This article compares the findings of "Avaliação da Rede Cegonha" (ARC - Stork Network Assessment), an evaluative study on the Rede Cegonha (RC - Stork Network) program, with Nascer no Brasil (NB - ...Born in Brazil), a national survey on labor and birth, conducted in 2011-12, before the start implementation of RC. ARC was conducted in 2017, in 606 maternity hospitals involved in RC and NB included a sample with national representation of 266 hospitals. In the current analysis, we included the 136 SUS hospitals that participated in both studies, totaling 3,790 and 12,227 puerperal women. We perform comparisons of best practices and interventions in the management of labor and delivery using Pearson's chi-square test for independent samples. The prevalence of best practices was, on average, 150% higher in ARC than in NB, with a greater relative increase in less developed regions, for older, brown and black women and less educated. Regarding interventions, there was an average reduction of 30% between NB and ARC, with a greater relative reduction in less developed regions and less educated women. There was a significant improvement in the scenario of care for labor and childbirth, with a reduction in regional, educational and racial inequalities in access to appropriate technologies, suggesting that the RC intervention was effective.
Using a judgment framework, this article analyzes the degree of implementation of the best practices in labor and childbirth care contained in the guidelines of the Rede Cegonha (RC) across Brazil. ...The study eligibility criteria were public and mixed hospitals located in a health region with a RC action plan in place in 2015, resulting in a total of 606 facilities distributed across the country. Three different data collection methods were used: face-to-face interviews with managers, health professionals and puerperal women; document analysis; and on-site observation. The framework was built around the five guidelines of the Labor and Childbirth component of the RC. Degree of implantation was rated as follows: adequate; partially adequate and inadequate. The performance of maternity facilities was rated as partially adequate for all guidelines except for hospital environment, which was rated as inadequate. A huge variation in degree of implementation was observed across regions, with the South and Southeast being the best-performing regions in most items. The results reinforce the need for an ongoing evaluation of the actions developed by the RC to inform policy-making and the regulation of labor and childbirth care.
Resumo: Este artigo tem como objetivo descrever os primeiros resultados de dois estudos avaliativos, um sobre a Rede Cegonha e outro sobre o projeto Parto Adequado, denominados, respectivamente, de ...avaliação da Rede Cegonha e Nascer Saudável, e identificar possíveis melhorias em comparação ao estudo Nascer no Brasil. Ambos os estudos têm desenho seccional, realizados em 2017. O estudo avaliação da Rede Cegonha incluiu todas as 606 maternidades públicas e mistas envolvidas na Rede Cegonha e um total de 10.675 puérperas. O estudo Nascer Saudável incluiu uma amostra de conveniência de 12 hospitais da rede privada e um total de 4.798 mulheres. Os indicadores de atenção ao parto e nascimento avaliados foram: presença de acompanhante, atendimento por enfermeira obstétrica, preenchimento de partograma, uso de métodos não farmacológicos, deambulação, alimentação, uso de cateter venoso periférico, analgesia, posição da mulher para o parto, episiotomia e manobra de Kristeler. Esses indicadores foram comparados aos encontrados no Nascer no Brasil, estudo de base nacional realizado em 2011-2012, antes do início dos dois programas de intervenção. Para as comparações utilizamos o teste do qui-quadrado para amostras independentes e nível de 95% de confiança. Houve um aumento significativo do número de mulheres com acesso à tecnologia apropriada ao parto entre os anos de 2011 e 2017 e redução de práticas consideradas prejudiciais. No setor privado, observou-se também redução nas taxas de cesariana e aumento da idade gestacional ao nascer. Os resultados deste estudo mostram que políticas públicas bem conduzidas podem mudar o cenário da atenção ao parto e nascimento, promovendo a redução de desfechos maternos e neonatais negativos.
Abstract: This article aims to describe the preliminary results of two evaluations studies, one about the Stork Network program and the other about the Adequate Birth program, called Stork Network Assessment and Healthy Birth, and to identify possible improvements in comparison to the Birth in Brazil study. Both studies used a cross-sectional design and were conducted in 2017. The Stork Network Assessment study included all 606 public and mixed maternity hospitals from the Stork Network and a total of 10,675 postpartum women. The Healthy Birth study included a convenience sample of 12 private hospitals and 4,798 women. Indicators of labour and childbirth care were: presence of a companion person, care by obstetric nurse, use of partograph, use of non-pharmacological methods, walking during labor, eating, use of peripheral venous catheter, position for delivery, episiotomy, and Kristeller maneuver. The indicators were compared to those verified in Birth in Brazil, a nationwide population-based study in 2011-2012, before the start of the two intervention programs. Comparisons used the chi-square test for independent samples and 95% confidence interval. There was a significant increase in the number of women with access to appropriate technology for labour and childbirth from 2011 to 2017 and a reduction in harmful practices. The private sector also showed a decrease in cesarean rates and an increase in gestational age at birth. The study’s results show that properly conducted public policies can change the scenario of care for labor and childbirth, helping to reduce in negative maternal and neonatal outcomes.
Resumen: El objetivo de este artículo es describir los primeros resultados de dos estudios evaluativos, uno sobre la Red Cigüeña y otro sobre el proyecto Parto Adecuado, denominados respectivamente como evaluación de la Red Cigüeña y Nacer Sano, e identificar posibles mejorías en comparación con el estudio Nacer en Brasil. Ambos estudios tienen un diseño transversal, realizados en 2017. El estudio evaluación de la Red Cigüeña incluyó todas las maternidades públicas (606) y mixtas implicadas en la Red Cigüeña y a un total de 10.675 puérperas. El estudio Nacer Sano incluyó una muestra de conveniencia de 12 hospitales privados y a un total de 4.798 mujeres. Los indicadores de atención al parto y nacimiento evaluados fueron: presencia de acompañante, atención por enfermera obstetra, cumplimentación de partograma, uso de métodos no farmacológicos, deambulación, alimentación, uso de catéter venoso periférico, analgesia, posición de la mujer para el parto, episiotomía y maniobra de Kristeler. Estos indicadores se compararon con los encontrados en Nacer en Brasil, un estudio a nivel nacional, realizado en 2011-2012, antes del inicio de los dos programas de intervención. Para las comparaciones utilizamos el test del chi-cuadrado para muestras independientes y nivel de confianza de un 95%. Hubo un aumento significativo del número de mujeres con acceso a la tecnología apropiada para el parto entre los años de 2011 y 2017 y una reducción de las prácticas consideradas perjudiciales. En el sector privado, se observó también una reducción en las tasas de cesárea y aumento de la edad gestacional al nacer. Los resultados de este estudio muestran que las políticas públicas bien dirigidas pueden cambiar el escenario de la atención al parto y nacimiento, promoviendo la reducción de desenlaces maternos y neonatales negativos.
This article aims to describe the preliminary results of two evaluations studies, one about the Stork Network program and the other about the Adequate Birth program, called Stork Network Assessment ...and Healthy Birth, and to identify possible improvements in comparison to the Birth in Brazil study. Both studies used a cross-sectional design and were conducted in 2017. The Stork Network Assessment study included all 606 public and mixed maternity hospitals from the Stork Network and a total of 10,675 postpartum women. The Healthy Birth study included a convenience sample of 12 private hospitals and 4,798 women. Indicators of labour and childbirth care were: presence of a companion person, care by obstetric nurse, use of partograph, use of non-pharmacological methods, walking during labor, eating, use of peripheral venous catheter, position for delivery, episiotomy, and Kristeller maneuver. The indicators were compared to those verified in Birth in Brazil, a nationwide population-based study in 2011-2012, before the start of the two intervention programs. Comparisons used the chi-square test for independent samples and 95% confidence interval. There was a significant increase in the number of women with access to appropriate technology for labour and childbirth from 2011 to 2017 and a reduction in harmful practices. The private sector also showed a decrease in cesarean rates and an increase in gestational age at birth. The study's results show that properly conducted public policies can change the scenario of care for labor and childbirth, helping to reduce in negative maternal and neonatal outcomes.
This paper presents a geotechnical centrifuge model of an embankment built in stages, over a 6.0 m layer of soft soil reinforced with nine floating granular columns arranged in a 3 × 3 square grid. ...The container was divided in two compartments where reinforced and unreinforced soil were tested simultaneously for comparison purposes. The load was applied by means of a 4 m high sand embankment (prototype dimensions) built in three steps. For each step, the centrifuge was stopped to allow the placement of the embankment layer and then re-accelerated up to 26 g and the excess of pore pressure was allowed to dissipate after each step. The instrumentation, comprised of total stress cells, pore pressure transducers and displacement transducers, was configured to collect information about the load transfer mechanism between the soil and the instrumented central column for each loading step during pore pressure dissipation. Results showed that despite representing only 30% of the total load, the first step provoked almost 70% of total vertical displacement. Finally, the columns were exhumed for a detailed and comprehensive visual analysis aiming to support and explain the results obtained.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The criteria for selecting materials for railway pavement (particle size distribution, California Support Index, and physical indexes) are not suitable for evaluating the hydraulic behavior of ...tropical soils under unsaturated conditions, often resulting in the rejection of soils with good mechanical and hydraulic performance. The railway trackbed is exposed to precipitation, allowing water infiltration into the pavement layers and consequently leading to moisture variation. Therefore, the present study aims to assess the moisture variation over time in the railway trackbed when subjected to the action of rainfall. For this purpose, five soils were analyzed as constituent materials of the subballast, with the infrastructure of the Carajás Railway in Brazil being used as a reference. Water retention curves and conductivity tests were conducted using the HYPROP (Hydraulic Property Analyzer) and WP4-C (Water Potential Four) equipment, and numerical modeling was developed using the IVFlow software. The numerical modeling revealed that sample 1 (lateritic sand) performed better compared to the other analyzed soils, as it exhibited lower moisture variation (3.25% above the optimum content) under the influence of rainfall and it also had low permeability.
This paper presents a comparison between rain gauge network and weather radar data in Angra dos Reis city, located in the State of Rio de Janeiro (RJ), Brazil. The city has a high incidence of ...natural disasters, especially associated with heavy rains in densely populated areas. In this work, weather radar data with a spatial resolution of 1 km were obtained from dual-polarimetric S-band radar operated by the Environmental State Institute of Rio de Janeiro (INEA), located in the Guaratiba neighborhood in Rio de Janeiro city, Brazil; the rain gauge measurements were provided by the National Center for Monitoring and Warning of Natural Disasters (CEMADEN), which is composed of a network with 30 rain gauges covering the studied area. The comparison between the two datasets enables the analysis of which radar products better fit the rain gauge network’s accumulated rainfall by quantifying the uncertainties in precipitation estimates at radar pixels where rain gauges are located. The results indicated that radar products generated with the help of regression techniques obtained from the relation between radar reflectivities and rain gauge measurements were a better fit, constituting essential information while dealing with efficient regulation for rainfall monitoring and forecasting to minimize the risks associated with extreme events.
The current study presents the evaluation of the mechanical behavior of an asphalt mixture using the alternative aggregate boiler coke ash, an element that originates in nickel processing. Hereby, we ...have focused the research on the runways for military purposes, which marks a great difference to the existing commercial runways in the Western Brazilian Amazon. This area suffers extreme heat, with temperatures oscillating up to 80 °C on the corresponding asphalts. This leads to deformations that are the main aim of the present investigation and the main consideration of fatigue damage. The main property of the alternative aggregate, whose granulometry composes the fine elements of the asphalt mix, is the pozzolanity that acts as a cement in the putty of the mix. Based on our experimental approaches, there is a significant improvement in the results of the tests standardized by DNIT, ABNT and DIRENG, allowing the technical and economic evaluation of the used mixture. Another fundamental aspect is the reduction of the volume of waste disposed of in nickel processing plants in Brazil.
Diagnosis of SARS-CoV-2 infections is mostly based on the nasopharyngeal swabs (NPS). However, this collection is invasive and uncomfortable, especially for children and patients with coagulopathies, ...whose NPS collection often causes bleeding. Thus, the aim of this study was to evaluate the usefulness and accuracy of saliva for the diagnosis of COVID-19 in patients presenting bleeding disorders. Samples of NPS, oropharyngeal swabs (OPS), and saliva were collected simultaneously from 1159 hospitalized patients with hematological diseases and from 524 healthcare workers, both symptomatic and asymptomatic for SARS-CoV-2. All samples were evaluated for SARS-CoV-2 by qRT-PCR. SARS-CoV-2 was detected in NPS, OPS and saliva from 16.9%, 14.4% and 15.6% individuals, respectively. Tests in saliva showed sensitivity, specificity, and overall agreement of 73.3%, 96.9% and 92.7% (=0.74), respectively. Salivary tests had good accuracy (AUC = 0.7) for discriminating negative and positive qRT-PCR for SARS-CoV-2. Higher sensitivity was observed in symptomatic than in non-symptomatic patients, as well as in healthy subjects than in patients with hematological disease, in both OPS and saliva. The mean viral load in NPS was significantly higher than in OPS and in saliva samples (
< 0.001). Saliva is a good diagnostic tool to detect SARS-CoV-2, especially among patients symptomatic for COVID-19, and is a valuable specimen for mass screening of hospitalized patients with hematological diseases, especially for those that with bleeding disorders.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The emission of greenhouse gases (GHG) is a cause for concern when seeking sustainable development in view of global warming. The multiple ecosystem services associated with land use and land cover ...are at the center of the global climate agenda, both as a mitigation and adaptation strategy to climate change and growing urbanization. Among these services is carbon storage and sequestration (CSS). It can remove GHG carbon from the atmosphere and store it in the form of organic matter, a natural carbon stock. Thus, to design projects that guarantee sustainable development, it is necessary to use metrics that can quantify the impact of sequestration on natural carbon stocks. We aimed to implement the InVEST CSS methodology in the region of Itaperuna-RJ (Brazil) to quantify the net change in carbon storage over time (sequestration and loss) between 2015 and 2020. The obtained total difference in carbon stocks between the analyzed maps was −39,103.56 × 103 kg C, which has an equivalent social cost of carbon of USD 16,559,187.69. This social value represents the social damage caused by releasing that amount of carbon into the atmosphere. This main result brings an important application for validating the InVEST CSS methodology in Brazil. Furthermore, it points out parameters that can help elaborate sustainable development policies.
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