Free capacity at spokes— “ k=41 & l=36”. Fig 6: The M-data table for network 3 It is assumed that there are 3 networks in the problem space, for purpose of analysis. Since these networks are named by their respective hubs, they are: e, i, and o. Accordingly, the distance matrix can be formulated giving the distance of hubs from each other as shown in table 6 .The nearest distance from a requesting HUB center is its collaborating network. Figure below shows how communication occurs between the collaborative networks. Here M1, M2, M3 represents metadata information (fig 4, 5, 6) with the help of which a network will find a meta data for another network. Also a network determines its adjacent network using the distance matrix described below .
Methodology/Principal Findings: 70 participants took part in an in-depth qualitative study involving 40 semi-structured interviews and three focus group discussions. Participants were senior and middle grade public healthdecision makers working in PrimaryCare Trusts, Local Authorities, Department of Health, academia, General Practice and Hospital Trusts and the third sector in England. Despite mature arrangements for partnership working in many areas, and much support for joint working in principle, many important barriers exist. These include cultural issues such as a lack of shared values and language, the inherent complexity of intersectoral collaboration for public health, and macro issues including political and resource constraints. There is particular uncertainty and anxiety about the future of joint working relating to the availability and distribution of scarce and diminishing financial resources. There is also the concern that existing effective collaborative networks may be completely disrupted as the proposed changes unfold. The extent to which the proposed reforms might mitigate or potentiate these issues remains unclear. However the threats currently remain more salient than opportunities. Conclusions: The current re-organisation of public health offers real opportunity to address some of the barriers to partnership working identified in this study. However, significant threats exist. These include the breakup of established networks, and the risk of cost cutting on effective public health interventions.
discussed in the sphere of international literature. In the study of the Brazilian primarycare, it was found that teams with good teamwork climate presented: Intense participation of their members in decision-making; activities oriented by consolidated work assessment mechanisms, such as individual feedback and team reflection meetings; support to new ideas; and user-centered care (developing consolidated health promotion and prevention actions with the participation of users and the community). Teams with higher climate scores were also those that were most able to expand collaboration from the sphere of teams to that of networks and work articulated with other sectors. This result suggests that investing in teams’ permanent education is an important step to comprehensive care and work in the RAS, not only because it is through teamwork that different professionals integrate their expertise, but because collaborative teams are also capable of integrating different social and health services, as well as the participation of users, families and the community 40 .
The following descriptors of the topic were selected: Humanization; Humanization of HealthCare; Reception; Humanized Care; Humanization in HealthCare: Bond; Family HealthCare Program; PrimaryCare; Public Health and Brazilian Unified Health System – Sistema Único de Saúde. These terms were sought in other languages. The Boolean operators (AND, OR, NOT) were used where necessary. Diverse strategies were used, inserting and/or withdrawing words, trying different combinations to ind the highest number of studies. These criteria were used to search the book texts. To select studies, the following inclusion criteria were adopted: research articles, case studies, reports of experience, dissertations, theses and texts, published in English, Spanish or Portuguese, refer- ring to qualitative empirical research on humanization practices in primarycare, in the 2003 to 2011 period. Oficial Brazilian Ministry of Health documents were not included, nor were studies with the central objective of humanization in other areas, not primaryhealthcare. The studies were collected and analyzed between July 2011 and January 2012. The data were collected separately by two researchers. All of the selected publi- cations were read in their entirety, and their principal characteristics were synthesized.
This paper is concerned with the use of simulation as a decisionsupport tool in maintenance systems, specifically in MFS (Maintenance Float Systems). For this purpose and due to its high complexity, in this paper the authors explore and present a possible way to construct a MFS model using Arena® simulation language, where some of the most common performance measures are identified, calculated and analysed.
age, who require paediatric cancer treatment. The patient treatment services offered at the unit are nursing con- sultations, medical consultations, pre- and post- surgery admissions, radiotherapy follow-up, clinical admissions, paediatric intensive care admissions, and chemotherapy administration. The unit offers an average of 600 consul- tations every month, of which 400 are for chemotherapy, according to the paediatric schedule in the electronic pa- tient records of the institution. The unit has 14 outpatient chemotherapy beds and 16 inpatient beds. Of mandatory presence, the companion is the legal guardian of the child, and can be a relative of the first degree, another degree of kinship or someone close to the child. The companion authorises treatment, participates in the consultations and procedures, and receives the information necessary for the continuity of patient care. Data were collected from De- cember 2015 to January 2016.
The recent review of projections of global mortality and burden of disease shows that NCDs (non-communicable diseases) and mental illness will continue to be the leading causes of mortality and morbidity in low-medium- and high- income countries [3•] and NCD and mental health co- morbidity has an additive effect [4–6]. In a review of 23 low- and medium-income countries, it has been estimated that US$84 billion of economic production could be lost if nothing is done to address long-term conditions in developing coun- tries  and costs to the health system are significant [8••]. This reinforces the need for a collaborative approach to care. The Global Mental Health Action Plan [9•] and the con- tinuing movement to Universal Health Coverage (UHC)  provide a challenge for all actors in healthcare provision and delivery who strive to deliver evidence-based healthcare with a good outcome in the face of increasing global morbidity, ageing and the development of new medical technologies within the context of ever dwindling resources, recognising that mental and physical health co-morbidity will continue to be the norm for many and not the exception.
There were some potential limitations with this type of analysis. These include: using indica- tors that only cover one year after the implemen- tation of the PMM, subjectively analyzing the score criteria, the use of secondary data that may be limited with reference to what they register (or not showing results that we had not found) and a lack of specific indicators that measures the ef- Table 3. Averages for the Indicators of children’s health, mortality for Chronic non-transmissible Diseases in adults between the ages of 30 and 69 years old, mortality rate due to external causes and rates of Hospital Admissions for ambulatory care sensitive conditions in the PrimaryHealthCare Network, for municipalities grouped by their APS scores.
Nowadays, people are becoming increasingly dependent in loans from financial institutions. However, it is not an uncommon situation the fact that some people are incapable of correctly assessing the type and amount of the loan that is affordable to them. As a consequence some people tend to delay their monthly installments or, in extreme cases even become incapable of repaying their debt back to the financial institution. A client’s history provides an excellent source of information for predicting the behavior of future clients. In fact, some rules and patterns can be identified in this data history that may be relevant when deciding where future clients have their loan application accepted or not. From the perspective of information as an asset, this client's history data usage creates valuable assets to an organization. The information gathered from these sources is considered to be one of the six types of assets for organizations, namely it falls into the category of IT information asset (1). Furthermore, the best managed companies recognize information as a key asset, and focus more on information than technology while optimizing their business performance (2). In this context, many financial institutions are implementing or improving client classification systems in order to distinguish good from potentially bad clients.
The results of MS must be understood as a dynamic totality: an articulated set of interrelated effects and reciprocal influences. Consequently, although we segmented its elements as a didactic resource, its understanding requires an integrated consideration of these various effects. The reduction of stigma allowed a greater approximation between team and persons with mental health problems, establishing the team’s healthcare responsibility for a series of demands. This approach has produced awareness and learning experience, creating new ways of dealing with and intervening with cases, facilitating their access to health services and producing new responses to their health needs. The recognition by workers and users of these small and big successes contributes to the dissolution of problematic and paralyzing notions such as the idea of the inevitable chronicity and degeneracy of people with mental disorder / psychic suffering, or the belief that mental health problems are far and apart from the general field of health. This brings us back to the theme of madness stigma and its reduction, in a circular process that reveals the artificiality of assigning a single point of this process as the "beginning" of observed changes.
Early signs of autism are identifiable before age 24 months. 7 However, late identification of ASD is a well- known problem, even in developed countries. 8 A recent review article including data from 42 studies (from 1990 to 2012) showed that the mean age of ASD diagnosis ranged from 38 to 120 months. 9 In Brazil, data on the age at ASD diagnosis and on the ability of primarycare providers to detect ASD are practically nonexistent. A single pilot study in a community sample showed that 75% of children with ASD from ages 7 to 10 had not received an accurate diagnosis. 3 Even when parents suspect the condition and seek assistance, there is usually a delay until proper diagnosis and care are achieved. 10
This study investigated the educational dimension of matrix support practices for mental health within primarycare. Using an interpretative-explanatory qualitative approach, professionals involved in matrix support for mental health in a municipality in the state of São Paulo, Brazil, were interviewed. The data were compared with matrix support frameworks with two pedagogical trends: directive and constructivist. The analysis on this content was incorporated with the interviews and two themes could be identified: “matrix supporter’s profile”, and “challenges for construction of matrix supporter’s practice.” The subjects’ perceptions regarding supporters’ competence profiles were coherent with matrix support assumptions, whereas their educational practices related mainly to the directive trend. The challenge of implementing constructivist practice was only partially recognized, since this requires a critical and transformative stance regarding the hegemonic educational practices within healthcare.
Abstract During the period of 1990-2000, Rio de Janeiro was characterized by a limited supply of public and universal primarycare services. In 2008, family health team coverage corresponded to 3.5% of the population, the lowest among cap- ital cities. At the end of 2013, coverage reached more than 40% of Rio residents with teams com- prised of doctors, nurses, practical nurses, com- munity health agents, and health surveillance agents, in addition to oral health teams. This ar- ticle describes and analyzes the main components of the Reform in PrimaryHealthCare (RCAPS) implemented since 2009, focusing on three lines of action: administrative reform, organizational model, and model of care. A new organization- al chart of the Municipal Health Secretary and a legal framework for a new results-based model were created. As for the model of care, the stan- dardization of procedures and health activities for all units and the monthly assessment of clinical indicators of results of implanted electronic med- ical records were created. Experience has shown the feasibility of RCAPS, pointing to new chal- lenges that will allow consolidation of the expan- sion of access, training of human resources, health communication, and a shift to a managerial re- sults-driven model.
Recognizing that changes in their population structures and health profiles have prompted many countries in the Region to take note of the growing priority of the health of adults and the elderly; Noting that the program presented gives particular emphasis to the prevention of harm and promotion of health, and to the importance of the area of health services and the integration approach in the setting of primaryhealthcare; and
The capacity of reaching a decision is an important task in the daily life of both companies and people. In fact the decision making process is present in all choices that a person, or a group, has to perform. This process can be made intuitively, when little knowledge about the situation exists or it can follow some kind of protocol using existing knowledge to reach a consistent decision. In some cases there is the need to collect knowledge and points of view from different specialists in different areas. In these cases the establishment of the correct set of criteria is a crucial point. Additionally it may also be needed to add a sort of voting system that enables reaching a conclusion at the end of the process. This situation is very common in many companies where decisions are no longer made by one person but are part of an integrated process where the different parts involved have a word to say in their field of experience. These decisions are normally oriented for reaching a subsequent higher level objective that is part of the overall strategy of the company.
Aim: investigate the exchange of related supporthealthcare between the family, inserted in the center of the convoy model, and nurses of primarycare. Method: descriptive study, conducted with 30 users of PrimaryCare of Maracanaú/CE in July 2014. Appealed to the Collective Subject Discourse to organize the data and the convoy model for visualization of the support exercised by the nurse. Results: the nurse is a secondary source of support to families; their actions are restricted to health facilities, demonstrating the mistaken role of their duties, and have focused on the orientation activities. Discussion: There are nurse’s detachment regarding the assisted families, as well as inluences of the hegemonic medical model, which distances the nurse from the carrying out of their real duties. Conclusion: nurses are undervalued and pointed as a secondary reference in relation to families solving health problems.
Such process of important expansion of the PHC throughout the country, although it has not been systematic and uniformly monitored along the entire period, it was followed by seve- ral sparse initiatives of evaluation and induction processes for the institutionalization of the evaluation of PrimaryCare in the SUS.
The country has made an option for innovative services and interventions, such as the CAPS, and the Return Home program. In little more than one decade, hundreds of services were established in the whole country, and older outpatient services and day hospital programs were remodeled according to general guidelines to maximize limited resources by adopting a mixed system of mental health outpatient services, day hospitals, and therapeutic workshops. Brazil has a sound legislation on mental health and a list of documents related to its mental health policy, which resulted in a major reform of the mental health system. Custodial care is in the process of abolishment, and the system is now providing care in the community, allowing free access to a variety of mental health services and essential psychotropic medicines. There are 5259 Psychiatrists, 12377 Psychologists, 11958 Social workers, 3119 Psychiatric nurses and 2661 Occupational Therapists working for the Unified Health System. The number of psychiatric beds is declining, and many acute cases have now been treated in general hospitals, and in the community services (CAPS). However, services are unequally distributed across regions of the country, and the growth of the elderly population (Veras, 1987) is promoting an increased impact in burden, combined with an existing treatment gap in mental healthcare. This gap may get even wider if funding does not increase, and mental health services are not expanded in the country. There is no solid data to show the impact of such policies in terms of cost-effectiveness of the community services and tangible indicators to assess the results of these policies. Moreover, despite of some acknowledged advances many hurdles have to be overcome and some will be listed as follows:
Human milk banks (HMBs) have difficulty maintaining and increasing their stocks, and the number of women enrolling as members remains low. The present qualitative study, based on social representation theory, aimed to understand women’s representations of the milk donation experience. The data were collected through semi-structured interviews conducted in 2013. In total, 12 women aged 18 to 39 years old participated in the study. Most were primiparous, married or living with a partner, housewives, completed high school, and belonged to lower economic classes. Four categories emerged from the testimonies: human milk donation; representations about human milk banks (HMB); the importance of breastfeeding for the baby and for one’s conceptualization as a mother; and prenatal care and donation awareness. The main reasons for donating were representations that value breastfeeding, human milk, and the donation act. These mothers had difficulties donating, but the rewarding feeling, the value of this practice, and the support they received from people important to them helped with the donation. The findings related to the value of the donation and breastfeeding provide ways to effectively encourage and motivate potential donors, achieving comprehensive care starting from the prenatal period.