Scale development of individual and organisation infrastructure for heart health promotion in regional health authorities

Objective : The purpose of this study was to validate measures of individual and organisational infrastructure for health promotion within Alberta's (Canada) 17 Regional Health Authorities (RHAs).

Design : A series of phases were conducted to develop individual and organisational scales to measure health promotion infrastructure. Instruments were designed with focus groups and then pre-tested prior to the validation study.

Setting : In 1993 all hospitals and Public Health Units in the province of Alberta were regionalised into 17 RHAs, with responsibility for public health, community health, and acute and long-term care. While regionalisation may offer more opportunity for community participation, reorganisation of the public health system may have fragmented and diluted resources and skills for heart health promotion in some RHAs. Infrastructure (for example, human and financial resources), amongst other items, is believed to contribute to the capacity to promote health.

Method : All 17 RHAs participated in the study, yielding a total of 144 individuals (that is board members, senior/middle management, and front line staff). These representative employees completed a self- administered questionnaire on individual- and organisational-level infrastructure measures.

Results : Psychometric analyses of survey data provided empirical evidence for the robustness of the measures. Principal component analyses verified the construct validity of the scales, with alpha coefficients ranging from 0.75 to 0.95.

Conclusion : The scales can be used by health professionals and researchers to assess individual- and organisational-level infrastructure, and tailor interventions to increase infrastructure for health promotion in health organisations.

Theorising stigma and the experiences of injecting drug users in Australia

This paper examines the stigma of injecting drug use as an underlying factor in the poor health status of
Australian injecting drug users. Drawing on various models of stigma described in the literature, we examine injecting drug users’ experiences. As a case study, examples from Victorian (specifically Melbourne) policy and practice are included to exemplify community and societal attitudes towards injecting drug users and the implications of these for injecting drug user health. We conclude that redressing the negative effects of stigma requires political will, financial support, increased community commitment and a better understanding of the links between the social determinant of health and the poor health status of injecting drug users.Without reducing the stigma of injecting drug use the health of this marginalised population is likely to get worse, which will have broader negative population health effects.

Integrating knowledge systems in local coastal management; the case of an estuary entrance management support system (EEMSS) in Australia

The management of social, economic, and ecological assets in coastal zones is fundamental to the maintenance and sustainability of coastal resources. A significant issue in this discussion is the role of governance structures. In Australia the governance of the coastal zone includes a range of institutional authorities, processes, and procedures that set the context for decision making about coastal management. As well as the formal institutional arrangements there is also a maze of other interests such as development commissions, NGOs, Indigenous Native Title holders and other stakeholders including recreational interests. A major issue for governance arrangements is the considerable gap that often exists between how those interests interpret and develop their positions especially when the knowledge is derived from different systems – scientific, managerial, lay and indigenous. This paper will explore the development of an Estuary Entrance Management Support System (EEMSS) in south west Victoria Australia. The EEMSS is a decision support tool to assist estuary managers in determining whether to artificially open a river mouth. A significant part of the process adopted was community participation which involved a ‘steps’ approach to engage local community groups and landholders. It is the process of engaging different knowledge systems in a meaningful conversation that has led to a system that now gains support from all of the stakeholders in the management of different estuaries. The paper will discuss the processes that surround the EEMSS and outline some lessons that arise in context of the ‘project state’.

Health system reform and social capital

Jim Hyde suggests that the research on building the capacity of communities and the accumulation of social capital shows that how we organize our health systems - in both micro and macro contexts - is important. He argues that collaboration, flexibility and community participation must become central in health structures.

E-governance as digital ecosystem : a new way to think about citizen engagement and the internet?

There has been a long history of attempting to deploy networked information and communications – mostly in the form of the Internet – to support the broad goals of effective, efficient and responsible democratic government. While there has been considerable talk about the way such technologies might promote better governance – through increased citizen participation in debates and discussions about future outcomes – there has been, in contrast, much action that actually uses the Internet for more efficient government, by creating online and networked interfaces by which citizens can transact business with government. There has been only limited success in using the Internet and similar communications channels to allow citizens to participate in their own governance. Undoubtedly, the Internet does facilitate public consultation. For example, the European Commission used an Interactive Policy Making web tool for public consultation on legislation for regulation of chemicals. Over 6,500 contributions were received over a period of 2 months and the consultation process led to the identification of key flaws in proposals, saving billions of Euros (Timmers,2008). However, consultation of this kind tends to be a mechanism for gathering opinion and gaining citizen approval for change that is not different except in transmission form than previous approaches based on meetings and written submissions. While the European Commission example can be seen as successful, Internet-based consultation can too easily become promotional or marketing oriented, as in recent efforts in Australian by the Federal Communications Minister to use a blog to discuss proposed changes to Internet censorship regulations: in this case, discussion and debate from participants appears largely to have been ignored in favour of a pre-existing position. This paper aims to provide a solution to some of these problems by drawing on the idea of how the Internet can host and support a digital eco-system.

Integrating psychologists into the Canadian health care system : the example of Australia

Canada and Australia share many similarities in terms of demographics and the structure of their health systems; however, there has been a divergence in policy approaches to public funding of psychological care. Recent policy reforms in Australia have substantially increased community access to psychologists for evidence-based treatment for high prevalence disorders. In Canada, access remains limited with the vast majority of consultations occurring in the private sector, which is beyond the reach of many individuals due to cost considerations. With the recent launch of the Mental Health Commission of Canada, it is timely to reflect on the context of the current Canadian and Australian systems of psychological care. We argue that integrating psychologists into the publicly-funded primary care system in Canada would be feasible, beneficial for consumers, and cost-effective.

Promoting health and well-being in social work education

This book contains contributions from social work educators from Australia, America, Canada, New Zealand and the UK. They reflect on how best to prepare students to put health and well-being to the forefront of practice, drawing on research on quality of life, subjective well-being, student well-being, community participation and social connectedness, religion and spirituality, mindful practices, trauma and health inequalities.

Alianças estratégicas e suas implicações para a configuração de capacidades tecnológicas: evidências da indústria farmacêutica multinacional

Esta dissertação examina as capacidades tecnológicas (sistema técnico-organizacional, molécula e medicamento) disponibilizadas em alianças estratégicas pela indústria farmacêutica multinacional, assim como as principais implicações das alianças estratégicas para a indústria farmacêutica em termos de configuração de suas capacidades tecnológicas . Essas questões são examinadas à base de evidências empíricas secundárias sobre alianças estratégicas em uma amostra de 25 companhias multinacionais da indústria farmacêutica, pertencentes a três grupos: companhia farmacêutica de grande porte (big pharma); companhia biofarmacêutica de grande porte (biofarma) e companhia pequena de pesquisa . A literatura relacionada oferece uma grande quantidade de estudos sobre alianças estratégicas e capacidades tecnológicas na indústria farmacêutica multinacional. Porém, o tema das implicações de tais alianças estratégicas para mudanças na configuração de capacidades tecnológicas ainda carece de mais fundamentação empírica, pela perspectiva de gestão de empresa e, mais precisamente, pela perspectiva de estratégia empresarial baseada em competências dinâmicas. Essa dissertação baseia-se em extensiva e sistemática coleta de evidências empíricas relativas às alianças estratégicas implementadas por 25 companhias da indústria farmacêutica e, publicadas durante o período de 1993 a 2003. Tais evidências empíricas foram coletadas a partir de três bancos de dados: Business & Industry; Galé e Dialog . Com relação aos resultados, foi encontrado que: Em termos de participações com capacidades tecnológicas ingressantes em alianças estratégicas: (i) as 'big pharmas' ingressaram com 11 % das 169 capacidades tecnológicas; (ii) as biofarmas ingressaram com 44% das 143 capacidades tecnológicas; (iii) as companhias pequenas de pesquisa ingressaram com 72% das 95 capacidades tecnológicas . 2 Em termos de implicações das alianças estratégicas para a mudança na configuração de capacidades tecnológicas que ingressaram em alianças estratégicas, foi encontrado que: (i) as 'big pharmas' aumentaram a proporção em moléculas (16% para 55%); (ii) as biofarmas aumentaram a participação em moléculas (22% para 32%) e sistema técnico-organizacional para pesquisa de molécula (49% para 55%); (iii) as companhias pequenas de pesquisa inseriram-se a uma nova atividade (comercialização de medicamento no mercado farmacêutico) a partir do aumento da participação em medicamentos (3% para 29%). Adicionalmente, atualizaram sistemas técnico-organizacionais para pesquisa de molécula . As evidências sugerem que o critério de escolha por companhia parceira e por mecanismo de aliança estratégica foi condicionado aos objetivos e às necessidades de cada grupo de companhia da indústria farmacêutica. Por fim, enquanto as companhias integradas, 'big pharmas' e biofarmas, principalmente, as primeiras, têm adaptado o modelo de negócio "Fully Integrated Pharmaceutical Company" com a adoção de alianças estratégicas para complementação de capacidades tecnológicas, as companhias pequenas de pesquisa capitalizam as suas capacidades tecnológicas através das alianças estratégicas e ingressam no mercado farmacêutico com a comercialização de medicamentos adquiridos por meio de alianças estratégicas. Portanto, as evidências sugerem que a busca por complementação de base de conhecimento para competir no mercado globalizado, tem implicado ainda que, informalmente, uma alteração na organização das atividades tecnológicas inovadoras, especialmente, em termos de produtos (medicamentos) .

Conselhos de saúde: informação, poder e política social

Esta dissertação descreve os acontecimentos molares das políticas de saüde no espaço a VIII e a IXª Conferências Nacionais de Saüde, especialmente no que se refere a participação comunitária e a controle social no sistema único de Saüde-SUS, assim como os acontecimentos moleculares na legislação e na organização do Conselho Municipal de Saúde de Joinville (Santa Catarina). A partir destas descrições são pensados os conceitos de informação, poder e política social. A política de saúde é peça estratégica na reprodução social, seja pela disciplina dos corpos, seja pelo governo da populações. A política de saúde define a sua forma e o seu modo a partir das relações de forças no espaço social. A política de saúde determina uma organização da sociedade e da circulação da informação no espaço social de comunicação. Os conselhos de saúde são locus privilegiados de discussão e de deliberação da política de saúde. Os conselhos de saúde são o locus de entendimento a partir da ética da discussão, ao mesmo tempo que são o locus de encontro de agenciamentos micro-políticos de grupos de interesse e de desejo. Os conselhos de saúde são a possibilidade viva de uma mudança na subjetividade que gira em torno do próprio conceito de saúde.

Policiamento comunitário no amazonas: ações implementadas e a percepção dos atores envolvidos

Este trabalho tem como objetivo descrever o policiamento comunitário, correlacionando com as ações implementadas no Amazonas, e analisando a percepção dos atores envolvidos no sistema de segurança pública sobre este modelo. As experiências internacionais e nacionais demonstram que a adoção deste modelo requer mudanças estruturais, administrativas e organizacionais. A participação comunitária é uma das principais características deste modelo. O sistema de segurança pública do Amazonas ainda não adota integralmente o modelo comunitário, apesar de constar em seu projeto de revitalização procedimentos semelhantes ao modelo, como interação entre a polícia civil e militar e instalação dos Conselhos Interativos Comunitários de Segurança Pública, embora estes não estejam regulados legalmente. Um fator importante neste processo diz respeito à percepção dos atores envolvidos que necessitam ter uma visão ampla sobre a atuação policial. As entrevistas realizadas com os atores envolvidos no sistema de segurança pública demonstram que o atual modelo não atende as expectativas tanto da sociedade quanto da própria instituição. O policiamento comunitário é visto como alternativa capaz de auxiliar na melhoria do sistema.

Growing research where economies grow: essays on strategy and international expansion of companies from emerging countries

In recent years, emerging countries have assumed an increasingly prominent position in the world economy, as growth has picked up in these countries and slowed in developed economies. Two related phenomena, among others, can be associated with this growth: emerging countries were less affected by the 2008-2009 global economic recession; and they increased their participation in foreign direct investment, both inflows and outflows. This doctoral dissertation contributes to research on firms from emerging countries through four independent papers. The first group of two papers examines firm strategy in recessionary moments and uses Brazil, one of the largest emerging countries, as setting for the investigation. Data were collected through a survey on Brazilian firms referring to the 2008-2009 global recession, and 17 hypotheses were tested using structural equation modeling based on partial least squares. Paper 1 offered an integrative model linking RBV to literatures on entrepreneurship, improvisation, and flexibility to indicate the characteristics and capabilities that allow a firm to have superior performance in recessions. We found that firms that pre-recession have a propensity to recognize opportunities and improvisation capabilities for fast and creative actions have superior performance in recessions. We also found that entrepreneurial orientation and flexibility have indirect effects. Paper 2 built on business cycle literature to study which strategies - pro-cyclical or counter-cyclical – enable superior performance in recessions. We found that while most firms pro-cyclically reduce costs and investments during recessions, a counter-cyclical strategy of investing in opportunities created by changes in the environment enables superior performance. Most successful are firms with a propensity to recognize opportunities, entrepreneurial orientation to invest, and flexibility to efficiently implement these investments. The second group of two papers investigated international expansion of multinational enterprises, particularly the use of distance for their location decisions. Paper 3 proposed a conceptual framework to examine circumstances under which distance is less important for international location decisions, taking the new perspective of economic institutional distance as theoretical foundation. The framework indicated that the general preference for low-distance countries is lower: (1) when the company is state owned, rather than private owned; (2) when its internationalization motives are asset, resource, or efficiency seeking, as opposed to market seeking; and (3) when internationalization occurred after globalization and the advent of new technologies. Paper 4 compared five concurrent perspectives of distance and indicated their suitability to the study of various issues based on industry, ownership, and type, motive, and timing of internationalization. The paper also proposed that distance represents the disadvantages of host countries for international location decisions; as such, it should be used in conjunction with factors that represent host country attractiveness, or advantages as international locations. In conjunction, papers 3 and 4 provided additional, alternative explanations for the mixed empirical results of current research on distance. Moreover, the studies shed light into the discussion of differences between multinational enterprises from emerging countries versus those from advanced countries.

Avaliação do programa saúde da família no Rio Grande do Norte

The Family Health Program implemented in Brazilian municipalities from 1994 represents today the most promising proposal to promote important changes in municipality`s health systems, to allow universal access to health care, comprehensiveness, equity and to promote social control, achievements provided by the health reform process and incorporated to the Unified Health System principles. However, many are the challenges imposed to the Family Health Program so that it can cause these advances. In this study, we aimed to answer the following research question: what are the results of the Family Health Program in relation to beneficiaries at small, medium and large municipalities? The hypothesis that guided this work was that the variation in levels of achievement/results (strict, impacts and effects) of the Family Health Program is related to the size of the municipalities. Therefore, our general aim was to evaluate the results of the Family Health Program in municipalities at Rio Grande do Norte, Brazil. And as specific objectives, to measure strict results, effects and impacts of the Program, from the criteria of efficiency and effectiveness on the beneficiated population, and to measure the Program`s impact on the organization of municipality`s health system. This is an impact assessment research, developed from multiple case studies with quanti-qualitative approach. The study included small municipalities (Acari and Taipu), midsize (Canguaretama and Santa Cruz) and large (Natal and Mossoró). The individuals chosen to the research were users/beneficiaries of the Program and health professionals. Data analysis was performed using descriptive statistics and content analysis compared from the Program`s logical /theoretical model. The results obtained in relation to the principles evaluated (universality, comprehensiveness and community participation) presented that municipalities show different results, although not directly related to the size, but related with characteristics of the Program`s implementation form in each municipality and the arrangements made for its operationalization. The positive effect that generated significant change in people`s lives has been linked to the increase of access and to the decrease of geographic barriers. However, to the municipal health system, regarding the changes desired by the Program, it was not observed a positive impact, but a negative impact related to the increase of barriers for the user to access other levels of the health system

Desenvolvimento Urbano e Cidades Inclusivas: Estudo Analítico do Princípio Constitucional da Função Social das Cidades

The reality of Latin America points out that the industrialization and urbanization are complementary processes associated each other. Thus, by consequence of the demographic growth, observes the aggravation of an urbanization completely disordered and without infrastructure capable of guaranteeing rights and basic services to the population. In parallel, the dissemination of information, the valorization of human dignity, promoted by social welfare, and expectations of consumption aggravates the tensions among social actors, leading to the Theory of the Right to Development to worry about the (re)construction of cities. Before this reality, the Federal Constitution of 1988 proposed a participatory urban policy, grounded in the ideal of confrontation of social exclusion of a more comprehensive, represented by the principle of the social function of cities, which must be stratified into four inclusion´s central axes, namely: the social in the strict sense, the economic, the cultural and the policy. The Analysis of each of these dimensions, keeping the focus on reality and the Brazilian legal system, composes specific objectives of this work. Thus, through deductive research, with use of technique bibliographical and interdisciplinary, this dissertation aims to make connections between social function and development, proposing an analytical concept for the proposing an analytical concept for the principle of social function of cities, through the study of its basic elements. With this, purports to demonstrate how results, firstly, that the juridical study, to fully understand the process of marginalization, must maintain multidisciplinary perspective, own social sciences. Also aims to demonstrate that the dimensions of inclusion are formed by fundamental rights, individual and collective, of liberties and of social guarantees and that without respect to all of them there is no way to talk about implementation of urban development and nor, consequently, about inclusive cities. At the end, after checking the main legal instruments of urban policy that emphasize the community participation, provided for in the Statute of the Cities, and that potentiate the breakup of the circles of exclusion, the work want contribute to the clarification and the awaken to the importance of a new perspective democratic of development in the country, grounded in the appreciation of the individual for realization of modern management, decentralized and that, therefore, inserts the effective participation of urban communities in the acting of the State

Direito fundamental à saúde: parâmetros e alternativas para sua concretização no Brasil

If, on one hand, only with the 1988 Federal Constitution the right to health began to receive the treatment of authentic fundamental social right; on the other, it is certain since then, the level of concretization reached as to such right depicts a mismatch between the constitutional will and the will of the rulers. That is because, despite the inherent gradualness of the process of concretization of the fundamental social rights, the Brazilian reality, marked by a picture of true chaos on public health routinely reported on the evening news, denatures the priority status constitutionally drew for the right to health, demonstrating, thus, that there is a clear deficit in this process, which must be corrected. This concern regarding the problem of the concretization of the social rights, in turn, is underlined when one speaks of the right to health, since such right, due to its intimate connection with the right to life and human dignity, ends up assuming a position of primacy among the social rights, presenting itself as an imperative right, since its perfect fruition becomes an essential condition for the potential enjoyment of the remaining social rights. From such premises, this paper aims to provide a proposal for the correction of this problem based upon the defense of an active role of the Judiciary in the concretization of the right to health as long as grounded to objective and solid parameters that come to correct, with legal certainty, the named deficit and to avoid the side effects and distortions that are currently beheld when the Judiciary intends to intervene in the matter. For that effect, emerges as flagship of this measure a proposition of an existential minimum specific to the right to health that, taking into account both the constitutionally priority points relating to this relevant right, as well as the very logic of the structuring of the Sistema Único de Saúde - SUS inserted within the core of the public health policies developed in the country, comes to contribute to a judicialization of the subject more in alignment with the ideals outlined in the 1988 Constitution. Furthermore, in the same intent to seek a concretization of the right to health in harmony with the constitutional priority inherent to this material right, the research alerts to the need to undertake a restructuring in the form of organization of the Boards of Health in order to enforce the constitutional guideline of SUS community participation, as well as the importance of establishing a new culture budget in the country, with the Constitution as a compass, pass accurately portray a special prioritization directed constitutional social rights, especially the right to health

Fazer a ponte para a escola de todos(as)

The purpose of this study is to understand what are the matrix elements in which everyday activities of social author/authors, actor/actors and actress/actresses are embedded, in order to carry out the Escola da Ponte s political and pedagogic process (PPP). Thus, the object of this study is to reflect on an experience developed in a public school supported by the Portuguese State within the scenario of institutions that are committed to building up a school of the people by investing in democratization and community participation in their management process. The methodological course of action was targeted at the presuppositions of qualitative research (WOODS, 1999; BURGESS, 1997; MILLS, 1982; OLIVEIRA, 1998; BOGDAN and BIKLEN, 1994; MACEDO, 2000; CASAL, 1996; GEERTZ, 2000), with data collected from random word association (MACHADO and CARVALHO, 2003), the discourse of the interviewed (KAUFMANN, 1996; SILVA, 2006; 2002), observation notes and documents (ELIAS, 1997). Based on a multiple reference and theoretical framework, the investigation revealed elements that are construed as the raw material and pillars supporting the bridge of a school of the people, as well as the self-organization of the school community which emerges as a dimension that binds together all the elements and brings new arrangements into the school dynamics by moving from the individual to the society (DUPUY, 1990). Along this line, the central argument is that in the short and long run the public school quality does not spring from macro educational policies, nor from ephemeral mass-production programs, projects or governmental policies, but from the intent of the professionals working there in becoming authors and characters in the process of building up and carrying out the PPP. The Project has been conceived in the light of the needs and intentionality of the community whose support comes from the participation and social control held by the students families and the community s power to force to action public administration central agencies aiming at having the State fulfill its responsibilities