A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion : a study protocol

Background. Continuous subcutaneous insulin infusion (CSII) treatment among children with type 1 diabetes is increasing in Sweden. However, studies evaluating glycaemic control in children using CSII show inconsistent results. Omitting bolus insulin doses using CSII may cause reduced glycaemic control among adolescents. The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification. There is much published support for continued parental involvement and shared diabetes management during adolescence. Guided Self-Determination (GSD) is an empowerment-based, person-centred, reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management. This method has been adapted for adolescents and parents as Guided Self-Determination-Young (GSD-Y). This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts, perceived health and quality of life (QoL), and metabolic control. Here, we describe the protocol and plans for study enrolment. Methods. This study is designed as a randomized, controlled, prospective, multicentre study. Eighty patients between 12-18 years of age who are planning to start CSII will be included. All adolescents and their parents will receive standard insulin pump training. The education intervention will be conducted when CSII is to be started and at four appointments in the first 4 months after starting CSII. The primary outcome is haemoglobin A1c levels. Secondary outcomes are perceived health and QoL, frequency of blood glucose self-monitoring and bolus doses, and usage of carbohydrate counting. The following instruments will be used to evaluate perceived health and QoL: Disabkids, 'Check your health', the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale. Outcomes will be evaluated within and between groups by comparing data at baseline, and at 6 and 12 months after starting treatment. Results and discussion. In this study, we will assess the effect of starting an insulin pump together with the model of Guided Self-Determination to determine whether this approach leads to retention of improved glycaemic control, QoL, responsibility distribution and reduced diabetes-related conflicts in the family. Trial registration: Current controlled trials: ISRCTN22444034

Attraktivt arbete ur enhetschefers perspektiv : En kvalitativ studie genomförd i Falu kommun

Sedan 1990- talet har de offentliga organisationerna genomgått flera stora förändringar som medfört att enhetschefer inom den kommunala verksamheten fått ökat ansvar och befogenheter, vilket gör enhetschefsrollen mer komplext. Rapporter visar på svårigheter att rekrytera och behålla chefer, därför är viktigt att undersöka hur enhetschefens arbete ska kunna utvecklas till ett mer attraktivt arbete. Ett attraktivt arbete skapas genom att ge medarbetarna bra förutsättningar inom arbetsinnehåll, arbetstillfredsställelse, samt arbetsförhållanden. I chefsyrket ingår tre roller varav en är medarbetarrollen som enligt teorin inte är speciellt prioriterad eller synliggjord. Studiens syfte är att identifiera vad som gör enhetschefyrket till ett attraktivt arbete samt hur det kan utvecklas. I studien har en kvalitativ forskningsmetod används för att uppnå en djupare förståelse kring enhetschefernas arbetssituation. Detta har bidragit till att ett hermeneutiska synsätt valts, då vi strävar efter att få en ökad förståelse. Studien genomfördes på Falu kommun, där sex enhetschefer inom omvårdnadsförvaltningen intervjuades. Resultatet visar att enhetscheferna är tillfredsställda med sin arbetssituation och upplever arbetet som attraktivt. Faktorer som varierande, handlingsfrihet, problemlösning, sociala kontakter och delar av erkänsla hör till attraktivitetsfaktorer i yrket. Enhetscheferna beskriver tre utvecklingsområden för att öka attraktiviteten. Det första innefattar ledarskapet i organisationen där brister förekommer inom kommunikation och planering. Andra utvecklingsområdet handlar om arbetstakten genom att individanpassa arbetsgruppernas storlek samt tid för reflektion och återhämtning. Tredje utvecklingsområdet enhetscheferna belyser är bristen på erkänsla från organisationen. Utöver enhetschefernas brister har vi identifierat ytterligare ett utvecklingsområde för att öka attraktiviteten. Under intervjuerna har det framkommit att det råder stor avsaknad av kollegor att "bolla idéer" med vilket i sin tur medför att arbetet upplevs som ensamt. För att motverka ensamheten är chefsgruppshandledning ett alternativ, där reflektion och feedback ingår. Forskningen visar att detta även leder till ökad självkänsla, engagemang.

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

Agir, aprender, formar, intervir, agir uma experiência dos consultores internos na gestão do conhecimento da Petrobrás UN-RNCE

This research aims at studying the formation of internal consultants in organizational setting in the joint resolution of problems, around the conversion of knowledge. The objective of research is to understand and explain the meanings attributed by Petrobras internal consultants to their practice and training for the conversion process of tacit knowledge into explicit, around the joint resolution of their problems with their collaborators. It has directed the next question: what the meanings assigned by the consultants of Unidade de Negócios Rio Grande do Norte e Ceara (UN-RNCE) in Knowledge Management (KM), for their interventionist and formative practices in problem solving, as well as conversion of tacit knowledge in explicit? This paper has assumed that there is a dual logic integrated into its daily practices: solving troubles and converting knowledge. The thesis has considered the daily practices of these consultants are characterized as epistemic spaces and permanent education through the conversion of knowledge. It has adopted the principles of multi-referential approach as foundations, regarding the translation of a variety of angles, perspectives and prospects which allow the interpretation and understanding of complex issues that are part of conversion of knowledge. The understanding and explanation of the senses are based on the methodology of the comprehensive interview; taking ownership is the sensitive listening for comprehensive interpretation of oral discourses of ten consultants, in addition to the autoscopy that putting into practice, thus, the stance of the researcher as an intellectual craftsman. Furthermore, it has assessed that the limits and possibilities for training and learning in the conversion of knowledge arise, on one hand from a predominantly driven training culture by the paradigm of technical rationality and one the other hand, from a set of relationship to knowledge and relation to know , revealed in the search for training in other dimensions. There are tensions between the local and global demands located in a situation marked by a systemic organization of knowledge. However, the context is perceived by researchers as impregnated by the discontinuity, unpredictability and uncertainty; mobilizing a number of elements necessary for the mediation in training practices of these consultants. Finally, it has set an instrumental and technological support, restricting the formation and undermining the position of the consultancy as nuclear function in Knowledge Management

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.