Healthcare providers balancing norms and practice : challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study

BACKGROUND: Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. OBJECTIVE: This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. DESIGN: We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. RESULTS: The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. CONCLUSIONS: Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in-service training including value clarification and attitude transformation to equip providers to be able to better cater to young people seeking sexual and reproductive health advice.

Provenance in Agent-mediated Healthcare Systems

Agent-oriented cooperation techniques and standardized electronic healthcare record exchange protocols can be used to combine information regarding different facets of a therapy received by a patient from different healthcare providers at different locations. Provenance is an innovative approach to trace events in complex distributed processes, dependencies between such events, and associated decisions by human actors. We focus on three aspects of provenance in agent-mediated healthcare systems: first, we define the provenance concept and show how it can be applied to agent-mediated healthcare applications; second, we investigate and provide a method for independent and autonomous healthcare agents to document the processes they are involved in without directly interacting with each other; and third, we show that this method solves the privacy issues of provenance in agent-mediated healthcare systems.

Relação entre os atributos de qualidade de um serviço de reabilitação ambulatorial e os padrões do modelo de acreditação Joint Commission on Accreditation of Healthcare Organizations : a visão do cliente

Mostra evidências de relação entre os atributos de qualidade de um serviço de realibilitação ambulatorial sob a percepção do cliente e os padrões do modelo internacional de acreditação de serviço de saúde.

Racial discrimination in Brazil: interviews with leaders of the black movement

Racism in Brazil has some specificities when compared to other countries, for, differently from, for instance, South Africa and the United States, Brazilian Constitutions, ever since the Independence (1822), have never distinguished the citizens according to race or color. Furthermore, since the mid-1900s, Afro-Brazilian cultural manifestations, such as, for example, samba and capoeira, started to be valued as a part of our “national identity”. These specificities make race relations in Brazilian society a much more complex issue. This paper is focused on selected parts of interviews that deal with the nature of racial discrimination in Brazil, extracted from interviews with leaders of the black movement produced within the scope of the project “The History of Black Movement in Brazil: organization of a collection of Oral History Interviews”, developed by CPDOC, Getulio Vargas Foundation (Rio de Janeiro). These “histories within history”, as told by our interviewees, may be transformed into images that will be able to condense a given reality, thus allowing us to evaluate the gains obtained by oral history methodology.

Courts as healthcare policy-makers: the problem, the responses to the problem and problems in the responses

This article starts by analysing healthcare litigation in Brazil by means of a literature review of articles that contribute with empirical findings on this phenomenon. Based on this review, I argue that health care litigation in Brazil makes the public health system less fair and rational. In the second part of this article, I discuss the three most overarching responses to control the level of litigation and its impact on the public health system: (i) the public hearing held by the Supreme Federal Court and the criteria the court established thereafter; (ii) the recommendations by the National Council of Justice aimed at building courts’ institutional capacity; and (iii) the enactment of the Federal Law 12.401/11, which created a new health technology assessment system. I argue that latter is the best response because it keeps the substantive decisions on the allocation of healthcare resources in the institution that is in the best position to make them. Moreover, this legislation will make the decisions about provision of health treatments more explicit, making easier for courts to control the procedure and the reasons for these decisions.

Discrimination in the workforce: how it impacts a business

Discrimination, in its best form, is a hard concept to fathom as an employee or ordinary citizen. In the workplace, there are times when discrimination is necessary due to extenuating circumstances that revolve around the form or act of discrimination. It could be conveyed to save a life or avoid future conflict. However, it must be clearly stated as a written law that the act is lawful. When unlawful discrimination occurs, it stages an entirely different tone, as it is mainly conducted out of malice, hatred, greed, control, or ignorance. Over the last few decades, discrimination has existed in the workplace, although Federal laws mandate that it does not occur. It does not exist in just one geographical area or is country specific, but covers a wide spectrum, linking countries together from their points of view to creating rifts amongst those who are affected and those who are not, not only from a business perspective, but social humanistic relationships as well. This thesis will use quantitative and qualitative data to support discrimination of sexual harassment, race or color, and gender issues, as well as personal experiences, and how it has and will continue to impact businesses if the acts do not cease, permanently. Leadership, from the Presidents and Heads of Countries, Chief Executive Officers (CEOs), managers, lowest-ranking supervisor, and employees should make it their personal goal to ensure these issues do not continue or arise in their perspective areas of responsibilities. When employees understand that they are valued, will be taken seriously when reporting acts of discrimination, and that some form of action will be taken, performance and productivity will escalate, and morale will increase in the workplace, resulting in higher productivity and subsequently higher profit margins for the company.

Voluntariado nas entidades sem fins lucrativos, rede colaborativa para uma saúde pública de qualidade

Trata-se de um caso para ensino descritivo sobre o voluntariado em organizações da sociedade civil sem fins lucrativos na área da saúde. Identificado como um dos vértices da rede de governança colaborativa dos prestadores de serviço em saúde pública. No contexto do caso são apresentados conceitos de liderança voluntária e tomada de decisão em uma organização da sociedade civil sem fins Lucrativos na área da saúde. Análise de atores de governança colaborativa como complemento de qualidade na prestação de serviços para saúde pública é o foco do caso de ensino apresentado. O caso traz como pontos para reflexão e debate sobre a força motriz e o elemento de sustentação da rede colaborativa da saúde pública e a importância deste arranjo de relação Sociedade-Estado. O caso é indicado para estudantes de administração pública, políticas públicas, governança colaborativa, gestão social e áreas e afins.

Discrimination of geomorphic surfaces with multivariate analysis of soil attributes in sandstone - basalt lithosequence

O conceito de superfície geomórfica permite uma interligação entre os diferentes ramos da ciência do solo, tais como geologia, geomorfologia e pedologia. Esta associação favorece a compreensão da distribuição espacial dos solos na paisagem, e torna possível compreender o comportamento dos atributos do solo, que estão principalmente relacionadas com a estratigrafia e formas do relevo. Assim, este estudo visa à aplicação da estatística multivariada para categorizar superfícies geomórficas em uma litossequência arenito-basalto, de modo a fornecer uma base para a avaliação do solo em áreas afins. A área de estudo está localizada no município de Pereira Barreto, São Paulo, Brasil. A área escolhida possui 530 hectares, onde foram localizadas e mapeadas três superfícies geomórficas (I, II e III). Na área, 134 amostras foram coletadas nas profundidades de 0,0-0,2 m e 0,8-1,0 m, foram determinados os conteúdos de areia, silte e argila, pH em CaCl2, conteúdo de MO, P, Ca, Mg, K, Al e H+Al. Com base nos resultados, foram realizadas a análise univariada e multivariada de variância, clusters e principal componente, a fim de comparar as três superfícies geomórficas. A análise estatística univariada dos atributos do solo não foi eficiente na identificação das três superfícies geomórficas. Utilizando-se os atributos físicos e químicos do solo, as técnicas estatísticas multivariada permitiram à separação dos três grupos de corpos naturais do solo que foram equivalentes as três superfícies geomórficas mapeadas. Estes resultados são interessantes, pois demonstram a viabilidade da utilização de classificação numérica das superfícies geomórficas para ajudar no mapeamento de solo.

p-iodophenol-enhanced luminol chemiluminescent assay applied to discrimination between acute lymphoblastic and minimally differentiated acute myeloid (FAB-M0) or acute megakaryoblastic (FAB-M7) leukemias

Introduction: In this report, we propose the application of the p-iodophenol-enhanced luminol chemiluminescent technique to the determination of peroxidase (myeloperoxidase and/or platelet peroxidase) activity in blasts of minimally differentiated acute myeloblastic leukemia (AML-M0) and acute megakaryoblastic leukemia (AML-M7).Methods: the frozen blast cells from 29 patients were thawed and submitted to the optimized protocol.Results: All cases of AML-M7 and AML-M0 exhibited integrated light emission greater than 73 (10(2) mV x s), which was the arbitrary cutoff point set for the discrimination between AML and acute lymphoblastic leukemia (ALL) (mean + 3 x s.d. of ALL samples, n = 10). In addition, five out of seven cases of AML-M0 showed results above the Cutoff point.Conclusion: This highly sensitive enhanced chemiluminescent technique may be applied to discriminate between ALL and AML-M7 or AML-M1 cases, and most AML-M0 cases. It is very simple, cheap and easy to perform compared to other procedures used to measure MPO activity in AML-leukemias including AML-M7 and AML-M0.

A university extension course in leprosy: telemedicine in the Amazon for primary healthcare

There is a high prevalence of leprosy in the Amazon region of Brazil. We have developed a distance education course in leprosy for training staff of the Family Health Teams (FHTs). The course was made available through a web portal. Tele-educational resources were mediated by professors and coordinators, and included the use of theoretical content available through the web, discussion lists, Internet chat, activity diaries, 3-D video animations (Virtual Human on Leprosy), classes in video streaming and case simulation. Sixty-five FHT staff members were enrolled. All of them completed the course and 47 participants received a certificate at the end of the course. At the end of the course, 48 course-evaluation questionnaires were answered. A total of 47 participants (98%) considered the course as excellent. The results demonstrate the feasibility of an interactive, tele-education model as an educational resource for staff in isolated regions. Improvements in diagnostic skills should increase diagnostic suspicion of leprosy and may contribute to early detection.

Predictors of adherence to influenza vaccination for healthcare workers from a teaching hospital: a study in the prepandemic era

Introduction: Even before the 2009 pandemics, influenza in healthcare workers (HCW) was a known threat to patient safety, while Influenza vaccine coverage in the same group was generally low. Identification of predictors for HCW adherence to Influenza vaccination has challenged infection control committees. Methods: Our group conducted a cross-sectional survey in December 2007, interviewing 125 HCWs from a teaching hospital to identify adherence predictors for Influenza vaccination. The outcomes of interest were: A - adherence to the 2007 vaccination campaign; B - adherence to at least three yearly campaigns in the past five years. Demographic and professional data were assessed through univariate and multivariate analysis. Results: of the HCWs interviewed, 43.2% were vaccinated against Influenza in 2007. However, only 34.3% of HCWs working in healthcare for more than five years had adhered to at least three of the last five vaccination campaigns. Multivariate analysis showed that working in a pediatric unit (OR = 7.35, 95% I = 1.90-28.44, p = 0.004) and number of years in the job (OR = 1.32, 95%CI = 1.00-1.74, p = 0.049) were significant predictors of adherence to the 2007 campaign. Physicians returned the worst outcome performances in A (OR = 0.40, 95%CI = 0.16-0.97, p = 0.04) and B (OR = 0.17, 95%CI = 0.05-0.60, p = 0.006). Conclusions: Strategies to improve adherence to Influenza vaccination should focus on physicians and newly-recruited HCWs. New studies are required to assess the impact of the recent Influenza A pandemics on HCW-directed immunization policies.

Discrimination of bile acids by the rainbow trout olfactory system: evidence as potential pheromone

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

Discrimination of Shark species by simple PCR of 5S rDNA repeats

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