A realist evaluation of the roles of opinion leaders in the diffusion of innovations in primary care in Florianopolis, Brazil

Local opinion leaders are people with credibility and influence within social groups. Therefore, they are often used as part of strategies to promote adoption of innovations in healthcare settings. Evidence from trials show that opinion leaders are an effective strategy to promote behaviour change, but the outcomes of their use are variable and unpredictable across studies. There is a need for better understanding of how and why opinion leaders work or not in different circumstances to improve the design of behaviour change interventions. This study addressed this knowledge gap by analysing the roles of opinion leaders during the implementation of two innovations in a primary care system of Brazil. Using a realist evaluation, I developed, tested and refined programme theories about the roles of the opinion leaders. First, I developed initial theories from documents, literature review, stakeholders’ consultation and my experience in the setting. Second, I tested and refined those initial theories drawing on 18 interviews with managers and practitioners and a reassessment of the literature. The three programme theories focused on how recognising opinion leaders motivates buy-in to innovations; how involving opinion leaders in implementation gives credibility to innovations; and how the practice of opinion leaders with innovations promotes adoption. The analytical framework was based on the programme theories and the Context-Mechanism-Outcome configuration. The causal processes identified in data analysis were compared to the initial theories to generate refined programme theories. The key findings across refined theories were summarised in a middle-range theory. The findings suggested causal processes that might explain some of the variability in opinion leaders’ interventions. Key mechanisms included ownership of innovations, trust, and reinforcement of group norms and modelling. Key contextual factors included interest in the innovations, similarity between opinion leader and peers, and informal relationships. The initial mobilisation of opinion leaders is a separate component of the intervention, leading to contradictory outcomes across system levels. Ultimately, there is a trade-off between harnessing the influence of opinion leaders as a resource for implementation and jeopardising their credibility

Formative Study Of The Implementation Of The Practical Approach To Care Kit In Brazil (PACK Brazil) / Estudo Formativo da Implementação do Practical Approach to Care Kit no Brasil (PACK Brasil)

Introduction: The Practical Approach to Care Kit (PACK) is a comprehensive clinical practice guideline created to qualify health professionals at primary care level. The objective of this research is to present the formative study of the initial implementation of the PACK in Brazil. Methodological Path: Qualitative study that used in-depth interviews, questionnaires and focus groups with the trainers responsible for introducing the PACK in the local health clinics. To analyse the data, a thematic matrix technique was used. Results: Four in-depth interviews were conducted; 22 trainers answered the questionnaires and 15 trainers participated in two focus groups. Four themes were identified: 1. Expectations / Feelings regarding the PACK and its training; 2. Use of the PACK; 3. After the PACK; 4. Suggestions. Final Considerations: Participants were very enthusiastic about the implementation of the PACK. Some effects of the training on health professionals were noted in relation to the use of the protocol, such as: it appears to have been more widely used by doctors and nurses, who are not only accustomed to the routine of teaching and research, but who often have a close professional relationship. In addition, the results of this study highlighted important issues that need to be explored in order to understand the implementation of the PACK, such as factors related to behaviour change in individual clinical practice and care sharing

Proyecto para el desarrollo de turismo rural sustentable en el Valle de Mazatepec y diseño de actividad para el Festival Cultural Mazatepec

Al ver la importancia que tienen algunas de las comunidades localizadas entre los municipios de Acatlán de Juárez y en su mayoría en el municipio de Tala, un equipo conformado por estudiantes del ITESO de diferentes áreas profesionales, tales como arquitectura, ingeniería, comercio y negocios, gestión cultural y los integrantes del Colectivo Cultural de Mazatepec, se dieron a la tarea de realizar visitas turísticas con la finalidad de encontrar lugares con potencial turístico para que las personas que asistieron al Festival Cultural de Mazatepec, pudieran acceder de manera más fácil, las comunidades visitadas fueron las siguientes: San Isidro Mazatepec, Las Navajas, Cuxpala, Ahuisculco. Para la elaboración del proyecto en curso, se realizaron visitas en cada comunidad mencionada a los lugares que pudieran ser de hospedaje y de alimentación principalmente, los cuales fueron encontrados por miembros del equipo al caminar por las comunidades, como continuación de lo que ya se ha estado trabajando en la zona del Valle los semestres anteriores, en los cuales se ha trabajado la implementación del turismo. 3 Se contó con la participación de los integrantes del equipo en el Festival Cultural de Mazatepec de manera que pudiéramos dar a conocer no solo este proyecto, sino también los demás proyectos mediante un pabellón y posteriormente por un festival de cine. La estrategia del proyecto se llevó a cabo mediante mapeo y registro, así como un formato de protección a algunas zonas del Valle, el cual será enviado a la Secretaría de Cultura para su posterior protección. Se pretende que las comunidades del Valle en conjunto con el Colectivo Cultural de Mazatepec mejoren sus condiciones y trabajen juntos para que sean más reconocidas y valoradas.ITESO, A.C

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

Construction of evaluation model of integrating Centers of Support for Family Health in Primary Care

Submitted by Gilvan Almeida ([email protected]) on 2016-08-10T18:28:33Z No. of bitstreams: 2 525.pdf: 7429458 bytes, checksum: c7c0e5d107604ac3cc53214227019399 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Approved for entry into archive by Maria Arruda ([email protected]) on 2018-01-31T17:29:49Z (GMT) No. of bitstreams: 2 525.pdf: 7429458 bytes, checksum: c7c0e5d107604ac3cc53214227019399 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2018-01-31T17:29:49Z (GMT). No. of bitstreams: 2 525.pdf: 7429458 bytes, checksum: c7c0e5d107604ac3cc53214227019399 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2013Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Os Núcleos de Apoio à Saúde da Família (NASF) são equipes multiprofissionais criadas pelo Ministério da Saúde em 2008 com o objetivo de aumentar a resolubilidade e a abrangência da atenção primária à saúde (APS) e apoiar sua integração nas redes de serviços de saúde e intersetoriais. Os NASF devem trabalhar de acordo com as diretrizes do apoio matricial, oferecendo suporte pedagógico e retaguarda assistencial às equipes de saúde da família (EqSF). A integração dos NASF na APS é um programa recente, e ainda não há uma definição consensual de critérios para seu monitoramento e avaliação. O objetivo do presente estudo foi contribuir para a definição de um modelo teórico de avaliação da integração dos NASF na APS. O desenho metodológico foi baseado nos estudos de avaliabilidade,um tipo de avaliação baseada na teoria dos programas. Foram realizadas: modelização do programa, a partir de análise documental; validação do modelo lógico, através de consenso com stakeholders do cenário de estudo; e análise de plausibilidade e coerência do modelo (análise lógica), através de comparação de seus elementos com o conteúdo de outras intervenções de integração de novos profissionais na APS. O conteúdo da intervenção avaliada foi ampliado das duas dimensões originais do apoio matricial para cinco componentes: organização e condução dos NASF; fortalecimento da integração assistencial; retaguarda especializada, englobando as duas dimensões originais do apoio matricial; apoio à integração intersetorial; e gestão da atenção compartilhada.O modelo lógico demonstrou boa validade interna, sustentando recomendação de utilizá-lo como referência para melhorias na organização e no monitoramento dos NASF. Sua utilização em diferentes contextos pode necessitar adaptação e validação adicionais. O desenvolvimento de um modelo teórico de avaliação, com matrizes de informação e de julgamento, e sua utilização em análises de implantação são recomendações para continuidade de estudos avaliativos sobre integração dos NASF na APS

Caso Sandra: Atividade avaliativa de múltipla escolha [odontologia]

A atividade de múltipla escolha versa sobre os principais conteúdos visto sobre traumatismo dentário

Caso Sandra [SCORM]

O caso fictício Sandra revela os problemas da paciente que tem dois filhos pequenos e grande sobrecarga física e emocional. Questões sobre o aleitamento infantil, traumatismo dentário em crianças e infecção das vias aéreas são desenvolvidos e discutidos