Extreme events, organizations and the politics of decision making

Purpose – Threats of extreme events, such as terrorist attacks or infrastructure breakdown, are potentially highly disruptive events for all types of organizations. This paper seeks to take a political perspective to power in strategic decision making and how this influences planning for extreme events. Design/methodology/approach – A sample of 160 informants drawn from 135 organizations, which are part of the critical national infrastructure in the UK, forms the empirical basis of the paper. Most of these organizations had publicly placed business continuity and preparedness as a strategic priority. The paper adopts a qualitative approach, coding data from focus groups. Findings – In nearly all cases there is a pre-existing dominant coalition which keeps business continuity decisions off the strategic agenda. The only exceptions to this are a handful of organizations which provide continuous production, such as some utilities, where disruption to business as usual can be readily quantified. The data reveal structural and decisional elements of the exercise of power. Structurally, the dominant coalition centralizes control by ensuring that only a few functional interests participate in decision making. Research limitations/implications – Decisional elements of power emphasize the dominance of calculative rationality where decisions are primarily made on information and arguments which can be quantified. Finally, the paper notes the recursive aspect of power relations whereby agency and structure are mutually constitutive over time. Organizational structures of control are maintained, despite the involvement of managers charged with organizational preparedness and resilience, who remain outside the dominant coalition. Originality/value – The paper constitutes a first attempt to show how planning for emergencies fits within the strategy-making process and how politically controlled this process is.

Menu Analysis: Review and Evaluation

In the article - Menu Analysis: Review and Evaluation - by Lendal H. Kotschevar, Distinguished Professor School of Hospitality Management, Florida International University, Kotschevar’s initial statement reads: “Various methods are used to evaluate menus. Some have quite different approaches and give different information. Even those using quite similar methods vary in the information they give. The author attempts to describe the most frequently used methods and to indicate their value. A correlation calculation is made to see how well certain of these methods agree in the information they give.” There is more than one way to look at the word menu. The culinary selections decided upon by the head chef or owner of a restaurant, which ultimately define the type of restaurant is one way. The physical outline of the food, which a patron actually holds in his or her hand, is another. These descriptions are most common to the word, menu. The author primarily concentrates on the latter description, and uses the act of counting the number of items sold on a menu to measure the popularity of any particular item. This, along with a formula, allows Kotschevar to arrive at a specific value per item. Menu analysis would appear a difficult subject to broach. How does a person approach a menu analysis, how do you qualify and quantify a menu; it seems such a subjective exercise. The author offers methods and outlines on approaching menu analysis from empirical perspectives. “Menus are often examined visually through the evaluation of various factors. It is a subjective method but has the advantage of allowing scrutiny of a wide range of factors which other methods do not,” says Distinguished Professor, Kotschevar. “The method is also highly flexible. Factors can be given a score value and scores summed to give a total for a menu. This allows comparison between menus. If the one making the evaluations knows menu values, it is a good method of judgment,” he further offers. The author wants you to know that assigning values is fundamental to a pragmatic menu analysis; it is how the reviewer keeps score, so to speak. Value merit provides reliable criteria from which to gauge a particular menu item. In the final analysis, menu evaluation provides the mechanism for either keeping or rejecting selected items on a menu. Kotschevar provides at least three different matrix evaluation methods; they are defined as the Miller method, the Smith and Kasavana method, and the Pavesic method. He offers illustrated examples of each via a table format. These are helpful tools since trying to explain the theories behind the tables would be difficult at best. Kotschevar also references examples of analysis methods which aren’t matrix based. The Hayes and Huffman - Goal Value Analysis - is one such method. The author sees no one method better than another, and suggests that combining two or more of the methods to be a benefit.

Individuals with mental disabilities: perceptions of work limitations

This research investigates the perceptions that individuals with mental illnesses have about the employment experience as a whole. Survey data from 72 respondents with mental disabilities were used to identify areas of perceived work limitations. Comparisons regarding employee work performance were made between eleven individuals with mental disabilities and their supervisors. Functional limitations identified by respondents with mental disabilities and the characteristic symptoms set forth in the Diagnostic and Statistical Manual of Mental Disorders were compared. Overall findings showed that individuals with mental disabilities in this study had problems in the areas of judgment, initiative, interacting and rapport with co-workers and supervisors, frustration tolerance and coping with job stress, and adapting to changes at work. Comparison of identified work task difficulties with diagnostic criteria indicate active symptomatology to have an effect on job performance. Recommendations regarding occupational therapy assessment approaches and roles to facilitate ADA implementation are presented.

A objetivação da linguagem no (con)texto do vestibular : mo(vi)mentos na história e no político

In this study, we join up in the theoretical assumptions of the French Discourse Analysis in order to analyze effects of the demand of objectification of language in the context of vestibular essays. More specifically, we analyze the operation of said objectification via discourses constructed by the traditional vestibular exam due to the requirement to have, in the students’ essays, paraphrases of statements from the motivating texts (TM) of the test in question. From our perspective, the objectification mechanism of language, the paraphrase, in the vestibular, its logic of clarity and non-contradiction of ideas, is made by (in)determination of senses in the order of its speech and, also, in its practice: the correction of the vestibular essay. Therefore, in spite of what is assumed as guarantee to language in the moment of the vestibular essay, we suggest there are regularization-recognition conflicts of same senses— the constitutive senses of TM — in the evaluative speech of two vestibular-essay correctors(CA and CB). These correctors, with their history of reading (grammar and Linguistic Textual), stress the concept of paraphrase taken by the vestibular instance for the correction of students’ essays. Such stress creates a dispute of speeches: the speech of knowledge (university policy) versus the speech of produce (neoliberal policy); the latter as reading policy that favors literal meanings, consensus. Because of all this, we question: what are the effects of senses produced in (and about) vestibular essays by the demand of determining of the saying there instituted? To answer this question, we build analysis from clippings of documents that regulate the vestibular exam (institutional texts) in our country and, also, analysis of two vestibular essays in which at times appear, at times not, according to the judgment of CA and CB of essays, paraphrases of TM statements of the essay. The analysis, in theory, punctuates effects of sense of the objectification process of the saying in vestibular, and primarily the rarefaction of legal-position subject-of-knowing by the current institution of the subject-of-making. Moreover, our work comprises affiliations of sense that relates to the subject-speech relationship in evaluative exercise of vestibular essays, on the question of authorship.

Commentary on: The Articles of the Pope's Bulle (1518)

One of the earliest examples of works printed by Richard Pynson, the King's Printer between 1508 and 1530, to make reference to the fact that the work in question was printed under the protection of the King. The royal printing privilege provided one of two different models for preventing the unauthorised reproduction of works after publication which prefigured the introduction of statutory copyright in the early eighteenth century.The commentary describes the early attitudes of the monarchy towards the regulation of the printing trade within England, and the exercise of the royal prerogative in granting printing privileges not just to the royal printer, but to other favoured subjects both in relation to individual works as well as to entire classes of work (with the latter more often referred to as printing patents).

The making of professionals: Embedded civil society development in a transition country

The paper addresses the development of non-governmental organisations (NGOs) in transition settings. Caught in the balance of knowledge exchange and translation of ideas from abroad, organisations in turbulent setting legitimise their existence by learning through professional networks. By association, organisational actors gain acknowledgement by their sector by traversing the corridors of influence provided by international partnerships. What they learn is how to conduct themselves as agents of change in society, and how to deliver on stated missions and goals, therefore, legitimising their presence in a budding civil society at home. The paper presents a knowledge production and learning practices framework which indicates a presence of dual identity of NGOs - their “embeddedness” locally and internationally. Selected framework dimensions and qualitative case study themes are discussed with respect to the level of independence of organisational actors in the East from their partners in the West in a post-socialist context. A professional global civil society as organisations are increasingly managed in similar, professional ways (Anheier & Themudo 2002). Here knowledge “handling” and knowledge “translation” take place through partnership exchanges fostering capable and/or competitive change-inducing institutions (Czarniawska & Sevon 2005; Hwang & Suarez 2005). How professional identity presents itself in the third sector, as well as the sector’s claim to expertise, need further attention, adding to ongoing discussions on professions in institutional theory (Hwang & Powell 2005; Scott 2008; Noordegraaf 2011). A conceptual framework on the dynamic involved for the construction professional fields follows: • Multiple case analysis provides a taxonomy for understanding what is happening in knowledge transition, adaptation, and organisational learning capacity for NGOs with respect to their role in a networked civil society. With the model we can observe the types of knowledge produced and learning employed by organisations. • There are elements of professionalisation in third sector work organisational activity with respect to its accreditation, sources and routines of learning, knowledge claims, interaction with the statutory sector, recognition in cross-sector partnerships etc. • It signals that there is a dual embeddedness in the development of the sector at the core to the shaping the sector’s professional status. This is instrumental in the NGOs’ goal to gain influence as institutions, as they are only one part of a cross-sector mission to address complex societal problems The case study material highlights nuances of knowledge production and learning practices in partnerships, with dual embeddedness a main feature of the findings. This provides some clues to how professionalisation as expert-making takes shape in organisations: • Depending on the type of organisations’ purpose, over its course of development there is an increase in participation in multiple networks, as opposed to reliance on a single strategic partner for knowledge artefacts and practices; • Some types of organisations are better connected within international and national networks than others and there seem to be preferences for each depending on the area of work; • The level of interpretation or adaptation of the knowledge artefacts is related to an organisation’s embeddedness locally, in turn giving it more influence within the network of key institutions; An overreaching theme across taxonomy categories (Table 1)is “professionalisation” or developing organisational “expertise”, embodied at the individual, organisational, and sector levels. Questions relevant to the exercise of power arise: Is competence in managing a dual embeddedness signals the development of a dual identity in professionalisation? Is professionalisation in this sense a sign of organisations maturing into more capable partners to the arguably more experienced (Western) institutions, shifting the power balance? Or is becoming more professional a sign of domestication to the agenda of certain powerful stakeholders, who define the boundaries of the profession? Which dominant dynamics can be observed in a broadly-defined transition country civil society, where individual participation in the form of activism may be overtaking the traditional forms of organised development work, especially with the spread of social media?

Institutional entrepreneurship and techniques of inclusiveness in the creation of the Intergovernmental Platform on Biodiversity and Ecosystem Services

This article contributes to understanding the conditions of social-ecological change by focusing on the agency of individuals in the pathways to institutionalization. Drawing on the case of the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES), it addresses institutional entrepreneurship in an emerging environmental science-policy institution (ESPI) at a global scale. Drawing on ethnographic observations, semistructured interviews, and document analysis, we propose a detailed chronology of the genesis of the IPBES before focusing on the final phase of the negotiations toward the creation of the institution. We analyze the techniques and skills deployed by the chairman during the conference to handle the tensions at play both to prevent participants from deserting the negotiations arena and to prevent a lack of inclusiveness from discrediting the future institution. We stress that creating a new global environmental institution requires the situated exercise of an art of “having everybody on board” through techniques of inclusiveness that we characterize. Our results emphazise the major challenge of handling the fragmentation and plasticity of the groups of interest involved in the institutionalization process, thus adding to the theory of transformative agency of institutional entrepreneurs. Although inclusiveness might remain partly unattainable, such techniques of inclusiveness appear to be a major condition of the legitimacy and success of the institutionalization of a new global ESPI. Our results also add to the literature on boundary making within ESPIs by emphasizing the multiplicity and plasticity of the groups actually at stake.

El gusto como un factor determinante en el ejercicio crítico del diseño

A partir de algunas reflexiones gadamerianas y de otras discusionescontemporáneas en torno a la idea de juicio estético, se propone entender el papel del gusto en el ejercicio valorativo en los procesos evaluativos y, por lo tanto, críticos de las disciplinas del diseño, entendidas como un saber-hacer artístico y comunicacional.

Los estados de excepción en Colombia y aplicación del principio de proporcionalidad: un análisis de seis casos representativos

El artículo que se presenta a continuación da cuenta de cómo ha funcionado el principio de proporcionalidad en Colombia en el control de constitucionalidad de las declaratorias de los estados de excepción, a través de la evaluación de seis (6) casos de excepcionalidad a partir de 1991, cuatro (4) de ellos referidosa estados de conmoción interior, y dos (2) referidos a emergencias sociales. Se utilizó una metodología cualitativa que permitió describir la forma como la Corte Constitucional aplicaba o no el principio de proporcionalidad para hacer el examen de dichas excepcionalidades, dando cuenta de una matriz de análisis que describe los puntos clave de dicho principio, a saber: a) laexistencia de una crisis coyuntural y no de un daño estructural en cualquiera de los estados de excepción declarados; b) la no suspensión de los derechos humanos ni de las libertades fundamentales de las personas a quienes van dirigidas las medidas incluidas en este; c) la no interrupción del normal funcionamiento de las ramas del poder público; d) el ejercicio de las facultades solo para enfrentar eficazmente la anormalidad; la relación estricta entrecausa y anormalidad, y, en este sentido, la dirección de los decretos única y exclusivamente a conjurar las causas que dan origen a la excepcionalidad; e) la duración definida de los estados de excepción (Cifuentes, 2002), para concluir que la Corte Constitucional, en su aplicación del principio de proporcionalidad, no ha realizado un juicio exhaustivo de los requisitos que este incorpora, de tal forma que ha permitido una perpetuación del poder presidencial y un gobierno con poca separación de poderes.

Transmission Easement and Adverse Possession of Transmission Easement in the Polish Law

The object of analysis in the text are the issues concerned with the transmission easement and the adverse possession thereof on the grounds of the Polish law. The text features: (1) a historical outline of the solutions concerned with easements in the Polish law following 1945, (2) the institution of transmission easement introduced in 2008 and the solutions concerned with the claims for the establishment thereof at court, (3) the institution of adverse possession of transmission easement pursuant to civil law regulations, judicature and the legal doctrine. On account of the need to elaborate the wide-ranging legal issues concerned with the transmission easement in this text, the analysis embraces two research questions giving rise to the following conclusions: (1) What function is performed by the institution of transmission easement in the system of civil-law relations in the Polish law? The legislator in the articles introducing a transmission easement ossified the solutions functioning in the judicature of the Polish courts before 2008. The legal interpretation took a turn for clarification, that is for the establishment of a norm in the situation where its comprehension was dubious. It is noteworthy that in the period prior to 2008, the law provided for easement appurtenant, and on account of the usual course of judicial decisions also for easement appurtenant with the content corresponding to transmission easement. In 2008 these two “legal existences” were supplemented with a transmission easement, which nevertheless failed to resolve all the legal problems; nay, this gave rise to even more problems, e.g. the one of non-establishment of interpolar norms which would address the issues arising in connection with the use of various easement institutions in legal transactions. While amending the civil law, the legislator aimed to bring order to legal transactions by streamlining the unregulated actual state of easement in relation to transmission infrastructure, but also in relation to the situations where an easement was yet to be established and a facility yet to be constructed. Thus, such action is intended to regulate the disorderly legislation in force as well as to safeguard investment processes. This is of particular significance, for example, for energy companies which are burdened with statutory public-law obligations as regards securing energy supplies and providing for the development of energy infrastructure. Hence, the de facto introduced civil-law solutions indirectly served to realise the principles of the doctrine of easement in the public interest. (2) What legal problems in the civil-law relations does the application of the institution of transmission easement by adverse possession entail? On account of the functioning of various institutions of easement, that is (1) an easement appurtenant, (2) an easement appurtenant with the content corresponding to a transmission easement, and as of 2008 (3) a transmission easement, a problem arose as to which of the given easements companies exercised in particular periods, all the more so because before 1989 the State Treasury owned them and many of the transmission facilities were put in place by virtue of administrative decisions. The commonly held belief is that in the period of “society-oriented economy” as well as up to 2008 infrastructure companies could exercise an easement appurtenant which corresponded to the content of a transmission easement. Therefore, in such a case the running of the prescriptive period should allow for the general rules laid down for an easement appurtenant. Apart from the problem of the relation of a capacity to exercise a right to property and the free development of civil-law relations before 1989, the recognition of the running of prescriptive periods – given the functioning of the three various easements as legal institutions – became a significant legal problem. By way of illustration, the recognition – against the period of exercising transmission easement – of the period required for the acquisition thereof by adverse possession, whereby before 3 August 2008 the real estate featured the legal state corresponding to the content of this right, is debatable. One cannot recognise that within that period a transmission easement was exercised, because such a right was not in existence as yet. Therefore, the institution that might be employed is the running of the period as regards the adverse possession in relation to an easement appurtenant with the content of a transmission easement. Still, the problem remains as to whether the period of the exercise of the easement appurtenant with the content corresponding to a transmission easement can be recognised against the period of possession required for the adverse possession of a transmission easement pursuant to the regulations introduced in 2008. One might incline to the position whereby in such a case it would be right to fully recognise – against the period of exercising a transmission easement – the period of exercising an easement appurtenant corresponding thereto in respect of its content. That being so, the adverse possession of a transmission easement might ensue in such a situation on 3 August 2008 at the earliest, that is the moment the regulations governing this right come into effect. Conversely, if the prescriptive period expires before that date, the entrepreneur would acquire an easement appurtenant with the content corresponding to the transmission easement. Such an interpretation is aligned with the purpose intended by the legislator, which is to bring order to the actual state of the broadest scope with the aid of a new legal instrument. The text, while analysing the issue of a transmission easement and an adverse possession thereof as a institution of the civil law, presents only some selected problems. Hence, the analysis does not include, for example, the issues concerned with claims for remuneration (for usufruct without contractual basis or usufruct fees), or claims for compensation (redress or amends). Furthermore, the text does not conduct a more profound analysis of the relation between the provisions regulating public-law relations (e.g. acts of law introducing the institution of dispossession) and the provisions regulating civil-law relations (the easements in question).

Administrative justice and the control of bureaucratic decision-making: A study investigating how decision-makers in local authority education departments respond to the work of redress mechanisms

This socio-legal thesis has explored the factors responsible for explaining whether and how redress mechanisms control bureaucratic decision-making. The research considered the three principal institutions of administrative justice: courts, tribunals, and ombudsman schemes. The field setting was the local authority education area and the thesis examined bureaucratic decision-making about admissions to school, home-to-school transport, and Special Educational Needs (SEN). The thesis adopted a qualitative approach, using interviews and documentary research, within a multiple embedded case study design. The intellectual foundations of the research were inter-disciplinary, cutting across law, socio-legal studies, public administration, organization studies, and social policy. The thesis drew on these scholarly fields to explore the nature of bureaucratic decision-making, the extent to which it can be controlled and the way that learning occurs in bureaucracies and, finally, the extent to which redress mechanisms might exercise control. The concept of control was studied across all its dimensions – in relation both to ex post control in specific cases and the more challenging notion of ex ante or structuring control. The aim of the thesis was not to measure the prevalence of bureaucratic control by redress mechanisms, but to understand the factors that might explain its presence or absence in a particular area. The findings of the research have allowed for a number of analytical refinements and extensions to be made to existing theoretical and empirical understandings. 14 factors, along with 87 supporting propositions, have been set out with the aim of making empirically derived suggestions which can be followed up in future research. In terms of the thesis’ contribution to existing knowledge, its comparative focus and its emphasis on the broad notion of control offered the potential for new insights to be developed. Overall, the thesis claims to have made three contributions to the conceptual framework for understanding the exercise of control by redress mechanisms: it emphasizes the importance of ‘feedback’ in relation to the nature of the cases referred to redress mechanisms; it calls attention to the structure of bureaucratic decision-making as well as its normative character; and it discusses how the operational modes of redress mechanisms relate to their control functions.

How do teachers prepare their students for statewide exit exams? A comparison of Finland, Ireland, and the Netherlands

Statewide exit exams are often believed to have a positive impact on school effectiveness and the alignment between instructional practice and state standards because of their mandatory nature and the stakes attached for students and teachers. They may also, however, lead to teaching to the test and to a perceived de-professionalization of the teaching role. While some studies suggest a narrowing of contents and an increase in teacher-centered instruction, little is known about how the impact on instructional practices and teacher cognitions varies between different exam systems. This study compares the strategies teachers use to prepare their students for the exams at the end of upper secondary education in Finland, Ireland, and the Netherlands using a standardized questionnaire survey with responses from 385 teachers. The goal was to develop hypotheses about the relationship between differences in the exam procedures and the stakes attached, and the differences in teacher preparation strategies. The results suggest country-specific variations regarding teacher beliefs as to how much time should be spent on exam preparation; however, there were smaller differences in the strategies applied. Regression analyses indicated that the way in which preparation intensity was associated with the stakes for students and schools, and the attitudes towards the exams themselves varied across the three countries. The different exam systems appeared to affect preparation in markedly different ways, but nevertheless led to the exercise of comparable strategies. (DIPF/Orig.)

Determinants of Terminal Value in the Evaluation of Companies: A Panel Data Approach to the Context of European Companies.

The uncertainty of the future of a firm has to be modelled and incorporated into the evaluation of companies outside their explicit period of analysis, i.e., in the continuing or terminal value considered within valuation models. However, there is a multiplicity of factors that influence the continuing value of businesses which are not currently being considered within valuation models. In fact, ignoring these factors may cause significant errors of judgment, which can lead models to values of goodwill or badwill, far from the substantial value of the inherent assets. Consequently, these results provided will be markedly different from market values. So, why not consider alternative models incorporating life expectancy of companies, as well as the influence of other attributes of the company in order to get a smoother adjustment between market price and valuation methods? This study aims to provide a contribution towards this area, having as its main objective the analysis of potential determinants of firm value in the long term. Using a sample of 714 listed companies, belonging to 15 European countries, and a panel data for the period between 1992 and 2011, our results show that continuing value cannot be regarded as the current value of a constant or growth perpetuity of a particular attribute of the company, but instead be according to a set of attributes such as free cash flow, net income, the average life expectancy of the company, investment in R&D, capabilities and quality of management, liquidity and financing structure.

Para una crítica de la educación democrática

El propósito central de este trabajo consiste en hacer un análisis crítico de la idea de educación democrática. Como hilo conductor se discute la tesis desarrollada por Amy Gutmann, según la cual, la educación democrática tiene como fin garantizar la reproducción consciente de la sociedad. En este contexto, la tesis que se defiende afirma que la educación democrática exige, además de los principios de no represión y la no discriminación desarrollados por Gutmann, un principio de reconocimiento, que articule la orientación de las acciones educativas a fuentes de normatividad asociadas con una interpretación intersubjetivista de la autonomía, de manera que se puedan generar más elementos de juicio, sobre todo, aquellos incorporados en las dimensiones moral, ética, política, legal y social de la persona, al momento de proponer prácticas educativas encaminadas a la formación de una ciudadanía participativa y crítica. Para esto se propone una interpretación que integra las perspectivas deliberativa y agonal de la democracia, se defiende que la expresión clave del ejercicio de la ciudadanía democrática es la participación, que el ejercicio de la participación tiene por condición la realización de la autonomía personal, por lo cual, en la parte final se elabora una lectura intersubjetivista de la autonomía, a partir de los trabajos de Axel Honneth y Rainer Forst.

Desórdenes muscoloesqueléticos en el trabajador avícola – intervenciones en salud

Introducción: El trabajador avícola presenta un alto riesgo de sufrir de Desórdenes Musculo esqueléticos, debido a la realización de trabajos manuales repetitivos; posición bípeda prolongada, posturas por fuera de ángulos de confort de miembros superiores Objetivo: Establecer las recomendaciones basadas en la evidencia de las intervenciones en salud para los Desórdenes Musculoesqueléticos (DME) en el trabajador avícola. Metodología: Se realizó una revisión de la literatura de los estudios primarios publicados en las bases de datos Medline, Scient Direct y Scielo desde 1990. Los artículos se clasificaron de acuerdo con: el tipo de estudio, la calidad de éste y el nivel de evidencia que aportaba. Resultados: Dentro de las recomendaciones de la evidencia disponible para el manejo integral de los pacientes de la industria avícola con riesgos o eventos asociados a DME se encuentran las siguientes: 1) incorporar un enfoque sistémico en la atención a dichos trabajadores, 2) incluir aspectos psicosociales en la identificación y explicación de los riesgos y eventos en salud, 3) permitir los descansos, microrupturas y pautas para el ejercicio, 4) facilitar la rotación y ampliación de puestos de trabajo, 5) mejorar las herramientas de trabajo - especialmente el corte de los cuchillos. Conclusiones: Las intervenciones descritas en la presente revisión, apuntan hacia el mejoramiento de la incidencia y la prevalencia de los DMS, la disminución de incapacidad temporal y definitiva por los DMS, el mejoramiento en la producción industrial y la reducción de costos tanto económicos como humanos. Sin embargo, se debe plantear la necesidad de continuar impulsando el desarrollo de investigaciones y estudios que permitan tener mayores elementos de juicio para poder realizar recomendaciones a los tipos de intervenciones propuestas. A pesar de lo anterior, las intervenciones en salud para los trabajadores de la industria avícola deben ser enfocadas desde la prestación integral de los servicios de salud.