not-for-profit and public sector organisations

Purpose The aim of this thesis1 is to analyse theoretically how institutionalisation of competitive tendering2, governance and budgetary policies cannot be taken for granted to lead to accountability among institutional actors3. The nature of an institutionalised management accounting policy, its relevance as a source of power in organisational decision making, and in negotiating inter-organisational relationships, are also analysed. Practical motivation The practical motivation of the thesis is to show how practitioners and policy makers can institutionalise changes which improve the power of management accounting and control systems4 as a mechanism of accountability among institutional actors and in negotiating relationships with other organisations. Theoretical motivation and conceptual approach The theoretical motivation of the thesis is to extend the institutional framework of management accounting change proposed by Burns and Scapens (2000) by using the theories of critical realism, communicative action, negotiated order and the framework of circuits of power. The Burns and Scapens framework needs further theorisation to analyse the relationship between the institutionalisation of management accounting and accountability; and the relevance of management accounting information in negotiating in inter-organisational relationships. Methodology and field studies Field research took place in public and not-for-profit health care organisations and a municipality in Finland from 2008 to 2013. Data were gathered by document analysis, interviews, participation in meetings and observations. Findings The findings are explained in four different essays that show that institutionalisation of competitive tendering, governance and budgetary policies cannot be taken for granted to lead to accountability among institutional actors. The ways by which institutional actors think and act can be influenced by other institutional mechanisms, such as inter-organisational circuits of power and intraorganisational governance policies, independent of the institutional change process. The relevance of institutionalised management accounting policies in negotiating relationships between two or more organisations depends on processes and contexts through which institutional actors use management accounting information as a tool of communication, mutual understanding and power. Research limitations / implications The theoretical framework used can be applied validly in other studies. The empirical findings cannot be generalised directly to other organisations than the organisations analysed. Practical implications Competitive tendering and budgetary policies can be institutionalised to shape actions of institutional actors within an organisation. To lead to accountability, practitioners and policy makers should implement governance policies that increase the use of management accounting information in institutional actors’ thinking, actions and responsibility for their actions. To reach a negotiated order between organisations, institutionalised management accounting policies should be used as one of the tools of communication aiming to reach mutual agreement among institutional actors.

Public and private sector cooperative opportunities in the Finnish healthcare internationalization : views from the public sector’s perspective

Traditionally mostly publicly provided Finnish healthcare services are confronted today by the evident challenge of rising healthcare costs as the expenditure on health and social case has exceeded Finland’s national GDP growth significantly since the new millennium. While the opening of the traditional barriers through the EU’s new patient directive resulting in increasing international competition and the free flow of patients within the EU present opportunities for the Finnish healthcare services industry there are also several challenges for the existing healthcare system as proposed by the Ministry of Employment and the Economy in 2011. Due to the structure and nature of the current Finnish healthcare service system the greatest potential for internationalization is seen from a joint cooperation of the public and private sectors in an internationalization network for Finnish healthcare services. As its formation has recently also taken as a strategic initiative to be completed by the Ministry of Employment and the Economy and no earlier research exists on how this is seen in practice by the network actors, the purpose of this study is to examine the proposed solution of forming an internationalization network between the public and private sector actors in Finland in practice from the viewpoint of public sector actors. The research relied heavily on the reports by the Finnish Ministries in understanding the current situation of the Finnish healthcare services internationalization and its potential. Suitable theories were also used to build a more comprehensive view of the matter. The study applied a qualitative research approach on the explorative research problem. The data collection was achieved through expert interviews in two of the largest Finnish public healthcare service providers; the Turku and Helsinki Central University Hospitals. Expert interviews were considered as the most suitable method for data collection in order to create an in-depth understanding of the topic within the limitations of this thesis. In turn, two different public healthcare service providers were chosen to give a broader view of the field instead of focusing on a specific unit and also to allow a possible comparison between the two different organizations. The latter however was shown not to be suitable for the purposes of this study as the opinions of the respondents varied largely also within their own organizations. The conclusion is that while the actors agree on the evident internationalization of Finnish healthcare services, there are several large-scale structural challenges effectively preventing such activities while at the same time the opportunities within Finland vary, as there are several niches but no real large-scale advantages in the highly competitive industry. Interest towards cooperation between the sectors are seen especially in exploiting the advantages offered by the private sector in commercialization and marketization, yet however no clear views exist on how these activities should be governed or structured in the short-term as a larger reform of the entire Finnish healthcare service sector is needed in the long-term.