922 resultados para Health facility environment


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This dissertation consists of three empirical studies that aim at providing new evidence in the field of public policy evaluation. In particular, the first two chapters focus on the effects of the European cohesion policy, while the third chapter assesses the effectiveness of Italian labour market incentives in reducing long-term unemployment. The first study analyses the effect of EU funds on life satisfaction across European regions , under the assumption that projects financed by structural funds in the fields of employment, education, health and environment may affect the overall quality of life in recipient regions. Using regional data from the European Social Survey in 2002-2006, it resorts to a regression discontinuity design, where the discontinuity is provided by the institutional framework of the policy. The second study aims at estimating the impact of large transfers from a centralized authority to a local administration on the incidence of white collar crimes. It merges a unique dataset on crimes committed in Italian municipalities between 2007 and 2011 with information on the disbursement of EU structural funds in 2007-2013 programming period, employing an instrumental variable estimation strategy that exploits the variation in the electoral cycle at local level. The third study analyses the impact of an Italian labour market policy that allowed firms to cut their labour costs on open-ended job contracts when hiring long-term unemployed workers. It takes advantage of a unique dataset that draws information from the unemployment lists in Veneto region and it resorts to a regression discontinuity approach to estimate the effect of the policy on the job finding rate of long-term unemployed workers.

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Sustainable management of solid waste is a global concern, as exemplified by the United Nations Millennium Development Goals (MDG) that 191 member states support. The seventh MDG indirectly advocates for municipal solid waste management (MSWM) by aiming to ensure environmental sustainability into countries’ policies and programs and reverse negative environmental impact. Proper MSWM will likely result in relieving poverty, reducing child mortality, improving maternal health, and preventing disease, which are MDG goals one, four, five, and six, respectively (UNMDG, 2005). Solid waste production is increasing worldwide as the global society strives to obtain a decent quality of life. Several means exist in which the amount of solid waste going to a landfill can be reduced, such as incineration with energy production, composting of organic wastes, and material recovery through recycling, which are all considered sustainable methods by which to manage MSW. In the developing world, composting is already a widely-accepted method to reduce waste fated for the landfill, and incineration for energy recovery can be a costly capital investment for most communities. Therefore, this research focuses on recycling as a solution to the municipal solid waste production problem while considering the three dimensions of sustainability environment, society, and economy. First, twenty-three developing country case studies were quantitatively and qualitatively examined for aspects of municipal solid waste management. The municipal solid waste (MSW) generation and recovery rates, as well as the composition were compiled and assessed. The average MSW generation rate was 0.77 kg/person/day, with recovery rates varying from 5 – 40%. The waste streams of nineteen of these case studies consisted of 0 – 70% recyclable material and 17 – 80% organic material. All twenty-three case studies were analyzed qualitatively by identifying any barriers or incentives to recycling, which justified the creation of twelve factors influencing sustainable municipal solid waste management (MSWM) in developing countries. The presence of regulations, enforcement of laws, and use of incentive schemes constitutes the first factor, Government Policy. Cost of MSWM operations, the budget allocated to MSWM by local to national governments, as well as the stability and reliability of funds comprise the Government Finances factor influencing recycling in the third world. Many case studies indicated that understanding features of a waste stream such as the generation and recovery rates and composition is the first measure in determining proper management solutions, which forms the third factor Waste Characterization. The presence and efficiency of waste collection and segregation by scavengers, municipalities, or private contractors was commonly addressed by the case studies, which justified Waste Collection and Segregation as the fourth factor. Having knowledge of MSWM and an understanding of the linkages between human behavior, waste handling, and health/sanitation/environment comprise the Household Education factor. Individuals’ income influencing waste handling behavior (e.g., reuse, recycling, and illegal dumping), presence of waste collection/disposal fees, and willingness to pay by residents were seen as one of the biggest incentives to recycling, which justified them being combined into the Household Economics factor. The MSWM Administration factor was formed following several references to the presence and effectiveness of private and/or public management of waste through collection, recovery, and disposal influencing recycling activity. Although the MSWM Personnel Education factor was only recognized by six of the twenty-two case studies, the lack of trained laborers and skilled professionals in MSWM positions was a barrier to sustainable MSWM in every case but one. The presence and effectiveness of a comprehensive, integrative, long-term MSWM strategy was highly encouraged by every case study that addressed the tenth factor, MSWM Plan. Although seemingly a subset of private MSWM administration, the existence and profitability of market systems relying on recycled-material throughput, involvement of small businesses, middlemen, and large industries/exporters is deserving of the factor Local Recycled-Material Market. Availability and effective use of technology and/or human workforce and the safety considerations of each were recurrent barriers and incentives to recycling to warrant the Technological and Human Resources factor. The Land Availability factor takes into consideration land attributes such as terrain, ownership, and development which can often times dictate MSWM. Understanding the relationships among the twelve factors influencing recycling in developing countries, made apparent the collaborative nature required of sustainable MSWM. Factors requiring the greatest collaborative inputs include waste collection and segregation, MSWM plan, and local recycled-material market. Aligning each factor to the societal, environmental, and economic dimensions of sustainability revealed the motives behind the institutions contributing to each factor. A correlation between stakeholder involvement and sustainability existed, as supported by the fact that the only three factors driven by all three dimensions of sustainability were the same three that required the greatest collaboration with other factors. With increasing urbanization, advocating for improved health for all through the MDG, and changing consumption patterns resulting in increasing and more complex waste streams, the utilization of the collaboration web offered by this research is ever needed in the developing world. Through its use, the institutions associated with each of the twelve factors can achieve a better understanding of the collaboration necessary and beneficial for more sustainable MSWM.

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Physician Assistants (PAs) are increasingly assuming more responsibilities as "front-line" health providers due to emphasis on primary care and cost-containment in the rapidly changing health care environment. Nutrition plays an important role in health promotion and disease prevention. Primary care providers, including PAs, have enormous potential as nutrition counselors and advocates. There have been no studies to date that address the PAs' adequacy of nutrition education or their attitudes toward the value of nutrition. Therefore, it was the purpose of the study to determine the nutrition knowledge and attitudes of PAs in Texas.^ All certified physician assistants in Texas were eligible for the study. A mailed survey was sent to 1,482 PAs in Texas with a response rate of 54.2%. The sample utilized for data analysis was 764 PAs.^ The study compared the nutrition knowledge mean scores for PAs who graduated from a PA program greater than 11 years ago with those who graduated less than 11 years ago. The study also examined Texas PAs' attitudes about their nutrition education training, the value of nutrition counseling, and their perceived ability to provide such nutrition counseling. Demographic and practice information was collected from the PAs. Demographically, PAs in Texas were found to be comparable to the national population of PAs surveyed in 1996.^ The overall mean level of nutrition knowledge was 70% correct. The mean level of nutrition knowledge was significantly related to the type of PA program that the PA graduated from (i.e., Certificate only or Master's degree level). No significant relationships were found between the mean nutrition knowledge score and age, year of graduation, length of practice, or the type of nutrition education provided in PA program.^ The majority of the PAs surveyed felt that diet and nutrition has an important role in disease prevention and felt that PA programs should place a greater emphasis on nutrition education. Many PAs surveyed were not satisfied with the amount of nutrition education they had received in their PA education programs and were not confident in their ability to provide nutrition counseling to patients.^ Suggestions are offered for improvement in PA nutrition education in the areas of both nutrition knowledge and patient counseling skills. In addition, this study recommends developing and strengthening partnerships between PAs and nutrition organizations. ^

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NORM (Naturally Occurring Radioactive Material) Waste Policies for the nation's oil and gas producing states have been in existence since the 1980's, when Louisiana was the first state to develop a NORM regulatory program in 1989. Since that time, expectations for NORM Waste Policies have evolved, as Health, Safety, Environment, and Social responsibility (HSE & SR) grows increasingly important to the public. Therefore, the oil and gas industry's safety and environmental performance record will face challenges in the future, about its best practices for managing the co-production of NORM wastes. ^ Within the United States, NORM is not federally regulated. The U.S. EPA claims it regulates NORM under CERCLA (superfund) and the Clean Water Act. Though, there are no universally applicable regulations for radium-based NORM waste. Therefore, individual states have taken responsibility for developing NORM regulatory programs, because of the potential radiological risk it can pose to man (bone and lung cancer) and his environment. This has led to inconsistencies in NORM Waste Policies as well as a NORM management gap in both state and federal regulatory structures. ^ Fourteen different NORM regulations and guidelines were compared between Louisiana and Texas, the nation's top two petroleum producing states. Louisiana is the country's top crude oil producer when production from its Federal offshore waters are included, and fourth in crude oil production, behind Texas, Alaska, and California when Federal offshore areas are excluded. Louisiana produces more petroleum products than any state but Texas. For these reasons, a comparative analysis between Louisiana and Texas was undertaken to identify differences in their NORM regulations and guidelines for managing, handling and disposing NORM wastes. Moreover, this analysis was undertaken because Texas is the most explored and drilled worldwide and yet appears to lag behind its neighboring state in terms of its NORM Waste Policy and developing an industry standard for handling, managing and disposing NORM. As a result of this analysis, fourteen recommendations were identified.^

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Background: Risky sexual behaviors have been shown to increase the risk of unintended pregnancy and sexually transmitted infections (STIs) among youth. Youth in military families may be especially at risk for engaging in risky sexual behaviors because they are exposed to factors that are unique to the military culture, such as multiple relocations and parental deployment. However, data on sexual behaviors among military-dependent youth are limited and few studies have examined how these factors influence the sexual behaviors among youth. Purpose: The purpose of this dissertation was to estimate the prevalence of risky sexual behaviors among military-dependent youth and to describe how military factors may influence their sexual behaviors. Methods: Youth, aged 15–19 years, who attended a military health facility in the southern United States between June 2011 and September 2011 were recruited to complete a short, paper-based survey (N= 208, males and females) and to participate in an in-depth interview (N = 25, females). For quantitative data, prevalence estimates were computed and chi-square analyses were conducted. Logistic regression analyses were also conducted, adjusting for age, gender, and parents' duty status. For qualitative data, thematic coding of transcribed interviews was performed. Common and unique themes were examined across participants' experiences. Results: Over half of the youth was sexually experienced (53.7%). Parental deployment and number of relocations were significantly associated with having had sex in the past 3 months; however no significant associations were found between these military factors and other sexual behaviors. Although some youth felt that being a military-dependent had negatively impacted their sexual decisions, most believed the military experience had little influence on their sexual decisions. Most youth in military families also perceived having higher parental expectations to avoid risky behaviors, in general, than youth in civilian families. Conclusions: The majority of military-dependent youth are sexually experienced; however, individual and parental factors may have a greater role in sexual initiation among youth than military stressors do. The findings highlight the need for implementation of evidence-based strategies to prevent teen pregnancy and STIs at military installations. Future studies with larger sample sizes are needed to further explore how youth may cope with these military factors and the impact of parental factors on the sexual behaviors of youth.^

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Desde este trabajo se pretende dar cuenta del deterioro de las condiciones de vida existentes de la población y de la fragmentación socio-espacial, a través de la aplicación de un Índice-resumen de Calidad de Vida para el aglomerado urbano de Bahía Blanca. Con este propósito se analizan las siguientes dimensiones: vivienda, educación, salud y ambiente, así como la combinación de las variables que participan en la configuración socio-espacial. De este modo, la investigación demuestra las fragmentaciones y diferenciación de áreas, plasmadas en profundas desigualdades en cuanto a condiciones habitacionales y disponibilidad de servicios públicos urbanos. La fuente de información para la medición de las diferencias de calidad de vida de la población bahiense corresponde a los datos del Censo 2001 en el nivel de radios censales y su tratamiento se realizó mediante la aplicación de REDATAM+SP. Además, se utilizó para la representación cartográfica un Sistema de Información Geográfica, lo que permitió un análisis intraurbano más detallado.

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Desde este trabajo se pretende dar cuenta del deterioro de las condiciones de vida existentes de la población y de la fragmentación socio-espacial, a través de la aplicación de un Índice-resumen de Calidad de Vida para el aglomerado urbano de Bahía Blanca. Con este propósito se analizan las siguientes dimensiones: vivienda, educación, salud y ambiente, así como la combinación de las variables que participan en la configuración socio-espacial. De este modo, la investigación demuestra las fragmentaciones y diferenciación de áreas, plasmadas en profundas desigualdades en cuanto a condiciones habitacionales y disponibilidad de servicios públicos urbanos. La fuente de información para la medición de las diferencias de calidad de vida de la población bahiense corresponde a los datos del Censo 2001 en el nivel de radios censales y su tratamiento se realizó mediante la aplicación de REDATAM+SP. Además, se utilizó para la representación cartográfica un Sistema de Información Geográfica, lo que permitió un análisis intraurbano más detallado.

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Desde este trabajo se pretende dar cuenta del deterioro de las condiciones de vida existentes de la población y de la fragmentación socio-espacial, a través de la aplicación de un Índice-resumen de Calidad de Vida para el aglomerado urbano de Bahía Blanca. Con este propósito se analizan las siguientes dimensiones: vivienda, educación, salud y ambiente, así como la combinación de las variables que participan en la configuración socio-espacial. De este modo, la investigación demuestra las fragmentaciones y diferenciación de áreas, plasmadas en profundas desigualdades en cuanto a condiciones habitacionales y disponibilidad de servicios públicos urbanos. La fuente de información para la medición de las diferencias de calidad de vida de la población bahiense corresponde a los datos del Censo 2001 en el nivel de radios censales y su tratamiento se realizó mediante la aplicación de REDATAM+SP. Además, se utilizó para la representación cartográfica un Sistema de Información Geográfica, lo que permitió un análisis intraurbano más detallado.

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We offer micro-econometric evidence for a positive impact of rural electrification on the nutritional status of children under five as measured by height-for-age Z-score (HAZ) in rural Bangladesh. In most estimates, access to electricity is found to improve HAZ by more than 0.15 points and this positive impact comes from increased wealth and reduced fertility, even though the evidence for the latter is weak. We also analyze the causal channels through the local health facility and exposure to television. We find no evidence for the presence of the former channel and mixed evidence for the latter.

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Com o atual desenvolvimento industrial e tecnológico da sociedade, a presença de substâncias inflamáveis e/ou tóxicas aumentou significativamente em um grande número de atividades. A possível dispersão de gases perigosos em instalações de armazenamento ou em operações de transporte representam uma grande ameaça à saúde e ao meio ambiente. Portanto, a caracterização de uma nuvem inflamável e/ou tóxica é um ponto crítico na análise quantitativa de riscos. O objetivo principal desta tese foi fornecer novas perspectivas que pudessem auxiliar analistas de risco envolvidos na análise de dispersões em cenários complexos, por exemplo, cenários com barreiras ou semi-confinados. A revisão bibliográfica mostrou que, tradicionalmente, modelos empíricos e integrais são usados na análise de dispersão de substâncias tóxicas / inflamáveis, fornecendo estimativas rápidas e geralmente confiáveis ao descrever cenários simples (por exemplo, dispersão em ambientes sem obstruções sobre terreno plano). No entanto, recentemente, o uso de ferramentas de CFD para simular dispersões aumentou de forma significativa. Estas ferramentas permitem modelar cenários mais complexos, como os que ocorrem em espaços semi-confinados ou com a presença de barreiras físicas. Entre todas as ferramentas CFD disponíveis, consta na bibliografia que o software FLACS® tem bom desempenho na simulação destes cenários. Porém, como outras ferramentas similares, ainda precisa ser totalmente validado. Após a revisão bibliográfica sobre testes de campo já executados ao longo dos anos, alguns testes foram selecionados para realização de um exame preliminar de desempenho da ferramenta CFD utilizado neste estudo. Foram investigadas as possíveis fontes de incertezas em termos de capacidade de reprodutibilidade, de dependência de malha e análise de sensibilidade das variáveis de entrada e parâmetros de simulação. Os principais resultados desta fase foram moldados como princípios práticos a serem utilizados por analistas de risco ao realizar análise de dispersão com a presença de barreiras utilizando ferramentas CFD. Embora a revisão bibliográfica tenha mostrado alguns dados experimentais disponíveis na literatura, nenhuma das fontes encontradas incluem estudos detalhados sobre como realizar simulações de CFD precisas nem fornecem indicadores precisos de desempenho. Portanto, novos testes de campo foram realizados a fim de oferecer novos dados para estudos de validação mais abrangentes. Testes de campo de dispersão de nuvem de propano (com e sem a presença de barreiras obstruindo o fluxo) foram realizados no campo de treinamento da empresa Can Padró Segurança e Proteção (em Barcelona). Quatro testes foram realizados, consistindo em liberações de propano com vazões de até 0,5 kg/s, com duração de 40 segundos em uma área de descarga de 700 m2. Os testes de campo contribuíram para a reavaliação dos pontos críticos mapeados durante as primeiras fases deste estudo e forneceram dados experimentais para serem utilizados pela comunidade internacional no estudo de dispersão e validação de modelos. Simulações feitas utilizando-se a ferramenta CFD foram comparadas com os dados experimentais obtidos nos testes de campo. Em termos gerais, o simulador mostrou bom desempenho em relação às taxas de concentração da nuvem. O simulador reproduziu com sucesso a geometria complexa e seus efeitos sobre a dispersão da nuvem, mostrando claramente o efeito da barreira na distribuição das concentrações. No entanto, as simulações não foram capazes de representar toda a dinâmica da dispersão no que concerne aos efeitos da variação do vento, uma vez que as nuvens simuladas diluíram mais rapidamente do que nuvens experimentais.

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Perinatal depression significantly impacts the mother, her partner, the unborn fetus, and the infant/child after delivery. A review of the literature supports the need for preventive intervention methods as research has shown that even with successful treatment, disruptions in attachment, temperament, and cognitive development often remain. Primary care settings are ideal targets for prevention given that they can reach a number of people at low-cost without the stigma associated with seeking help in a mental health facility. This paper purposes a preventive intervention method for perinatal depression that can be implemented in primary care settings in both Western and non-Western countries. The intervention targets two of the primary risk factors for perinatal depression; partner support and relationship quality. The intervention is structured around key target periods in gestational development and during the early weeks after delivery. Suggestions for each target visit are based on prior research that has demonstrated how psychoeducation about the transition to parenthood, as well as increased communication, can positively affect partner support and relationship quality. The ultimate goal of the intervention is not only to prevent perinatal depression but also to improve the mental health and wellbeing of the entire family system.

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It is striking that there is little or no mention in the TTIP debate so far of the US-EU Mutual Recognition Agreement (MRA) concluded in 1998. At the time, expectations of the gains from the MRA were high. One should expect the MRA to be instructive for TTIP and entail some lessons to be learned for today’s attempt to lower technical barriers to trade (TBTs) across the North Atlantic. We offer an analysis of the 1998 MRA, the difficulties in the prior negotiations and those during the implementation phase, the subsequent and present status of sectoral approaches. The MRA experience revealed clearly how difficult it is to accomplish the acceptance of all relevant aspects of conformity assessment of the trading partner for the mere purpose of testing and certifying export goods on the requirements of the importing economy. The MRA has succeeded only in a few sectors. However, the ambition in TTIP with respect to TBTs is said to go so much further. It is therefore important for all those involved or interested in TTIP to learn the lessons of this early exercise in lowering TBT costs. This paper reaches two main conclusions: i) the US-EU MRA was only partially successful and only for some one-fifth of the export flows at the time: a disappointing outcome and a far cry from the expectations of business and political leaders; and ii) the EU’s attempt to ‘balance’ the negotiations in 1995 by bringing in three relatively competitive sectors did not work out – it was precisely there that problems accumulated. It is critical that domestic regulators must be satisfied during and after the negotiations that their pursuit of health, safety, environment and consumer protection objectives will not be watered down in any way. Lessons drawn include, among others: MRAs are not about regulatory change (by definition), but if initial regulatory cleavages between trading partners are too wide, conditions become so restrictive that parties may regard them as a denial of the very purpose of the MRA. There are incentives to opt for alternatives in the market for the formalised designation of conformity assessment bodies in the MRA and these are often cheaper and faster, while equally qualified. Even in heavily regulated sectors such as medicines and medical devices, the narrow MRA has been superseded by near-global forms of effective cost-reducing cooperative (i.e. not treaty-based) regulatory alignment, a confirmation of the OECD approach that governments should think in terms of an entire spectrum of forms of regulatory cooperation.