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.

Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

Affordable Housing in Kennebec County

The U.S. Department of Housing and Urban Development defines affordable housing as a household paying no more than 30 percent of its annual income on housing. That is, families who pay more than 30 percent of their income on housing are considered cost burdened and may have difficulty affording necessities such as food, clothing, healthcare, and transportation. This project focused on Kennebec County, Maine. Between 1990 and 2000, market demand for housing increased at a faster rate than did the supply of housing. Despite the addition of 6,719 homes, the average home price increased faster than average household income. This raises the question of just how many households in Kennebec County are facing unaffordable housing. Using shapefiles and data provided by the US Census Bureau, a map was created with ArcGIS to illustrate the percentage of households, down to the Census Block level of detail, that are paying more than 30 percent of their income to housing. By looking at this information I was able to get a better picture of the housing situation and where in the county households are having the hardest time meeting their needs. The results indicate that households in the more urbanized sections of the county are more likely than rurally located households to be facing unaffordable housing. Namely, Waterville and Augusta held the highest percentage of households paying more than 30 percent of their income for housing.

Endogenous collateral

We study an economy where there are two types of assets. Consumers’ promises are the primitive defaultable assets secured by collateral chosen by the consumers themselves. The purchase of these personalized assets by financial intermediaries is financed by selling back derivatives to consumers. We show that nonarbitrage prices of primitive assets are strict submartingales, whereas nonarbitrage prices of derivatives are supermartingales. Next we establish existence of equilibrium, without imposing bounds on short sales. The nonconvexity of the budget set is overcome by considering a continuum of agents.

A influência da exportação no desenvolvimento de arranjos produtivos locais de moda no estado do Rio de Janeiro

In recent years, clusters have become a central part in discussions about local and regional economic development, as well as in the elaboration of public policies for generating jobs and income. Concurrent with the discussions about clusters, the subject globalization has also received growing attention from the media in the academic and government fields. Different aspects are considered in the discussions regarding globalization and one of the subjects is the insertion of local economies into international commerce. One of these ways of insertion is by global value chains. This term began to be used at the end of 90s, and refers to the productive value chains dispersed throughout the world, but with integrated production and commercialization. The aim of this thesis is to understand how the exportation process influences the development of fashion clusters, this being done by the insertion of these clusters into the global value chains. Each year, the Brazilian fashion sector seeks to broaden their participation in the global economy by means of insertion into the global value chains. This insertion, however, has caused impacts in specialized clusters of garment manufacturers, such as beach fashion, jeans and women¿s clothing. As a way of identifying these impacts, three cluster manufacturers were studied in the state of Rio de Janeiro, namely Cabo Frio, São Gonçalo and Niterói. The impacts of internationalization on the companies integrated into these three clusters were explored by means of a six-month field study, including semistructured interviews. This internationalization occurs either by direct exportation or by means of inserting these companies into the global value chains. The results of the study points out the opportunities and threats to these companies, as well as shows the importance of more adequate public policies for the development of Brazilian fashion clusters. Among these threats, the possibility of inserting these cluster companies into the global value chains in a captive manner (Gereffi, Humphrey, Sturgeon, 2005) was singled out, placing them ¿under control¿ of the exporting companies. As for opportunities, the participation of government support agencies and improvements in fashion show good alternatives for inserting these companies into the global value chains, making possible autonomous and competitive performance.

Incerteza e dívida pública prefixada no Brasil

This study analyses the bids¿ dispersion in fixed income government securities auctions issued by the National Treasury of Brazil. We try to estimate the bids¿ variance based on factors that may forecast its movement. We hope to help the security issuer by offering more data before the auction. The basic idea is to relate the market uncertainty with the primary auction of government securities. Results indicates the importance of uncertainty on the bidding decisions. It shows also the need for a liquid secondary market to the selling of long-term fixed income securities.

A abertura comercial brasileira e o impacto no processo gerencial das micro e pequenas empresas do setor de confecção do Espírito Santo

ESTA MONOGRAFIA OBJETIVOU IDENTIFICAR ATÉ QUE PONTO A ABERTURA DO MERCADO BRASILEIRO AFETOU O PROCESSO GERENCIAL DAS MICRO E PEQUENAS EMPRESAS DO SETOR DE CONFECÇÃO DO ESPÍRITO SANTO. UTILIZOU-SE METODOLOGIA DIVERSIFICADA CONSISTENTE DE REVISÃO BIBLIOGRÁFICA SOBRE O TEMA, ANÁLISE E INTERPRETAÇÃO DE DADOS FORNECIDOS PELO SEBRAE-ES, IBGE E UNIVERSIDADE FEDERAL DO ESPÍRITO SANTO (UFES) E PESQUISA DE CAMPO EM QUE FORAM ENTREVISTADOS EMPRESÁRIOS DO SETOR DE CONFECÇÃO EM MUNICÍPIOS DO ESTADO. PELO ESTUDO, CONCLUI-SE QUE: O PROCESSO DE GLOBALIZAÇÃO TEM AFETADO A ECONOMIA BRASILEIRA E, PARTICULARMENTE, A CAPIXABA; EM RELAÇÃO AO SETOR DE CONFECÇÃO, O IMPACTO DA GLOBALIZAÇÃO NÃO TEM SIDO ACENTUADO; E O PROCESSO GERENCIAL DAS MICRO E PEQUENAS EMPRESAS DO RAMO DE CONFECÇÃO NO ESTADO, SURGIU COMO UMA DAS PRINCIPAIS CAUSAS DA FRAGILIDADE E INEFICÁCIA DO SETOR, TORNANDO-SE INADIÁVEIS E IMPERATIVAS AÇÕES QUE PROPICIEM O DESENVOLVIMENTO GERENCIAL, A FIM DE PERMITIR-LHE CONTRIBUIR PARA A DISTRIBUIÇÃO SOCIAL DOS MEIOS DE PRODUÇÃO.

As mudanças da cadeia produtiva têxtil em Valença-RJ: das indústrias do setor de tecidos para o APL do setor de Confecções

This study shows how the Industrial Cluster of garments in Valença, RJ ¿ comprised of micro and small enterprises ¿ contributes to overcome the problems left by the declining period of the textile industry. At first, the city took advantage of its talent for textile work and turned to the clothing sector, which now relies on garment factories, subcontractors, cooperatives and laundries in order to create jobs. There is institutional support, but the analysis of the situation identified the need for higher involvement of cluster players, as well as a higher interaction among them to help their own development. In regard to public and private institutions, there is room for steps to guide informal companies that find it difficult to afford labor, financial, and environmental costs towards formalization, the offer of management and labor skill programs, as well as entrepreneurs¿ awareness about the acquisition of modern-technology machinery. It is important to encourage higher participation of Valença firms in the national fashion events, since this draws attention to the name of the city, discloses the work that is carried out there, and attracts new businesses. The entry of Valença companies in the fashion arena of the southern region of Rio de Janeiro state is beneficial, especially to make them better prepared for the Fashion Rio/Fashion Business event. Informality as a way out of the unemployment problem is a growing trend in Valença, as well as in most of Brazilian cities. In this sense, the entrepreneurs need to find favorable steps to make them feel motivated to formalize their businesses.

Implantação de tecnologia de monitoramento remoto para e-service: um estudo exploratório

The purpose of this study is to define measures to increase customer satisfaction and company competitiveness using a remote monitoring technology, in an exploratory study of Alpha Elevator Company (nick name chosen to the company by the actor of the dissertation). Regarding the competitive market, the service industry is striving to achieve productivity, following the example of the manufacturing industry. Nevertheless, these efforts are limited by the amount of hours worked per week, month or year, since the sector charges its services based on the hours spent working on the equipment of the client or based on the numbers of visits. This study is based in the overcoming of the traditional paradigm of selling number of hours by a system of selling results and performance. Employing a remote monitoring system, the elevators under the company service are monitored continually and defects are detected and transmitted to the customer care center, via phone line. The customers can access this data through the Internet and obtain information like availability rate of their elevators and call back response time rate, besides being able to buy products on the company¿s home page and to send feedback. The results were obtained by participating in conferences among experts of the company, in Japan and the United States. Through the analysis of the business environment and based on the bibliographic reference, a strategy was developed to implement e-service as a competitive differentiation.

Relacionamento Interpessoal entre Compradores e Vendedores: Troca de Atendimento em Vendas e o Impacto na Continuidade das Relações Comerciais.

In a highly competitive environment, the ability to retain a substantial customer base represents a tremendous competitive advantage, therefore this transaction-based emphasis in sales is increasingly being replaced by relationally focused approach. Although existing sales literature is in agreement to the theoretical composition of buyer-seller relationships, a lack of empirical evidence exists for the interrelationships of various aspects of relational selling on individual salesperson¿s performance. This paper explores the impact of interpersonal relationships on customer satisfaction and loyalty towards the firm. Based on a review of different streams of research, the paper contributes to the existing theories using a case analysis of customer behavior when there is salesperson turnover. Much of the relationship with the company comes from trust in the salesperson, which is built up through the development of the relationship. The existence of a friendship interpersonal relationship with a salesperson also increases the customer willingness to follow him in case he leaves the company, thus possibly switching to another service provider. Utilizing a case analysis method this paper has the objective to find evidences that could prove the positive or negative impact of the salesperson¿s turnover in the organizations. Finally, the paper discusses managerial implications and directions for future research.

A Adoção das Estratégicas de CRM e a Fidelização do Cliente

As relações comerciais observadas no início do século passado se baseavam no atendimento personalizado, em que cada cliente era recebido pessoalmente pelo dono da loja, que por sua vez conhecia a clientela e suas principais necessidades. Com a massificação da produção e o surgimento dos grandes magazines e shopping centers, o foco das empresas se voltou para produtos e serviços, futor que promoveu o distanciamento das relações com os clientes, tornando-os ilustres desconhecidos para as empresas. Quase um século depois, o advento da Internet prOpICIOU um processo de reaproximação entre empresas e clientes, eis que as fronteiras geográficas começaram a desaparecer, as empresas locais começaram a atuar e concorrer mundialmente através da web, o mercado apresentou-se mais competitivo e os clientes conquistaram maior poder de escolha e se tornaram mais voláteis. Neste contexto de grandes massas, surge o CRM contemplando um conjunto de estratégias que permeiam toda a organização, como por exemplo, a revisão dos processos de negócios, a mudança da cultura com o foco no cliente, a automação dos serviços de marketing, vendas e atendimento, a disponibilização de multi-canais de contato com o cliente e a integração das bases de dados com os canais de interação. As estratégias de CRM, com base na revisão dos processos de negócios, na mudança da cultura organizacional e na infra-estrutura tecnológica, objetivam estabelecer relações individualizadas com uma imensa massa de clientes. Neste sentido, esse trabalho de pesquisa intenciona aprofundar os conhecimentos sobre influência do CRM na fidelização do cliente.

Pharmaceutical patent bargains: the Brazilian experience

In the backdrop of the strict patent regime flatly adopted by the World Trade Organization (WTO) for all countries, a few countries constantly challenge this system through aggressive patent bargains. Within the pharmaceutical sector, noticeably, some countries now threaten to issue or otherwise actually issue compulsory licenses that may sway large pharmaceutical companies into selling drugs with large discounts or into granting voluntary licenses domestically. That is conspicuously the negotiation strategy adopted by Brazil in its negotiations with big international pharmaceutical companies.This paper explains Brazil’s aggressive bargaining approach based on an analysis of two aspects of its political economy. The first has to do with the international context of patent bargaining in the post-WTO era. Accordingly, the existence of large and fast growing domestic markets position countries such as Brazil as strategic destinations for Foreign Direct Investment (FDI) and trade. Together with an absence of a propensity to innovate in pharmaceutical products, these conditions boost Brazil’s bargaining power for issuing compulsory licenses over pharmaceutical products. The second aspect is related to political economy dynamics inside Brazil. Accordingly, the political framework in Brazil undermines long-term policies and favors short-sighted ones also vis-a-vis R&D investments in the pharmaceutical industry. This remains true regardless of the strictness of the patent regime in place. The lesson of Brazil is relevant arguably for other more powerful developing countries which presently examine Brazil's approach while further challenging the WTO's strict patent policy for the future.

Synergies and price trends in sequential auctions

In this paper we consider sequential auctions where an individual’s value for a bundle of objects is either greater than the sum of the values for the objects separately (positive synergy) or less than the sum (negative synergy). We show that the existence of positive synergies implies declining expected prices. When synergies are negative, expected prices are increasing. There are several corollaries. First, the seller is indi¤erent between selling the objects simultaneously as a bundle or sequentially when synergies are positive. Second, when synergies are negative, the expected revenue generated by the simultaneous auction can be larger or smaller than the expected revenue generated by the sequential auction. In addition, in the presence of positive synergies, an option to buy the additional object at the price of the …rst object is never exercised in the symmetric equilibrium and the seller’s revenue is unchanged. Under negative synergies, in contrast, if there is an equilibrium where the option is never exercised, then equilibrium prices may either increase or decrease and, therefore, the net e¤ect on the seller’s revenue of the introduction of an option is ambiguous. Finally, we examine two special cases with asymmetric players. In the …rst case, players have distinct synergies. In this example, even if one player has positive synergies and the other has negative synergies, it is still possible for expected prices to decline. In the second case, one player wants two objects and the remaining players want one object each. For this example, we show that expected prices may not necessarily decrease as predicted by Branco (1997). The reason is that players with singleunit demand will generally bid less than their true valuations in the …rst period. Therefore, there are two opposing forces; the reduction in the bid of the player with multiple-demand in the last auction and less aggressive bidding in the …rst auction by the players with single-unit demand.

O apelo ecológico na propaganda como fator de influência na atitude de compra do consumidor: um estudo experimental

Este estudo examinou o apelo ecológico utilizado na propaganda como influenciador na atitude de compra do consumidor, tendo em vista que nas duas últimas décadas houve um crescimento nos anúncios que utilizam este tipo de apelo, demonstrando que, pelo surgimento de um novo nicho de mercado, empresas têm se valido do marketing verde e da influência normativa na sua estratégia de marketing. Buscou-se investigar se efetivamente o uso do apelo ecológico na propaganda influencia positivamente na intenção de compra do consumidor. A fundamentação teórica sobre o tema foi desenvolvida a partir dos estudos sobre comportamento do consumidor, atitudes em relação à propaganda, psicologia social e outros ligados ao tema. Esta fundamentação gerou algumas propostas conceituais, traduzidas em um conjunto de hipóteses, que, por se tratar de uma pesquisa causal, foram testadas por meio de metodologia experimental entre sujeitos, com oito níveis de manipulação, uma amostra não probabilística, formada por 215 estudantes de pós-graduação na cidade de Curitiba, e aplicação de questionário estruturado, constituído de perguntas fechadas e respostas escalonadas não-comparativas, intervalar do tipo diferencial semântico, com sete categorias. Os resultados obtidos indicaram que o apelo ecológico utilizado na propaganda como argumento de venda não gerou uma resposta significativamente mais favorável na intenção de compra; contudo, em relação à intenção de compra, o apelo ecológico na propaganda gerou uma atitude significativamente mais favorável do que a atitude em relação à marca, e uma atitude menos favorável do que a atitude em relação ao preço. Os resultados também indicaram que o consumidor não está disposto a pagar um preço maior por um produto anunciado com apelo ecológico de venda. Sugestões de pesquisa futura são comentadas à luz da teoria de marketing.