As organizações são consideradas sistemas abertos e, como tal, estão constantemente sujeitas às demandas do ambiente, o que leva à necessidade de constante adaptação a ele. Uma das exigências do ambiente organizacional refere-se à implementação de sistemas de gestão normalizados, que têm como objetivo o estabelecimento de bom relacionamento com os mais diversos stakeholders, como a sociedade, os funcionários e os clientes. Devido às expectativas distintas dos stakeholders, vários sistemas de gestão normalizados são implementados, o que gera dificuldades no gerenciamento paralelo destes sistemas. Neste contexto surgem os sistemas de gestão integrados, que visam coordenar os sistemas adotados pela organização a fim de gerar maior eficiência, reduzir custos e eliminar redundâncias. Diversos pesquisadores elaboraram modelos para facilitar a integração dos sistemas de gestão, tanto no que se refere à integração dos requisitos das normas quanto aos passos para a implementação de um sistema de gestão integrado. Estudos empíricos também abordam a questão da integração dos sistemas de gestão; entretanto os mesmos não detalham como esse processo acontece nas organizações. Desta forma, este trabalho propõe uma análise da integração de sistemas de gestão normalizados, utilizando como método o estudo de caso. A análise foi realizada sob três variáveis: processo de implementação do SGI, integração dos requisitos das normas e estrutura de gestão do SGI. Como escopo para a realização deste trabalho, optou-se por estudar como ocorre a integração dos sistemas de gestão ISO 9001 e OHSAS 18001. Com os resultados desta pesquisa observaram-se várias similaridades na integração dos sistemas de gestão ISO 9001 e OHSAS 18001, como os passos realizados para a implementação do SGI e as características da documentação desenvolvida pelas empresas para atender aos requisitos das normas. Observouse ainda que a integração pode ser influenciada por diversas variáveis organizacionais, como padrões corporativos, no caso da integração da documentação, e o número de funcionários, no caso da estrutura de gestão do SGI. Identificaram-se também oportunidades de realização de pesquisas a fim de melhorar esta integração por meio de, dentre outros aspectos, o estabelecimento de procedimentos para a resolução de conflitos entre estes departamentos. / As open systems, organizations are constantly subject to environments demands, which generates a growing need for adaptation. The implementation of normalized management systems is one of the environments demands, aiming at establishing a good relationship with a variety of stakeholders, such as society, employees and clients. Due to the diversity of stakeholderss expections, the organizations have attempted to implement several normalized management systems, generating difficulties concerning their parallel management. Given this scenario the Integrated Management Systems (IMS) have arisen to coordinate various management systems adopted by the organizations, increasing efficiency, reducing costs and eliminating redundances. Several researchers aiming at facilitating integration have developed models concerning both integration of standard requirements and implementation of an IMS. Empirical researches have also allowed for studies on the subject, but they have failed to demonstrate the management systems integration process in detail. By means of a case study method this dissertation proposes an analysis of the management systems integration process considering three variables: process of IMS implementation, integration of the standards requirements and structure of the IMS management. The scope of this research comprised the study of the integration of two specific management systems: ISO 9001 and OHSAS 18001. The results have showed several similarities as the steps taken by the organizations to implement the IMS as well as the characteristics of the documents developed by the companies to meet the standards. They have also allowed observing that integration is influenced by several organizational variables, as corporate standards and number of employees, which influence the integration of documentation and complexity of IMS management structure, respectively. Opportunities for further investigations to improve the integration among departments have also been identified. Such an improvement can be achieved by the establishment of procedures to solve conflicts among these departments.

Alcançar a sustentabilidade ambiental-social-econômica ainda é um desafio, embora seja vista como algo de grande importância. Pesquisas apontam que a integração dos sistemas de gestão contribui para promoção da sustentabilidade, portanto, essa é uma das formas consideradas para se chegar a sustentabilidade. Ao se pensar em integração, é preciso ter em vista que ela pode ocorrer em diferentes níveis e de diferentes formas. O que se busca verificar com o presente trabalho é verificar se empresas com maior maturidade na integração dos seus sistemas de gestão apresentam maior desempenho sustentável, tendo em vista que esta foi uma lacuna encontrada na literatura durante a revisão bibliográfica. Para isso, foi elaborado um instrumento que avalia a maturidade da integração e o desempenho sustentável, sendo que o mesmo foi aplicado em forma de survey em empresas brasileiras certificadas em, ao menos, dois dos seguintes sistemas de gestão: ISO 9001, ISO 14001 e OHSAS 18001. Também foi avaliado se o tamanho da empresa afeta o desempenho sustentável e se também exerce algum efeito moderador entre a maturidade e o desempenho. Outro aspecto investigado foi quanto a comparação entre o desempenho sustentável de empresas que possuem apenas a certificação da ISO 9001 e as que possuem mais de um sistema de gestão. Através dos resultados obtidos, conclui-se que empresas podem obter um maior desempenho sustentável se investirem numa maior integração dos seus sistemas de gestão. Nota-se o tamanho influencia no desempenho sustentável e que empresas com menor maturidade na integração dos seus sistemas de gestão observam um maior desempenho ambiental e social conforme aumentam de tamanho. Por fim, percebe-se que empresas que possuem mais de um sistema de gestão apresentam um maior desempenho ambiental e social. / As important as it is considered to be, attaining environmental-social-economic sustainability is still quite a challenge. Research indicates that the integration of management systems promotes sustainability and is, therefore, one of the paths towards sustainability. Integration, however, should be considered as occurring in many levels and forms. The present work aims to verify whether companies presenting more maturity in management system integration present more sustainable performances, since this is a gap found during the literature review. An evaluation instrument was developed for this purpose, to evaluate integration maturity and sustainable development. It was applied as a survey in Brazilian companies presenting at least two of the following management systems: ISO 9001, ISO 14001 and OHSAS 18001. Company size was also evaluated, to verify whether it affects sustainable performance and also whether it has a moderating effect over maturity and performance. The comparison between the sustainable development of companies which only had ISO 9001 certification versus the ones employing more than one management system was another aspect studied. Results show that companies can achieve more sustainable development if they invest in better management system integration. Company size was found to affect sustainable development and companies presenting less maturity in management system integration achieve better environmental and social performance as their size increases. Lastly, companies presenting more than one management system were found to present better environmental and social performance.

Os afídeos são importantes pragas na agricultura, principalmente por serem vetores de fitovírus, os quais são transmitidos geralmente no momento da picada de prova. Além disso, os afídeos também removem os aminoácidos nitrogenados das plantas ao se alimentarem no floema e injetam substâncias presentes na saliva, que interferem na fisiologia da planta. Entre as táticas de controle para o manejo integrado desses insetos, pode-se citar o emprego de inseticidas químicos ou botânicos e o uso de produtos repelentes que tornam as plantas pulverizadas não atrativas, evitando que pulgões pousem e se alimentem normalmente da planta. Nesse contexto, objetivou-se estudar a bioatividade de extratos orgânicos das Meliaceae Trichilia pallida, Trichillia claussenii,Trichilia catigua, Toona ciliata e Guarea guidonia e dos óleos essenciais das Piperaceae Piper amalago, Piper umbellatum, Piper claussenianum e Piper sp. em relação a pulgões, utilizando como espécie-modelo R. maidis. Os extratos orgânicos das Meliaceae foram obtidos, por maceração, com o uso dos solventes hexano, diclorometano e etanol, nessa sequência de extração. O extrato hexânico de T. pallida foi o que apresentou a maior atividade aficida, sendo então selecionado para fracionamento por cromatografia de coluna rápida utilizando, sequencialmente, os solventes hexano, acetato de etila e metanol. Entre as frações, a hexânica causou a maior mortalidade, sendo selecionada para a determinação dos modos de ação sobre R. maidis. A referida fração não apresentou ação de contato e nem ação neurotóxica; entretanto, foi constatada ação translaminar. No ensaio com Electrical Penetration Graph - EPG, os insetos apresentaram maior dificuldade para se alimentar. Entre as Piperaceae, a maior repelência e mortalidade a R. maidis foi causada por P. claussenianum, cujo óleo essencial foi então selecionado para os testes subsequentes. Sua atividade inseticida ocorreu por contato, causando rápida mortalidade, acreditandose, assim, tratar-se de um efeito neurotóxico; não foi constatado, entretanto, efeito fumigante. Quanto às alterações comportamentais, constatou-se efeito repelente sobre alados por meio de teste com olfatômetro e o efeito fagodeterrente com uso do EPG. Com base nos resultados, conclui-se que entre os extratos orgânicos e óleos essenciais testados, a fração hexânica do extrato hexânico de T. pallida apresenta substâncias com atividade inseticida sobre R. maidis, sendo uma possível fonte para síntese de novos inseticidas e que o óleo essencial de P. claussenianum pode ser utilizado diretamente no controle de pulgões ou servir de fonte para a identificação de moléculas inseticidas para a síntese. / Aphids are important pests in agriculture mainly because they are vectors of phytovíruses, which are normally transmitted during the aphids probe. In addition, aphids not only remove amino-nitrogen from the plants while feeding in the phloem but also inject substances present in their saliva, which interfere in plant physiology. Among the strategies for the integrated management of these insects, we can state the use of chemical or botanical insecticides as well as repellents which turn the plants into nonattractive ones, thus avoiding that aphids land and feed normally from the plant. Therefore, we studied the bioactivity of organic extracts from the Meliaceae plants Trichilia pallida, Trichilia claussenii, Trichilia catigua, Toona ciliata and Guarea guidonia and essential oils from the Piperaceae plants Piper amalago, Piper umbellatum, Piper claussenianum and Piper sp. against aphids, using R. maidis as a model species. Organic extracts from Meliaceae were obtained by maceration technique using hexane, dichloromethane and ethanol solvents, in this sequence of extraction. Hexanic extract from T. pallida provoked the highest activity against aphids being chosen for the fractionation using a chromatographic column with fast flow and using hexane, ethyl acetate and methanol solvents, in this sequence. Hexanic fraction provoked the highest mortality among the fractions evaluated being chosen in order to understand its modes of action on R. maidis. This fraction had neither mode of action by contact nor neurotoxic action; however, its translaminar action was proved. Using the Electrical Penetration Graph - EPG, we observed that most of the insects had difficulty to feed themselves. Among the Piperaceae plants, the highest repellency and mortality of R. maidis was caused by P. claussenianum which was selected for the subsequent assays. Its insecticidal activity occurred through contact causing a fast mortality perhaps due to a neurotoxic effect. Nevertheless, a fumigant effect was not observed. With regard to behavioral changes, a repellent effect was proven on alates through olfactometer assay and a phagodeterrent effect was proven using EPG assay. According to the results, we concluded that among the organic extracts and essential oils evaluated, the hexanic fraction from hexanic extract from T. pallida contains substances with insecticidal activity against R. maidis being a potential source for synthesis of new insecticides while the essential oil from P. claussenianum may be used both to control aphids and to be a source for identification of insecticidal molecules aiming their synthesis.

Este trabalho busca otimizar a utilização de biomassa de macrófitas aquáticas na produção de adobe (tijolos de terra crua, secos ao sol), baseado na determinação e estudo de suas características físicas e mecânicas, assim como nas características físicas e químicas destas plantas. A pesquisa foi desenvolvida no reservatório de Salto Grande, no município de Americana - SP. Este lago está localizado em uma área com déficit de habitações de interesse social, apresentando altos índices de urbanização e industrialização, o que acarreta no seu avançado processo de eutrofização artificial, decorrente das ações antrópicas. As macrófitas aquáticas predominantes no reservatório (Brachiaria arrecta, Eichhornia crassipes e Pistia stratiotes) apresentam níveis elevados de metais pesados e nutrientes (nitrogênio e fósforo), o que torna inviável sua utilização como forragem ou fertilizante. A utilização desta biomassa em materiais de construção é aqui apresentada como uma alternativa de manejo integrado do lago, na forma de encapsulamento (ou solidificação / estabilização) destas substâncias químicas, além de possibilitar a autoconstrução de habitações de baixo custo. Uma outra função do uso da biomassa no adobe é a estabilização do solo, que apresenta alto teor de argila (59 %, com 21 % de silte e 20 % de areia, classificado como A-7-6 HRB) e sofreria grandes retrações durante o processo de secagem, com surgimento de fissuras excessivas e conseqüente redução de resistência mecânica dos tijolos. A adição da biomassa contribuiu com a redução destas fissuras e da massa específica dos tijolos. Os resultados demonstraram ser esta utilização perfeitamente viável, com expressiva retirada de biomassa (juntamente com os metais e nutrientes) do sistema, além de significativas melhorias na qualidade do adobe, tanto físicas como mecânicas. Em linhas gerais, Eichhornia crassipes se mostrou a mais eficiente neste aspecto. Além de tudo, os resultados da pesquisa mostram que, apesar do adobe ser talvez o mais antigo material de construção manufaturado, sua aplicação se mostra perfeitamente viável, numa perspectiva mais ampla de sustentabilidade, se apresentando como um material completamente ecológico e adequado para regiões tropicais. / This work intends to optimise the utilization of aquatic macrophyte biomass in the adobe (a sun-dried mud brick) production, based on the study of the physical and mechanical characteristics of these bricks and the macrophytes biomass estimate as well as their chemical characteristics. The research was developed in the Salto Grande Reservoir region, in Americana (a town in São Paulo State, Brazil). This lake is located in an area of high urbanization and industrialization level, with common dwelling deficit, which is in advanced artificial eutrophication process by human activity action. The aquatic macrophytes found in that place (Brachiaria arrecta, Eichhornia crassipes and Pistia stratiotes) present a high level of heavy metals and nutrients that make impracticable their utilization as forage or fertilizer. The biomass utilization in the construction of materials appears here as an alternative of integrated management of the lake in the stabilization/solidification (or “encapsulation”) of these chemical substances, in addition to the fact that it makes possible the self-building of low cost dwellings. The other biomass function is to stabilize the soil that has a high clay concentration (59%, with 21% silt and 20% sandy) and would suffer a large drawing back during the drying process, with the introduction of excessive fissures. This biomass addition was made to reduce these fissures and the specific mass of the bricks. Besides, the research results show that, even though the adobe bricks are perhaps the oldest manufactured building material, their application persists practicable mainly in the sustainability hopes for being a completely ecological building material and adequate for the tropical regions.

A produção de café é uma das atividades de maior tradição agrícola no território brasileiro. As principais pragas que ocorrem no cafeeiro são broca-do-café, Hypothenemus hampei e bicho-mineiro-do-cafeeiro, Leucoptera coffeella e os parasitoides possuem importante papel na regulação dessas pragas. O objetivo deste trabalho foi comparar em sistemas de produção convencional e orgânico de café, os níveis populacionais de H. hampei e L. coffeella e a ocorrência de seus parasitoides. Os experimentos foram realizados em área de café orgânico e convencional no município de Dois Córregos/SP e as amostragens foram realizadas mensalmente de fevereiro de 2009 a junho de 2010. Foram amostradas folhas para os níveis de infestação e de predação de minas por vespas; foram coletadas folhas com minas intactas para a observação da emergência de parasitoides. Foram coletados mensalmente 2 L de frutos de café para a obtenção da infestação da broca; também, foi avaliada a ocorrência do fungo Beauveria bassiana e foram coletados mensalmente frutos de café brocados para a obtenção de parasitoides da broca. Os manejos orgânico e convencional não diferiram estatisticamente em relação às médias das porcentagens de infestação de L. coffeella. Houve diferença em relação às médias das porcentagens de predação das minas por vespas, sendo que no manejo convencional a média foi maior do que no manejo orgânico. Foram obtidos no total 708 himenópteros parasitoides e as espécies coletadas foram Proacrias coffeae, Cirrospilus neotropicus, Cirrospilus sp.1, Cirrospilus sp.2, Closterocerus coffeellae, Closterocerus flavicinctus, Closterocerus sp.1, Horismenus cupreus, Orgilus niger, Centistidea striata e Stiropius reticulatus. Não houve diferença na média da porcentagem de parasitismo entre os manejos, 18,5 % no manejo orgânico e 19,47% no manejo convencional. Em relação à broca-do-café, na safra 2008/2009, as amostragens de frutos brocados foi diferente em função do manejo, porém na safra 2009/2010, as porcentagens de infestação não apresentaram diferença significativa entre as áreas. Na safra 2009/2010, a média de frutos brocados infectados pelo fungo B. bassiana foi de 3,5% e 2,1% do total de frutos nos manejos orgânico e convencional respectivamente. Foram obtidos 25 indivíduos do parasitoide Prorops nasuta na área de café orgânico na safra 2008/2009 e nenhum na área convencional. / Coffee production is one of the most Brazilian traditional activities. The main pests of coffee crops are the coffee berry borer, Hypothenemus hampei and the coffee leaf miner Leucoptera coffeella and the parasitoids play an important role in the control of these pests. This research deals with the comparison between production systems of conventional and organic coffee concerning the population levels of L. coffeella and H. hampei as well as the occurrence of their parasitoids. The experiments were set in areas of conventional and organic coffee and plant (leaf and berries) samples were monthly taken from February/2009 to June/2010, in Dois Córregos, State of São Paulo, Brazil. Coffee leaves were sampled for levels of infestation and mine predation by wasps, while leaves with undisturbed mines were samples to observe the emergence of parasitoids. Two liters of coffee berries were monthly collected to determine the infestation of the coffee berry borer. One also observed the occurrence of the fungus Beauveria bassiana bored coffee berries were monthly collected for obtaining the berry borer parasitoids. The values of the means of percentage of L. coffeella infestation did not statically differ between the organic and the conventional coffee management. The means of percentage of predation by wasps were higher in the conventional management than in the organic one. A total of 708 hymenopteran parasitoids were obtained. The species collected were as follows: Proacrias coffeae, Cirrospilus neotropicus, Cirrospilus sp.1, Cirrospilus sp.2, Closterocerus coffeellae, Closterocerus flavicinctus, Closterocerus sp.1, Horismenus cupreus, Orgilus niger, Centistidea striata and Stiropius reticulatus. The mean percentage of parasitism showed no difference between the organic management (18.5%) and the conventional one (19.47%). As to the coffee berry borer, in the 2008/2009 harvest, the sampling of bored berries was different according to the management. However, in the 2009/2010 harvest, the percentages of infestation did not present significant difference between the areas. At the 2009/2010 harvesting the mean of bored berries infected by the fungus Beauveria bassiana was 3,5% (organic area) and 2.1% (conventional area). A total of 25 specimens of the parasitoid Prorops nasuta were collected in the organic coffee area but none in the conventional coffee area.

<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &amp / Zupan, 2005). Early&nbsp / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing&nbsp / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking&nbsp / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home&nbsp / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,&nbsp / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing&nbsp / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured&nbsp / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study&nbsp / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.&nbsp / Descriptive analysis was&nbsp / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant&nbsp / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were&nbsp / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the&nbsp / highest number of which occurred within&nbsp / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking&nbsp / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.&nbsp / Conclusion: This study found&nbsp / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South&nbsp / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams&nbsp / including community health workers. A key function of these workers will&nbsp / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with&nbsp / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by&nbsp / community health workers. Most of the referrals in this study were&nbsp / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal&nbsp / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater&nbsp / realization of a team approach to PHC.</p>

Les forêts occidentales sont aujourd’hui de plus en plus prisées pour la pratique d’activités récréatives en milieu naturel. Dès lors, la mise en place d’une gestion intégrée des forêts est plus que jamais indispensable au maintien des conditions nécessaires à la pratique de l’ensemble des activités sur le territoire. Le Québec s’est doté d’une nouvelle législation pour répondre aux nombreux enjeux qui touchent le milieu forestier, notamment en ce qui a trait à l’harmonisation entre les activités récréatives et la production ligneuse. Dans le cadre de cette recherche, nous nous sommes intéressés au concept d’expérience du visiteur comme moyen de faciliter cette harmonisation. Il s’agissait à la fois de caractériser l’expérience de visite des utilisateurs d’un parc régional et de se questionner sur son opérationnalisation dans l’aménagement forestier. Deux méthodes qualitatives complémentaires ont été utilisées : d’une part, l’analyse de récits inscrits dans des livres d’or placés dans différents hébergements et d’autre part, des entrevues ont été conduites auprès de visiteurs rencontrés sur le site. Les résultats révèlent la pertinence de considérer l’expérience du visiteur pour favoriser une utilisation plurielle et harmonieuse du territoire forestier. Son étude permet une compréhension fine des composantes communes et spécifiques des expériences, en fonction des visiteurs. Par ailleurs, l’étude témoigne de la possibilité de mettre en relation des typologies d’expériences recherchées et les modalités d’harmonisation. Enfin, au-delà de l’expérience, le suivi de la perception de la foresterie et des représentations peut également s’avérer pertinent pour les gestionnaires. / The practice of outdoor recreational activities in western forests is becoming increasingly popular. Therefore, the implementation of integrated management with regards to publicly-owned forests is more important than ever in order to maintain conditions necessary for all activities on the territory. The province of Québec which has recently adopted a new Forestry Act is following this trend by addressing the numerous forest management issues such as harmonizing of various uses which represents a major challenge, particularly with regards to recreation and timber production. Throughout this research, we focused on the concept of visitors’ experience as a means to facilitate harmonization. The objectives were to identify the attributes of visitors’ experiences in a regional park and to assess how it can be useful in forest management. Two complementary qualitative methodologies were applied: on the one hand, we analyzed the comments written by visitors on guest books, and on the other hand, we interviewed visitors we met on the site. Results indicate the relevance of using visitors’ experiences to promote a plural and harmonious use of forest lands. The study allows for an in-depth understanding of experience components, both common and specific, which vary according to visitors. Moreover, the study reveals that it’s possible to connect certain experience profiles with harmonization terms. Finally, beyond the mere experience, it appears that forest managers who are aware of the perception and image of forest management will certainly benefit from this information.

<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &amp / Zupan, 2005). Early&nbsp / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing&nbsp / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking&nbsp / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home&nbsp / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,&nbsp / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing&nbsp / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured&nbsp / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study&nbsp / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.&nbsp / Descriptive analysis was&nbsp / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant&nbsp / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were&nbsp / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the&nbsp / highest number of which occurred within&nbsp / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking&nbsp / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.&nbsp / Conclusion: This study found&nbsp / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South&nbsp / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams&nbsp / including community health workers. A key function of these workers will&nbsp / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with&nbsp / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by&nbsp / community health workers. Most of the referrals in this study were&nbsp / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal&nbsp / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater&nbsp / realization of a team approach to PHC.</p>

Submitted by Aelson Maciera (aelsoncm@terra.com.br) on 2017-08-25T18:31:26Z No. of bitstreams: 1 TeseGMR.pdf: 2791855 bytes, checksum: 3e707fcaeafbe44747001bd27a789cca (MD5) / Approved for entry into archive by Ronildo Prado (bco.producao.intelectual@gmail.com) on 2018-01-29T18:18:50Z (GMT) No. of bitstreams: 1 TeseGMR.pdf: 2791855 bytes, checksum: 3e707fcaeafbe44747001bd27a789cca (MD5) / Approved for entry into archive by Ronildo Prado (bco.producao.intelectual@gmail.com) on 2018-01-29T18:18:58Z (GMT) No. of bitstreams: 1 TeseGMR.pdf: 2791855 bytes, checksum: 3e707fcaeafbe44747001bd27a789cca (MD5) / Made available in DSpace on 2018-01-29T18:22:29Z (GMT). No. of bitstreams: 1 TeseGMR.pdf: 2791855 bytes, checksum: 3e707fcaeafbe44747001bd27a789cca (MD5) Previous issue date: 2017-03-02 / Não recebi financiamento / There are few hospitals with accredited and/or certified status in Brazil. However, it was observed that a small number of private hospitals has been invested in multiple certification and/or accreditation strategy, cumulating two or more certificates. This unusual condition outbursts on the hypothesis that these hospitals integrate their management systems in some degree, resulting in integrated management systems (SGI). Despite the SGI theory has been covered many manufacturing and service sectors, it is still under development stage and needs more research in healthcare field. This work has performed case studies in four hospitals which have integrated two or more management systems, seeking to identify the integration model, the integration degree, the integration strategy, and the integration maintenance mechanism used. It applied a retrospective multiple case study approach, using a semi-structured interview as main instrument to interview managers in charge of the management systems at the analysis units. All analysis units are in Minas Gerais state and were selected by convenience. The case studies indicated external stimulus as main ground to adopt multiple certification and/or accreditation strategy. As for the management systems integration process, this did not rely straightly on the models proposed by the literature, but it has emerged from the need of rule and integrate crucial disciplines in healthcare (safety, risk management, clinical pharmacy, hospital governance, etc.), which become possible through complementation of different management system standards requirements. It was not recognized any use of structured integration model, but the observed characteristics of the SGIs resembled the theoretical tecnocentric model, the integration degree just achieved the tactical and operational stratums at partial and full integrated levels, respectively. The integration strategy was characterized as mixed in three analysis units and sequential in another one. The maintenance of the SGIs has been performed by the mechanism of assimilation in all the analysis units. At the end, it presents a framework to guide the management system integration process of the standards NBR ISO 9001:2015 and NIAHO based on the model of systems. / Existem poucos hospitais acreditados e/ou certificados no Brasil. Contudo, observou-se que um reduzido grupo de hospitais privados tem investido na múltipla certificação e/ou acreditação, acumulando duas ou mais acreditações e/ou certificações. Essa situação particular culminou na hipótese de que os sistemas de gestão implementados nesses hospitais estivessem integrados em algum grau, resultando em um sistema de gestão integrado (SGI). Apesar da teoria de SGI já ter coberto diversos setores de manufatura e de serviços, essa ainda está em desenvolvimento e carece de pesquisas na área da saúde. Este trabalho realizou estudo de casos em quatro hospitais que integraram dois ou mais sistemas de gestão, buscando identificar o modelo, o nível e a estratégia de integração e o mecanismo de manutenção utilizados. Empregou-se o procedimento de estudo de casos múltiplos retrospectivos, utilizando como principal instrumento de pesquisa entrevistas semiestruturadas junto aos gestores responsáveis pelos sistemas de gestão. As unidades de análise constituíram-se de hospitais escolhidos por conveniência sediados no estado de Minas Gerais. A análise dos casos apontou como principal motivação para a adoção da estratégia de múltipla certificação e/ou acreditação estímulos externos. Quanto ao processo de integração identificado, esse não se apoiou diretamente em modelos propostos na literatura específica, mas na necessidade de se dominar e integrar disciplinas críticas à área da saúde (segurança, gestão de riscos, farmácia clínica, governança hospitalar etc.), o que foi possível pela complementação de requisitos de diferentes normas de sistemas de gestão. Não foi identificada a aplicação de nenhum modelo teórico de integração estruturado, mas as características dos SGIs observadas se aproximaram daquelas atribuídas ao modelo teórico tecnocêntrico, a integração alcançou apenas os estratos organizacionais tático e operacional em nível parcialmente integrado e totalmente integrado, respectivamente. A estratégia de integração foi classificada como mista em três unidades de análise e sequencial em uma. Em todas as unidades de análise a manutenção do SGI foi realizada pelo mecanismo de assimilação. Apresenta-se ao final uma estrutura de orientação para o processo de integração das normas NBR ISO 9001:2015 e NIAHO embasada no modelo sistêmico.

The use of certification is considered a facilitating tool in demonstrating the company's commitment to all the stakeholders, and how organizations today are increasingly under pressure to perform more with less, the search for the junction of these standards in an integrated management system is seen as an opportunity. As the work program this management need the cooperation of everyone involved, this idea infiltrate into the company culture is necessary. This study aimed to propose a system of integrated management of ISO 14001 and OHSAS 18001 standards from the ISO 9001 implemented in leather tanning company, based on the adaptation and use of organizational culture. In this sense, the research is classified as applied qualitative and quantitative approach and procedure as a case study. The main results obtained highlight the relevance of this study for both academia and for the business sector, which reported that the merits of an integrated management arising from a system of standards facilitates the process. The conceptual model used in this study found that there is a significant interaction between the quality systems, environmental and OHS thus from a rigorous analysis of the ISO 9001 standard implemented in the company of this study may suggest actions which have created competence to harmonize understanding the business and subsystems that most influence on your performance, it is expected that by using the suggestions proposed the organization deliberately turn for the better and as a result, disseminate gains in perceived quality of its products and brand reliability internally and externally. It was concluded that with some adjustments in the Gobba Leather enterprise system, it can integrate their quality processes, environment and safety as well as to guarantee such certifications, noting that the proposed action adaptation of the organizational culture of the company in order to that everyone understands the many benefits of this procedure will ensure the success of management. / A utilização de certificações é considerada uma ferramenta facilitadora na demonstração do comprometimento da empresa perante todos os stakeholders, e como as organizações atuais estão sendo cada vez mais pressionadas a executarem mais com menos, a busca pela junção destas normas em um sistema de gestão integrada é observada como oportunidade. Visto que o trabalho de programar essa gestão necessita da colaboração de todos os envolvidos, infiltrar esta ideia na cultura da empresa se faz necessário. Este trabalho teve como objetivo propor uma sistemática de gestão integrada das normas ISO 14001 e OHSAS 18001, a partir da certificação ISO 9001 implementada na empresa de curtimento de couro, com base na adaptação e utilização da cultura organizacional. Neste sentido a pesquisa classifica-se como aplicada com abordagem qualitativa e quantitativa, tendo como procedimento um estudo de caso. Como principais resultados obtidos, destaca-se a relevância deste estudo tanto para o meio acadêmico como para o âmbito empresarial, onde registrou-se que a procedência de uma gestão integrada advinda de uma das normas do sistema facilita o processo. O modelo conceitual utilizado nesta pesquisa considerou que há uma significativa interação entre os sistemas da qualidade, ambiental e SST, dessa forma a partir de uma análise rigorosa da norma ISO 9001 implantada na empresa deste estudo pode-se sugerir ações as quais criaram competência ao harmonizar o entendimento do negócio e dos subsistemas que mais influenciarão no seu desempenho, espera-se que ao utilizar as sugestões propostas a organização se transforme deliberadamente para melhor e em consequência, dissemine ganhos na qualidade percebida de seus produtos e confiabilidade da marca internamente e externamente. Concluiu-se que com alguns ajustes no sistema da empresa Gobba Leather, esta poderá integrar seus processos de qualidade, meio ambiente e segurança do trabalho além de poder garantir tais certificações, lembrando que a ação proposta de adaptação da cultura organizacional da empresa a fim de que todos compreendam os inúmeros benefícios deste procedimento garantirá o sucesso da gestão.