Improving continence services for older people from the service-providers’ perspective : a qualitative interview study

Objective: To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Design: Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. Setting: 3 acute and 13 primary care National Health Service Trusts in England. Participants: 16 continence service leads in England actively treating and managing older people with UI. Results: In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and highquality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Conclusions: Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.

Barriers and facilitators in the provision of post-abortion care at district level in central Uganda : a qualitative study focusing on task sharing between physicians and midwives

Background: Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians' and midwives' perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods: In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results: Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions: Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.

Personalised Grid Service Discovery

The authors take a broad view that ultimately Grid- or Web-services must be located via personalised, semantic-rich discovery processes. They argue that such processes must rely on the storage of arbitrary metadata about services that originates from both service providers and service users. Examples of such metadata are reliability metrics, quality of service data, or semantic service description markup. This paper presents UDDI-MT, an extension to the standard UDDI service directory approach that supports the storage of such metadata via a tunnelling technique that ties the metadata store to the original UDDI directory. They also discuss the use of a rich, graph-based RDF query language for syntactic queries on this data. Finally, they analyse the performance of each of these contributions in our implementation.

Personalised Grid Service Discovery

We take a broad view that ultimately Grid- or Web-services must be located via personalised, semantic-rich discovery processes. We argue that such processes must rely on the storage of arbitrary metadata about services that originates from both service providers and service users. Examples of such metadata are reliability metrics, quality of service data, or semantic service description markup. This paper presents UDDI-MT, an extension to the standard UDDI service directory approach that supports the storage of such metadata via a tunnelling technique that ties the metadata store to the original UDDI directory. We also discuss the use of a rich, graph-based RDF query language for syntactic queries on this data. Finally, we analyse the performance of each of these contributions in our implementation.

Candidate Quality and Voter Response in U.S. House Elections

We propose and test the implications of a two-dimensional concept of candidate quality in U.S. House elections. Strategic quality is composed of the skills and resources necessary to wage an effective campaign; personal quality is composed of the characteristics most ordinary citizens value in their leaders and representatives, such as personal integrity and dedication to public service. We employ district informants in studies of the 1998 and 2002 congressional elections to measure these qualities in candidates, and we merge mass survey data with the district informant indicators to assess constituents’ awareness and evaluation of House candidates, and voting choice. We find that awareness tends to be responsive to candidates’ strategic quality, and that incumbent evaluation is remarkably responsive to variation in personal quality, even taking into account the quality of challenger emergence. These and other findings appear to support a more positive view of citizen capacity than is common in the congressional elections literature, especially in light of the electoral security of House incumbents.

A PPCCIPS: a Política Pública da Coleta Complementar Itinerante e Programada de Sangue, sob a luz da teoria do ciclo da política pública

This study aimed to focus on aspects of public administration concerning the implementation of the public policy of complementary blood collection by the itinerant and scheduled PPCCIPS services either trough off local unity or mobile unit blood collection operations, which are managed by the State Institute of Hematology Arthur de Siqueira Cavalcanti - HEMORIO. The case study method was used in that public health institutional field, in search for a better understanding of responsibilities and management related to collection, serology, fractionation, storage and distribution of blood supply to almost all public hospitals and clinics, summed up to agreements with the single health system of the State of Rio de Janeiro. Bibliographic references, documentary and field data obtained through interviews and systematic observation in the public servants of HEMORIO workplaces, were treated by the analysis of the content method and the results of this research revealed the complexity of those services, and needs in outstanding aspects of infrastructure, equipment, logistics and personnel, which are critical for the achievement of the increased public collection of blood in the Rio de Janeiro State, endorsing the suggestions for the implementation of PPCCIPS in HEMORIO. The main point found in this research results concern the immanent ethical commitment of that public service personnel, including staff members and low ranking members as well, perceived due to a brief philosophical overlook on that personnel¿s attitudes. An important strategic aspect was revealed by the need for excellence of midia communications and education programs to implement the community involvement in the whole process. Final reflections point out that personnel posture is considered vital for the quality of the expected care of the technical activities and also for the quality of its final products release to the local public, fluminense, which is the irreplaceable human blood, and their derivatives. Despite the author¿s effort in this dissertation there is much more to be studied on that crucial theme.

Fatores-chave na qualidade de sistemas de home broker : uma análise teórico-empírica

This work has as main objective the development of a key factors¿ model for the quality of Home Broker systems. An explanatory research was performed, based on a quantitative approach. To achieve this goal, some theoretical models of technology acceptance (TAM, TRA, TPB and IDT), reliability and quality of service were reviewed. It was proposed an extended key factors¿ model and developed a questionnaire, which was the research instrument used in this study. The questionnaire was applied over the Internet, from which was obtained a participation of 113 valid respondents, all of them users of Home Broker system. Once performed the data collection, statistical tests were used for the Factorial Analysis in order to achieve a definitive model. The key factors found were Perceived Usefulness, Perceived Ease of Use, Subjective Norms, Compatibility, Reliability and Relative Advantage. Some hypotheses from the model were also tested to investigate the relationship between the importance given to the factors and the resulting degree of satisfaction about quality of service. As a result of the study, a key factors¿ model for the quality of Home Broker systems was established, and identified that the factor Compatibility" has more explanatory power than the others."

Valor percebido e o comportamento do consumidor de supermercado: um estudo exploratório em uma média cidade brasileira

Este estudo esteve envolvido com o desenvolvimento de um modelo para avaliação de valor de supermercado, sob a perspectiva do consumidor. O conceito de valor empregado neste trabalho parte da idéiade que um comportamento somente deve ser levado adiante caso o prazer decorrente seja superior à dor relacionada à obtenção desse prazer. Em Marketing, isto quer dizer que o consumo de determinado bem ou serviço exige do indivíduo uma certa quantidade de sacrifício (sacrifício percebido) para gozar dos benefícios associados (qualidade percebida). Em outras palavras, o consumidor precisa levar em consideração uma série de fatores numa situação de n avaliação e escolha. Para tanto, foram feitas duas consultas a clientes de supermercado do sexo feminino, pertencentes às classes A e B, na cidade de Campo Grande (MS), sendo uma qualitativa (n = 25) e outra quantitativa (n = 200). Os resultados indicam que valor percebido (VP) é uma função linear de qualidade percebida (QP), mas não de sacrifício percebido (SP). Portanto, duas das quatro hipóteses do estudo não foram confirmadas. Cerca de três quartos das mulheres preferem fazer ·uma compra pesada por mês e várias avulsas", aliás comportamento mais evidente nas faixa etárias mais elevadas. Para metade das entrevistadas, fazer compra em supermercado dá mais prazer do que trabalho. A maioria das mulheres que não trabalha fora sente prazer em fazer compra, ao contrário das mulheres que trabalham fora que acham isso uma obrigação. Por último, as mulheres que não trabalham fora, as de idade mais elevada e aquelas que consideram a compra um prazer, valorizam melhor o seu supermercado. O estudotambém permitiu verificar as características determinantes do supermercado que o cliente leva em consideração. Os atributos mais valorizados pelas entrevistadas foram substituiçao de produtos estragados e/ou vencidos e limpeza da loja. No entanto, elas usaram exposiçêo e organizaçao dos produtos, limpeza da loja e qualidade dos produtos hortifrutícolas para perceber valor. Os resultados dos testes de hipóteses parecem indicar que não é necessário o uso de variáveis de baixo nível de percepção (atributos de qualidade e de custo) para medir VP de supermercado. Os três atributos que permaneceram no modelo para explicar VP, através de QP (limpeza da loja, exposiçêo e organizaçao dos produtos e qualidade dos produtos hortifrutlcolas), o fazem moderadamente (R2 = 24,7%). Por outro lado, na avaliação global que as entrevistadas fizeram das lojas, QP (agora como variável independente) apresenta um coeficiente de explicação R 2 = 37,4%, resultadosuperior aoverificado quando a relação se deu com atributos específicos. Entretanto, se os clientes percebem valor apenas se valendo de QP (avaliação global), a formação da percepção de qualidade é feita usando sinais específicos associados ao produto "supermercado", sinais estes que incluem os três atributos que permaneceram no modelo. Assim, um modelo que inclui variáveis de percepção mais elevada (QP e SP) para inferir VP permite responder à seguinte questão: qual é a avaliação global que os clientes fazem de seu supermercado? Por outro lado, um modelo que julga VP a partir de atributos especificos (variáveis de baixo nível de percepção) deve responder à seguinte indagação: como se dá a percepção de valor do cliente em relação ao seu supermercado? Outros resultados são discutidos e também são apresentadas sugestões para futuras pesquisas e as principais implicações acadêmicas e empresariais .

Adoção de governo eletrônico no Brasil: a perspectiva do usuário do Programa Nota Fiscal Paulista

A intensa utilização da tecnologia da informação (TI) por todos os setores disseminou-se também na Administração Pública. A utilização da TI aliada à internet como ferramenta de gestão pública é denominada governo eletrônico e tem como objetivos qualificar melhor a prestação dos serviços e possibilitar aos cidadãos uma participação mais efetiva no processo político. O presente estudo buscou investigar o contexto do governo eletrônico no Brasil e apresenta um modelo de adoção baseado numa iniciativa de informatização de mecanismos de controle fiscal do Estado de São Paulo. O objetivo geral da tese foi estudar quais são os elementos que influenciam a utilização do governo eletrônico no Brasil, por meio de um estudo no programa Nota Fiscal Paulista (NFP). A metodologia envolveu técnicas do método qualitativo, pelo uso de opiniões de especialistas, associadas a procedimentos do método quantitativo, por meio de um survey aplicado em 715 usuários da NFP. A análise utilizou modelagem por equações estruturais. Os resultados contribuem para as pesquisas em TI, apresentando um modelo que reforça e amplia os estudos anteriores sobre adoção tecnológica e os estudos de governo eletrônico, acrescentando um modelo em um novo contexto ainda pouco explorado. No caso da NFP, os fatores testados e que influenciam no processo de adoção são: Benefício Percebido, Facilidade de Uso Percebida, Influências Sociais, Segurança Percebida, Confiança e Hábito. Em termos práticos, a pesquisa auxilia na compreensão da participação e do envolvimento dos cidadãos na fase atual de desenvolvimento de governo eletrônico no Brasil. Com melhor esclarecimento da influência dessa tecnologia na vida pessoal e profissional dos usuários, é possível elevar a qualidade da prestação dos serviços para atender às demandas da sociedade. Isto posto, auxilia também na implantação mais rápida do programa em outros contextos administrativos para o governo eletrônico, gerando informações úteis para os principais pontos a se considerar para ampliar a adesão dos cidadãos e ter mais chance de sucesso na implantação.

Qualidade do serviço em organização do terceiro setor: um estudo na casa de apoio à criança com câncer

The research aimed identify how the quality of services provided by Casa de Apoio à Criança com Câncer Durval Paiva is perceived by its users, giving an opportunity of improve their performance in social services provision pointing out the failures experienced, the institution will have the user as a important partner in fails identification, serving as a subsidy to the actions of correction and improvement to such situations demands. With this work implementation will be observed contributions that will permeate to the fields of theory and practice, enabling progress and enrichment on the subject. The theoretical contribution is observed as this work execution will provide greater advance about the models developed for the third sector. The proposed work will raise awareness issues about the full potential of the social economy, with regard to the quality of services provided by organizations, allowing a better definition of priorities on their development. The study addressed three issues: identifying the people that receive support of the Casa Durval Paiva, identifying what is the level of satisfaction of families served and evaluate the services provided by Casa Durval Paiva that demand improvements in the perception of families assisted. Found a demand for services has been found that the institution has a multidisciplinary team with a high level of professionalism, and supervised with students of various educational institutions and many volunteers to complement the actions of individual professionals. Was measured a high satisfaction of users of the services provided by Casa Durval Paiva

Egressos na avaliação da qualidade de um curso: o caso da Engenharia de Produção da UFRN

This thesis aims at analyzing the perspective of graduates perceived quality of an undergraduate course in order to contribute to continuous improvement. In order to achieve the proposed objectives, we performed a literature search, seeking together the work surrounding this issue, with the intent to update the concepts discussed today on the subject studied, they are: quality management, quality in higher education institutions and the system national assessment of higher education - Sinaes. The methodology is characterized as a case study, quantitative, and the object of study is composed of students who graduated from Production Engineering, Federal University of Rio Grande do Norte, which includes students who graduated from 2002 to 2010; data collection was done through the survey instrument, questionnaire, available online through SurveyMonkey interface, data analysis was done by means of descriptive statistics and multivariate analysis, including factor analysis. The proposed survey instrument consists of questions nineteen and twenty statements that address the central theme of this dissertation. The results show the identification of four latent factors (obtained by exploratory factor analysis), through two perspectives, the analysis of perception and importance, the results were similar in terms of the variable factors. The first factor was related to the support given to students, a factor known to support two extra class, the third factor related aspects of the library, and finalizing the evaluation and approached a factor of 4 facilities. Through research it was concluded that this study presents several points to be improved by the management team, and recommended to continue to evaluate the perceptions of graduates, seeking continuous improvement in service delivery by the university

A framework for monitoring and runtime recovery of web service-based applications

Service provisioning is a challenging research area for the design and implementation of autonomic service-oriented software systems. It includes automated QoS management for such systems and their applications. Monitoring, Diagnosis and Repair are three key features of QoS management. This work presents a self-healing Web service-based framework that manages QoS degradation at runtime. Our approach is based on proxies. Proxies act on meta-level communications and extend the HTTP envelope of the exchanged messages with QoS-related parameter values. QoS Data are filtered over time and analysed using statistical functions and the Hidden Markov Model. Detected QoS degradations are handled with proxies. We experienced our framework using an orchestrated electronic shop application (FoodShop).

Diagnóstico do usuário no aprimoramento dos serviços de tecnologia da informação: um projeto de intervenção para o Ministério Público do Estado do Rio Grande do Norte

The information tecnology (IT) has, over the years, gaining prominence as a strategic element and competitive edge in organizations, public or private. In the judiciary, with the implementation of actions related to Judiciário Eletrônico, information technology (IT), definitely earns its status as a strategic element and significantly raises the level of dependence of the organs of their services and products. Increasingly, the quality of services provided by IT has direct impact on the quality of services provided by the agency as a whole. The Ministério Público do Estado do Rio Grande do Norte (MPRN) deployments shares of Electronic Government, along with an administrative reform, beyond these issues raised, caused a large increase in institutional demand for products and services provided by the Diretoria de Tecnologia da Informação (DTI), a sector responsible for the provision of IT services. Taking as starting point strategic goal set by MPRN to reach a 85% level of user satisfaction in four years, we seek to propose a method that assists in meeting the goal, respecting the capacity constraints of the IT sector. To achieve the proposed objective, we conducted a work in two distinct and complementary stages. In the first step we conducted a case study in MPRN, in which, through an internal and external diagnosis of DTI, accomplished by an action of internal consulting and one research of the user satisfaction, we seek to identify opportunities of change seeking to raise the quality perceived of the services provided by the DTI , from the viewpoint of their customers. The situational report, drawn from the data collected, fostered changes in DTI, which were then evaluated with the managers. In the second stage, with the results obtained in the initial process, empirical observation, evaluation of side projects of quality improvement in the sector, and validation with the managers, of the initial model, we developed an improved process, gazing beyond the identification of gaps in service a strategy for the selection of best management practices and deployment of these, in a incremental and adaptive way, allowing the application of the process in organs with little staff allocated to the provision of information technology services

Percepção dos idosos sobre saúde bucal

The assessment of oral health status in elderly patients is essential for the development of specific health policies. The prevalence of oral diseases is high in this population. The self-perception of oral health conditions influences the demand for oral care and quality of life for seniors. The aim of this study was to assess self-perception of oral health status in 100 elderly of both sexes, aged 60 years or older and functionally independent the Basic Health Unit of Felipe Camarão II, Natal, Brazil. For comparison of self-perception data was collected in Bom Pastor, Natal / RN. In this research data were collected a questionnaire grouped into two parts. The first part with the socio-demographic data, subjective and objective condition of oral health and access to the service, the second part GOHAI Index. This index consists of 12 items that make it possible to obtain information involving aspects of chewing, speech, phonation, and self-assessed oral health. The results were subjected to statistical tests of Mann-Whitney and Kruskal-Wallis test (α = 0.05), to identify possible predictors of self-evaluation. As a result, 69% were female, ages ranged from 60 to 86 years, with a median of 65 years. In relation to marital status 48% were married. For the years of study, the sample had an average of 3 years. For the last visit to the dentist, only 27% of seniors had visited the Dentist for less than a year. Regarding the questions about the presence of gingival and dental problems were answered by 46% and 21% respectively. The data on the perception of your teeth and gums, 44%. The index showed GOHAI value for self-perception of 30 points to Felipe Camarão and 28 points for the Bom Pastor, both considered a low perception. We identified predictors of self-rated number of people in the room, participate in any associational activity, there is problems with your teeth and your gums. Concluded a negative self-perception of oral health condition by Gone in both areas, influenced by socioeconomic and cultural issues, although they realize the importance given to oral health, but by the misfortunes of other prominent favored little valuing of oral health

Doadores de sangue: qualidade de vida e atendimento em hemocentro de Natal / RN

The context of blood donation in Brazil faces problems since the start of its operations in the 1940, in the beginning the biggest obstacle was obtain safe and qualified blood, and then, established criteria for donations, the barrier is the low number of suitable candidates for donation. This suitability is associated with the good health of those who goes to the services of blood banks and the return of the donor is often conditioned by the way care is given and perceived by the user. The quality of life, defined as a perception that a person has of her/his position in the world, can influence the health and emerges as a way to focus on the subjectivity in a context dominated by objective and practical exams; listen to the views about the received services increases the focus on the user and provides feedback to the institution, guiding and planning its future actions. The purpose of this study was to verify the quality of life in blood donors and their perceptions of care in a blood center in Natal/RN. This is a descriptive cross sectional study conducted with blood donors from Dalton Cunha Barbosa blood center. The used protocols were: a structures questionnaire with questions on sociodemographic and services perception data, and SF-36 quality of life instrument. The sociodemographic and SF-36 data ware analyzed using descriptive and inferential statistics, using the statistical package PASW 18.0; those related to treatment were submitted to thematic content analysis. The results revealed a sample mainly composed by men, married people, who attended high school and had already made previous donations, with the first two groups returning more often for donations. The scores of the SF-36 confirm the certificated of good health of the screens, beind high in all areas and featuring a healthy population; statistically significant differences were denoted between sexes, levels of education and marital status. The speeches about the service were mostly positive and had as main focus acess, agility, technical aspects and subjective feelings. The data regarding the Rio Grande do Norte blood donors profile confirmed some characteristics of the Brazilian ones, those data of the SF-36 were similar to those found in studies with healthy groups and the impressions about the care received show similarities with national and international studies about the attendance at blood banks