Suchergebnisse

Competent physicians working in teams with other health professionals are a prerequisite for excellent patient care. The context for this thesis is physicians' specialist training, which consists of workplace learning in an environment primarily designed for other purposes than education, with sometimes contradictory objectives. Educational leaders have been singled out as important for the educational quality. Their tasks are complex and their influence on education may be challenging. Notwithstanding, factors that are influencing effectiveness in completing the tasks remain unexplored. The overall aim of this thesis is to explore educational leadership in physicians' specialist training. The central research question is, 'Which factors influence the role of the programme directors in Sweden?' The four empirical studies are positioned within a cultural conceptual perspective on leadership, recognizing context as an influential factor in facilitating and limiting leadership. The studies are guided by a constructivist approach, three using qualitative methods and one a quantitative method. Study I explored programme directors' perceptions of their work tasks, interpreted within Bolman and Deal's theoretical framework. The structural (structuring the education) and human resource function (supporting individuals and handling relations) were emphasized. Less described were the political (negotiating and mediating) and the symbolic function (influencing the educational culture). Study II explored factors perceived to influence programme directors' effectiveness. Individual factors, such as the programme director's own competence, were mainly facilitating, while structural factors, such as conditions for the role, were mainly hindering. Whether relational (such as communication and support) and attitudinal factors (such as values and attitudes) were perceived to be hindering or facilitating differed between the participants. Study III investigated factors related to the role of the programme directors that are associated with high educational quality. The findings showed that factors at both individual, relational, attitudinal and structural level were associated with high quality. Factors related to communication, support and attitude seemed to be of particular importance. Most high-quality education was found for the programme directors at a single unit that experienced sufficient impact on education. Study IV explored the process of successful change implementation. Similarities shown included experiencing the change to be meaningful, working in coalition with others and employing a long-term perspective on change, where involvement and anchoring were essential. Experiencing mandate was central, which was dependent on the next level of leadership. The findings show that the programme director role is influenced by contextual factors such as organisatorial characteristics and values, factors related to the leadership role such as conditions fore the role and competence, and factors related to the specialist training organisation and climate, such as communicationn and attitudes.Power and mandate are central concepts, and since the role mainly relies on personal power sources, relational factors may be of particular importance. In line with a diminished focus on leadership traits, the main message in this thesis argues that in order to strengthen the role of programme directors, a differentiated strategy with an aim to increase programme directors' influence on specialist training should be used.

A classificação de risco é um processo de identificação de pacientes que prioriza os que necessitam de tratamento imediato, de acordo com o potencial de risco, agravos à saúde ou grau de sofrimento, e não com a ordem de chegada ao serviço de urgência e emergência. O Sistema de Triagem de Manchester (STM), o mais utilizado no país, é um exemplo de protocolo de classificação de risco que busca atingir tal meta, devendo ser aplicado diante do adequado treinamento das equipes de saúde e, em especial, o enfermeiro classificador. O objetivo desse relato de experiência é compartilhar os desafios na implementação do STM por meio da vivência de enfermeiros de um hospital terciário de uma cidade do Norte do Paraná. O intuito na implementação do STM é otimizar os métodos de triagens no atendimento de urgência e emergência, e pode vir a se tornar falhos se não utilizados e aplicados corretamente por profissionais qualificados, treinados e comprometidos a usá-la da maneira correta e sensatamente, tanto por parte da instituição, quanto de enfermeiros e médicos. Concluiu-se que o conhecimento teórico-científico junto com a experiência profissional se faz importante para a implantação e utilização do método de classificação de risco por meio do STM em unidade hospitalar de urgência, bem como a necessidade de se adaptar o STM com a realidade, seja para melhorar a aderência do protocolo, bem como ter parâmetros objetivos na cobrança de melhorias essenciais ao serviço visando atender a real demanda do serviço. Palavras-chaves: Acolhimento. Medição de Risco. Enfermagem. Abstract Risk classification is a process of patient identification that prioritizes those who need immediate treatment, according to the potential for risk, health problems or degree of suffering, and not the order of arrival at the emergency and emergency service. The Manchester Screening System (MSS), the most widely used in our country, is an example of a risk classification protocol that seeks to achieve this goal. This protocol must be applied in the face of adequate training, especially the classifying nurse. The objective of this experience report is to share the challenges in the MSS implementation through the experience of nurses from a tertiary hospital in a city in the north of Paraná. The purpose of the MSS implementation is optimizing thescreening methods in emergency and emergency care, and it might become flawed if not used and applied correctly by qualified, trained and committed professionals to use it in the correct and sensible way, both by the institution, nurses and doctors. It was concluded that the theoretical-scientific knowledge together with the professional experience are important for the implantation and use of the risk classification method through MSS in an emergency hospital unit, as well as the need to adapt the MSS with our reality, either to improve protocol adherence, as well as to have objective parameters in the collection of essential improvements to the service in order to meet the real servie demand. Keywords: User Reception; Risk Assessment; Nursing.

Objective: to identify the socio-demographic and clinical factors in laparoscopic cholecystectomy in two decades of experience in the Military Hospital of the city of Cuenca. Cholecystectomy is the most common surgery to treat pathologies such as cholelithiasis, acute cholecystitis and vesicular polyposis, currently the laparoscopic technique is the treatment of choice. Materials and Methods. a descriptive, retrospective study of patients undergoing laparoscopic cholecystectomy in the last two decades; we worked with 468 clinical records that met the inclusion criteria. Results. 61,8% were women and 38,2% were men with a mean age of 50,77 years and standard deviation (SD) of 0,727. The surgical indications were cholelithiasis 60,2%, acute cholecystitis 29,2%, vesicular polyposis 4,7%, choledocholithiasis 4,5%, sclerotrophic vesicle 0,9%. The postoperative stay was 80,6% less than three days and 19.4% equal to or greater than 4 days; with an average of 1,09 and DS = 0,292. The conversion percentage to open surgery was 0,4%. The surgical time was 50,2% within 31-60 min and 46,2% more than 60 minutes with an average of 42,43min and DS = 0,564. When the age and operative time were related, it was evidenced that in those older than 60 years, they had more days of hospitalization with statistical significance, with a value of p = 0,0006. Conclusion. Laparoscopic cholecystectomy decreases the operative and hospitalization times, contributing directly to the decrease in morbidity and mortality due to this type of pathologies and allowing health services in developing countries to improve the quality of care for their populations. ; Objetivo: identificar los factores socio-demográficos y clínicos, en la colecistectomía laparoscópica en dos décadas de experiencia en el Hospital Militar de la ciudad de Cuenca. La colecistectomía es la cirugía más común para tratar patologías como la colelitiasis, colecistitis agudas y poliposis vesicular, siendo en la actualidad la técnica laparoscópica el tratamiento de elección. Materiales y Métodos: estudio de tipo descriptivo, retrospectivo, de pacientes sometidos a colecistectomía laparoscópica en las últimas dos décadas; se trabajaron con 468 historias clínicas que cumplieron los criterios de inclusión. Resultados: un 61,8% fueron mujeres con una edad media de 50,77 años y un desvío estándar (DS) de 0,727. Las indicaciones quirúrgicas fueron colelitiasis 60,2%, colecistitis aguda 29,2%, poliposis vesiculares 4,7%, coledocolitiasis 4,5%, vesícula esclerotrófica 0,9%. La estancia postoperatoria fue de 80,6% menos de tres días y el 19,4% igual o mayor a 4 días; con un promedio de 1,09 y un DS=0,292. El porcentaje de conversión a cirugía abierta fue del 0,4%. El tiempo quirúrgico fue en 50,2% dentro de 31-60min y 46,2% más de 60 minutos con un promedio de 42,43min y un DS=0,564. Al relacionar la edad y el tiempo operatorio se evidenció que en los mayores de 60 años tenían más días de hospitalización con significancia estadística, con un valor de p=0,0006. Conclusión: La colecistectomía laparoscópica disminuye los tiempos operatorios y de hospitalización, contribuyendo directamente al descenso de la morbilidad y mortalidad por este tipo de patologías y permitiendo a los servicios de salud, de países en vías de desarrollo, mejorar la calidad de la atención de sus poblaciones.

Esclerosi múltiple; Classificació d'aprenentatge automàtic; Selecció de funcions ; Esclerosis múltiple; Clasificación de aprendizaje automático; Selección de características ; Multiple sclerosis; Machine learning classification; Feature selection ; Machine learning classification is an attractive approach to automatically differentiate patients from healthy subjects, and to predict future disease outcomes. A clinically isolated syndrome (CIS) is often the first presentation of multiple sclerosis (MS), but it is difficult at onset to predict who will have a second relapse and hence convert to clinically definite MS. In this study, we thus aimed to distinguish CIS converters from non-converters at onset of a CIS, using recursive feature elimination and weight averaging with support vector machines. We also sought to assess the influence of cohort size and cross-validation methods on the accuracy estimate of the classification. We retrospectively collected 400 patients with CIS from six European MAGNIMS MS centres. Patients underwent brain MRI at onset of a CIS according to local standard-of-care protocols. The diagnosis of clinically definite MS at one-year follow-up was the standard against which the accuracy of the model was tested. For each patient, we derived MRI-based features, such as grey matter probability, white matter lesion load, cortical thickness, and volume of specific cortical and white matter regions. Features with little contribution to the classification model were removed iteratively through an interleaved sample bootstrapping and feature averaging approach. Classification of CIS outcome at one-year follow-up was performed with 2-fold, 5-fold, 10-fold and leave-one-out cross-validation for each centre cohort independently and in all patients together. The estimated classification accuracy across centres ranged from 64.9% to 88.1% using 2-fold cross-validation and from 73% to 92.9% using leave-one-out cross-validation. The classification accuracy estimate was higher in single-centre, smaller data sets than in combinations of data sets, being the lowest when all patients were merged together. Regional MRI features such as WM lesions, grey matter probability in the thalamus and the precuneus or cortical thickness in the cuneus and inferior temporal gyrus predicted the occurrence of a second relapse in patients at onset of a CIS using support vector machines. The increased accuracy estimate of the classification achieved with smaller and single-centre samples may indicate a model bias (overfitting) when data points were limited, but also more homogeneous. We provide an overview of classifier performance from a range of cross-validation schemes to give insight into the variability across schemes. The proposed recursive feature elimination approach with weight averaging can be used both in single- and multi-centre data sets in order to bridge the gap between group-level comparisons and making predictions for individual patients. ; This project received funding from the European Union's Horizon2020 Research and Innovation Program EuroPOND under grant agreement number 666992, and it was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. We thank all participating partners of the MAGNIMS study group for sharing their data with us.

The author of the article, based on the analysis of the norms of national legislation and international regulatory acts, as well as the positions of the European Court of Human Rights, has studied the provisions concerning persons who are authorized to provide informed consent to participate in clinical trials of other person's medicinal products. This refers to the involvement of patients into clinical trials, who are minors, whose dispositive legal capacity is limited, or who are admitted legally incapable, and those who due to their clinical condition can not personally give informed consent. The author has formulated propositions to bring the list of these persons in accordance with the provisions of the current legislation on dispositive legal capacity of an individual and legal representation. In particular, the author has substantiated the necessity of normative consolidation for obtaining informed consent from both a person whose dispositive legal capacity is limited, and from his tutor to be involved into clinical trials of medicinal products. It has been proved that it is appropriate to exclude close relatives from the range of persons, who have the right to give consent for the involvement of legally incapable patients to participate in clinical trials of medicinal products, since such consent is solely provided by a trustee of legally incapable person.The author has suggested to exclude adoptive parents and parents-educators from the range of legal representatives of a patient, who may give consent to his involvement for clinical trials, since children deprived of parental care, adopted children or orphans are not allowed to be involved in such trials. The author has proved the expediency of replacing the term «close relatives», which does not cover a husband or a wife of a patient with the term «family members and close relatives» within the Procedure of conducting clinical trials of medicinal products and examinations of the materials of clinical trials. It has been suggested to include adoptive parents into this list. The range of such persons does not include people who live together with one family without registration of a marriage. Involvement of patients to clinical trials of medicinal products on the basis of informed consent of an unauthorized person is the violation of inherent rights of patients to health and personal integrity. ; В статье исследованы положения о лицах, уполномоченных давать информированное согласие на участие иного лица в клиническом испытании лекарственного средства в случае его несовершеннолетия, ограничения его дееспособности или признания недееспособным, а также в случае, когда пациент в силу своего клиничес-кого состояния не может лично дать информированное согласие. Сформулированы предложения по приведению перечня данных лиц в соответствие с положениями о дееспособности и законном представительстве. ; У статті досліджені положення щодо осіб, які уповноважуються надавати інформовану згоду на участь іншої особи у клінічному випробуванні лікарських засобів у разі недосягнення нею повноліття, обмеження її дієздатно-сті або визнання недієздатною, а також коли пацієнт з огляду на свій клінічний стан неспроможний особисто дати інформовану згоду. Сформульовані пропозиції стосовно приведення переліку цих осіб у відповідність до положень щодо дієздатності та законного представництва.

A culture of social taboos and silence leaves many young women beginning menarche in isolation, without complete understanding of the changes occurring in their bodies. There is a widespread stigma surrounding menstruation all around the world. These stigma impose significant barriers to education and proper hygiene for young girls during a critical time in their lives. Not having the proper support and resources to manage this process, 1 in 10 girls in sub-Saharan Africa miss school during their period, and therefore are more likely to drop out altogether. In Kenya specifically, menstruating girls miss an average of 4.9 days of school each month, contributing to 37% of Kenyan girls completing secondary school compared to 46% of boys. This problem is compounded by financial barriers to accessing sanitary pads, especially for low-income Kenyan women, since only 35% of Kenyan women can afford sanitary pads independently. Recognizing this disparity, in June 2017, the Kenyan government pledged to provide free sanitary pads to all Kenyan schoolgirls. Our team has utilized this opportunity to develop a culturally appropriate, Android-based menstruation education mobile application using Googles Android Studio- Hedhi Help. Aiming to empower Kenyan girls with the knowledge, support, and resources needed to take charge of their menstrual cycles and understand their bodies, the application has been developed with two end-users in mind: girls who have begun menstruating, and those who have not yet begun. The application features four components: (i) a period tracking calendar, (ii) a Facebook discussion forum, (iii) a resource connection page, and (iv) a menstruation education component. The period tracker calendar utilizes the Google Calendar API to enable users to track the dates of their periods and predict future periods based on past entries. The Facebook discussion forum will be a dedicated Facebook page where girls can connect and communicate with others. The resource connection page uses the Google Maps API to find health clinics near the users current location to increase access to healthcare resources. The menstruation education component is comprised of three modules that utilize a storybook approach focusing on how the body changes prior to menarche, the purpose and process of menstruation, debunking myths and stigmas, and explaining proper menstruation self-care. The app does not require any internet connection after the initial download because users can create a personalized profile to use the educational modules and calendar functions without network connectivity. The core logic and all visual elements were coded using the Java and XML languages, respectively. Information regarding the users profiles is stored and managed with Google Firebase, and version control is managed with Github. This mobile app provides a frugal platform for delivery of menstruation education and access to healthcare resources to a large audience, empowering young women with the tools and knowledge to properly manage their menstruation and stay in school. This is an e ample of how mobile technology can be impactful when the appropriate app is developed for a specific population.

The child in need of protection is a neglected child who has been subjected to physical, sexual or emotional abuse that is not maintained by his family for various reasons. The aim of protecting these children is; to get away from their experiences that adversely affect their psycho-social development, and to raise the beneficial, mental health-conscious individuals. However, from time to time it is known that protected children can experience various problems after being protected. Social welfare workers are those who are in favor of protected children in solving these problems, and who support their scientific knowledge and experiences and overcome their problems. However, it is a fact that social welfare workers can also face various problems in the process. The purpose of this study is; the problem that the underprivileged children face when they are in institutional care and the disruptions in child protection policies are to be considered by the social welfare workers. The subjects of the research conducted by the qualitative method constitute 15 social welfare workers who are working in the province of Ankara between 10 February and 28 February 2017. In the research, an in-depth interview form developed by the researcher was used to determine the experiences of the social welfare workers. When the data are analyzed, it is determined that social welfare workers have problems in different issues such as cooperation, support, enforcement and enforcement of laws, regulations and injunctions, education and transfers during their professional work with children. The study concludes with various social service application proposals aimed at solving problems for national, international, voluntary persons, institutions and organizations working with protected children. ; Korunma ihtiyacı içindeki çocuk, çeşitli sebeplerle ailesi yanında bakımı sürdürülemeyen fiziksel, cinsel veya duygusal istismara uğramış, ihmal edilmiş ve yoksulluk sebebi ile korunma altına alınmış çocuktur. Bu çocukları koruma altına almaktaki amaç; psiko-sosyal gelişimlerini olumsuz etkileyen yaşantılarından uzaklaşmalarını sağlamak ve topluma yararlı, ruh sağlığı yerinde bireyler yetiştirmektir. Ancak zaman zaman koruma altındaki çocukların koruma altına alındıktan sonra da çeşitli sorunlar yaşayabildikleri bilinmektedir. Bu sorunların çözümünde koruma altındaki çocukların yanında olan, bilimsel bilgi ve tecrübeleri ile çocukların sorunlarını aşmalarına destek olan kişiler ise sosyal refah çalışanlarıdır. Ne var ki, sosyal refah çalışanlarının da süreç içerisinde çeşitli sorunlarla karşılaşabildikleri bilinen bir gerçektir. Bu çalışmanın amacı da; koruma altındaki çocukların kurum bakımında iken yaşadıkları sorunların ve çocuk koruma politikalarındaki aksaklıkların sosyal refah çalışanlarının gözüyle değerlendirilmesidir. Nitel yöntemle yapılan araştırmanın öznelerini, 10 Şubat-28 Şubat 2017 tarihleri arasında Ankara ilinde görev yapmakta olan 15 sosyal refah çalışanı oluşturmaktadır. Araştırmada, sosyal refah çalışanlarının alandaki deneyimlerini belirlemeye yönelik araştırmacı tarafından geliştirilen derinlemesine görüşme formu kullanılmıştır. Veriler analiz edildiğinde sosyal refah çalışanlarının çocuklarla yaptıkları mesleki çalışmalar sırasında işbirliği, destek alma, yasa, yönetmelik ve tedbir kararlarının alınması ve uygulanması, eğitim ve nakiller gibi farklı konularda sorun yaşadıkları saptanmıştır. viii Çalışma, koruma altındaki çocuklarla çalışan ulusal, uluslararası, gönüllü kişi, kurum ve kuruluşlara sorunların çözümüne yönelik çeşitli sosyal hizmet uygulama önerileri ile son bulmaktadır.

A period of European Renaissance is the birth of the modern personality and virtues Renaissance Christian humanism is a model of ethical attitudes today. The first attempt of early modern European youth education in educational system of coordinates of Renaissance humanism, no doubt, was created within the youth Order of St. Ignatius.The proposed article is devoted to the analysis of verbal communicative competence of early modern Jesuit teachers. The author revealed the contents of value-semantic, spiritual and pedagogical concepts of educational communication in the Society of Jesuits, and proved that it was based on Renaissance and Christian- humanistic positions of "brilliance, beauty and sophistication" of the academic word, the skill of public speaking and high style and the art of eloquence of the early modern university speaker.The author concludes that the Jesuits interpreted pedagogically Renaissance and humanistic intellectual heritage to the implementation of the Order implementing schooling some semantic meaning loads of humanism in this article. Recognizing it as "imitation of ancient people", as an appeal to samples of ancient learning,fundamental virtues of the Society of Jesus proclaimed erudition, sophistication of Latin, intellectual culture, exquisite taste, eloquence, perfection scientist speech and public speaking, virtuous behavior. With the Renaissance and humanistic individualism priorities code integrity Jesuit added active devotion, diligence, active, creative enthusiasm and initiative, determination and zeal, compassion, rationality and prudence, the Jesuits appreciated the talent and abilities of youth, drawn attention to the need to care for the physical health etc. Etymological interpretation of humanity as humanity in correctional priorities Jesuits answered task of building virtues of modesty and politeness, prudent and tolerance, respect and attention for elders, love and kindness, ethics, partnership and unity.The article highlights and grounds the components of the Jesuit methodology of formation of conversational competencies in the youth of the Order (didactically and cognitive, rhetoric and stylistic, moral and aesthetic); the article also proves the sonority of the Jesuit practice of teaching literature with the didactic pedagogy of the European Renaissance. The conclusion was made about the significant role of socio- cultural, socio-integrating task and spiritual significance of educational communication of Jesuit teachers for implementation of the European Youth Policy of St. Ignatius rank in XVI – XVII centuries. ; У статті проаналізовано вербальні комунікативні компетентності ранньомодерних викладачів європейських колегіумів ордену єзуїтів. Автор розкрив зміст ціннісно-смислового та духовно-педагогічного концептів педагогічної комунікації в освітніх закладах Товариства Ісуса і довів, що в її основу покладено ренесансні та християнсько-гуманістичні ідеї про «блиск, красу і вишуканість» вченого слова, майстерність публічного виступу та високий стиль і мистецтво красномовства ранньомодерного університетського оратора.Окрім обґрунтування світоглядного ракурсу єзуїтської комунікації, виділено й проаналізовано компоненти орденської методики формування мовленнєвих компетентностей в орденської молоді (когнітивно- дидактичний, риторико-стилістичний і театрально-естетичний), доведено співзвучність єзуїтської практики навчання словесності дидактичним положенням педагогіки європейського Відродження. Зроблено висновок про вагому соціокультурну роль, соціально-інтегруючі завдання та духовно-моральне значення педагогічної комунікації викладачів-єзуїтів для реалізації європейської молодіжної політики чину св. Ігнатія у XVI – XVII століттях.

A period of European Renaissance is the birth of the modern personality and virtues Renaissance Christian humanism is a model of ethical attitudes today. The first attempt of early modern European youth education in educational system of coordinates of Renaissance humanism, no doubt, was created within the youth Order of St. Ignatius.The proposed article is devoted to the analysis of verbal communicative competence of early modern Jesuit teachers. The author revealed the contents of value-semantic, spiritual and pedagogical concepts of educational communication in the Society of Jesuits, and proved that it was based on Renaissance and Christian- humanistic positions of "brilliance, beauty and sophistication" of the academic word, the skill of public speaking and high style and the art of eloquence of the early modern university speaker.The author concludes that the Jesuits interpreted pedagogically Renaissance and humanistic intellectual heritage to the implementation of the Order implementing schooling some semantic meaning loads of humanism in this article. Recognizing it as "imitation of ancient people", as an appeal to samples of ancient learning,fundamental virtues of the Society of Jesus proclaimed erudition, sophistication of Latin, intellectual culture, exquisite taste, eloquence, perfection scientist speech and public speaking, virtuous behavior. With the Renaissance and humanistic individualism priorities code integrity Jesuit added active devotion, diligence, active, creative enthusiasm and initiative, determination and zeal, compassion, rationality and prudence, the Jesuits appreciated the talent and abilities of youth, drawn attention to the need to care for the physical health etc. Etymological interpretation of humanity as humanity in correctional priorities Jesuits answered task of building virtues of modesty and politeness, prudent and tolerance, respect and attention for elders, love and kindness, ethics, partnership and unity.The article highlights and grounds the components of the Jesuit methodology of formation of conversational competencies in the youth of the Order (didactically and cognitive, rhetoric and stylistic, moral and aesthetic); the article also proves the sonority of the Jesuit practice of teaching literature with the didactic pedagogy of the European Renaissance. The conclusion was made about the significant role of socio- cultural, socio-integrating task and spiritual significance of educational communication of Jesuit teachers for implementation of the European Youth Policy of St. Ignatius rank in XVI – XVII centuries. ; У статті проаналізовано вербальні комунікативні компетентності ранньомодерних викладачів європейських колегіумів ордену єзуїтів. Автор розкрив зміст ціннісно-смислового та духовно-педагогічного концептів педагогічної комунікації в освітніх закладах Товариства Ісуса і довів, що в її основу покладено ренесансні та християнсько-гуманістичні ідеї про «блиск, красу і вишуканість» вченого слова, майстерність публічного виступу та високий стиль і мистецтво красномовства ранньомодерного університетського оратора.Окрім обґрунтування світоглядного ракурсу єзуїтської комунікації, виділено й проаналізовано компоненти орденської методики формування мовленнєвих компетентностей в орденської молоді (когнітивно- дидактичний, риторико-стилістичний і театрально-естетичний), доведено співзвучність єзуїтської практики навчання словесності дидактичним положенням педагогіки європейського Відродження. Зроблено висновок про вагому соціокультурну роль, соціально-інтегруючі завдання та духовно-моральне значення педагогічної комунікації викладачів-єзуїтів для реалізації європейської молодіжної політики чину св. Ігнатія у XVI – XVII століттях.

OBJETIVO Analisar a gênese da política de controle da aids no Brasil. MÉTODOS Estudo sócio-histórico (1981-1989), orientado pela sociologia genética de Bourdieu, por meio de análise documental, revisão bibliográfica e entrevistas em profundidade. Consistiu na articulação entre a análise das trajetórias de 33 agentes envolvidos na criação de um espaço social voltado para as questões relativas à aids e as condições históricas de possibilidade para a formulação de uma política específica. RESULTADOS O Espaço Aids constituiu-se como produto do encontro da trajetória de agentes de diversos campos sociais (médico, científico, político e burocrático). Um espaço específico de relações, que possibilitou a formulação de uma política para o controle da epidemia da aids, mas onde também estava em disputa a autoridade de falar sobre o significado da doença, suas formas de prevenção e tratamento. A análise mostrou como as estruturas (governos democráticos no estado de São Paulo e no âmbito nacional, com sanitaristas assumindo posições importantes) e a ausência de terapia específica contribuíram para que agentes sociais com disposições e formações diversas formulassem uma política que priorizou inicialmente a prevenção. CONCLUSÕES A ascensão do movimento sanitário, a constituição do SUS e a dominância do campo médico no Espaço Aids contribuíram para a valorização do tratamento, como parte das medidas de controle da epidemia. Essas condições possibilitaram a formulação de uma política baseada na integralidade das ações, articulando prevenção e tratamento, na década seguinte, com importante participação da burocracia estatal e de pesquisadores. ; OBJECTIVE To analyze the genesis of the policy for controlling AIDS in Brazil. METHODS Socio-historical study (1981-1989), based on Bordieu's genetic sociology, by document analysis, bibliographical review, and in-depth interviews. It consisted of a connection between the analysis of the paths of 33 agents involved in the creation of a social space focusing on AIDS-related issues and the historical possibility conditions of the drafting of a specific policy. RESULTS AIDS Space is a gathering point for the paths of agents from several social fields (medical, scientific, political, and bureaucratic fields). A specific space for relationships, which enabled the drafting of a policy for controlling the AIDS epidemic, but also a place where the authority to talk about the meaning of the disease, the methods to prevent and treat it was under dispute. The analysis showed how the various structures (democratic administrations in Sao Paulo and at the national level, with public health officers taking important positions) and the lack of a specific therapy contributed to social agents of different ranks and backgrounds to initially set prevention as a priority. CONCLUSIONS The rise of the sanitary movement, the organization of SUS, and the dominance of the medical field at the AIDS Space contributed to foster treatment as a part of the measures to control the epidemic. These conditions allowed drafting a policy based on the integrality of care, by linking prevention and treatment in the following decade, with important participation from state bureaucracy and researchers.

The use of drugs constitutes an emerging phenomenon, that affects the young boys and girls´ quality of life and it also deteriorates the state economy. The enactment of a new law and the creation of the National Youth Institute opens a gap pen gap for advocacy work, promoting public policy initiatives towards youth as rights holders in Honduran legislation.Materials and methods were analyzed from the perspective of the right to health and equity of 15 programs on the prevention of licit and illicit consumption of drugs in young people (12 to 30 years) and its relationship with the National Youth Policy. The study was based on a quantitative analysis, starting at the beginning of the National Youth Council, the Law for Integral Development framework, until the development and enactment of the policy.The National System of Youth responsible for strategic management and social equity for young people in the prevention of drug interventions, has not established a strategy for the reduction in the use and abuse of drugs. The signing of agreements and implementation of programs is linked with the strategic guidelines of the National Youth Policy, however, they have not achieved expected results in the full enjoyment of the rights of youth. With respect to the location of programs they are mostly in rural areas, focusing its actions, spiritual, educational and entrepreneurialism integral processes of psychological care. They also play social protection functions. ; El consumo de drogas constituye un fenómeno emergente en Salud Pública, su impacto se ve en la calidad de vida de los jóvenes y deteriora la economía del Estado. La promulgación de una nueva ley y la creación del Instituto Nacional de la Juventud abren brecha para el trabajo de incidencia política, impulsando iniciativas de políticas públicas en pro de la juventud, como titulares de derecho en la legislación hondureña. Materiales y métodos: se analizaron desde el enfoque de derecho a la salud y la equidad 15 programas sobre prevención del consumo de drogas lícitas e ilícitas en los jóvenes de 12 a 30 años; y su vinculación con la Política Nacional de Juventud. Se realizó un análisis cuantitativo basado en un estudio documental, desde el inicio del Consejo Nacional de Juventud, la Ley Marco para el Desarrollo Integral, hasta la elaboración y promulgación de la política.El Sistema Nacional de Juventud responsable de la gestión e Intervenciones estratégicas para la equidad social de los jóvenes en la prevención del consumo de drogas, no ha consolidado una estrategia que permita la disminución en el uso y abuso de drogas. La suscripción de acuerdos e implementación de programas se vinculan con los lineamientos estratégicos de la Política Nacional de Juventud, no obstante, no han alcanzado resultados esperados en el disfrute pleno de los derechos de la juventud. Con respecto a la ubicación de los programas, están en su mayoría en el área rural, enfocando sus acciones en procesos integrales de atención psicológica, espiritual, educativa y emprendedurismo. Asimismo, desempeñan funciones de protección social.

In the Commonwealth of Puerto Rico, a 3,500 square mile island located in the Caribbean, highway safety is a vital factor for all citizens which depend primarily on the private vehicle for the mobility of people and goods. According to the crash data in the Critical Analysis Reporting Environment (CARE), the six main contributing factors for fatal crashes along the Commonwealth's highway network are: aggressive driving (43%), vulnerable users (32%), alcohol impaired drivers (28%), roadway departure (25.5%), young drivers between 18-24 years of age (25.4%), and intersections (13%). As part of the efforts to reduce the frequency of severe injury or fatal motor vehicle crashes, public agencies, the private sector, and non-profit organizations established the Puerto Rico Strategic Highway Safety Plan (PR-SHSP) for years 2014 - 2018. The vision of the PR-SHSP is that "all users of the transportation system move safely and effectively to their destinations", and the mission is to "provide a safe, efficient and cost effective transportation system taking into account the needs of all users". The goal of this five-year plan is to "achieve a reduction in serious crashes, injuries, and fatalities on Puerto Rico's public roadways." The slogan for the PR-SHSP is "Working together toward highway safety to save more lives." The PR-SHSP five-year plan was prepared in alliance with the Puerto Rico Highway and Transportation Authority (PRHTA), the Puerto Rico Traffic Safety Commission (PRTSC), the Department of Health, the Puerto Rico Police Department (PRPD), the Federal Highway Administration (FHWA), the National Highway Traffic Safety Administration (NHTSA), and the Federal Motor Carrier Safety Administration (FMCSA). The plan was developed following guidelines from the FHWA adapted to the local conditions and opportunities. The PR-SHSP development included case studies, crash data analysis, a survey of highway safety stakeholders, and a Safety Summit. The nine safety Emphasis Areas in the PR-SHSP include three core areas, which are expected to remain in future SHSPs, are: emergency medical response, occupant protection, and traffic records and information systems. The six non-core Emphasis Areas, in the order of highest to lowest percentage of fatal crashes, are: aggressive driving, vulnerable road users, alcohol impaired driving, road departure, young drivers, and intersections. Ample participation from academic, non-profit, private and governmental stakeholder organizations have ensured acceptance of the plan and participation during the implementation process. This makes it possible to achieve positive results for the benefit of all road users. This paper primarily describes the principal components of the Puerto Rico Strategic Highway Safety Plan, the analysis of historical trends of fatalities and serious crashes using the five year moving average, the identification and participation of stakeholders in the process, and the accomplishments during the first two years of its implementation. Furthermore, the proposed action plan, as well as, the challenges for the remaining three years, will also be described. Finally, general guidelines on how the PR-SHSP can be adapted to be implemented in other countries with similar traffic, infrastructure, and climatic conditions, with the potential to increase awareness in road safety and save lives, will also be discussed.

Este artigo analisa o modo como as políticas públicas voltadas para a saúde e a assistência social no Brasil se consolidam a partir da centralidade da atuação das mulheres pobres. Por meio de uma pesquisa qualitativa e de análise das trajetórias das usuárias e das agentes de ponta dos ditos "novos" programas sociais brasileiros, pretende-se mostrar que o sucesso que tais programas têm conquistado depende, em grande medida, da atuação dessas mulheres mediadoras dentro da lógica conservadora da divisão sexual do trabalho e da disposição feminina para o cuidado. Em particular, as agentes, em contraponto às usuárias, têm acesso à mobilidade social que as tira do confinamento na esfera privada pela sua presença no mercado de trabalho. No entanto, o maior ganho dessa mobilização feminina a baixo custo e de alta produtividade é direcionado às instituições gestoras dos "novos" programas sociais em questão, desde as organizações filantrópicas até os governos.Palavras-chave : "Novos" programas sociais; Mediação feminina; Família; Trabalho; Divisão sexual do trabalho. Women as the strength behing social programs Yumi Garcia dos Santos This article examines how public policies for health and social care in Brazil are consolidated with the actions of poor women. Through a qualitative research and analysis of the trajectories of these users and top agents of the so called "new" Brazilian social programs, I intend to show that the success such programs have achieved is largely due to the work of these women, who are mediators within the conservative logic of a gender bias division of labor and denomination of women as caregivers. In particular, the agents, as opposed to the users, have access to social mobility that frees them from the confinement of their private sphere by being present in the labor market. However, this female mobilization, with low costs and high productivity, benefits mainly the institutions of the "new" social programs in question, from philanthropic organizations to governmental ones.Keywords:"New" social programs; Feminine mediation; Family; Work; Gender bias labor division. Les femmes comme piliers de la construction des programmes sociaux. Yumi Garcia dos Santos Cet article analyse comment les politiques publiques en matière de santé et d'aide sociale au Brésil se consolident à partir de la centralité d'action des femmes pauvres. Grâce à une recherche qualitative et à une analyse de la trajectoire des utilisatrices et des agents des dits "nouveaux" programmes sociaux brésiliens, notre intention est de montrer que le succès de ces programmes dépend en grande partie de l'action de ces femmes médiatrices au sein d'une logique conservatrice de la division sexuelle du travail et d'un enclin féminin pour les soins. Les agents, en opposition aux usagers, ont tout particulièrement accès à la mobilité sociale qui les sort du confinement de la sphère privée par leur présence sur le marché du travail. Cependant le résultat le plus important, obtenu grâce à cette mobilisation féminine à faible coût mais dont la productivité est élevée, bénéficie les institutions qui gèrent ces "nouveaux" programmes sociaux en question, allant des organisations philanthropiques aux gouvernements.Mots-clés: "Nouveaux" programmes sociaux; Médiation féminine; Famille; Travail; Division sexuelle du travail.Publicação Online do Caderno CRH no Scielo: http://www.scielo.br/ccrh Publicação Online do Caderno CRH: http://www.cadernocrh.ufba.br

The purpose of this study is to understand the impact of external events on the development of patient advocacy organizations in Hong Kong. I use the advocacy coalition framework (ACF) to explore: (1) the relationship between external events and policy change; (2) the roles and responses of patient advocates towards external events; (3) the changes in resources and strategies of patient advocates following external events; (4) the causal mechanism between external events and policy change. The ACF suggests that external events is one of the factors to explain policy change in the policy making process. However, the framework has not clearly specified the causal mechanism between external events and policy change. It mainly suggests the critical role of minority policy actors in mobilizing resources to advance their belief following external events which may lead to policy change. By analyzing policy responses of patient advocacy organizations to a series of external events between the 1990s and the present, this study attempts to explore how external events may influence the occurrence of policy change, contributing to this theoretical gap in the ACF. The target of this study includes three patient advocacy organizations, namely Community Rehabilitation Network (CRN), Hong Kong Alliance for Patients' Organizations (HKAPO), Braincare. Qualitative research method was used. Around twenty in-depth interviews were conducted with leaders and staff of the patient advocacy organizations and professionals who had worked with them. Findings reveal that the origins and development of these patient advocacy organizations were closely tied to the occurrence of external events. The external events mainly related to the governmental policy initiatives in the healthcare and welfare spectrum and the SARS outbreak. In these three organizations, the mobilization of skillful leadership is critical for their formation and policy advocacy, particularly with the role of social work professionals. In their formation stage, these patient advocacy organizations did make use of external events to advance their belief on policy change. When time elapsed, contrary to the ACF assumptions, empirical evidence is found to demonstrate how external events had gradually transformed their original belief on patient advocacy and thus their roles in the policy making process. It was found that CRN has changed from a patient advocacy in the 1990s to a service provider in the primary care sector from 2000s onwards; HKAPO shifted its role as a patient advocate to a health policy decision-making stakeholder; Braincare enlarged its mission on patient education into policy advocacy for patients of brain injury. The allocation of resources, specifically, the behavior orientations on seeking resources were critical factors that explained these changes. It is argued that the resource-seeking behavior is the intervening variable between external events and policy change. Through the experiences of these three organizations, the importance of external events do not lay on its role in redistributing their resources, instead, it gradually shaped their beliefs on policy advocacy which affects the path of policy change. ; published_or_final_version ; Social Work and Social Administration ; Master ; Master of Philosophy

This article examines the relevance of the cooperative model in the field of renewable energy (RE). RE sources have been developed since the end of the 1970s and their growth has been expansive since then. While social-ecological movements have been instrumental in shifting the public attention towards the need for alternative energies (Sine and Lee, 2009), in most countries the sector has rapidly become dominated by corporate actors experienced in building large-scale RE projects. In an attempt to counter the corporate hegemony and to protect available lands, a range of citizen initiatives have emerged under different forms and names such as community energy groups or renewable energy (source) cooperatives (van der Horst, 2008; Willis and Willis, 2012; Lipp et al., 2012; Schreuer and Weismeier-Sammer, 2010; Weismeier-Sammer and Reiner, 2011). Pioneering examples include EWS in Germany, Enercoop in France, Energy4All in the UK, or Ecopower in Belgium. As these citizen groups tend to adopt the cooperative model, or a related form depending on the local legislation and context, it seems important to understand what are the specific features, assets and limitations of this model in the field of RE. Indeed, while 'traditional' cooperatives operating for a long time in fields such as banking, agriculture, or retail, have received an important attention in the cooperative literature, much work still needs to be done to understand why and how cooperatives emerge either in fields in which they have not traditionally been widespread (such as health and care, services, etc.), or in 'new' fields or sub-fields (such as fair trade, microfinance or renewable energy). Research is even more needed insofar as 'new' cooperatives tend to differ from traditional ones in several ways, for instance through the involvement of multiple stakeholders (rather than a dominant one such as producers, consumers or workers) or through a stronger orientation towards general interest goals (beyond traditional mutual interest at the basis of most cooperatives). While RE cooperatives have strongly developed in countries such as Denmark (Lipp et al., 2012), Germany (Schreuer, 2012; Weismeier-Sammer and Reiner, 2011) and to a lesser extent the UK (Aitken, 2010; Kellett, 2007; Seyfang et al., 2012; van der Horst, 2008; Willis and Willis, 2012; Walker et al., 2007), their development has been much slower in other countries, particularly Southern Europe (Lipp et al., 2012). This seems to echo, to a certain extent, the general development of RE in these countries (Haas et al., 2011). Before mapping these differences against the background of RE development in these countries, it is necessary to understand how the assets and limits of the cooperative model apply to the particular case of RE. This is precisely the aim of this article. On the one hand, the assets of the cooperative model enable to understand why this form has been adopted by citizen groups and has developed in certain countries. On the other hand, the limits or weaknesses of the model enable to explain why cooperatives are still a minority in the field of RE and why their development is constrained by obstacles in certain countries. ; Peer reviewed