Blood pressure values and depression in hypertensive individuals at high cardiovascular risk

[EN]Hypertension and depression are both important risk factors for cardiovascular diseases. Nevertheless, the association of blood pressure on and depression has not been completely established. This study aims to analyze whether depression may influence the control of blood pressure in hypertensive individuals at high cardiovascular risk

My Attitudes and Beliefs about Different Types of Research

[Excerpt] In this issue’s “From the Editor,” I describe a new review policy and process for both authors and reviewers. Authors should find that this new policy and process provides them with faster editorial decisions, higher quality feedback, and greater clarity about required revisions, as well as greater freedom to disagree with reviewers and to write the papers they (the authors) want. Reviewers should find that this new policy and process saves them from having to review obviously flawed papers and from having to review different versions of the same paper over and over again.

Indigenous Māori values and perspectives to inform freshwater management in Aotearoa-New Zealand

In response to widespread water quality and quantity issues, the New Zealand Government has recently embarked on a number of comprehensive freshwater management reforms, developing a raft of national discussion and policy documents such as “Freshwater Reform 2013 and Beyond” and a National Policy Statement for freshwater management (NPS-FM 2014). Recent resource management reforms and amendments (RMA 2014), based on previous overarching resource management legislation (RMA 1991), set out a new approach and pathway to manage freshwater nationwide. Internationally, there is an increasing trend to engage with indigenous communities for research and collaboration, including indigenous groups as active participants in resource management decision making. What is driving this change toward more engagement and collaboration with indigenous communities is different for each country, and we document the progress and innovation made in this area in New Zealand. The indigenous rights of Māori in New Zealand are stated in the 1840 Treaty of Waitangi and in many forms of New Zealand's legislation. Local and central governments are eager to include local indigenous Māori groups (iwi/hapū) in freshwater management planning processes through meaningful engagement and collaboration. Key to the success of collaborative planning processes for Māori are enduring relationships between local government and Māori, along with adequate resourcing for all partners contributing to the collaborative process. A large number of shared governance and management models for natural resource management have emerged in New Zealand over the past 20 years, and some recent examples are reviewed. We provide some discussion to improve understanding and use of the terms used in these management models such as cogovernance, comanagement, and coplanning, and describe some of the more important frameworks and tools being developed with Māori groups (e.g., iwi/hapū), to strengthen Māori capacity in freshwater management and to support good collaborative process and planning.

How far student´s perceptions, attitudes and beliefs have incidence on english learning at languages center of La Salle University

Tesis (Licenciado en Lenguas Castellana, Inglés y Francés).--Universidad de La Salle. Facultad de Ciencias de La Educación. Licenciatura en Lengua Castellana, Inglés y Francés, 2013

Maxmin with multiple tastes and beliefs

Tese (doutorado)—Universidade de Brasília, Departamento de Economia, Brasília, 2016.

Rational choice, social identity, and beliefs about oneself

Social identity poses one of the most important challenges to rational choice theory, but rational choice theorists do not hold a common position regarding identity. On one hand, externalist rational choice ignores the concept of identity or reduces it to revealed preferences. On the other hand, internalist rational choice considers identity as a key concept in explaining social action because it permits expressive motivations to be included in the models. However, internalist theorists tend to reduce identity to desire—the desire of a person to express his or her social being. From an internalist point of view, that is, from a viewpoint in which not only desires but also beliefs play a key role in social explanations as mental entities, this article rejects externalist reductionism and proposes a redefinition of social identity as a net of beliefs about oneself, beliefs that are indexical, robust, and socially shaped.

Um olhar sobre a surdez: uma história de vida

Dissertação de mestrado em Educação Especial (área de especialização em Intervenção Precoce)

Speech by Mr. Micheál Martin TD – Meeting The Challenges Of Cultural Diversity In The Irish Healthcare Sector

It gives me great pleasure to accept the invitation to address this conference on “Meeting the Challenges of Cultural Diversity in the Irish Healthcare Sector” which is being organised by the Irish Health Services Management Institute in partnership with the National Consultative Committee on Racism and Interculturalism. The conference provides an important opportunity to develop our knowledge and understanding of the issues surrounding cultural diversity in the health sector from the twin perspectives of patients and staff. Cultural diversity has over recent years become an increasingly visible aspect of Irish society bringing with it both opportunities and challenges. It holds out great possibilities for the enrichment of all who live in Ireland but it also challenges us to adapt creatively to the changes required to realise this potential and to ensure that the experience is a positive one for all concerned but particularly for those in the minority ethnic groups. In the last number of years in particular, the focus has tended to be on people coming to this country either as refugees, asylum seekers or economic migrants. Government figures estimate that as many as 340,000 immigrants are expected in the next six years. However ethnic and cultural diversity are not new phenomena in Ireland. Travellers have a long history as an indigenous minority group in Ireland with a strong culture and identity of their own. The changing experience and dynamics of their relationship with the wider society and its institutions over time can, I think, provide some valuable lessons for us as we seek to address the more numerous and complex issues of cultural diversity which have arisen for us in the last decade. Turning more specifically to the health sector which is the focus of this conference, culture and identity have particular relevance to health service policy and provision in that The first requirement is that we in the health service acknowledge cultural diversity and the differences in behaviours and in the less obvious areas of values and beliefs that this often implies. Only by acknowledging these differences in a respectful way and informing ourselves of them can we address them. Our equality legislation – The Employment Equality Act, 1998 and the Equal Status Act, 2000 – prohibits discrimination on nine grounds including race and membership of the Traveller community. The Equal Status Act prohibits discrimination on an individual basis in relation to the nine grounds while for groups it provides for the promotion of equality of opportunity. The Act applies to the provision of services including health services. I will speak first about cultural diversity in relation to the patient. In this respect it is worth mentioning that the recognition of cultural diversity and appropriate responses to it were issues which were strongly emphasised in the public consultation process which we held earlier this year in the context of developing National Anti-Poverty targets for the health sector and also our new national health strategy. Awareness and sensitivity training for staff is a key requirement for adapting to a culturally diverse patient population. The focus of this training should be the development of the knowledge and skills to provide services sensitive to cultural diversity. Such training can often be most effectively delivered in partnership with members of the minority groups themselves. I am aware that the Traveller community, for example, is involved in in-service training for health care workers. I am also aware that the National Consultative Committee on Racism and Interculturalism has been involved in training with the Eastern Regional Health Authority. We need to have more such initiatives. A step beyond the sensitivity training for existing staff is the training of members of the minority communities themselves as workers in our health services. Again the Traveller community has set an example in this area with its Primary Health Care Project for Travellers. The Primary Health Care for Travellers Project was established in 1994 as a joint partnership initiative with the Eastern Health Board and Pavee Point, with ongoing technical assistance being provided from the Department of Community Health and General Practice, Trinity College, Dublin. This project was the first of its kind in the country and has facilitated The project included a training course which concentrated on skills development, capacity building and the empowerment of Travellers. This confidence and skill allowed the Community Health Workers to go out and conduct a baseline survey to identify and articulate Travellers’ health needs. This was the first time that Travellers were involved in this process; in the past their needs were assumed. The results of the survey were fed back to the community and they prioritised their needs and suggested changes to the health services which would facilitate their access and utilisation. Ongoing monitoring and data collection demonstrates a big improvement in levels of satisfaction and uptake and ulitisation of health services by Travellers in the pilot area. This Primary Health Care for Travellers initiative is being replicated in three other areas around the country and funding has been approved for a further 9 new projects. This pilot project was the recipient of a WHO 50th anniversary commemorative award in 1998. The project is developing as a model of good practice which could inspire further initiatives of this type for other minority groups. Access to information has been identified in numerous consultative processes as a key factor in enabling people to take a proactive approach to managing their own health and that of their families and in facilitating their access to health services. Honouring our commitment to equity in these areas requires that information is provided in culturally appropriate formats. The National Health Promotion Strategy 2000-2005, for example, recognises that there exists within our society many groups with different requirements which need to be identified and accommodated when planning and implementing health promotion interventions. These groups include Travellers, refugees and asylum seekers, people with intellectual, physical or sensory disability and the gay and lesbian community. The Strategy acknowledges the challenge involved in being sensitive to the potential differences in patterns of poor health among these different groups. The Strategic aim is to promote the physical, mental and social well-being of individuals from these groups. The objective of the Strategy on these issues are: While our long term aim may be to mainstream responses so that our health services is truly multicultural, we must recognise the need at this point in time for very specific focused responses particularly for groups with poor health status such as Travellers and also for refugees and asylum seekers. In the case of refugees and asylum seekers examples of targeted services are screening for communicable diseases – offered on a voluntary basis – and psychological support services for those who have suffered trauma before coming here. The two approaches of targeting and mainstreaming are not mutually exclusive. A combination of both is required at this point in time but the balance between them must be kept under constant review in the light of changing needs. A major requirement if we are to meet the challenge of cultural diversity is an appropriate data and research base. I think it is important that we build up our information and research data base in partnership with the minority groups themselves. We must establish what the health needs of diverse groups are; we must monitor uptake of services and how well we are responding to needs and we must monitor outcomes and health status. We must also examine the impact of the policies in other sectors on the health of minority groups. The National Health Information Strategy, currently being developed, and the recently published National Strategy for Health Research – Making Knowledge Work for Health provide important frameworks within which we can improve our data and research base. A culturally diverse health sector workforce – challenges and opportunities The Irish health service can benefit greatly from successful international recruitment. There has been a strong non-national representation amongst the medical profession for more than 30 years. More recently there have been significant increases in other categories of health service workers from overseas. The Department recognises the enormous value that overseas recruitment brings over a wide range of services and supports the development of effective and appropriate recruitment strategies in partnership with health service employers. These changes have made cultural diversity an important issue for all health service organisations. Diversity in the workplace is primarily about creating a culture that seeks, respects, values and harnesses difference. This includes all the differences that when added together make each person unique. So instead of the focus being on particular groups, diversity is about all of us. Change is not about helping “them” to join “us” but about critically looking at “us” and rooting out all aspects of our culture that inappropriately exclude people and prevent us from being inclusive in the way we relate to employees, potential employees and clients of the health service. International recruitment benefits consumers, Irish employees and the overseas personnel alike. Regardless of whether they are employed by the health service, members of minority groups will be clients of our service and consequently we need to be flexible in order to accommodate different cultural needs. For staff, we recognise that coming from other cultures can be a difficult transition. Consequently health service employers have made strong efforts to assist them during this period. Many organisations provide induction courses, religious facilities (such as prayer rooms) and help in finding suitable accommodation. The Health Service Employers Agency (HSEA) is developing an equal opportunities/diversity strategy and action plans as well as training programmes to support their implementation, to ensure that all health service employment policies and practices promote the equality/diversity agenda to continue the development of a culturally diverse health service. The management of this new environment is extremely important for the health service as it offers an opportunity to go beyond set legal requirements and to strive for an acceptance and nurturing of cultural differences. Workforce cultural diversity affords us the opportunity to learn from the working practices and perspectives of others by allowing personnel to present their ideas and experience through teamwork, partnership structures and other appropriate fora, leading to further improvement in the services we provide. It is important to ensure that both personnel units and line managers communicate directly with their staff and demonstrate by their actions that they intend to create an inclusive work place which doesn´t demand that minority staff fit. Contented, valued employees who feel that there is a place for them in the organisation will deliver a high quality health service. Your conference here today has two laudable aims – to heighten awareness and assist health care staff to work effectively with their colleagues from different cultural backgrounds and to gain a greater understanding of the diverse needs of patients from minority ethnic backgrounds. There is a synergy in these aims and in the tasks to which they give rise in the management of our health service. The creative adaptations required for one have the potential to feed into the other. I would like to commend both organisations which are hosting this conference for their initiative in making this event happen, particularly at this time – Racism in the Workplace Week. I look forward very much to hearing the outcome of your deliberations. Thank you.

Cos i espiritualitat : in-corporant rituals i creences en les noves formes de religiositat

El fenomen de les noves religions posa de relleu la importància del cos i les emocions com a elements constitutius de la subjectivitat. En aquest treball s'estudia el procés de construcció de la identitat espiritual, a través de la in-corporació de nous valors i creences, i de la corporeïtzació dels rituals. Es parteix d'una aproximació etnogràfica, a través d'un treball de camp al sí d'un grup d'orientació oriental. A partir de l'observació participant i la celebració d'entrevistes, es proposa analitzar com es forja l'espiritualitat. En tant que experiència corporal, es posa de manifest la rellevància de les emocions en els processos d'interacció i socialització de la persona en un grup donat.

Dynamics of IS Adaptation in Multinational Corporations: A New Theoretical Lens

The specificities of multinational corporations (MNCs) have to date not been a focus area of IS research. Extant literature mostly proposes IS configurations for specific types of MNCs, following a static and prescriptive approach. Our research seeks to explain the dynamics of global IS design. It suggests a new theoretical lens for studying global IS design by applying the structural adjustment paradigm from organizational change theories. Relying on archetype theory, we conduct a longitudinal case study to theorize the dynamics of IS adaptation. We find that global IS design emerges as an organizational adaptation process to balance interpretative schemes (i.e. the organization's values and beliefs) and structural arrangements (i.e. strategic, organizational, and IS configurations). The resulting insights can be used as a basis to further explore alternative global IS designs and movements between them.

Literature review on advance care planning of nursing home residents

Aim: Conduct a search and analytic review of literature regarding attributes of Advance Care Planning (ACP) and Advance Directive in order to identify the experiences and the best care strategies for older adults resident in nursing homes or long term institutions. Methodology: An extensive electronic search was undertaken in the following databases: Pubmed (via Ovid search), Cumulative Index of Nursing and Allied Health (CINAHL, via EBHOST), psychINFO and Cochrane. After analyzing and eliminating duplicates and professional's point of view (19), 144 titles were considered relevant: 28 opinion papers, 94 descriptive/qualitative studies or predictive studies, 17 experimental and five systematic reviews. Most of them were produced in North America and only 10 were in French. Results: With regard to European experiences, studies are scarce and further research could benefit from North American evidence. Contrary to Europe, nurses in North America play a major role in the process of care planning. The major findings were related to the poor efficacy of the completion of Advance Directives, even in presence of a substantial variety of implementation strategies. The evidence supports interventions that conceptualize ACP as a process, with an emphasis on the ascertainment of patients' values and beliefs and the necessity to include the family or loved ones from the beginning of the process in order to favor the expression and sharing of one's life perspectives and priorities in care. The most relevant findings were associated with the conceptualization of the ACP as a change in health behaviors which needs an involvement in different stages to overcome a variety of barriers. Conclusion: Rigorous research in ACP for the older adults in Swiss nursing homes that promote respect and dignity in this frail population is needed. How to best achieve patients and families goals should be the focus of nursing intervention and research in this domain.

Wellspring: an intrinsic case study of community-based education for adults living with cancer /

This paper presents education research as vital to addressing the issues faced by adults living with cancer. This qualitative study looked at philosophies of practice for cancer patient education. It was about understanding how values and beliefs shape the way program planners and managers operationalize their knowledge of adult education and how this has significant impact on meeting the needs of those touched by cancer. Improved technology has extended life expectancy, so that Canadians living with cancer, or even dying with cancer now spend less time in direct medical care. The notion of cancer as simply a medical concern is outdated. This study found that informational and support needs of adults living with cancer are often unmet, ignored or unknown. This research investigated a community-based education initiative that is inviting, accessible, and promotes a sense of hope. More specifically, this case study uncovered factors contributing to the success of Wellspring, a grass-roots cancer patient support centre which has been recognized nationally for its ability to effectively meet the diverse non-medical supportive care needs of as many cancer patients and caregivers as possible. Therefore, Wellspring was selected as a case study. Educating people to take charge of their own lives and supporting them in making informed decisions about their lifestyle choices made Wellspring part of a social action movement that focused on improving social attitudes toward people living with cancer. Results of this descriptive inquiry and philosophical inquiry evolved into data that was used to devise an organic model of community-based education that encompasses Adler's (1993) four dimensions of philosophy within a socio-cultural context.

La dimension humaine des enjeux environnementaux dans un bassin versant au Brésil

RÉSUMÉ La richesse en ressources naturelles est une source de développement économique et social, mais peut également constituer un facteur de dégradation environnementale et de problèmes pour la santé humaine. Les systèmes techniques de gestion des ressources naturelles ne sont pas suffisants pour apporter des solutions à tous les problèmes environnementaux. Mises à part les catastrophes naturelles, c'est l'intervention humaine qui cause la grande majorité des problèmes environnementaux. C'est pour comprendre cette dynamique entre les facteurs naturels et les facteurs économiques, sociaux, politiques, culturels et psychosociologiques que nous avons choisi de centrer cette thèse sur la dimension humaine des problèmes environnementaux – ce qui implique l'analyse des dimensions psychosociologiques et sociales entourant les problèmes environnementaux. Pour une gestion efficace des ressources naturelles, il nous faut donc comprendre l'action humaine, ses motivations et ses contraintes, ses orientations de valeurs et ses croyances, qui orientent les perceptions, les attitudes et les comportements humains par rapport à leur environnement. Pour ce faire, l’étude de valeurs, attitudes, croyances et comportements passe par l’examen attentif des concepts et de leurs définitions, ainsi que par l’analyse des diverses « dimensions » auxquelles chacun des concepts fait référence. Cette thèse porte justement sur les relations entre les valeurs, les croyances, les attitudes et les comportements humains par rapport aux problèmes environnementaux. Pour ce faire, nous avons utilisé un sondage auprès de 1800 répondants, habitants de la région du bassin versant de la Rio das Velhas, située dans la province du Minas Gerais, au Brésil.

Processus de facilitation d'une pratique réflexive, de type codéveloppement, auprès d'infirmières pivots en oncologie et son influence sur leur pratique professionnelle

Deux catégories de compétences influenceraient toute pratique professionnelle, les compétences disciplinaires et relationnelles. Selon le cadre théorique de ce projet, la pratique réflexive (PR) aiderait le professionnel à développer les compétences relationnelles, grâce à l’approfondissement de sa conscience et de son autocritique des composantes tacites de sa pratique, telles que ses valeurs et principes, ses perceptions et ses stratégies d’action, afin de les rendre plus efficaces et satisfaisantes lors de la résolution de problèmes. Dans cette étude, la PR souhaitait aider un groupe d’infirmières pivots en oncologie (IPO) à réfléchir et agir sur les composantes de leur pratique qui contribuaient à certaines difficultés relationnelles persistantes vécues auprès de gestionnaires, collègues et familles et qui, selon les IPO, avaient un impact sur l’expérience de santé de familles touchées par le cancer. Toutefois, la recension des écrits effectuée dans cette recherche soutient qu’il y a un nombre insuffisant d’études qui a trait à l’influence d’une PR sur la pratique infirmière et, plus encore, sur le développement des compétences relationnelles des infirmières. Les écueils théoriques et méthodologiques suivants ont entre autres été rapportés: la PR étudiée ne reposait pas toujours sur un modèle théorique clair et le but poursuivi par la PR n’était pas toujours énoncé; aucune recherche n’a documenté de quelle manière la PR s’était développée et, une fois acquise, de quelle façon elle avait contribué aux résultats; et, enfin, aucune étude recensée n’a exploré l’influence d’une PR intégrée par l’infirmière, en tenant compte de la perspective de familles qui bénéficiaient de leurs soins. Considérant ces principaux écueils, cette étude a privilégié la recherche-action participative afin de documenter la facilitation d’une PR et son influence sur les compétences relationnelles d’IPO et sur d’autres dimensions à la fois personnelles, organisationnelles et cliniques. Six IPO ont pris part à l’intervention de l’étude d’une durée d’un an. Cinq collègues des équipes de soins et douze membres de familles touchées par le cancer ont participé à l’évaluation de son influence. Les résultats de cette recherche portent à croire que les IPO qui développent une PR plus profonde, c’est-à-dire jusqu’à leurs sentiments et besoins internes, parviennent à établir des relations plus mutuelles auprès de collègues et de familles, grâce à des changements importants réalisés sur le plan de leurs valeurs et principes, de leurs perceptions et de leurs stratégies d’action. Les résultats de l’étude soutiennent aussi que ces changements au sein de la pratique infirmière génèrent des effets positifs. Les IPO ont parlé d’une plus grande satisfaction liée à leur travail et de bienfaits sur leur santé. La majorité des IPO et des participantes-collègues de l’étude ont rapporté un climat de travail plus calme et des processus d’équipe plus satisfaisants lors, par exemple, de la résolution de problèmes. Enfin, lorsque les IPO intégraient une approche plus mutuelle, des familles rapportaient une atténuation de leur inquiétude ou de leur détresse psychologique, une plus grande capacité de donner du sens à leur expérience de cancer, une qualité accrue de leur communication intrafamiliale ou avec l’équipe soignante.

Multiculturalisme et respect de soi : une défense libérale du droit à un contexte de valorisation

Alors que la plupart des théories libérales ont mis l’accent sur les principes de justice, et sur une conception de la justice qui nous fait penser la société et les relations individuelles de manière de plus en plus abstraite, les réflexions sur le respect de soi nous portent plutôt vers ce qui est essentiel à la valeur et l’importance de l’identité des personnes et de leurs relations sociales. Ces réflexions nous révèlent que non seulement les principes de justice ne sont pas la seule source de respect, mais que tant les cultures et les religions que les communautés morales et les groupes compréhensifs ont des rôles fondamentaux pour le niveau de respect de soi et de respect mutuel que les individus éprouvent envers eux-mêmes et envers les autres. Si les projets de vie, les valeurs et les croyances des individus sont révélés comme fondamentaux à leur autonomie et leur vie comme individu, les réflexions sur le multiculturalisme et le pluralisme révèlent les difficultés de notre temps : comment une société peut-elle promouvoir le respect de soi des individus dans un tel contexte de diversité morale, compréhensive, religieuse, etc.? Critiquant les théories de John Rawls, Will Kymlicka, ainsi que certains arguments de philosophes tels que Bhiku Parekh et David Miller, la thèse défendue dans ce mémoire prend la position très forte qu’une société doit donner beaucoup plus de moyens aux individus pour que leur respect de soi soit favorisé. La thèse centrale est que les individus ont tous le droit à un contexte de valorisation, soit un espace politique propre à une communauté ou un groupe et qui inclut les institutions et les pouvoirs nécessaires pour que le respect de soi des membres de ces groupes puisse être favorisé. C’est seulement par un tel droit et par les revendications structurelles et institutionnelles qui s’y rapportent que les groupes culturels et religieux, ainsi que les communautés morales et les groupes compréhensifs peuvent être reconnus politiquement et qu’une théorie libérale et multiculturelle des individus et des groupes puisse concilier idéal et réalité.