Indicadores de calidad y la evaluación del gerenciamento de recursos humanos en salud

Estudo qualitativo objetivando subsidiar a avaliação da qualidade do gerenciamento de recursos humanos (RH) em enfermagem e apreender como enfermeiros gerentes e docentes vivenciam o uso de indicadores de qualidade. Participaram 12 docentes, 10 gerentes, de quatro instituições de ensino e assistência, públicas e privadas do Município de São Paulo. A coleta deu-se de março a julho de 2007, por meio de entrevistas semi-estruturadas, gravadas e analisadas segundo referencial de análise temática. Dos achados emergiram duas categorias: Dimensão Institucional e Profissional; na primeira foram resgatadas percepções, sentimentos e demandas que as colaboradoras consideram inerentes à organização e que deveriam ser contrapartida na relação da instituição com os atores operativos. Na segunda, explicitaram os fatores intervenientes - motivos, interesses, disposições e necessidades dos profissionais no desempenho das atividades demandadas pela instituição. O estudo evidenciou o caráter processual da construção e validação de indicadores como ferramenta de gestão de qualidade em RH.The aim of this qualitative study was to subsidize an evaluation of human resources management (HR) in nursing and to apprehend how the nursing managers and academic professors experience the use of quality indicators. Twelve academic professors, 10 managers from four teaching and assistance, public and private institutions in the city of São Paulo took part of this study. Data collection was carried out from March to July 2007, by means of semi-structured interviews, recorded and analyzed according to the thematic analysis referential. Two categories emerged from the results: Institutional and Professional Dimensions; in the first category, perceptions, feelings and demands that the collaborators found inherent to the organization and that could be the counterpart in the institution relationship with the operative actors were recovered. In the second category, they reported the intervenient factors - reasons, interests, disposition and professionals´ needs when performing activities required by the Institution. This study showed the processual character of construction and validation of indicators as a quality management instrument in HR.Estudio cualitativo objetivando subsidiar la evaluación de la calidad del gerenciamento de recursos humanos (RH) en enfermería y aprehender como los enfermeros gerentes y docentes vivencian el uso de indicadores de calidad. En este estudio participaron12 docentes, 10 gerentes de cuatro instituciones de enseñanza y asistencia, públicas y privadas, del Municipio de São Paulo. La colecta se hizo de Marzo a Julio de 2007, a través de entrevistas semiestructuradas, grabadas y analizadas según referencial del análisis temático. De los hallazgos emergieron dos categorías: dimensión Institucional y Profesional; en la primera se rescataron percepciones, sentimientos y demandas que las colaboradoras consideraron inherentes a la organización y que deberían ser la contrapartida con relación a la institución con los actores operativos. En la segunda, explicitaron los factores intervinientes - motivos, intereses, disposiciones y necesidades de los profesionales en el desempeño de las actividades demandadas por la institución. Este estudio mostró el carácter procesual y validación de indicadores como una herramienta de gestión en calidad del RH

Dibucaine in Ionic-Gradient Liposomes: Biophysical, Toxicological, and Activity Characterization

Administration of local anesthetics is one of the most effective pain control techniques for postoperative analgesia. However, anesthetic agents easily diffuse into the injection site, limiting the time of anesthesia. One approach to prolong analgesia is to entrap local anesthetic agents in nanostructured carriers (e.g., liposomes). Here, we report that using an ammonium sulphate gradient was the best strategy to improve the encapsulation (62.6%) of dibucaine (DBC) into liposomes. Light scattering and nanotracking analyses were used to characterize vesicle properties, such as, size, polydispersity, zeta potentials, and number. In vitro kinetic experiments revealed the sustained release of DBC (50% in 7 h) from the liposomes. In addition, in vitro (3T3 cells in culture) and in vivo (zebrafish) toxicity assays revealed that ionic-gradient liposomes were able to reduce DBC cyto/cardiotoxicity and morphological changes in zebrafish larvae. Moreover, the anesthesia time attained after infiltrative administration in mice was longer with encapsulated DBC (27 h) than that with free DBC (11 h), at 320 μM (0.012%), confirming it as a promising long-acting liposome formulation for parenteral drug administration of dibucaine.Fil: Couto, Verônica M.. Universidade Estadual de Campinas; BrasilFil: Prieto, Maria Jimena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto Multidisciplinario de Biología Celular. Grupo Vinculado al IMBICE - Grupo de Biología Estructural y Biotecnología-Universidad Nacional de Quilmes - GBEyB | Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto Multidisciplinario de Biología Celular. Grupo Vinculado al IMBICE - Grupo de Biología Estructural y Biotecnología-Universidad Nacional de Quilmes - GBEyB | Universidad Nacional de la Plata. Instituto Multidisciplinario de Biología Celular. Grupo Vinculado al IMBICE - Grupo de Biología Estructural y Biotecnología-Universidad Nacional de Quilmes - GBEyB; ArgentinaFil: Igartúa, Daniela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto Multidisciplinario de Biología Celular. Grupo Vinculado al IMBICE - Grupo de Biología Estructural y Biotecnología-Universidad Nacional de Quilmes - GBEyB | Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto Multidisciplinario de Biología Celular. Grupo Vinculado al IMBICE - Grupo de Biología Estructural y Biotecnología-Universidad Nacional de Quilmes - GBEyB | Universidad Nacional de la Plata. Instituto Multidisciplinario de Biología Celular. Grupo Vinculado al IMBICE - Grupo de Biología Estructural y Biotecnología-Universidad Nacional de Quilmes - GBEyB; ArgentinaFil: Feas, Daniela Agustina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto Multidisciplinario de Biología Celular. Grupo Vinculado al IMBICE - Grupo de Biología Estructural y Biotecnología-Universidad Nacional de Quilmes - GBEyB | Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto Multidisciplinario de Biología Celular. Grupo Vinculado al IMBICE - Grupo de Biología Estructural y Biotecnología-Universidad Nacional de Quilmes - GBEyB | Universidad Nacional de la Plata. Instituto Multidisciplinario de Biología Celular. Grupo Vinculado al IMBICE - Grupo de Biología Estructural y Biotecnología-Universidad Nacional de Quilmes - GBEyB; ArgentinaFil: Ribeiro, Lígia N.M.. Universidade Estadual de Campinas; BrasilFil: Silva, Camila M.G.. Universidade Estadual de Campinas; BrasilFil: Castro, Simone R.. Universidade Estadual de Campinas; BrasilFil: Guilherme, Viviane A.. Universidade Estadual de Campinas; BrasilFil: Dantzger, Darlene D.. Universidade Estadual de Campinas; BrasilFil: Machado, Daisy. Universidade Estadual de Campinas; BrasilFil: Alonso, Silvia del Valle. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto Multidisciplinario de Biología Celular. Grupo Vinculado al IMBICE - Grupo de Biología Estructural y Biotecnología-Universidad Nacional de Quilmes - GBEyB | Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Instituto Multidisciplinario de Biología Celular. Grupo Vinculado al IMBICE - Grupo de Biología Estructural y Biotecnología-Universidad Nacional de Quilmes - GBEyB | Universidad Nacional de la Plata. Instituto Multidisciplinario de Biología Celular. Grupo Vinculado al IMBICE - Grupo de Biología Estructural y Biotecnología-Universidad Nacional de Quilmes - GBEyB; ArgentinaFil: de Paula, Eneida. Universidade Estadual de Campinas; Brasi

Quality indicators and evaluation of human resources management in health

Estudo qualitativo objetivando subsidiar a avaliação da qualidade do gerenciamento de recursos humanos (RH) em enfermagem e apreender como enfermeiros gerentes e docentes vivenciam o uso de indicadores de qualidade. Participaram 12 docentes, 10 gerentes, de quatro instituições de ensino e assistência, públicas e privadas do Município de São Paulo. A coleta deu-se de março a julho de 2007, por meio de entrevistas semi-estruturadas, gravadas e analisadas segundo referencial de análise temática. Dos achados emergiram duas categorias: Dimensão Institucional e Profissional; na primeira foram resgatadas percepções, sentimentos e demandas que as colaboradoras consideram inerentes à organização e que deveriam ser contrapartida na relação da instituição com os atores operativos. Na segunda, explicitaram os fatores intervenientes - motivos, interesses, disposições e necessidades dos profissionais no desempenho das atividades demandadas pela instituição. O estudo evidenciou o caráter processual da construção e validação de indicadores como ferramenta de gestão de qualidade em RH.Estudio cualitativo objetivando subsidiar la evaluación de la calidad del gerenciamento de recursos humanos (RH) en enfermería y aprehender como los enfermeros gerentes y docentes vivencian el uso de indicadores de calidad. En este estudio participaron12 docentes, 10 gerentes de cuatro instituciones de enseñanza y asistencia, públicas y privadas, del Municipio de São Paulo. La colecta se hizo de Marzo a Julio de 2007, a través de entrevistas semiestructuradas, grabadas y analizadas según referencial del análisis temático. De los hallazgos emergieron dos categorías: dimensión Institucional y Profesional; en la primera se rescataron percepciones, sentimientos y demandas que las colaboradoras consideraron inherentes a la organización y que deberían ser la contrapartida con relación a la institución con los actores operativos. En la segunda, explicitaron los factores intervinientes - motivos, intereses, disposiciones y necesidades de los profesionales en el desempeño de las actividades demandadas por la institución. Este estudio mostró el carácter procesual y validación de indicadores como una herramienta de gestión en calidad del RH.The aim of this qualitative study was to subsidize an evaluation of human resources management (HR) in nursing and to apprehend how the nursing managers and academic professors experience the use of quality indicators. Twelve academic professors, 10 managers from four teaching and assistance, public and private institutions in the city of São Paulo took part of this study. Data collection was carried out from March to July 2007, by means of semi-structured interviews, recorded and analyzed according to the thematic analysis referential. Two categories emerged from the results: Institutional and Professional Dimensions; in the first category, perceptions, feelings and demands that the collaborators found inherent to the organization and that could be the counterpart in the institution relationship with the operative actors were recovered. In the second category, they reported the intervenient factors - reasons, interests, disposition and professionals´ needs when performing activities required by the Institution. This study showed the processual character of construction and validation of indicators as a quality management instrument in HR

Combined evaluation of sexually transmitted infections in HIV-infected pregnant women and infant HIV transmission

Background Sexually transmitted infections (STIs) including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and cytomegalovirus (CMV) may lead to adverse pregnancy and infant outcomes. The role of combined maternal STIs in HIV mother-to-child transmission (MTCT) was evaluated in mother-infant pairs from NICHD HPTN 040. Methodology Urine samples from HIV-infected pregnant women during labor were tested by polymerase chain reaction (PCR) for CT, NG, and CMV. Infant HIV infection was determined by serial HIV DNA PCR testing. Maternal syphilis was tested by VDRL and confirmatory treponemal antibodies. Results A total of 899 mother-infant pairs were evaluated. Over 30% had at least one of the following infections (TP, CT, NG, and/or CMV) detected at the time of delivery. High rates of TP (8.7%), CT (17.8%), NG (4%), and CMV (6.3%) were observed. HIV MTCT was 9.1% (n = 82 infants). HIV MTCT was 12.5%, 10.3%, 11.1%, and 26.3% among infants born to women with CT, TP, NG or CMV respectively. Forty-two percent of HIV-infected infants were born to women with at least one of these 4 infections. Women with these infections were nearly twice as likely to have an HIV-infected infant (aOR 1.9, 95% CI 1.1-3.0), particularly those with 2 STIs (aOR 3.4, 95% CI 1.5-7.7). Individually, maternal CMV (aOR 4.4 1.5-13.0) and infant congenital CMV (OR 4.1, 95% CI 2.2-7.8) but not other STIs (TP, CT, or NG) were associated with an increased risk of HIV MTCT. Conclusion HIV-infected pregnant women identified during labor are at high risk for STIs. Co-infection with STIs including CMV nearly doubles HIV MTCT risk. CMV infection appears to confer the largest risk of HIV MTCT.NICHD (NICHD)(Brazilian AIDS Prevention Trials International Network), NIAID/ NIHNational Institute of Allergy and Infectious Diseases (NIAID)Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)National Institute of Mental Health (NIMH)Boehringer Ingelheim Pharmaceuticals Inc. (BIPI)GlaxoSmithKline, on behalf of ViiV HealthcareCepheid for the testing of CTNG in a prior HPTNUCLA Children's Discovery and Innovation Institute (CDI) through the Harry Winston Fellowship AwardUCLA AIDS InstituteUCLA Center for AIDS Research (CFAR) NIH/ NIAIDUCLA Pediatric AIDS Coalition, and WestatNIH/NICHDDavid Geffen UCLA Sch Med, Los Angeles, CA 90095 USAWestat Corp, Rockville, MD USAFundacao Oswaldo Cruz FIOCRUZ, Rio De Janeiro, RJ, BrazilUS Dept State, Off Global AIDS Coordinator, Washington, DC 20520 USAElizabeth Glaser Pediat AIDS Fdn, Washington, DC USAHosp Geral Nova Iguacu, Nova Iguacu, RJ, BrazilHosp Fed Servidores Estado, Rio De Janeiro, RJ, BrazilUniv Witwatersrand, SAMRC & Perinatal HIV Res Unit, Johannesburg, South AfricaStellenbosch Univ, Tygerberg Hosp, Cape Town, South AfricaHosp Conceicao, Porto Alegre, RS, BrazilHosp Femina, Porto Alegre, RS, BrazilIrmandade Santa Casa Misericordia Porto Alegre, Porto Alegre, RS, BrazilUniv Fed Minas Gerais, Belo Horizonte, MG, BrazilUniv Sao Paulo, Ribeirao Preto Med Sch, Sao Paulo, BrazilFdn Maternal & Infant Hlth FUNDASAMIN, Buenos Aires, DF, ArgentinaUniv Fed Sao Paulo, Escola Paulista Med, Sao Paulo, SP, BrazilEunice Kennedy Shriver Natl Inst Child Hlth & Hum, NIH, Bethesda, MD USAUCLA, Fielding Sch Publ Hlth, Los Angeles, CA USAUCSD Sch Med, La Jolla, CA USAUC Davis Sch Med, Davis, CA USABoston Univ, Sch Med, Boston, MA 02118 USAUniv Fed Sao Paulo, Escola Paulista Med, Sao Paulo, SP, BrazilNICHD (NICHD): HHSN267200800001C, N01-HD-8-0001Brazilian AIDS Prevention Trials International Network: NIAID/ NIH [U01 AI047986National Institute of Allergy and Infectious Diseases (NIAID): U01 AI068632, UM1AI068632, UM1AI068616, UM1AI106716NIMH: AI068632NG in a prior HPTN :040UCLA Center for AIDS Research (CFAR) NIH/ NIAID: AI02869, AI28697NIH/NICHD: HHSN275201300003CWeb of Scienc

Exame clínico pediátrico: aquisição de habilidades na disciplina Pediatria Preventiva Social, FAMEB - UFBa.

This study analyzes the main difficulties and the acquired skilles of the medical students  in the ambulatorial practice of Social Preventive Pediatrics Discipline, from the College of Medicine of Bahia - Federal University of Bahia - in their first contact with the pediatric clinic.  The students were inquired about their main difficulties at the begining and at the end of the discipline, through a questionnaire, with the objective of identifying the acquired skills and the most hardly surpassed difficulties. This practical activity is characterized by the ambulatorial primary attendance, in which the pediatric consultation is performed,  emphasizing a detailed interview and a complete physical examination, besides the peculiarities of each pediatric age group. As to the interview, the students  demonstrated to be less secure on  the analysis of  growth and  neuropsychomotor development; whereas on  physical examination, a reduced self-confidence has been noted on abdominal and genital examination. A clear acquisition of skills was noted in the performance of the interview as well as of the physical examination, although in  some  variables  this evolution was more evident.O estudo analisa as principais dificuldades referidas e as habilidades adquiridas pelos estudantes de Medicina na prática ambulatorial da disciplina Pediatria Preventiva Social, da Faculdade de Medicina da Universidade Federal da Bahia, em seu primeiro contato com a clínica pediátrica. Através de um questionário, os estudantes foram inquiridos, em dois momentos distintos (início e término da disciplina) acerca dos aspectos com maior dificuldade de superação e progressos obtidos no contato com as crianças. Essa atividade prática se caracteriza pelo atendimento primário ambulatorial, na qual se exercita a consulta pediátrica, enfatizando anamnese detalhada e o exame físico completo, além das peculiaridades das diversas faixas etárias pediátricas. Com relação à anamnese, os estudantes demonstraram ter menor segurança na análise do crescimento e do desenvolvimento neuropsicomotor, enquanto que, no exame físico, relataram redução no grau de segurança no exame do abdômen (palpação de órgãos) e dos órgãos genitais. No geral, houve aquisição de habilidades tanto na realização da anamnese quanto do exame físico, sendo que, para algumas variáveis, essa evolução foi mais evidente

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe