This dissertation presents the analysis of reverse logistics fluorescent lamps in the city of Não-Me-Toque, located in the northwest of Rio Grande do Sul. With increased production and consumption of fluorescent lamps since 2001 and also due to discouragement the consumption of incandescent lamps, the generation of hazardous waste is increasing. These products have in their composition dangerous metals such as mercury, which is a heavy metal, toxic to organisms and can bioaccumulate in the food chain. Reverse logistics is an instrument provided for in the Federal Law 12.305/2010 which determines the final destination environmentally suitable fluorescent lamps after consumption through shared responsibility. Thus, this study aimed to examine the reverse logistics of fluorescent lamps in the city of Não-Me-Toque from the point of view of the social actors involved, through interviews and questionnaires. It was observed that 36% of household consumers discard fluorescent lamps with the MSW while 35% return to place of purchase. Only 10% of companies surveyed discard fluorescent lamps with the MSW. Traders and the municipal authorities are organizing to reverse logistics, however, do not have adequate facilities in the storage of collected lamps. Manufacturers, importers and distributors are not adequate. Finally, we proposed a model for reverse logistics fluorescent lamps by centralizing the gathering. / Esta dissertação apresenta a análise da logística reversa de lâmpadas fluorescentes no município de Não-Me-Toque, situado na região noroeste do Rio Grande do Sul. Com o aumento da produção e consumo de lâmpadas fluorescentes a partir de 2001 e também em função do desestímulo ao consumo de lâmpadas incandescentes, a geração de resíduos perigosos está aumentando. Esses produtos possuem em sua composição metais perigosos, como o mercúrio, que é um metal pesado, tóxico aos organismos e que pode se bioacumular na cadeia alimentar. A logística reversa é um instrumento previsto na Lei Federal 12.305/2010 que determina a destinação final ambientalmente adequada de lâmpadas fluorescentes após o consumo por meio da responsabilidade compartilhada. Deste modo, objetivou-se analisar a logística reversa de lâmpadas fluorescentes no município de Não-Me-Toque sob o ponto de vista dos atores sociais envolvidos, através da realização de entrevistas e aplicação de questionários. Foi possível observar que 36% dos consumidores domiciliares descartam as lâmpadas fluorescentes junto ao RSU enquanto 35% devolvem ao local de compra. Apenas 10% das empresas pesquisadas descartam as lâmpadas fluorescentes junto ao RSU. Os comerciantes e o poder público municipal estão se organizando para realizar a logística reversa, entretanto, não apresentam instalações adequadas quanto ao armazenamento das lâmpadas recolhidas. Os fabricantes, importadores e distribuidores ainda não estão adequados. Por fim, foi proposto um modelo para a logística reversa de lâmpadas fluorescentes através da centralização do recolhimento.

Magister Public Health - MPH / 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 Zupan, 2005). Early 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 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 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 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, 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 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 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 home or at the study 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. Descriptive analysis was conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were 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 highest number of which occurred within 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 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. Conclusion: This study found 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 African National Department of Health (SANDOH) which will involve the establishment of family health worker teams including community health workers. A key function of these workers will 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 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 community health workers. Most of the referrals in this study were neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal 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 realization of a team approach to PHC. / South Africa

Magister Public Health - MPH / The Outpatient Therapeutic Programme (OTP) is an integrated public health innovation for treating severe acute malnutrition without medical complications in children 6 to 59 months of age as outpatients within their communities using Ready to Use Therapeutic Food with the aim of reducing case fatality rates. The OTP approach is implemented in the three districts in Eastern Province of Zambia namely; Chipata, Katete and Petauke. Since inception of the OTP in the province, an evaluation of the OTP has not been conducted. The study is aimed at assessing the effectiveness of the implementation of the OTP for management of severe acute malnutrition in the three districts of Eastern Province of Zambia.

[pt] Este trabalho estuda, sob a perspectiva da gestão participativa, como a articulação na estrutura de rede pode facilitar o papel dos atores sociais para transformar as propostas da comunidade em ações concretas e integradas, seja com o poder público ou com a iniciativa privada. A análise utilizou a metodologia da pesquisa-ação aplicada à Rede Comunitária do Borel no sentido de observar o papel de articuladora e protagonista na transposição da proposta de desenvolver um plano de ação que atendesse melhor às necessidades da comunidade em relação ao sistema de coleta de lixo. Para isto, foi feita uma revisão da literatura sobre organizações em rede, gestão participativa e gestão integrada de resíduos sólidos. A metodologia empregada proporcionou um espaço de debate construtivo e troca de conhecimento entre a população, técnicos da Comlurb e esta pesquisadora. Os resultados foram positivos do ponto de vista participativo e também prático com a implantação do plano sugerido pela comunidade, mas compreendendo que a educação ambiental necessária para o sucesso completo da ação deve ser contínua e não acaba com a implantação do novo sistema de coleta. O estudo sugere que a organização comunitária em rede mostra-se como um facilitador da promoção de ações conjuntas, principalmente, quando há abertura do Estado para o desenvolvimento políticas públicas participativas. / [en] This work investigates the perspective of participatory management, as the hinge on the network structure can facilitate the role of social actors to turn the proposals into concrete community and integrated it with the public or the private sector. The analysis used the methodology of action-research applied to the Borel Community Network in order to observe the role of protagonist in articulating and implementing the proposal to develop an action plan that best met the needs of the community about the system of garbage collection. For this, a review was made of the literature on network organizations, participative management and integrated management of solid waste. The methodology provided a forum for constructive debate and exchange of knowledge among the population, technical Comlurb s employees and the researcher. The results were positive in terms of participatory and also with the practical implementation of the plan suggested by the community, but understanding that the environmental education mest continuous to achieve the success of the action and does not end just with the implementation of the new collection system. The study suggests that the community organization network shows up as a facilitator of the promotion of joint actions, especially when the State is opened to develop a participatory public policy.

A pesquisa estabeleceu como objetivo geral, analisar a gestão dos Resíduos Sólidos Urbanos em dois casos distintos; um na cidade de Varginha, MG e outro no Distrito de Jaçanã na cidade de São Paulo. Tem como finalidade, indicar caminhos sustentáveis para um melhor desempenho no processo de triagem, com ganho de tempo e renda para os cooperados. O método empregado foi baseado em revisão bibliográfica e trabalho de campo com entrevistas participativas, para melhor analisar e avaliar a sustentabilidade dos sistemas utilizados nos dois casos. Com o mesmo intuito foram investigadas a geração, coleta, triagem, o processamento e transporte, bem como o destino final dos resíduos gerados em ambos os casos, visando auxiliar a análise comparativa da rentabilidade e produtividade nos processos de triagem de Resíduos Sólidos Urbanos, das cooperativas em estudo. Como resultados, a COOPER-ET do caso Varginha MG, apresentou um índice de sustentabilidade sócio-econômico relativamente mais elevado do que a COOPER-SF do caso Jaçanã SP, onde esta última apresentou relativamente um maior índice no aspecto ambiental. A análise integrada da produtividade dos sistemas demonstrou uma taxa de tratamento com triagem mensal de Resíduos Sólidos Domiciliares de 10 % para o caso Jaçanã e 35% para o caso Varginha, em relação a todos os Resíduos Sólidos Urbanos produzidos pelas duas comunidades. De acordo com o quadro sócio-econômico apresentado pelas cooperativas, a COOPER-ET foi classificada como Cooperativa de Lugar Social, com características de Economia Solidária, segundo os conceitos de Singer (2000). A COOPER-SF foi classificada de acordo com o conceito das cooperativas organizativas, segundo Pinho (1982), uma vez que este conceito justifica como ela foi criada. O processo de triagem no transbordo (caso Varginha) mostrou-se relativamente mais rentável e mais econômico do que a coleta seletiva porta a porta promovida pelas Prefeituras de São Paulo, que mostrou ser relativamente menos rentável para os cooperados e mais dispendiosa para as Prefeituras, além de competir com os coletores autônomos de Resíduos Sólidos Recicláveis. Foram indicadas maneiras sustentáveis no Gerenciamento Integrado de Resíduos Sólidos Urbanos, com propostas de inclusão social não só dos cooperados, mas também dos coletores autônomos de Resíduos Sólidos Recicláveis. / The research has established as a general objective, analyze the management of the Urban Solid Waste in two distinct cases; one in the city of Varginha, Minas Gerais and another one in the District of Jaçanã in the city of São Paulo. It has as purpose to indicate sustainable ways to better performance in the process of screening, with profit of time and income for the cooperated. The employed method was based on bibliographical revision and work of field with participatory interviews, better to analyze and to evaluate the sustainability of the systems used in the two cases. With same to that effect were investigated the generation, it collects, screening, processing and transportation, as well as the final destination of the waste generated in both the cases, aiming at to assist comparative analysis of profitability and productivity in the process of screening of Urban Solid Waste, of the cooperatives in study. As results, the COOPER-ET of the Varginha case - MG, presented an index of socio-economic sustainability relatively higher than the COOPER-SF of the Jaçanã case - SP, where the latter presented relatively index higher in the environmental aspect. The integrated analysis of the productivity of the systems, demonstrated a tax of treatment with monthly screening of Solid Waste Domiciliary of the 10% for the Jaçanã case and 35% for the Varginha case, for all Urban Solid Residue produced by the two communities. In accordance with the partner-economic context presented by the cooperatives, the COOPER-ET was classified as Cooperative of Social Position, with characteristics of Solidarity Economy, according to concepts of Singer (2000). The COOPER-SF, was classified in accordance with the concept of the organizational cooperatives, according to Pinho (1982), a time that this concept justifies as it was created. The process of screening in the transshipment (case Varginha) revealed relatively more profitable and more economic of what the selective collection door the door promoted by the City halls of São Paulo, that it showed to be relatively less profitable for the cooperated ones and expensive to the City halls, beyond competing with the autonomous collectors of Solid Waste Recyclable. Were indicated sustainable ways in the Integrated Management of Urban Solid Waste, with proposals for inclusion social not only of the cooperated, but also of the collectors autonomous of Recyclable Solid Waste.

O presente estudo teve como objetivo descrever e apreender as contribuições da estratégia atenção integrada às doenças prevalentes na infância (AIDPI) para o acolhimento realizado por profissionais de enfermagem às crianças menores de cinco anos de idade em uma unidade de saúde da família (USF). Trata-se de um estudo descritivo com abordagem qualitativa em saúde, realizado em uma USF da cidade de Ribeirão Preto, SP. Os dados foram coletados em duas etapas, através de observação participante. A primeira etapa ocorreu durante uma experiência de educação permanente (EP) com a equipe de saúde da família, enfocando o acolhimento realizado na unidade e a AIDPI, com dados registrados em diário de campo. A segunda etapa ocorreu durante a implantação de uma estratégia de acolhimento embasada em aspectos da AIDPI, realizada por profissionais de enfermagem, sendo os dados sobre o acolhimento a 30 crianças registrados em roteiro e diário de campo. Durante as discussões da EP, emergiram questões relacionadas à demanda espontânea, à maneira como a equipe lida com essa demanda, ao acolhimento, ao resgate dos espaços coletivos de ação e à necessidade de capacitação dos profissionais para o acolhimento. Visando atender à demanda da população infantil por atendimentos não-agendados, buscou-se, durante a EP, estruturar o acolhimento às crianças menores de cinco anos de idade, através de aspectos da AIDPI, após a apresentação dessa estratégia à equipe, enfocando o trabalho dos profissionais de enfermagem. Com o intuito de apreender o processo de implantação desse acolhimento, os dados coletados na segunda etapa foram descritos e explorados segundo três temas: comunicação e atitudes promotoras de vínculo; anamnese e avaliação clínica; e resolutividade. Os profissionais de enfermagem demonstraram atitude de escuta comprometida e preocupação com a continuidade do processo de trabalho na equipe. Forneceram orientações claras ao cuidador, embora algumas estratégias de comunicação tenham sido pouco utilizadas. Revelou-se uma maior atuação da enfermagem na avaliação da criança. No entanto, a utilização do gráfico de crescimento e o levantamento de hábitos de saúde e questões alimentares necessitam ser mais bem explorados. Foram identificadas situações prioritárias e outros problemas além da queixa inicial, agilizando as ações. As principais dificuldades relacionaram-se à inadequação do espaço físico e à continuidade desse acolhimento qualificado pela AIDPI no cotidiano do serviço. Considera-se que a experiência contribuiu para um trabalho em equipe contínuo, que promoveu o manejo adequado dos casos e organizou o atendimento às crianças que chegam ao serviço para atendimento não agendado. Apontamos a necessidade da incorporação da EP na filosofia de trabalho da unidade, como forma de contribuir para o aprimoramento e continuidade desse acolhimento, no processo de trabalho cotidiano e com a saída e inclusão de membros na equipe. / This study aimed to describe and learn about the contributions of the Integrated Management of Childhood Illness (IMCI) strategy to the welcoming of children under five years old in a Family Health Unit (FHU) by nursing professionals. This is a descriptive health study with a qualitative approach, carried out in a FHU in Ribeirão Preto, São Paulo, Brazil. Data were collected in two stages through participant observation. The first stage occurred during a permanent education (PE) experience with the family health team, which focused on the welcoming performed in the unit and the IMCI. Data about this stage were recorded in a field diary. The second stage occurred during the implementation of a welcoming strategy based on IMCI aspects, performed by nursing professionals. Data about the welcoming of 30 children were recorded in a script and field diary. During PE discussions, some questions emerged related to the spontaneous demand, to the ways the team dealt with this demand, the welcoming, the rescuing of collective spaces of action and to the need to train professionals for welcoming. With a view to attending to the infant population?s demands for non-scheduled care, during PE, we tried to structure the welcoming of children under five years old according to IMCI aspects, after presenting this strategy to the team, with a focus on nursing professionals? work. In order to apprehend the implementation of this welcoming, data collected data in the second stage were described and explored according to three themes: communication and bond-promoting attitudes; medical history taking and clinical assessment; and problem solving capacity. The nursing professionals listened attentively and demonstrated concern regarding the continuity of the work process in the team. They provided clear orientation to caregivers, although some communication strategies were underused. It was demonstrated that nurses are more active in child assessment. However, the use of the growth chart and surveys of health and eating habits should be better explored. Besides initial complaints, priority situations and other problems were identified, streamlining actions. The main difficulties were related to inadequate physical space and the continuity of this welcoming qualified by IMCI in routine care. The experience contributed to continuous team work, promoted adequate case management and organized the attendance of non-scheduled demands. Permanent education needs to be incorporated into the units work philosophy, as a way to contribute to the improvement and continuity of this welcoming in the daily work process and in view of the turnover of team members.

No description available.

The diploma thesis deals with an implementation of three subsystems into one integrated system. That includes a quality management system, an enviromental system and a health and safety system transfered to the practice of a commercial company with a construction activity. The diploma thesis describes a management function by chapters of appropriate standards and a suggestion of QMS, EHS and HSMS integrated management system manual.

The thesis deals with quality theory, quality management system based on the ISO ČSN EN 9001 norm and disagreement management in a construction production company. In addition, the work describes ways of reaching quality and principles of managing quality of a given product. Procedures, methods and appropriate measures emerging from the theory of managing product quality are followingly implemented into a proposal for leading a real construction production company.

La presente tesis fue desarrollada con el objetivo de identificar la relación entre la Implementación del sistema integrado de gestión ISO 9001:2015, ISO 14001:2015 e ISO 45001:2018 y la innovación como fuente de la ventaja competitiva en las empresas del sector servicios logísticos en Lima 2019 El alcance se circunscribe al sector servicios logísticos de almacenamiento, transporte y distribución, debido a que mueve alrededor de S/ 1,600 millones al año en el país y porque conocer el nivel de desarrollo de su sistema integrado de gestión podría ayudarlas a optimizar sus procesos enfocándose en gran medida por la mejora continua y la innovación que serían producto de la implementación del SIG y la ventaja competitiva. La investigación de enfoque mixto y diseño no experimental, transversal, correlacional, utilizó como instrumentos la entrevista y encuestas, aplicándolas a nuestro público objetivo y como principales resultados identificamos la relación positiva y fuerte que existe entre las herramientas del SIG, el impacto operacional y organizacional dentro de una empresa con la innovación como fuente de la ventaja competitiva como lo puede ser, la cultura de los colaboradores dentro de su empresa o la innovación en línea a sus productos/servicios, procesos o nuevos mercados a los cuales penetrar. En tanto a lo expuesto anteriormente, podemos concluir que tener una cultura de innovación en los tres campos que abordamos afecta de manera directa positiva a la implementación al sistema integrado de gestión de cualquier empresa del sector logístico en Lima y Callao (2019). El resultado de la presente investigación permite entender la implicancia de implementar un sistema integrado de gestión y como las variables que proporcionan evidencian la mejora en los estándares de los servicios ofrecidos, alcanzando un nivel superior con procesos estandarizados y costos controlados; relacionándose directamente con la innovación como fuente de la ventaja competitiva de las empresas del sector logístico en Lima y Callao. El hallazgo que podemos destacar como resultado de la investigación, es como la innovación del mercado va a requerir que las empresas puedan adaptarse con mayor velocidad a los nuevos lineamientos exigidos por el sector. Para poder brindar los servicios en un nuevo esquema bajo la situación de pandemia que se ha desarrollado en el primer semestre del 2020. Dentro de las recomendaciones, destacamos tres puntos claves; las oportunidades de financiamiento que pueden solicitar las organizaciones a los proyectos del estado para la implementación del SIG y de esta manera iniciar con el proceso. El segundo punto, las nuevas herramientas de gestión de procesos que las empresas deberían considerar para la homogenizar sus procesos. Por último, considerar para futuras investigaciones la implementación del SIG bajo el marco regulatorio del Covid-19 y como pueden hacer uso de sus beneficios para reducir el riesgo en la salud del personal. / This thesis was developed with the aim of identifying the relationship between the Implementation of the integrated management system ISO 9001: 2015, ISO 14001: 2015 and ISO 45001: 2018 and innovation as a source of competitive advantage in companies in the logistics services sector in Lima 2019 The scope of this project consists of delving into the logistics services sector storage, transportation and distribution, since it moves around S / 1,600 million a year in the country and improves the level of development of its integrated management system for all companies in the logistic sector. This could help them optimize their processes, focusing largely on the continuous improvement and the innovation that would be a product of the implementation of the GIS and the competitive advantage. The research with a mixed approach and non-experimental, cross-sectional, correlational. As techniques, interviews and surveys were used, applying them to our target audience and as main results we identified the strong relationship that exists between the IMS tools, the operational and organizational impact within a company with innovation as a source of competitive advantage. from collaborators within the company or online innovation to your products / services, processes, or new markets to penetrate. As detail above, we can conclude that having a culture of innovation in the three fields we can address that this would enhance the integrated management system of any company in the logistics sector in Lima and Callao (2019). The implications of the conclusions we reached in this work allow us to understand the approach that should be taken when developing an integrated management system and how the benefits they provide are evidenced with the possibility of improving the standard of services offered, reaching a superior level with standardized processes and controlled costs, being directly related to innovation as a source of competitive advantage for companies in the logistics sector in Lima and Callao. Within our recommendations, we highlight three key points; the financing opportunities that organizations can request from state projects for the implementation of the IMS and with it start the process. The second point, the new process management tools that companies should consider for the homogenization of their processes. Finally, consider in future research to deepen the issues of IMS implementation under the regulatory framework of Covid-19 and how they can make use of its benefits to reduce the risk to personnel health. Among the discoveries that we can highlight is how the Market innovation will require that companies can adapt more quickly to the new guidelines required by the sector. In order to provide services in a new scheme under the pandemic situation that has developed in the first half of 2020. / Tesis