Global Health Initiatives and aid effectiveness: insights from a Ugandan case study

BACKGROUND: The emergence of Global Health Initiatives (GHIs) has been a major feature of the aid environment of the last decade. This paper seeks to examine in depth the behaviour of two prominent GHIs in the early stages of their operation in Uganda as well as the responses of the government. METHODS: The study adopted a qualitative and case study approach to investigate the governance of aid transactions in Uganda. Data sources included documentary review, in-depth and semi-structured interviews and observation of meetings. Agency theory guided the conceptual framework of the study. RESULTS: The Ugandan government had a stated preference for donor funding to be channelled through the general or sectoral budgets. Despite this preference, two large GHIs opted to allocate resources and deliver activities through projects with a disease-specific approach. The mixed motives of contributor country governments, recipient country governments and GHI executives produced incentive regimes in conflict between different aid mechanisms. CONCLUSION: Notwithstanding attempts to align and harmonize donor activities, the interests and motives of the various actors (GHIs and different parts of the government) undermine such efforts

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O SETOR FERROVIÁRIO SOB A PERSPECTIVA DA ECONOMIA DOS CUSTOS DE TRANSAÇÃO: A EXPERIÊNCIA DO TRANSPORTE DE ALGUMAS COMMODITIES DO AGRONEGÓCIO

As transformações ocorridas após a privatização do setor ferroviário, aliada a criação da agência reguladora (Agência Nacional de Transportes Terrestre - ANTT), fizeram com que a estrutura de governança desse setor fosse alterada. A nova forma de coordenação em que as ferrovias estão inseridas pode ser avaliada através da análise das transações. O presente trabalho busca identificar a existência de custo de transação no ambiente ferroviário avaliando-se a forma de governança. As movimentações de três importantes commodities do agronegócio foram avaliadas: soja, açúcar e álcool. As dimensões das transações analisadas foram: especificidade dos ativos, freqüência e incerteza. Os resultados indicaram que os ativos avaliados apresentaram média e alta especificidade, o que permitiu concluir que no setor ferroviário os custos de transação envolvidos são altos, fazendo com que sejam adotadas novas estratégias e formas de governança para mitigar o risco associado às transações, como por exemplo, os contratos de longo de prazo e de parcerias.---------------------------------------------Changes happened after the rail privatization and the creation of the regulatory agency altered the governance structure of the sector. The new coordination form where the railroads are inserted can be evaluated through an analysis of the transactions. The present work identifies the existence of transaction cost in the rail environment, evaluating the governance. The rail transportation of three important agricultural commodities was appraised: soybean, sugar and alcohol. The dimensions of the analyzed transactions were: asset specificity, frequency and uncertainty. The results show that the appraised assets presented average and high specificity, allowing to conclude that in the railway sector the transaction costs involved are high, conducing that new strategies and governance forms are adopted to mitigate risk associated to the transactions, for instance, long-term contracts and of partnership contracts.custos de transação, agronegócio, transporte, logística, transaction costs, agribusiness, transportation, logistics, Agribusiness,

Observing Grasping Actions Directed to Emotion-Laden Objects: Effects upon Corticospinal Excitability

The motor system is recruited whenever one executes an action as well as when one observes the same action being executed by others. Although it is well established that emotion modulates the motor system, the effect of observing other individuals acting in an emotional context is particularly elusive. The main aim of this study was to investigate the effect induced by the observation of grasping directed to emotion-laden objects upon corticospinal excitability (CSE). Participants classified video-clips depicting the right-hand of an actor grasping emotion-laden objects. Twenty video-clips differing in terms of valence but balanced in arousal level were selected. Motor evoked potentials (MEPs) were then recorded from the first dorsal interosseous using transcranial magnetic stimulation (TMS) while the participants observed the selected emotional video-clips. During the video-clip presentation, TMS pulses were randomly applied at one of two different time points of grasping: (1) maximum grip aperture, and (2) object contact time. CSE was higher during the observation of grasping directed to unpleasant objects compared to pleasant ones. These results indicate that when someone observes an action of grasping directed to emotion-laden objects, the effect of the object valence promotes a specific modulation over the motor system.Fil: Nogueira Campos, Anaelli A.. Universidade Federal de Juiz de Fora; BrasilFil: Saunier, Ghislain. Universidade Federal do Pará; BrasilFil: Della Maggiore, Valeria Monica. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; ArgentinaFil: De Oliveira, Laura A. S.. Centro Universitário Augusto Motta; BrasilFil: Rodrigues, Erika C.. Centro Universitário Augusto Motta; BrasilFil: Vargas, Claudia D.. Universidade Federal do Rio de Janeiro; Brasi

Gestão de hotelaria hospitalar: percepções e fundamentos

Neste trabalho, busca-se uma análise sobre o segmento da hotelaria hospitalar, que se apresenta como relativamente nova, na qual é avaliada como uma tendência que tenta livrar os hospitais da imagem de ambientes pouco humanizados com ausência de serviços diferenciados, fazendo com que seus clientes sintam-se em um espaço confortável não apenas na infraestrutura, mas no apoio ao paciente, no que se diz respeito à humanização dos serviços e bem-estar do mesmo. Este artigo teve como objetivo analisar o conceito da hotelaria hospitalar no olhar de autores e na percepção de gestores da área com relação aos serviços prestados neste segmento em alguns hospitais da cidade do Natal/RN. Estudo de natureza qualitativa, exploratório e descritivo com uma abordagem não probabilística. Pode-se concluir que esta temática traz em sua essência a humanização dos serviços e que influência a estadia dos pacientes e acompanhante

Sarcopenia and mortality risk in community-dwelling Brazilian older adults

We estimated the impact of sarcopenia parameters on mortality risk and assessed its prevalence and associated factors in the older adults according to the European Working Group on Sarcopenia in Older People’s 2010 (EWGSOP1) and 2018 (EWGSOP2) criteria. This was a 10-year follow-up cohort study. Low muscle mass (MM) was defined as low skeletal muscle mass index (SMI) using dual-energy X-ray absorptiometry (DXA), and low calf circumference (CC). Cox regression and the Kaplan–Meier method were performed. The prevalence of sarcopenia and associated factors were influenced by the MM measurement method and diagnostic criteria used [6.8% (SMI and EWGSOP2), 12.8% (CC and EWGSOP2; and SMI and EWGSOP1) and 17.4% (CC and EWGSOP1)]. While a low BMI was associated with sarcopenia regardless of the sarcopenia definitions, diabetes, and high TGs were associated with sarcopenia only when using the EWGSOP1 criteria. Low SMI increased mortality risk (EWGSOP1: HR = 2.01, 95% CI 1.03–3.92; EWGSOP2: HR = 2.07, 95% CI 1.05–4.06). The prevalence of sarcopenia was higher according to EWGSOP1 than EWGSOP2. A low BMI, diabetes, and high TGs were associated with sarcopenia. A low SMI doubled the risk of mortality in community-dwelling older adults

The Cost of Pediatric Unrelated HSCT

Instituto de Oncologia Pediátrica, São Paulo, BrazilBone Marrow Transplantation, Instituto de Oncologia Pediátrica - GRAACC - Unifesp, São Paulo, BrazilInstituto de Oncologia Pediátrica - GRAACC - UnifespAssociação da Medula Óssea - AMEOCell Processing Laboratory, Instituto de Oncologia Pediátrica, São Paulo, BrazilTransplante de Medula Óssea, Instituto de Oncologia Pediatrica, São Paulo, SP, BrazilInstituto de ONcologia Pediátrica - GRAACC – UnifespBone Marrow Transplantation, Instituto de Oncologia Pediátrica - GRAACC - Unifesp, São Paulo, BrazilInstituto de Oncologia Pediátrica - GRAACC - UnifespTransplante de Medula Óssea, Instituto de Oncologia Pediatrica, São Paulo, SP, BrazilInstituto de Oncologia Pediátrica - GRAACC – UnifespWeb of Scienc

Associated factors with discontinuation use of combined oral contraceptives

OBJETIVO: Avaliar as razões para descontinuar diversos anticoncepcionais orais combinados entre mulheres brasileiras iniciantes do método, residentes em áreas urbanas. MÉTODOS: Estudo de corte transversal com 400 ginecologistas do Brasil, registrados na Federação Brasileira de Ginecologia e Obstetrícia. Cada médico entrevistou 10 mulheres não grávidas, não lactantes, não em amenorreia, com idades entre 18 e 39 anos que consultavam solicitando anticoncepcional oral combinado (ACO), com um questionário no início de uso e aos 6 meses posteriores. O questionário incluiu dados sociodemográficos, tipo de ACO escolhido ou prescrito e razões para descontinuação, caso ocorresse durante o seguimento. A estratégia de seleção permitiu a inclusão de mulheres de diferentes estratos socioeconômicos, mas somente atendidas em consultórios privados ou de convênios. O tamanho da amostra foi estimado em 1.427 mulheres. RESULTADOS: Foram obtidas 3.465 entrevistas na primeira visita e 1.699 aos 6 meses posteriores. As mulheres tinham predominantemente entre 20 e 29 anos, 57,3% eram solteiras e em proporção quase igual de 45% tinham ensino médio ou superior. A maioria (60,7%) era nuligestas e dentre as que tinham usado algum método contraceptivo anteriormente, 71,8% tinham utilizado ACO. Entre os ACO mais prescritos ou escolhidos, o mais prevalente foram os monofásicos com etinilestradiol (20 µg) e no tocante ao progestágeno, o mais prevalente foi com gestodeno (36,5%), seguido por ACO com drosperinona (22,0%). Aos 6 meses, 63,5% continuavam em uso do ACO. Dentre as que descontinuaram o uso, as principais razões dadas foram: desejo de engravidar (36,5%) e efeitos colaterais (57,3%) como cefaléia (37,6%), aumento de peso (16,6%) e sangramento irregular (23,6%). CONCLUSÕES: A taxa de continuação do uso de ACO foi baixa aos seis meses e este estudo pode contribuir para que os médicos orientem melhor suas pacientes iniciantes no uso de ACO sobre os eventos adversos esperados que são mínimos e temporários e sobre os benefícios não contraceptivos dos ACO.PURPOSE: Due to the scarce information available in Brazil in relation to the number of women who initiated the use of combined oral contraceptives and prematurely discontinued, the objective was to assess the reasons for discontinuation of the use of several combined oral contraceptives among Brazilian women living in urban areas. METHODS: A cross-sectional study with 400 gynecologists registered withy the Brazilian Federation of Obstetricians and Gynecologists. Each physician interviewed 10 non-pregnant, not breastfeeding, not amenorrheic women aged 18 to 39 years who consulted requesting combined oral contraceptive (COC) with a questionnaire at the beginning of use and at six months later. The questionnaire included sociodemographic data, type of COC chosen or prescribed and reasons for discontinuation when it occurred during follow-up. The strategy of selection allowed the inclusion of women from different socioeconomic strata, however, only those attended at private or insurance offices. The sample size was estimated at 1,427 women. RESULTS: A total of 3,465 interviews were conducted at the first visit and 1,699 six months later. The women were 20 to 29 years old, 57.3% were single and an equal proportion of 45.0% attended high school or college. Most (60.7%) were nulligravidas and among those who had used some contraceptive before, 71.8% had used a COC. Among the more prescribed or chosen COC the most prevalent were monophasic with ethynil estradiol (20 µg) and regarding progestin the most prevalent was with gestodene (36.5%) followed by a COC with drosperinone (22.0%). At six months 63.5% still used COC. Among those who discontinued the main reasons were wishing to become pregnant (36.5%) and side effects (57.3%) and the most prevalent were headache (37.6%), weight gain (16.6%) and irregular bleeding (23.6%). CONCLUSIONS: The continuation rate of COC was low at six months and this study could contribute to a better counseling on the part of physicians of patients who initiate COC about side-events that are rare, minimal and temporary and about the benefits of COC use

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