Monologue or Intercultural Dialogue Between Medical Systems? An Educational Challenge for Medical Sciences

Each medical cultural system constructs knowledge about health through specialization or interculturalism. The knowledge constructed through interculturalism has sought, mainly, to adapt the delivery of health care services to the users’ cultural referents. This emphasis has overlooked the opportunities embedded in the establishment of intercultural relationships between medical systems based on dialogue, especially in regard to the adjustment of the disciplinary boundaries of medical cultural systems that would allow the construction of new knowledge on health. This absence of dialogue has been determined by epistemological barriers inherent to every system as well as by social domination. This article presents some concepts related to cognition processes which encourage the reflection on the possibilities to overcome such barriers so that the health sciences may contribute to the effective implementation of the World Health Organization and the State’s recommendations on the matter.

Teachers as researchers and teachers as software developers: how use-case analysis helps build better educational software

A series of government initiatives has raised both the profile of ICT in the curriculum and the expectation that high quality teaching and learning resources will be accessible across electronic networks. In order for e-learning resources such as websites to have the maximum educational impact, teachers need to be involved in their design and development. Use-case analysis provides a means of defining user requirements and other constraints in such a way that software developers can produce e-learning resources which reflect teachers' professional knowledge and support their classroom practice. It has some features in common with the participatory action research used to develop other aspects of classroom practice. Two case-studies are presented: one involves the development of an on-line resource centred on transcripts of original historical documents; the other describes how 'Learning how to Learn', a major, distributed research project funded under the ESRC Teaching and Learning Research Programme is using use-case analysis to develop web resources and services.

Introducing matrix management within a children's services setting - personal reflections

This article reflects on the introduction of ‘matrix management’ arrangements for an Educational Psychology Service (EPS) within a Children’s Service Directorate of a Local Authority (LA). It seeks to demonstrate critical self-awareness, consider relevant literature with a view to bringing insights to processes and outcomes, and offers recommendations regarding the use of matrix management. The report arises from an East Midland’s LA initiative: ALICSE − Advanced Leadership in an Integrated Children’s Service Environment. Through a literature review and personal reflection, the authors consider the following: possible tensions within the development of matrix management arrangements; whether matrix management is a prerequisite within complex organizational systems; and whether competing professional cultures may contribute barriers to creating complementary and collegiate working. The authors briefly consider some research paradigms, notably ethnographic approaches, soft systems methodology, activity theory and appreciative inquiry. These provide an analytic framework for the project and inform this iterative process of collaborative inquiry. Whilst these models help illuminate otherwise hidden processes, none have been implemented following full research methodologies, reflecting the messy reality of local authority working within dynamic organizational structures and shrinking budgets. Nevertheless, this article offers an honest reflection of organizational change within a children’s services environment.

Educational inclusiveness through Ludic engagement and digital creativity

This paper describes an approach to teaching and learning that combines elements of ludic engagement, gamification and digital creativity in order to make the learning of a serious subject a fun, interactive and inclusive experience for students regardless of their gender, age, culture, experience or any disabilities that they may have. This approach has been successfully used to teach software engineering to first year students but could in principle be transferred to any subject or discipline.

The use of ICT by adults with learning disabilities in day and residential services

The use of Information and Communication Technology (ICT) by adults with learning disabilities has been positively promoted over the past decade. More recently, policy statements and guidance from the UK government have underlined the importance of ICT for adults with learning disabilities specifically, as well as for the population in general, through the potential it offers for social inclusion. The aim of the present study was to provide a picture of how ICT is currently being used within one organisation providing specialist services for adults with learning disabilities and more specifically to provide a picture of its use in promoting community participation. Nine day and 14 residential services were visited as part of a qualitative study to answer three main questions: What kinds of computer programs are being used? What are they being used for? Does this differ between day and residential services? Computers and digital cameras were used for a wide range of activities and ‘mainstream’ programs were used more widely than those developed for specific user groups. In day services, ICT was often embedded in wider projects and activities, whilst use in houses was based around leisure interests. In both contexts, ICT was being used to facilitate communication, although this was more linked to within-service activities, rather than those external to service provision.

Building a Learning Architecture : e-Learning and e-Services

With the rapid advancement of the webtechnology, more and more educationalresources, including software applications forteaching/learning methods, are available acrossthe web, which enables learners to access thelearning materials and use various ways oflearning at any time and any place. Moreover,various web-based teaching/learning approacheshave been developed during the last decade toenhance the capability of both educators andlearners. Particularly, researchers from bothcomputer science and education are workingtogether, collaboratively focusing ondevelopment of pedagogically enablingtechnologies which are believed to improve theinfrastructure of education systems andprocesses, including curriculum developmentmodels, teaching/learning methods, managementof educational resources, systematic organizationof communication and dissemination ofknowledge and skills required by and adapted tousers. Despite of its fast development, however,there are still great gaps between learningintentions, organization of supporting resources,management of educational structures,knowledge points to be learned and interknowledgepoint relationships such as prerequisites,assessment of learning outcomes, andtechnical and pedagogic approaches. Moreconcretely, the issues have been widelyaddressed in literature include a) availability andusefulness of resources, b) smooth integration ofvarious resources and their presentation, c)learners’ requirements and supposed learningoutcomes, d) automation of learning process interms of its schedule and interaction, and e)customization of the resources and agilemanagement of the learning services for deliveryas well as necessary human interferences.Considering these problems and bearing in mindthe advanced web technology of which weshould make full use, in this report we willaddress the following two aspects of systematicarchitecture of learning/teaching systems: 1)learning objects – a semantic description andorganization of learning resources using the webservice models and methods, and 2) learningservices discovery and learning goals match foreducational coordination and learning serviceplanning.

Meeting the Standards: An Analysis of Eight Grade Educational Assesment Test Scores in Maine

This paper examines the impact of socioeconomic factors on eighth grade achievement test scores in the face of federal and state initiatives for educational reform in Maine. We use student-level data over a five year period to provide a framework for understanding the policy implications of these initiatives. We model performance on standardized tests using a seemingly unrelated regressions approach and then determine the likelihood of meeting the standards defined by the adequate yearly progress requirements of the No Child Left Behind Act and Maine Learning Results initiatives. Our results indicate that the key factors influencing a student’s test scores include the education of a student’s parents, special services received for learning disabilities, and alternative measures of academic achievement.

Three essays on local demand for public services

Local provision of public services has the positive effect of increasing the efficiency because each locality has its idiosyncrasies that determine a particular demand for public services. This dissertation addresses different aspects of the local demand for public goods and services and their relationship with political incentives. The text is divided in three essays. The first essay aims to test the existence of yardstick competition in education spending using panel data from Brazilian municipalities. The essay estimates two-regime spatial Durbin models with time and spatial fixed effects using maximum likelihood, where the regimes represent different electoral and educational accountability institutional settings. First, it is investigated whether the lame duck incumbents tend to engage in less strategic interaction as a result of the impossibility of reelection, which lowers the incentives for them to signal their type (good or bad) to the voters by mimicking their neighbors’ expenditures. Additionally, it is evaluated whether the lack of electorate support faced by the minority governments causes the incumbents to mimic the neighbors’ spending to a greater extent to increase their odds of reelection. Next, the essay estimates the effects of the institutional change introduced by the disclosure on April 2007 of the Basic Education Development Index (known as IDEB) and its goals on the strategic interaction at the municipality level. This institutional change potentially increased the incentives for incumbents to follow the national best practices in an attempt to signal their type to voters, thus reducing the importance of local information spillover. The same model is also tested using school inputs that are believed to improve students’ performance in place of education spending. The results show evidence for yardstick competition in education spending. Spatial auto-correlation is lower among the lame ducks and higher among the incumbents with minority support (a smaller vote margin). In addition, the institutional change introduced by the IDEB reduced the spatial interaction in education spending and input-setting, thus diminishing the importance of local information spillover. The second essay investigates the role played by the geographic distance between the poor and non-poor in the local demand for income redistribution. In particular, the study provides an empirical test of the geographically limited altruism model proposed in Pauly (1973), incorporating the possibility of participation costs associated with the provision of transfers (Van de Wale, 1998). First, the discussion is motivated by allowing for an “iceberg cost” of participation in the programs for the poor individuals in Pauly’s original model. Next, using data from the 2000 Brazilian Census and a panel of municipalities based on the National Household Sample Survey (PNAD) from 2001 to 2007, all the distance-related explanatory variables indicate that an increased proximity between poor and non-poor is associated with better targeting of the programs (demand for redistribution). For instance, a 1-hour increase in the time spent commuting by the poor reduces the targeting by 3.158 percentage points. This result is similar to that of Ashworth, Heyndels and Smolders (2002) but is definitely not due to the program leakages. To empirically disentangle participation costs and spatially restricted altruism effects, an additional test is conducted using unique panel data based on the 2004 and 2006 PNAD, which assess the number of benefits and the average benefit value received by beneficiaries. The estimates suggest that both cost and altruism play important roles in targeting determination in Brazil, and thus, in the determination of the demand for redistribution. Lastly, the results indicate that ‘size matters’; i.e., the budget for redistribution has a positive impact on targeting. The third essay aims to empirically test the validity of the median voter model for the Brazilian case. Information on municipalities are obtained from the Population Census and the Brazilian Supreme Electoral Court for the year 2000. First, the median voter demand for local public services is estimated. The bundles of services offered by reelection candidates are identified as the expenditures realized during incumbents’ first term in office. The assumption of perfect information of candidates concerning the median demand is relaxed and a weaker hypothesis, of rational expectation, is imposed. Thus, incumbents make mistakes about the median demand that are referred to as misperception errors. Thus, at a given point in time, incumbents can provide a bundle (given by the amount of expenditures per capita) that differs from median voter’s demand for public services by a multiplicative error term, which is included in the residuals of the demand equation. Next, it is estimated the impact of the module of this misperception error on the electoral performance of incumbents using a selection models. The result suggests that the median voter model is valid for the case of Brazilian municipalities.

Breastfeeding knowledge and practice of health professionals in public health care services

Objetivou-se avaliar conhecimentos e práticas sobre aleitamento materno de profissionais que atendem lactentes em unidades de atenção básica, ou maternidades públicas, de município do interior paulista, Brasil. É estudo epidemiológico, sendo a população composta por 89 enfermeiros e médicos. Suas respostas a um questionário estruturado foram analisadas no total e segundo o local de trabalho, aplicando-se o teste de diferença de proporções (qui-quadrado), considerando-se p<0,05 como nível crítico. Como parâmetros de acertos foram consideradas as recomendações do Ministério da Saúde. As diferenças significativas para conhecimentos e práticas, segundo o local de trabalho, foram restritas a alguns aspectos, com resultados discretamente melhores dos escores médios de acertos dos profissionais das unidades de atenção básica. Independente do local de trabalho, verificou-se desempenho regular e ruim em diferentes aspectos estudados, indicando que possíveis intervenções para a capacitação nessa temática deverão incluir profissionais de todos os níveis de atenção à saúde.

The effectiveness of educational practice in diabetic foot: a view from Brazil

Background: The aim of the present study was to evaluate the prevention and self-inspection behavior of diabetic subjects with foot at ulcer risk, no previous episode, who participated in the routine visits and standardized education provided by the service and who received prescribed footwear. This evaluation was carried out using a questionnaire scoring from 0-10 (high scores reflect worse practice compliance).Results: 60 patients were studied (30 of each sex); mean age was 62 years, mean duration of the disease was 17 years. As for compliance, 90% showed a total score <= 5, only 8.7% regularly wore the footwear supplied; self foot inspection 65%, 28,3% with additional familiar inspection; creaming 77%; proper washing and drying 88%; proper cutting of toe nails 83%; no cuticle cutting 83%; routine shoe inspection 77%; no use of pumice stones or similar abrasive 70%; no barefoot walking 95%.Conclusion: the planned and multidisciplinary educational approach enabled high compliance of the ulcer prevention care needed in diabetic patients at risk for complications. In contrast, compliance observed for the use of footwear provided was extremely low, demonstrating that the issue of its acceptability should be further and carefully addressed. In countries of such vast dimensions as Brazil multidisciplinary educational approaches can and should be performed by the services providing care for patients with foot at risk for complications according to the reality of local scenarios. Furthermore, every educational program should assess the learning, results obtained and efficacy in the target population by use of an adequate evaluation system.

An Educational international partnership responding to local needs: Process evaluation of the Brazil FAIMER Regional Institute

The Brazilian public health system requires competent professionals sensitive to the needs of the population. The Foundation for Advancement of International Medical Education and Research (FAIMER) provides a two-year faculty development programme for health professions educators, aiming to build leadership in education to improve health. A partnership with governmental initiatives and FAIMER was established for meeting these needs. This paper describes the initial process evaluation results of the Brazilian FAIMER Institute Fellowship (FAIMER BR). Methods: Data were analysed for the classes 2007-2010 regarding: application processes; innovation project themes; retrospective post-pre self-ratings of knowledge acquisition; and professional development portfolios. Results: Seventeen of 26 Brazilian states were represented among 98 Fellows, predominantly from public medical schools (75.5%) and schools awarded Ministry of Health grants to align education with public health services (89.8%). One-third (n = 32) of Fellows' innovation projects were related to these grants. Significant increases occurred in all topic subscales on self-report of knowledge acquisition (eff ect sizes, 1.21-2.77). In the follow up questionnaire, 63% of Fellows reported that their projects were incorporated into the curriculum or institutional policies. The majority reported that the programme deepened their knowledge (98%), provided new ideas about medical education (90%) and provided skills for conflict management (63%). One-half of the Fellows reported sustained benefits from the programme listserv and other communications, including breadth of expertise, establishment of research collaboration and receiving emotional support. Conclusion: Contributors to initial programme success included alignment of curriculum with governmental initiatives, curriculum design merging educational technology, leadership and management skills and central role of an innovation educational project responding to local needs.

Educational decentralization models in Latin America

Includes bibliography

Media Education and Brazilian Educational Policies for the Enhancement of Learning

As media education concepts and practices have been disseminated and strengthened in European countries and Americas, the policies responsible for that expansion remain little known, particularly in countries where the achievements have been recently noted. That is the case for Brazil, where there have been new opportunities for media education, considered as a valuable resource to help accomplish goals of the educational system. This paper looks into the contribution of media education to the enhancement of teaching and learning in the context of innovations brought by recent policies of the Brazilian Ministry of Education. After educational reform programmes which brought the opportunity for emerging fields such as media education, we produced teaching material and conducted a series of workshops with students and teachers from state secondary schools. By reading and producing multimedia information about local public services available to young people, pupils learned about democracy, citizenship, civic engagement, media language, and identity. Lessons from our experiment are discussed against the backdrop of education policies being implemented to ameliorate harsh conditions resulting from the recent economic crisis. We suggest that media education can help by creating a learning environment in which the students become aware of the value of educational attainments.

Case study of children of referrals to health services: an individualizing design?

Nowadays education for all is recommended as an international action. However in Brazil one can observe homogeneous practices for a heterogeneous public. When the student has learning difficulties, there seems to be an attempt to normalization and pathologization by the means of referral, many times being indiscriminate, to health services. This case study aimed to analyze records of pedagogical strategies to meet the students educational needs before sending them to health services. Two records sent to a multidisciplinary team of a Regional Specialty Clinic (ARE) in a city of the state of São Paulo/Brazil, were used. The results reflect that the records of the educators do not show the pedagogical strategies used with the students and that the education system still seeks homogeneous classes, devaluating the diversity present in its context.

Globalisation, E-learning and the Monetary Pressure on the Educational Field

Globalisation, this is my thesis, change first the trade of goods and services, produce a mercantilist pressure on different political fields and affect finally as a consequence effectively our normative comprehension of education. As states will be more and more under pressure to compete on an economic basis against each other they will rank decisions which generate jobs higher than any thing else. Also Education policy is changing its focus. E-learning is a driving force to bring together education, trade of ICT equipment, trade of educational used content and trade of study degrees and to merge the different objectives into effective distribution of knowledge and maximising profits.