BackgroundGuinea-Bissau is one of the world’s poorest and least developed countries. Amid poverty, political turmoil and state withdrawal, its health workforce (HW) has been swamped for the last four decades in a deepening crisis of under-resourcing, poor performance and laissez-faire.MethodsThe present study aimed at analysing the human resources for health (HRH) situation in Guinea-Bissau in light of the recent literature on distressed health systems, with the objective of contributing to understanding the ways health workers react to protracted turmoil, the resulting distortions and the counter-measures that might be considered. Through document analysis, focus group discussions, 14 semi-structured and 5 in-depth interviews, we explored patterns as they became visible on the ground.ResultsSince independence, Guinea-Bissau experienced political events that have reflected on the healthcare arena and on the evolution of its health workforce, such as different coup attempts, waves of diaspora and shifting external assistance. The chronic scarcity of funds and a ‘stable political instability’ have lead to the commercialisation of public health services and to flawed mechanisms for training and deploying health personnel. In absence of any form of governance, health workers have come to own and run the health system. We show that the HRH crisis in Guinea-Bissau can only be understood by looking at its historical evolution and at the wider socio-economic context. There are no quick fixes for the deterioration of HRH in undergoverned states; however, the recognition of the ingrained distortions and an understanding of the forces determining the behaviour of key actors are essential premises for the identification of solutions.ConclusionsGuinea-Bissau’s case study suggests that any policy that does not factor in the limited clout of health authorities over a effectively privatised healthcare arena is doomed from the start. Improving health system governance and quality of training should take precedence over expanding HRH. A bloated and ineffective workforce must be managed through incentives rather than administrative orders, in order to improve skills and productivity against higher remuneration and better working conditions. Donor support might be crucial to trigger positive changes, through realistic and sustained investments.
This study is focused on the characterization of particles emitted in the metal active gas welding of carbon steel using mixture of Ar + CO2, and intends to analyze which are the main process parameters that influence the emission itself. It was found that the amount of emitted particles (measured by particle number and alveolar deposited surface area) are clearly dependent on the distance to the welding front and also on the main welding parameters, namely the current intensity and heat input in the welding process. The emission of airborne fine particles seems to increase with the current intensity as fume-formation rate does. When comparing the tested gas mixtures, higher emissions are observed for more oxidant mixtures, that is, mixtures with higher CO2 content, which result in higher arc stability. These mixtures originate higher concentrations of fine particles (as measured by number of particles by cm(3) of air) and higher values of alveolar deposited surface area of particles, thus resulting in a more severe worker's exposure.
RESUMO Na República da Guiné-Bissau, um dos países mais pobres do mundo, o Plano Nacional de Desenvolvimento Sanitário (PNDS) pretende ser o documento de orientação nacional em saúde. O PNDS II (2008-2017) sucedeu ao PNDS I (1998-2002, revisto para 2003-2007). Ambos foram alvo de avaliações. Em 2017, completou-se um novo processo de planejamento, o PNDS III. Considerando o PNDS, procedeu-se a uma meta-avaliação objetivando avaliar a qualidade das avaliações efetuadas e verificar a utilização dos resultados das avaliações em intervenções subsequentes. Aplicados padrões de meta-avaliação aos relatórios de avaliação, verificou-se que, relativamente aos quatro princípios de meta-avaliação – utilidade, exequibilidade ou factibilidade, propriedade e precisão ou acurácia –, ambas as avaliações apresentam a classificação de ‘satisfatório’ (score superior a 66,6%), revelando um caráter de excelência para vários padrões. Metodologicamente, o relatório referente ao PNDS I sobressai sobre o do PNDS II. Na fase de planejamento, as sugestões deixadas pela avaliação anterior foram levadas em conta tanto para o PNDS II como para o III. A fragilidade do Estado da Guiné-Bissau emerge como padrão de especificidade. O PNDS tem sido uma referência em cenários de instabilidade. Tais avaliações foram ao encontro do atual desafio de considerar o contexto, e, nele, a cultura dos povos, como parte integrante da avaliação.
Background: The use of the meta-evaluation, especially in health promotion programs, is still scarce. Aim: To verify if the evaluation studies conducted about the Academia da Cidade Programme and the Academia da Saúde Programme comply with the principles and standards of the meta-evaluation. Methods: This meta-evaluation study was conducted using articles from scientific databases. The parameters of utility, propriety, and accuracy, as defined by the Joint Committee on Standards for Educational Evaluation, and specificity, were applied. The classification of the studies was based on the Stufflebeam's checklist.Results: Of the 18 selected articles, the principle of utility was fully met in 50%, given that 27.8% were classified as very good, 5.6% as good, and 16.7% as fair. The principle of propriety mostly received the result of very good (44.4%), followed by excellent (38.9%), good (11.15), and weak (5.6%). The principle of accuracy was classified as excellent in 44.4% of the studies, considering that in 33.3% it was considered very good; 11.1% good, and 11.1% fair. Specificity was classified as very good in 94.4% of the studies. Conclusion:The physical activity community programs evaluations were carried out in accordance to the principles and standards of meta-evaluation tenets. Most studies were classified as excellent regarding the principle of utility and accuracy, or very good as for the principle of propriety and specificity.
RESUMOTendo Portugal superado o atraso científico estrutural vivido até há cerca de três décadas, a análise desta matéria à luz das políticas de investigação definidas a nível global e europeu mostra que há ainda um longo caminho a percorrer quando se fala em investimento global em Investigação & Desenvolvimento. A investigação para a saúde em Portugal tem tido tutela partilhada entre a Fundação para a Ciência e Tecnologia e o Instituto Nacional de Saúde Doutor Ricardo Jorge, sendo que esta matéria não tem sido uma prioridade -a realidade demonstra a não existência de um plano de investigação científica para a saúde em Portugal, o qual possa pôr em franca articulação os diferentes atores intervenientes. As orientações estratégias do Plano Nacional de Saúde 2004 -2010 são as que mais se aproximam de uma política de investigação para a saúde para Portugal sem que, no entanto, as questões então abordadas tenham sido desenvolvidas de uma forma abrangente ou, à posteriori, implementadas pelas instituições que têm responsabilidades sobre a investigação científica no setor da saúde. Na convicção de que adoptar uma estratégia de incentivo à investigação para a saúde consiste uma mais-valia para o sistema de saúde português, os autores propõem neste trabalho cinco sugestões estratégicas em matérias de investigação para a saúde em Portugal. INTRODUÇÃOO presente trabalho pretende apresentar uma visão global da política de investigação científica para a saúde em Portugal. Partindo do enquadramento da experiência portuguesa em matéria de política de investigação científica efetuado na primeira parte do presente artigo, 1 aprofunda--se agora especificamente a investigação científica para a saúde, apresentando alguns dos atores envolvidos. Da reflexão efetuada discorre um conjunto de sugestões que pretende contribuir para a definição de uma política de investigação para a saúde em Portugal. A INVESTIGAÇÃO PARA A SAÚDE EM PORTUGAL, ATORES E AGENDATendo Portugal superado o atraso científico estrutural de que foi alvo até há cerca de três décadas, 2 a análise deste progresso à luz das políticas de investigação definidas a nível global e europeu mostra que há ainda um longo caminho a percorrer quando se fala em investimento global em Investigação & Desenvolvimento, sendo que o país tem evidenciado uma capacidade insuficiente para conceber e implementar, de forma participativa, uma política de investigação e ciência. 3,4 Até à década de 90, a realidade da ciência e tecnologia em Portugal era caracterizada por uma dimensão e articulação consideravelmente reduzidas. Apenas a partir de 1996 as instituições científicas começam a ser sujeitas a avaliações independentes, o que constituiu um acontecimento chave no âmbito da efetiva abertura da comunidade científica e da construção do sistema científico português.
Welding is the principal industrial process used for joining metals. However, it can produce dangerous fumes that may be hazardous to the welder's health and it is estimated that, presently, 1-2% of workers from different professional backgrounds (which accounts for more than 3 million persons) are subjected to welding fume and gas action. With the advent of new types of welding procedures and consumables, the number of welders exposed to welding fumes is growing constantly in spite of the mechanization and automation of the processes. Simultaneously, the number of publications on epidemiologic studies and the devices for welders' protection is also increasing. Apart from that, the influence of very ultrafine particulate, lying in the nanoparticles range, on human health has been pointed to be of much concern as airborne nanoparticles are resulting both from nanotechnologies processes and also from macroscopic common industrial processes such as welding. In fact, nanotoxicological research is still in its infancy and the issuing and implementation of standards for appropriate safety control systems can still take several years. Yet, the advanced understanding of toxicological phenomena on the nanometre scale is largely dependent on technological innovations and scientific results stemming from enhanced R&D. Meanwhile, the industry has to adopt proactive risk management strategies in order to provide a safe working environment for their staff, clients and customers, and obtain products without posing health threats at any point of their lifecycle. Understanding the relationship of airborne nano sized particulate and human health, under different environmental conditions is of great importance for improving exposure estimates and for developing efficient control strategies to reduce human exposure and health risk and for establishing, evaluating and improving regulations and legislation both on air quality, airborne emissions and the incorporation of nano sized materials in other products and commodities [1].Mass measurement methods are not sufficiently sensitive for airborne nanoparticles and are not sensitive toward the specific health relevant properties of nanoparticles [2,3]. The most sensitive concentration measured in this particle range (< 100 nm diameter) is the number concentration. In fact, surface area is a relevant metric for nanoparticles, as most of the processes in the human body environment take place via the particle surface, which is increasing significantly with decreasing particle size in the nanometer size range for the same amount of mass. In order to perform the toxicological assessment of welding processes a Nanoparticle Surface Area Monitor, TSI, Model 3550, based on diffusion charging (measuring the electrostatic charge on a sampled aerosol, mainly composed of nanoparticles) was used for monitoring the emission of nanoparticles resulting from several welding processes. This equipment indicates the human lung-deposited surface area of particles expressed as square micrometers per cubic cen...
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