Orientador: Vera Lucia Pamplona Tonete / Resumo: Introdução: atualmente, embora se constate a redução dos índices de morbimortalidade infantil em todas as regiões do país, ainda há muito que se fazer para promover a saúde de crianças, especialmente daquelas mais vulneráveis. O presente estudo aborda o tema da vigilância à saúde de recém-nascidos de risco, com base em protocolo de organização de serviços. Considera-se que protocolo compõe-se de rotinas de cuidados e ações de gestão de um determinado serviço, equipe ou departamento, elaborado a partir da produção de conhecimentos e práticas dos profissionais envolvidos, com respaldo de evidências científicas. Objetivo: elaborar protocolo de organização de serviços para a redução de óbitos infantis na região de saúde do Vale do Jurumirim, São Paulo, com enfoque na vigilância à saúde de recém-nascidos de risco. Aspectos metodológicos: trata-se de uma pesquisa-intervenção, composta por uma etapa inicial, quando foi realizado estudo transversal e descritivo sobre o perfil epidemiológico regional de recém-nascidos vivos em 2013 e das crianças que foram a óbito nesse mesmo ano, durante o primeiro ano de vida, buscando a correspondência aos critérios de risco ao nascer indicados pelo Ministério da Saúde. Nesta primeira etapa, buscou-se também caracterizar a rede de atenção à saúde materno-infantil disponível na região em foco. Em uma etapa posterior, foi realizada intervenção participativa, que incluiu duas oficinas de oito horas para elaboração do protocolo pretendido, envolvendo 3... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Although it is currently noticed a decline in infant mortality rate in all the regions of the country there is still a lot to do to promote child health care, especially those children who are more vulnerable. The current study deals with the topic of health monitoring of newborn babies at risk based on service organizing protocol. It is considered that protocol consists of routine care and management procedure of a particular service, team or department, by putting together healthcare professionals’ knowledge and experience and supported by scientific evidences. Objective: Putting together service organizing protocol to decline infant mortality in the region of Vale do Jurumirim, São Paulo, focused on health care monitoring of newborn babies at risk. Methodological Aspects: It is about intervention survey consisted of an initial stage when it was done a transversal and descriptive study of the regional epidemic profile of newborn babies born in 2013 and one-year-old children or younger who died that year, aiming at the correspondence between risk criteria at birth according to the Department of Health. In this initial stage, attention to maternal-infant health care was given when it was available in that region. In a later stage, participative intervention was carried out, which included two eight-hour workshops to put together intended protocol, involving 34 managers and healthcare professionals and maternal-infant health care monitoring of that particular reg... (Complete abstract click electronic access below) / Mestre

Thesis (M.Sc. (Statistics)) -- University of Limpopo, 2014 / The health and survival of children are important measures of the social wellbeing and health status of the community. The World Community made a commitment to reduce under-five mortality by two-thirds between 1990 and 2015. The purpose of this study was to identify factors that have influence on child survival. The Dikgale Health and Demographic Surveillance System (HDSS) data for children born between 01 January 1996 and 31 December 2010 were analysed using cross-tabulation, logistic regression and survival analysis to determine factors that have influence on child survival. The findings revealed that mother’s survival status and child birth weight are significantly associated with child survival. The results showed that the odds that children born to mothers who are alive survive beyond five years are almost four times the odds that children born to mothers who are not alive survive beyond five years. The study also found that the odds that children born with birth weight 2.5kg or more survive beyond five years are almost two times that of children born with birth weight less than 2.5kg. The results of this study may help in formulating strategies and interventions that improve the lifespan of children and assist in the reduction of child mortality. KEY CONCEPTS Child survival, Health Demographic Surveillance System, Cross-tabulation, Logistic regression, Survival analysis, Mother’s survival status, Birth weight.

Bakgrund: Barnhälsovården spelar en betydelsefull roll i det svenska folkhälsoarbetet. En femtedel av de inskrivna barnen har minst en förälder som är född utanför Sverige. Majoriteten av BVC-sköterskorna upplever arbetet med invandrarfamiljerna som stimulerande men anger också att svårigheter förekommer. Syftet: var att belysa faktorer som påverkar BVC-sköterskans transkulturella vårdrelationer med invandrarfamiljer i Barnhälsovården. Metod: Studien genomfördes som en allmän litteraturstudie och baserades på elva vetenskapliga artiklar som kvalitetsgranskades och analyserades. Resultatet redovisades i olika tre teman. Resultat: Faktorer som påverkade den transkulturella vårdrelationen i Barnhälsovården var BVC-sköterskans förmåga att kommunicera, bemötandet och förhållningssättet samt den kulturella kompetensen. Diskussion: Kommunikationssvårigheterna påverkade möjligheterna att skapa trygghet och förtroende i den transkulturella vårdrelationen. BVC-sköterskans bemötande och förhållningssätt hade betydelse inte bara för utgången av hälsovårdsarbetet utan även för invandrarfamiljens inställning till integration. Kulturell kompetens påverkade BVC-sköterskans möjligheter att se varje invandrarfamilj individuellt snarare än som en representant för sin kulturgrupp. Slutsats: För att möjliggöra en förtroendefull och trygg transkulturell vårdrelation i Barnhälsovården ställs inte bara krav på BVC-sköterskans skicklighet i att finna bra vägar för kommunikation, utan även på förmågan att praktiskt kunna omsätta sin kulturella kompetens samt insikt om betydelsen av att ge ett vänligt, empatiskt och individuellt bemötande åt invandrarfamiljen. / Background: The primary child health care services (PCHC services) plays an important part in the Swedish public health work. One fifth of the enrolled children have at least one parent born outside of Sweden. The majority of the PCHC nurses finds the interaction with the immigrant families stimulating but also recognizes difficulties. The aim: was to illuminate factors that influence the PCHC nurse's transcultural caring relationship with immigrant families in PCHC services. Method: The study was conducted as a literature review and based upon eleven scientific articles which were quality assessed and analyzed. The result was reported in three different themes. Result: Factors affecting the transcultural caring relationship in the PCHC services were the PCHC nurse's ability to communicate, the reception and approach and the cultural competence. Discussion: Communication difficulties affected the possibilities to create trust and confidence in the transcultural caring relationship. The PCHC nurse's reception and approach had implications not only for the outcome of the health care work but also for the immigrant family's attitude towards integration. Cultural competence affected the PCHC nurse's possibilities to see each immigrant family individually rather than as a representative of their cultural group. Conclusion: To enable a safe and trusting transcultural caring relationship in the PCHC services it’s necessary that the PCHC nurse has good communication skills, is able to use and incorporate cultural competence and understands the importance of providing a friendly, empathetic and individual approach to the immigrant family.

Rural hospitals in America hold a critical position within their communities because they possess the duty and responsibility of not only providing adequate healthcare services for the population, but also bearing the heavy burden of functioning as one of the main socio-economic engines within the area. These factors, along with drastically inadequate operating budgets, often create programmatic and operational challenges for these entities to confront as they fight to provide the technologically current facilities and services needed to adequately care for their community. All of this must be done in the most cost effective way possible. This thesis will look at current trends being administered within the widespread replacement effort of these facilities, and propose several alternative strategies aimed at facilitating feasible solutions to these and other issues that are not currently being addressed. Design resolution strategies will be formulated and tested. These will then be directly implemented through a specific project design exercise that will then be evaluated.

Žmogaus sveikata – multidimensinis reiškinys, tai – tarpusavyje susijusių veiksnių: fizinės, emocinės/dvasinės sveikatos, socialinės gerovės, visuma. Todėl integruotos sveikatos priežiūros pagrindas yra visuminė (holistinė) idėja, reikalaujanti reiškinį suvokti kaip tam tikrą visumą, netolygią jos elementų sumai. Siekiant visapusiškai padėti sergančiam žmogui reikia ne tik medicininės srities specialistų pagalbos, tačiau reikalinga ir svarbi tampa sveikatos priežiūros įstaigoje dirbančio kompetentingo socialinio darbuotojo veikla. Socialinis darbas sveikatos priežiūroje yra pakankamai nauja socialinio darbo sritis Lietuvoje, dėl to susiduriama su: informacijos apie socialinio darbo profesiją, socialinio darbuotojo veiklą ir jo funkcijas, problema. Pastebėta, kad socialinio darbo problematika sveikatos priežiūros įstaigose aktuali, todėl reikalinga sistemingų ir išsamių tyrimų šioje srityje. Lietuvos sveikatos priežiūros įstaigose socialinio darbo profesija nuvertinama, o socialinio darbo specialistai susiduria su įvairiais sunkumai ir problemomis dirbdami medikų apsuptyje. Nors socialinių darbuotojų padėtis sveikatos priežiūros srityje nėra palanki, tačiau profesija reikalinga dėl sveikatos ir socialinių klausimų susietumo bei naujo požiūrio, kad sveikatos priežiūros paslaugos turi būti teikiamos kartu su socialinėmis paslaugomis. Socialinis darbuotojas, remdamasis savo profesine kompetencija, sveikatos priežiūros įstaigose, teikia socialines paslaugas, padeda asmenims... [toliau žr. visą tekstą] / Health is a multidimensional concept. It is a complex combination of a person's physical, mental, emotional and social health factors. Therefore an integrated health care is based on the total (holistic) concept and requires understanding the phenomenon into account and seen as a whole. In order to fully help to sick person need not only medical professionals, necessary and important are qualified social worker’s activities working in health care institutions. Social work in health care is quite new field of social work in Lithuania, therefore faced with: information about the social work profession, social worker’s activities and social worker’s functions, problems. It was noticed that social work issues is relevant in health care institutions and requires systematic and comprehensive research in this social work area. Social work profession is downplayed in health care institutions in Lithuania and social work professionals are facing to various difficulties and problems of working in the medical teams. Although the social worker’s status in the health care sector is not favorable, but the social work profession is necessary for the relationship between health and social issues as well as the new approached that health care services must be providing integrated with social services. In health care institutions, social worker on the basis of the professional competence, provides social services, he helps people with health problems to integrate into society and encourages... [to full text]

Magistro baigiamąjį darbą sudaro: įvadas, 8 skyriai, 7 poskyriai. Darbo pabaigoje pateikiamos išvados ir rekomendacijos, naudotos literatūros sąrašas, santrauka lietuvių ir anglų kalba bei priedai. Darbo uždaviniai: - išnagrinėti įstatymus ir kitus teisės aktus, reglamentuojančius mokamas medicinines paslaugas; - apžvelgti vaistų kompensavimo tvarką; - ištirti, kokios medicininės paslaugos, kiek jų teikiama ir kaip kinta jų apimtys dviejose Vilniaus ligoninėse; - išsiaiškinti atskirų grupių žmonių (medikų, pacientų, studentų- medikų, teisininkų) požiūrį į šiuo metu esantį sveikatos apsaugos finansavimą, dalinius mokėjimus už sveikatos priežiūros paslaugas. Metodika. Naudojantis finansinėmis ligoninių ataskaitomis, skaičiuojant kasos čekius, tirtos mokamos paslaugos ligoninėse. Atlikta anketinė respondentų apklausa. Duomenys apdoroti naudojant programas MS Excell ir SPSS for Windows 12.0. Išvados. LR įstatymuose ir kt. teisės aktuose yra aiškiai nurodyta, kada gyventojai turi mokėti už sveikatos priežiūros paslaugas ir kokios paslaugos jiems turi būti atliekamos nemokamai. Yra sukurtos gana tobulos vaistų kompensavimo metodikos, kurių pagrindinius principus būtų galima pritaikyti ir kt. medicininėms paslaugoms. Lėšos už mokamas medicinines paslaugas sudaro tik labai mažą dalį ligoninių biudžeto. Daliniai mokėjimai už sveikatos priežiūros paslaugas yra žmonėms nepatrauklūs. Labai mažai apsidraudusiųjų papildomuoju (savanoriškuoju) sveikatos draudimu. / Scientific advisor: Prof. Ass. Dr. Gediminas Černiauskas The master degree thesis consists of introduction, 8 chapters, and 7 units. Conclusions, recomendations, a list of literature, a summary in Lithuanian and English, and supplements are given in the closing part of the thesis. Goals of the thesis: - to examine laws and other legal acts regulating paid medical services, - to provide and overview of paying out compensations for expenses relating to drug acquisition; - to investigate into the range, number, and dynamics of volume of paid services provided by two hospitals in Vilnius; - to reveal the attitude of groups of people (medical people, patients, medical students, and lawyers) towards the current funding of health care system and partial payments for health care services. Methodology. Paid medical services provided by the hospitals were analysed on the basis of relevant financial statements and cash-register receipts. To reveal people’s attitude to partial payments for health services, a questionnaire-based survey was carried out. Data were processed by MS Excell and SPSS for Windows 12.0 programs. Conclusions: LR laws and other legal acts specify the cases when residents are to pay for health care services and what services are to be provided to them free of charge. Quite perfect techniques for the compensation of expenses relating to drugs’ acquisition have been developed. The basic principles of these techniques might be applied in the area of other medical... [to full text]

The purpose of the research – to evaluate satisfaction of patients expectations in Vilnius emergency university hospital. The object of the research. In-patient expectations in Vilnius emergency university hospital. The hypothesis of the research- patient’s expectations are not successfully satisfied because of the organizational problems, their analysis is useful in order to make better organizational work. Conclusions. Patient's expectayions satisfaction is influenced by the structure of resources in healthcare organization and person's (patient's) individual characteristics.

Darbo tikslas: Įvertinti Reabilitacijos centro pacientų informuotumą apie jiems teikiamas medicininės reabilitacijos paslaugas. Uždaviniai: 1. Įvertinti reabilitacijos centro pacientų informuotumą apie saugią reabilitaciją. 2. Nustatyti ryšį tarp pacientų informuotumo, socialinių demografinių charakteristikų ir savo sveikatos būklės vertinimo. 3. Nustatyti ryšį tarp pacientų informuotumo apie reabilitacijos paslaugas ir nuomonės apie jiems teikiamų paslaugų kokybę. Tyrimo metodika. 2012 m. birželio - 2013 m. vasario mėnesiais atlikta anoniminė pacientų apklausa reabilitacijos centre teikiančiame stacionarias reabilitacijos paslaugas. Atliekant tyrimą, buvo išdalintos 300 anketų, atsako dažnis 90,6 proc. Anketinių duomenų analizei naudota statistinė programa SPSS 19.0. Rezultatai. 78,3 proc. reabilitacijos centro pacientų mano, kad jų informuotumas paslaugų saugos klausimais yra pakankamas, 5,3 proc. – nepakankamas, o 16,4 proc. respondentų nesupranta sveikatos priežiūros saugos sąvokos. Informuotumas sveikatos priežiūros saugos klausimais nėra susijęs su lytimi, tačiau didesnė dalis vyresnių nei 60 metų amžiaus pacientų (91,3 proc.) lyginant su jaunesniais nei 60 metų amžiaus pacientais (8,7 proc.) teigė nesuprantantys sveikatos priežiūros saugos sąvokos. 84,8 proc. pacientų atsakė, kad suprato visą informaciją, 12,5 proc. – nesuprato, bet pasakė, ko nesuprato, 2,7 proc. nesuprato ir neišdrįso pasakyti, ko nesuprato. Dauguma (88,3 proc.) pacientų, kurie suprato jiems... [toliau žr. visą tekstą] / Research aim: to assess awareness of rehabilitation center patients ‘about provided services of medical rehabilitation. Goals: 1. To assess awareness of rehabilitation center patients ‘about safe rehabilitation. 2. To identify connection among patient‘ awareness, social demographic characteristics and self-health status assessment. 3. To identify connection between patient‘ awareness about rehabilitation services and their opinion on quality of provided services. Research methodic. Research was performed during June 2012 - February 2013 with anonymous questionnaire in rehabilitation center with inpatient rehabilitation services. 300 questionnaires were distributed, response rate 90.6 %. Statistical program SPSS 19.0 was used for data analysis. Results. 78.3 % of rehabilitation patients think that their awareness on safety of services is sufficient, 5.3 % – insufficient and 16.4 % of patients don‘t understand concept of safety of health care. Awareness on safety of health care is not related to gender, but more of older than 60 years patients (91.3 %) comparing to younger than 60 years (8.7 %) stated about misunderstanding in concept of safety of health care. 84.8 % of patients stated that they understood all information, 12.5 % – didn‘t understood and stated what is unclear, 2.7 % didn‘t understood and didn‘t named what is unclear. Mostly of patients (88.3 %), who understood provided information, knew how to behave safely at home. 95.4 % of respondents stated about... [to full text]

The recognition by societies of the problems caused by deafness and hearing impairment has led to a significant increase in the need for audiologists. Additionally, the rapid development of audiology in the last few decades, a wide diversity of audiology education programs, and increased globalisation highlighted the need to evaluate current audiology education and practice from an international perspective. A major aim of this thesis was therefore to study comparative audiology, to allow systematic analysis of what hearing health care is needed worldwide, and the strategies required to achieve future improvements. Rather than remaining theoretical, this thesis also aimed to develop an affordable and sustainable seeding model for audiology education, which would build capacity in countries with inadequate audiology education. An international study surveyed major audiology organisations, and completed surveys were received from 62 countries (representing 78% of the world population). Eighty-six percent of countries needed more audiologists, and cited a lack of government funding, low public awareness of deafness and inadequate audiology education as major reasons for the shortages. There was a wide range of professionals providing hearing health care and a large overlap in their scope of practices. To discuss these complex issues, a conceptual model for hearing health care was developed which formalised the interacting issues, and highlighted the feedback loops between them. The conceptual model presented a framework that was used to discuss individual countries in more detail, and provided a basis for the design of strategies aimed at improving hearing health care and education for groups of countries. Although five distinct groups were described, in practice, most countries may benefit to some extent from hearing health care systems that range from decentralised community-based models (providing basic care), to more institutionally-based models (offering advanced services and technologies). Evolution of hearing health care systems from basic community-based, to more advanced institutionally-based services, would presumably come with strengthening economies and health and education infrastructures, and concurrent growth in audiology education and private and public hearing health care markets. The rate at which this occurs depends in part on the strength of a country’s economy, but also on its other health priorities, the equality of its wealth distribution, the diversity and geographic spread of its population, and the adequacy and efficiency of its hearing health care education programs.

Submitted by JULIANA PIERAMI DE FREITAS null (jupierami@hotmail.com) on 2016-04-28T23:49:36Z No. of bitstreams: 1 Dissertacao Juliana 2504.pdf: 1553097 bytes, checksum: 7fab2bad78418aed6d927c6d8c388edc (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-05-02T16:57:55Z (GMT) No. of bitstreams: 1 freitas_jp_me_bot.pdf: 1553097 bytes, checksum: 7fab2bad78418aed6d927c6d8c388edc (MD5) / Made available in DSpace on 2016-05-02T16:57:55Z (GMT). No. of bitstreams: 1 freitas_jp_me_bot.pdf: 1553097 bytes, checksum: 7fab2bad78418aed6d927c6d8c388edc (MD5) Previous issue date: 2016-03-02 / Introdução: atualmente, embora se constate a redução dos índices de morbimortalidade infantil em todas as regiões do país, ainda há muito que se fazer para promover a saúde de crianças, especialmente daquelas mais vulneráveis. O presente estudo aborda o tema da vigilância à saúde de recém-nascidos de risco, com base em protocolo de organização de serviços. Considera-se que protocolo compõe-se de rotinas de cuidados e ações de gestão de um determinado serviço, equipe ou departamento, elaborado a partir da produção de conhecimentos e práticas dos profissionais envolvidos, com respaldo de evidências científicas. Objetivo: elaborar protocolo de organização de serviços para a redução de óbitos infantis na região de saúde do Vale do Jurumirim, São Paulo, com enfoque na vigilância à saúde de recém-nascidos de risco. Aspectos metodológicos: trata-se de uma pesquisa-intervenção, composta por uma etapa inicial, quando foi realizado estudo transversal e descritivo sobre o perfil epidemiológico regional de recém-nascidos vivos em 2013 e das crianças que foram a óbito nesse mesmo ano, durante o primeiro ano de vida, buscando a correspondência aos critérios de risco ao nascer indicados pelo Ministério da Saúde. Nesta primeira etapa, buscou-se também caracterizar a rede de atenção à saúde materno-infantil disponível na região em foco. Em uma etapa posterior, foi realizada intervenção participativa, que incluiu duas oficinas de oito horas para elaboração do protocolo pretendido, envolvendo 34 gestores e profissionais da atenção e vigilância à saúde materno-infantil da referida região. Os dados de cunho quantitativo foram colhidos de bancos públicos e documentos oficiais e descritos estatisticamente, enquanto que os de cunho qualitativo foram obtidos a partir do preenchimento do modelo proposto por Werneck, Faria e Campos, anotações em diário de campo e de roteiro com questões que nortearam as discussões durante as oficinas. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista. Resultados: no ano de 2013, na região de saúde do Vale do Jurumirim foram contabilizados 3748 nascidos vivos, sendo que 9,8% desses apresentaram correspondência a pelo menos um dos critérios de risco ao nascer estudados. Neste mesmo ano, ocorreram 47 óbitos infantis, com 80,8% desses no componente neonatal, distribuídos em 12 municípios dos 17 municípios da região. Constatou-se que houve em todos os óbitos infantis correspondência a pelo menos um dos critérios de risco ao nascer estudados. Sobre vigilância e atenção à saúde materno-infantil, verificou-se que existiam fragilidades quanto ao trabalho em rede, bem como não se tinham estabelecidas estratégias para identificação e segmento de crianças expostas a riscos de adoecer e morrer. Com base nesses achados, coletivamente, foi possível estabelecer: os critérios de risco ao nascer para classificar os recém-nascidos vivos da região e a forma de considerá-los; o elenco de atividades a serem desenvolvidas, com seus respectivos responsáveis; os mecanismos de acompanhamento e avaliação; bem como o fluxograma de atividades para detecção e abordagem de recém-nascido de risco. Considerações finais: como produto desta pesquisa-intervenção foi elaborado o protocolo para a vigilância de recém-nascidos de risco na região de saúde do Vale do Jurumirim. Considera-se que o processo para tal produção foi cientificamente respaldado, contando com a participação ampla e ativa dos profissionais envolvidos com a vigilância e atenção à saúde materno-infantil dessa região. Sendo por definição um instrumento a ser revisto periodicamente, recomenda-se a avaliação do protocolo elaborado após um ano de sua implementação. / Introduction: Although it is currently noticed a decline in infant mortality rate in all the regions of the country there is still a lot to do to promote child health care, especially those children who are more vulnerable. The current study deals with the topic of health monitoring of newborn babies at risk based on service organizing protocol. It is considered that protocol consists of routine care and management procedure of a particular service, team or department, by putting together healthcare professionals’ knowledge and experience and supported by scientific evidences. Objective: Putting together service organizing protocol to decline infant mortality in the region of Vale do Jurumirim, São Paulo, focused on health care monitoring of newborn babies at risk. Methodological Aspects: It is about intervention survey consisted of an initial stage when it was done a transversal and descriptive study of the regional epidemic profile of newborn babies born in 2013 and one-year-old children or younger who died that year, aiming at the correspondence between risk criteria at birth according to the Department of Health. In this initial stage, attention to maternal-infant health care was given when it was available in that region. In a later stage, participative intervention was carried out, which included two eight-hour workshops to put together intended protocol, involving 34 managers and healthcare professionals and maternal-infant health care monitoring of that particular region. Information characterized by quantity was collected from public data and statistical official documents whereas information characterized by quality was collected from the filling out of model proposed by Werneck, Faria and Campos, notes in field log and itinerary containing questions asked during the workshop. This study was approved by Ethic Committee in Survey of the Medical University in Botucatu of the Paulista State University. Results: In 2013, 3,748 newborn babies were born in Vale do Jurumirim region, 9.8% showed at least one correspondence of the risk criteria studied. That year, 47 infants died, 80.8% during neonatal in 12 cities of that 17-city region. It was noticed that there was, at birth, at least one correspondence of the risk criteria studied in all the infant deaths. When it comes to maternalinfant health care monitoring, it was checked that there were flaws in networking and strategies to identify children exposed to risks of becoming sick and dying had not been established. Based on these findings, it has been possible to establish collectively: risk criteria at birth to classify newborn babies in the region and the way to consider them; activities to be developed with their respective responsible ones; the mechanics of accompanying and evaluating; as well as the flow chart of activities to detect and approach newborn babies at risk. Final Consideration: As a product of this intervention survey, a protocol to monitor newborn babies at risk in the region of Vale do Jurumirim was put together. It is considered that the procedure to produce such a protocol was scientifically supported, counting on the ample and active participation of healthcare professionals concerned with maternal-infant health care in that region. It is also, by definition, a tool to be revised periodically, evaluation of this protocol is recommended after one year of its implementation.