A randomised controlled trial of an intervention to increase the implementation of a healthy canteen policy in Australian primary schools: study protocol

Background: The implementation of healthy school canteen policies has been recommended as a strategy to help prevent unhealthy eating and excessive weight gain. Internationally, research suggests that schools often fail to implement practices consistent with healthy school canteen policies. Without a population wide implementation, the potential benefits of these policies will not be realised. The aim of this trial is to assess the effectiveness of an implementation intervention in increasing school canteen practices consistent with a healthy canteen policy of the New South Wales (NSW), Australia, government known as the 'Fresh Tastes @ School NSW Healthy School Canteen Strategy'.Methods/design: The parallel randomised trial will be conducted in 70 primary schools located in the Hunter region of New South Wales, Australia. Schools will be eligible to participate if they are not currently meeting key components of the healthy canteen policy. Schools will be randomly allocated after baseline data collection in a 1:1 ratio to either an intervention or control group using a computerised random number function in Microsoft Excel. Thirty-five schools will be selected to receive a multi-component intervention including implementation support from research staff, staff training, resources, recognition and incentives, consensus and leadership strategies, follow-up support and implementation feedback. The 35 schools allocated to the control group will not receive any intervention support as part of the research trial. The primary outcome measures will be i) the proportion of schools with a canteen menu that does not contain foods or beverages restricted from regular sale ('red' and 'banned' items) and ii) the proportion of schools where healthy canteen items ('green' items) represent the majority (>50%) of products listed on the menu. Outcome data will be collected via a comprehensive menu audit, conducted by dietitians blind to group allocation. Intervention effectiveness will be assessed using logistic regression models adjusting for baseline values.Discussion: The proposed trial will represent a novel contribution to the literature, being the first randomised trial internationally to examine the effectiveness of an intervention to facilitate implementation of a healthy canteen policy.

Dilemas da administração prisional: a Escola de Gestão Penitenciária do Rio de Janeiro

Este trabalho tem o objetivo de analisar as peculiaridades dos cursos oferecidos pela Escola de Gestão Penitenciária do Estado do Rio de Janeiro. Para isso, foi utilizado como metodologia a analise documental a partir do documento coletado na própria sede da Escola. Busca-se analisar se existe ou não alguma particularidade nas aulas oferecidas para os servidores penitenciários, tendo em vista que os mesmos realizam um trabalho de extrema importância dentro do sistema carcerário. Em um primeiro momento foi exposta a bibliografia pertinente à temática que se encontra o presente trabalho. Em seguida, foi realizada uma exposição, com base nas próprias afirmações da Escola embasadas no documento, sobre os cursos que a mesma oferece. A partir da análise minuciosa a respeito das aulas oferecidas, foi elaborada uma investigação a fim de constatar se existe ou não uma ideologia carcerária por trás da pedagogia dos cursos.

Gestão compartilhada de P&D em petróleo:a interação entre a Petrobrás e a Universidade Federal do Rio Grande do Norte

This work addresses the relationship between University-Firm aims to understand the model of shared management of R&D in petroleum of Petrobras with UFRN. This is a case study which sought to investigate whether the model of cooperation established by the two institutions brings innovation to generate technical-scientific knowledge and contribute to the coordination with other actors in the promotion of technological innovation. In addition to desk research the necessary data for analysis were obtained by sending questionnaires to the coordinators of projects in R&D at the company and university. Also, interviews were conducted with subjects who participated in the study since its inception to the present day. This case study were analysed through the Resource-Based View and Interorganizational Networks theory. The sample data also stands that: searches were aligned to the strategic planning and that 29% of R&D projects have been successful on the scope of the proposed objectives (of which 11% were incorporated into business processes); which was produced technical and scientific knowledge caracterized by hundreds of national and international publications; thesis, dissertations, eleven patents, and radical and incremental innovations; the partnership has also brought benefits to the academic processes induced by the improved infrastructure UFRN and changing the "attitude" of the university (currently with national prominence in research and staff training for the oil sector). As for the model, the technical point of view, although it has some problems, it follows that it is appropriate. From the viewpoint of the management model is criticized for containing an excess of bureaucracy. From the standpoint of strategic allocation of resources from the legal framework needs to be reassessed, because it is focused only on the college level and it is understood that should also reach the high school given the new reality of the oil sector in Brazil. For this it is desirable to add the local government to this partnership. The set of information leads to the conclusion that the model is identified and named as a innovation of organizational arrangement here known as Shared Management of R&D in petroleum of Petrobras with UFRN. It is said that the shared management model it is possible to exist, which is a simple and effective way to manage partnerships between firms and Science and Technology Institutions. It was created by contingencies arising from regulatory stand points and resource dependence. The partnership is the result of a process of Convergence, Construction and Evaluation supported by the tripod Simplicity, Systematization and Continuity, important factors for its consolidation. In practice an organizational arrangement was built to manage innovative university-industry partnership that is defined by a dyadic relationship on two levels (institutional and technical, therefore governance is hybrid), by measuring the quarterly meetings of systematic and standardized financial contribution proportional to the advancement of research. These details have led to the establishment of a point of interaction between the scientific and technological-business dimension, demystifying they are two worlds apart

Atitudes sociais de professores da rede de ensino municipal de Guarapuava/PR em relação à educação inclusiva

Pós-graduação em Educação - FFC

Desafios de uma nova gestão pública para o desenvolvimento dos municípios no Pará

O desenvolvimento econômico em nível municipal tem sido tradicionalmente estudado a partir de variáveis econômicas, da estrutura política ou da capacidade endógena de inovar e criar riqueza. A hipótese teórica que guia esta pesquisa é que o desenvolvimento econômico de um município depende essencialmente da qualificação da gestão municipal. A partir de uma abordagem multidisciplinar e interdisciplinar, em nível metodológico, expõe-se a primeira fase da investigação, exploratória, baseada em uma metodologia quantitativa, em diversos municípios do estado do Pará. Expõem-se e analisam-se as variáveis planejamento e a gestão de pessoas. Como conclusão, observa-se a importância que adquire o planejamento a médio e longo prazos e a formação do pessoal para o fortalecimento institucional.

Percepção de risco sanitário na bovinocultura de corte no estado de São Paulo

Pós-graduação em Medicina Veterinária - FCAV

O engavetamento de modelos de ensino superior dentro da universidade pública

This paper explores the contradictions between models conflicting today in Brazilian universities. The conglomeration of isolated institutions, integrated and multifunctional university and university-enterprise, service provider. This last model attempts to integrate higher education institutions to supply chains dominated by capital. Public universities were designed to provide innovative services and train staff researchers for such activity. The training of skilled workforce would be fundamentally task of private universities. But in any case, the onus would be on this training students. This model has been driven from the 1990s, with "instruction manuals" of the World Bank, and in 2000, with the IMF recommendations and, in the case of Latin American universities, Fundación Universia, sponsored by the Santander Bank. The question remains: the university will be able to organize the productive forces which have around research goals and staff training for independent development.

Análise dos fatores influentes nos riscos de descontinuidade na cadeia de peças de reposição automotivas

Pós-graduação em Engenharia Mecânica - FEG

Vancomycin-resistant enterococcus outbreak in a pediatric intensive care unit: report of successful interventions for control and prevention

The objective of this study is to retrospectively report the results of interventions for controlling a vancomycin-resistant enterococcus (VRE) outbreak in a tertiary-care pediatric intensive care unit (PICU) of a University Hospital. After identification of the outbreak, interventions were made at the following levels: patient care, microbiological surveillance, and medical and nursing staff training. Data were collected from computer-based databases and from the electronic prescription system. Vancomycin use progressively increased after March 2008, peaking in August 2009. Five cases of VRE infection were identified, with 3 deaths. After the interventions, we noted a significant reduction in vancomycin prescription and use (75% reduction), and the last case of VRE infection was identified 4 months later. The survivors remained colonized until hospital discharge. After interventions there was a transient increase in PICU length-of-stay and mortality. Since then, the use of vancomycin has remained relatively constant and strict, no other cases of VRE infection or colonization have been identified and length-of-stay and mortality returned to baseline. In conclusion, we showed that a bundle intervention aiming at a strict control of vancomycin use and full compliance with the Hospital Infection Control Practices Advisory Committee guidelines, along with contact precautions and hand-hygiene promotion, can be effective in reducing vancomycin use and the emergence and spread of vancomycin-resistant bacteria in a tertiary-care PICU.

Vad man ska kunna och hur man ska vara : En studie om enhetschefers och vårdbiträdens yrkeskompetens inom äldreomsorgens särskilda boendeformer

The dissertation What to do and how to be reflects upon the professional skills needed by unit managers and nursing staff within the institutions of eldercare. Throughout the study, three conceptions are essential: formal education and training, professional skills, and individual competence. In order to understand the professional skills within its proper context, an activity perspective has been applied. The study is based on empirical materials, historical and present national and municipal documents, interviews with and observations of unit managers as well as questionnaires filled in by nursing staff members. A main result is the stress the respondents put on the importance of individual competence among unit managers and nursing staff members. “How to be” is more important than formal training and professional skills. To work with – and develop – individual competence therefore becomes momentous both to job activities and to education. The result shows a discrepancy between the way professional skills are discussed and the actual work performance. A lot of tasks carried out by unit managers and nursing stuff are never mentioned in connection with professional skills. The unit manager’s task is to lead both unit operations and staff work. Such responsibilities demand basic knowledge in social sciences, an overall understanding of the work activities from political management, job conditions and duties of the nursing staff. The professional skills given priority are those present in organisations and leadership. Problematic are economic and budget tasks which may sometimes cause unit managers to give up their economic responsibility, favouring client – directed over economy – directed care. The main task of the nursing staff is the care of elderly. It calls for social, caring, medical and housekeeping skills. For this one needs an upper secondary level education supplying the students with solid knowledge within social science as well as basic medicine and an overall understanding of the situation and needs of the elderly. Throughout the study, knowledge of the demented and of other mental disorders is emphasized as well as treatment of elderly persons suffering from those disorders. Units still have a long way to go before reaching the goal that every nursing staff member be given a formal education. Some municipalities already offer employees shorter nursing staff training. As to the rest, the educational development is neglected.

Reduction of inappropriate medications among older nursing-home residents: a nurse-led, pre/post-design, intervention study

Background: Medication-related problems are common in the growing population of older adults and inappropriate prescribing is a preventable risk factor. Explicit criteria such as the Beers criteria provide a valid instrument for describing the rate of inappropriate medication (IM) prescriptions among older adults. Objective: To reduce IM prescriptions based on explicit Beers criteria using a nurse-led intervention in a nursing-home (NH) setting. Study Design: The pre/post-design included IM assessment at study start (pre-intervention), a 4-month intervention period, IM assessment after the intervention period (post-intervention) and a further IM assessment at 1-year follow-up. Setting: 204-bed inpatient NH in Bern, Switzerland. Participants: NH residents aged ≥60 years. Intervention: The intervention included four key intervention elements: (i) adaptation of Beers criteria to the Swiss setting; (ii) IM identification; (iii) IM discontinuation; and (iv) staff training. Main Outcome Measure: IM prescription at study start, after the 4-month intervention period and at 1-year follow-up. Results: The mean±SD resident age was 80.3±8.8 years. Residents were prescribed a mean±SD 7.8±4.0 medications. The prescription rate of IMs decreased from 14.5% pre-intervention to 2.8% post-intervention (relative risk [RR] = 0.2; 95% CI 0.06, 0.5). The risk of IM prescription increased nonstatistically significantly in the 1-year follow-up period compared with post-intervention (RR = 1.6; 95% CI 0.5, 6.1). Conclusions: This intervention to reduce IM prescriptions based on explicit Beers criteria was feasible, easy to implement in an NH setting, and resulted in a substantial decrease in IMs. These results underscore the importance of involving nursing staff in the medication prescription process in a long-term care setting.

Assessing Nursing Assistants' Knowledge of Behavioral Approaches to Mental Health Problems

Nurse's aides are the primary caregivers in nursing homes, a major receiving site for elders with behavioral and psychiatric problems. We describe the development, psychometric properties, and utility of a brief instrument designed to assess aides' knowledge of three specific mental health problems (depression, agitation, and disorientation) and behavioral approaches to them. The instrument was administered to 191 nurse's aides and 21 clinicians with training in behavioral management and experience with older residents. The nurse's aides averaged 11 of 17 correct answers, and the clinicians averaged 15 of 17 correct answers. Implications for staff training and consultation activities in nursing homes are discussed.

Anesthesia or sedation for gastroenterologic endoscopies

PURPOSE OF REVIEW: Because propofol is the sedative preferred by gastroenterologists, we focus this review on gastroenterologist-directed propofol sedation, provide simulations of the respiratory depressant effect of different dosing protocols and give a perspective on future developments in computer-assisted sedation techniques. RECENT FINDINGS: Propofol use by nonanesthesiologists remains a contraindication in the package insert of propofol in most countries. Sedation guidelines produced by the American Society of Gastroenterology partially contradict those produced by the American Society of Anesthesiologists for sedation by nonanesthesiologists, whereas the German guidelines were developed with anesthesiologists involved. The use of fospropofol, recently approved by the US Food and Drug Administration for sedation, is considered an alternative to propofol by some gastroenterologists. Methodological errors in earlier pharmacological studies have to be solved before widespread use of fospropofol is justified, however. Our simulations show that dosing protocols with small boluses administered at reasonable intervals induce less respiratory depression than large boluses. Interindividual variability of propofol-induced respiratory depression is illustrated by different pharmacokinetic and dynamic parameter sets used in the simulation. Two computer-assisted propofol infusion systems are currently being investigated. They not only incorporate the target effect but also the side effects, which may limit respiratory depression. SUMMARY: Propofol use by gastroenterologists may be well tolerated if appropriate patient selection, staff training, monitoring and low-dose sedation protocols are applied.

Field performance of two rapid screening tests in active surveillance of transmissible spongiform encephalopathies in small ruminants

Recently, screening tests for monitoring the prevalence of transmissible spongiform encephalopathies specifically in sheep and goats became available. Although most countries require comprehensive test validation prior to approval, little is known about their performance under normal operating conditions. Switzerland was one of the first countries to implement 2 of these tests, an enzyme-linked immunosorbent assay (ELISA) and a Western blot, in a 1-year active surveillance program. Slaughtered animals (n = 32,777) were analyzed in either of the 2 tests with immunohistochemistry for confirmation of initial reactive results, and fallen stock samples (n = 3,193) were subjected to both screening tests and immunohistochemistry in parallel. Initial reactive and false-positive rates were recorded over time. Both tests revealed an excellent diagnostic specificity (>99.5%). However, initial reactive rates were elevated at the beginning of the program but dropped to levels below 1% with routine and enhanced staff training. Only those in the ELISA increased again in the second half of the program and correlated with the degree of tissue autolysis in the fallen stock samples. It is noteworthy that the Western blot missed 1 of the 3 atypical scrapie cases in the fallen stock, indicating potential differences in the diagnostic sensitivities between the 2 screening tests. However, an estimation of the diagnostic sensitivity for both tests on field samples remained difficult due to the low disease prevalence. Taken together, these results highlight the importance of staff training, sample quality, and interlaboratory comparison trials when such screening tests are implemented in the field.

A practice-based culminating experience with Texas Children's Hospital: A hospital's journey to baby-friendly status

Breastfeeding and the use of human milk are widely accepted as the most complete form of nutrition for infants. Breastfeeding is shown to be associated with many positive health outcomes for both infants and mothers. Healthy People 2000 goals to increase breastfeeding rates in the early postpartum period to 75% fell short, with only 64% of mothers meeting this objective. Lack of support from healthcare providers, and unsupportive hospital policies and practices are noted as barriers to the initiation and duration of breastfeeding. The purpose of this study was to evaluate implementation of the BFHI Ten Steps to Successful Breastfeeding at Texas Children's Hospital. ^ The Baby-Friendly Hospital Initiative (BFHI) was developed in 1991 by the World Health Organization and the United Nations Children's Fund (UNICEF) to ensure that healthcare facilities offering maternity services adhere to the Ten Steps of Successful Breastfeeding and the International Code of Marketing of Breast-Milk Substitutes, and create legislation to protect the rights of breastfeeding women. The instrument used in this study was the BFHI 100 Assessment Tool created by Dr. Laura Haiek, Director of Public Health in Monteregie, Quebec, and her staff at Health and Social Services Agency of Quebec. The BFHI 100 tool utilizes 100 different indicators of compliance with BFHI through questionnaires administered to staff and administrators, pregnant and postpartum mothers, and an observer. ^ The study concluded that although there is much room for improvement in educating breastfeeding mothers, overall, the mothers interviewed were satisfied with their level of care in regards to breastfeeding support. Areas of improvement include staff training, as some nursing staff admitted to relying on the lactation consultants to provide most of the breastfeeding education for mothers. Only a small percentage of mothers interviewed reported that their baby “roomed-in” on average of 22 hours per day during their hospital stay. Staff encouragement of the rooming-in practice will help to increase the proportion of mothers who allow their babies to room-in. The current breastfeeding policy will also need to be revised and strengthened to be compliant with the Ten Steps. Ideally, Baby-Friendly practices will become the norm after staff are trained and policy revisions are made. Staff training and acceptance of breastfeeding as optimal nutrition for infants are the most critical factors that will ultimately drive change for the organization. ^