Effectiveness of an exercise program on postural control in frail older adults

Background: Exercise programs have proved to be helpful for frail older adults. This study aimed to investigate the effects of an exercise program with a focus on postural control exercises in frail older adults. Method: Twenty-six older adults (76.7 +/- 4.9 years) deemed clinically stable, chosen from the Falls Unit, University Hospital Mutua Terrassa, Barcelona, Spain, participated in this single-group study. Volunteers' postural control was evaluated using the Timed Up and Go test (TUG) and the Guralnik test battery, and their static and dynamic posturography were evaluated using the Synapsys Posturography System (R). These evaluations were performed before and after the intervention program, which included an educational session and two weekly 1-hour sessions over an 8-week period of stretching exercises, proprioception, balance, and motor coordination. Data were analyzed using the Student's t-test or the Wilcoxon test, with a significance level of 5%. Results: The TUG and Guralnik tests did not show significant differences. Concerning static posturography, there was improvement in the base of support (P = 0.006), anteroposterior displacement with eyes open (P = 0.02) and closed (P = 0.03), and the total amplitude of the center of pressure with eyes closed (P = 0.02). Regarding dynamic posturography, a decrease of the oscillation speed in the anteroposterior direction (P = 0.01) was observed in individuals with their eyes open. Conclusion: The program used in this study was safe and was able to promote some improvement in postural control, especially in the anteroposterior direction and in the base of support. However, it is noteworthy that further improvements could be obtained from a program of longer duration and greater frequency.

Impact of a participatory program to reduce noise in a Neonatal Unit

This study evaluated the impact of a participatory program to reduce noise in a neonatal intermediate care unit of a university hospital. A time-series quasi-experimental design was used, in which sound pressure levels were measured before and after the intervention was implemented using the Quest-400 dosimeter. Non-parametric statistical tests were used to compare noise with the level of significance fixed at 5%. Results showed significant reduction of sound pressure levels in the neonatal unit after the intervention program was implemented (p<0.0001). The average Leq before the intervention was 62.5dBA and was reduced to 58.8dBA after the intervention. A reduction of 7.1dBA in the average Lmax(from 104.8 to 87.7dBA) and of 30.6dBA in the average Lpeak(from 138.1 to 107.5dBA) was observed. The program was proven to be effective in significantly reducing noise levels in the neonatal unit, although levels were still more intense than recommended.

Enhancing health care for type 2 diabetes in Northern Brazil: A pilot study of pharmaceutical care in community pharmacy

To evaluate the impact of a medication therapy management (MTM) program on the clinical outcomes and the quality of life (QoL) of a group of elderly patients with type 2 diabetes mellitus (DM). The study was conducted in a community pharmacy in Aracaju, Brazil, from February to November 2009. A quasi-experimental, longitudinal, prospective study was conducted by intervention. The group patients received medication therapy management from a clinical pharmacist. A sample of convenience was obtained for patients of both genders aged from 60 to 75 years. Monthly visits were scheduled over 10 months. At these consultations, sociodemographic, clinical data were obtained. QoL assessment was conducted using a generic instrument-the Medical Outcomes Studies 36-item Short Form Survey (SF-36 (R)). In total, 34 completed the study. The mean age of the patients was 65.9 (4.7) years. In total, 117 DRPs were identified. Patients' baseline and final evaluation measures for glycosylated hemoglobin, capillary blood glucose, blood pressure, and waist circumference were significantly different (p < 0.05). The domains of QoL assessed by the SF-36 (R) also shows significant differences between patients' baseline and final evaluation scores. The co-responsibility and active participation on the part of the elderly may have helped pharmacotherapy achieve its clinical and humanistic aims.

A behavioral intervention in a cohort of Japanese-Brazilians at high cardiometabolic risk

OBJECTIVE: To assess the effect of a health promotion program on cardiometabolic risk profile in Japanese-Brazilians. METHODS: A total of 466 subjects from a study on diabetes prevalence conducted in the city of Bauru, southeastern Brazil, in 2000 completed a 1-year intervention program (2005-2006) based on healthy diet counseling and physical activity. Changes in blood pressure and metabolic parameters in the 2005-2006 period were compared with annual changes in these same variables in the 2000-2005 period. RESULTS: During the intervention, there were greater annual reductions in mean (SD) waist circumference [-0.5(3.8) vs. 1.2(1.2) cm per year, p<0.001], systolic blood pressure [-4.6(17.9) vs. 1.8(4.3) mmHg per year, p<0.001], 2-hour plasma glucose [-1.2(2.1) vs. -0.2(0.6) mmol/L per year, p<0.001], LDL-cholesterol [-0.3(0.9) vs. -0.1(0.2) mmol/L per year, p<0.001] and Framingham coronary heart disease risk score [-0.25(3.03) vs. 0.11(0.66) per year, p=0.02] but not in triglycerides [0.2(1.6) vs. 0.1(0.42) mmol/L per year, p<0.001], and fasting insulin level [1.2(5.8) vs. -0.7(2.2) IU/mL per year, p<0.001] compared with the pre-intervention period. Significant reductions in the prevalence of impaired fasting glucose/impaired glucose tolerance and diabetes were seen during the intervention (from 58.4% to 35.4%, p<0.001; and from 30.1% to 21.7%, p= 0.004, respectively). CONCLUSIONS: A one-year community-based health promotion program brings cardiometabolic benefits in a high-risk population of Japanese-Brazilians.

Addressing schemes of self-monitoring of blood glucose in type 2 diabetes: a European perspective and expert recommendation

Self-monitoring of blood glucose (SMBG) in type 2 diabetes has increasingly been shown to display beneficial effects on glycemic control. SMBG is not only associated with a reduction of hemoglobin A1c but has also been demonstrated to increase patients' awareness of the disease. SMBG has also the potential to visualize and predict hypoglycemic episodes. International guidelines by the International Diabetes Federation, the European Society of Cardiology, and the European Association for the Study of Diabetes and also the International Society for Pediatric and Adolescent Diabetes emphasize that SMBG is an integral part of self-management. More recently, two European consensus documents have been published to give recommendations for frequency and timing of SMBG also for various clinical scenarios. Recently, a European expert panel was held to further facilitate and enhance standardized approaches to SMBG. The aim was to present simple, clinically meaningful, and standardized SMBG strategies for type 2 diabetes. The panel recommended a less intensive and an intensive scheme for SMBG across the type 2 diabetes continuum. The length and frequency of SMBG performance depend on the clinical circumstances and the quality of glycemic control. The expert panel also recommended further evaluation of various schemes for SMBG in type 2 diabetes in clinical studies.

Food Volume Computation for Self Dietary Assessment Applications

There is great demand for easily-accessible, user-friendly dietary self-management applications. Yet accurate, fully-automatic estimation of nutritional intake using computer vision methods remains an open research problem. One key element of this problem is the volume estimation, which can be computed from 3D models obtained using multi-view geometry. The paper presents a computational system for volume estimation based on the processing of two meal images. A 3D model of the served meal is reconstructed using the acquired images and the volume is computed from the shape. The algorithm was tested on food models (dummy foods) with known volume and on real served food. Volume accuracy was in the order of 90 %, while the total execution time was below 15 seconds per image pair. The proposed system combines simple and computational affordable methods for 3D reconstruction, remained stable throughout the experiments, operates in near real time, and places minimum constraints on users.

Determining acquisition and cessation antecedents to adolescent cigarette smoking for development of intervention strategies

Our national focus and emphasis on the promotion of healthy behavior choices regarding tobacco and other drugs continues to target adolescents. Multiple studies have shown that adolescence is the optimum period for the prevention of substance use initiation as life-long patterns of health behaviors are established during this critical developmental stage. Tobacco use is associated with an increase in morbid and mortal health conditions of which prevalence increases throughout the lifespan. Attention to the antecedents of preventable health conditions aims to modify the risks and identify health promotion factors. Modifying antecedent factors for tobacco initiation in youth and identifying protective factors for successful smoking cessation has major public health implications across the lifespan. Of foremost interest are those risk factors and resultant behaviors that predict a youth's probability of initiating cigarette use and their cessation of cigarette use. Specifically, this dissertation supports previous results identifying intervention variables on the initiation/cessation continuum model especially with the established predictors of smoking (decisional balance and susceptibility) and with more recently identified predictors of smoking (nicotine dependence and withdrawal symptoms) in current and former smokers in a sample of high school students in Austin and Houston, Texas. These results offer insight for the development of appropriate intervention program strategies for our youth. ^

Roadmap for implementing the Chronic Care Model for weight management: Healthcare Institution's Response to Obesity (HIRO)

Background. Excess weight and obesity are at epidemic proportions in the United States and place individuals at increased risk for a variety of chronic conditions. Rates of diabetes, high blood pressure, coronary artery disease, stroke, cancer, and arthritis are all influenced by the presence of obesity. Small reductions in excess weight can produce significant positive clinical outcomes. Healthcare organizations have a vital role to play in the identification and management of obesity. Currently, healthcare providers do not adequately diagnose and manage excess weight in patients. Lack of skill, time, and knowledge are commonly cited as reasons for non-adherence to recommended standards of care. The Chronic Care Model offers an approach to healthcare organizations for chronic disease management. The model consists of six elements that work together to empower both providers and patients to have more productive interactions: the community, the health system itself, self-management support, delivery system design, decision support, and clinical information systems. The model and its elements may offer a framework through which healthcare organizations can adapt to support, educate, and empower providers and patients in the management of excess weight and obesity. Successful management of excess weight will reduce morbidity and mortality of many chronic conditions. Purpose. The purpose of this review is to synthesize existing research on the effectiveness of the Chronic Care Model and its elements as they relate to weight management and behaviors associated with maintaining a healthy weight. Methods: A narrative review of the literature between November 1998 and November 2008 was conducted. The review focused on clinical trials, systematic reviews, and reports related to the chronic care model or its elements and weight management, physical activity, nutrition, or diabetes. Fifty-nine articles are included in the review. Results. This review highlights the use of the Chronic Care Model and its elements that can result in improved quality of care and clinical outcomes related to weight management, physical activity, nutrition, and diabetes. Conclusions. Healthcare organizations can use the Chronic Care Model framework to implement changes within their systems to successfully address overweight and obesity in their patient populations. Specific recommendations for operationalizing the Chronic Care Model elements for weight management are presented.^

An intervention mapping approach: Identification of human trafficking victims by health professionals

Background. Today modern day slavery is known as human trafficking and is a growing pandemic that is a grave human rights violation. Estimates suggest that 12.3 million people are working under conditions of force, fraud or coercion. Working toward eradication is a worthy effort; it would free millions of humans from slavery, mostly women and children, as well as uphold basic human rights. One tactic to eradicating human trafficking is to increase identification of victims among those likely to encounter victims of human trafficking.^ Purpose. This study aims to develop an intervention that improves certain stakeholders' ability, in the health clinic setting, to appropriately identify and report victims of human trafficking to the National Human Trafficking Resource Center.^ Methods. The Intervention Mapping (IM) process was used by program planners to develop an intervention for health professionals. This methodology is a six step process that guides program planners to develop an intervention. Each step builds on the others through the execution of a needs assessment, and the development of matrices based on performance objectives and determinants of the targeted health behavior. The end product results in an ecological, theoretical, and evidence based intervention.^ Discussion. The IM process served as a useful protocol for program planners to take an ecological approach as well as incorporate theory and evidence into the intervention. Consultation with key informants, the planning group, adopters, implementers, and individuals responsible for institutionalization also contributed to the practicality and feasibility of the intervention. Program planners believe that this intervention fully meets recommendations set forth in the literature.^ Conclusions. The intervention mapping methodology enabled program planners to develop an intervention that is appropriate and acceptable to the implementer and the recipients.^

Effective interventions for lowering HbA1C in African Americans with type 2 diabetes: A review

This synthesis of the literature provides descriptive analysis and outlines current self-management interventions for African Americans with type 2 diabetes. Specifically, this study describes and explores the design of those studies whose interventions have been shown to lower HbA1C levels in this population by at least 0.5% points, an improvement that provides approximately 10% reduction in long term complications from this disease.^ Results. In total, 37 articles were reviewed and 17 articles met inclusion criteria for analysis. Analysis of each study's methodology and results was performed and selected studies with interventions that resulted in improvements in HbA1C outcomes equal to 0.5% or greater for both group 1 and 2 were summarized by intervention type in table format. Descriptive analysis, outlining the number and characteristics of proximal and distal mediating components addressed in Group 1 studies, was performed in order to determine whether mediating components may have had some relation to effectiveness of intervention on outcome HbA1C. Descriptive analysis revealed that no particular design is substantially more effective than another among Behavioral studies although, there may be an advantage in using culturally sensitive, group interventions that address greater numbers of distal mediating components. Among Process studies, structured approaches (i.e. algorithm care and scheduled follow up), as well as utilization of specialty and group care are represented as effective for African American populations. ^ Conclusions. It may be summarized that by targeting behavior and addressing provider delivery (i.e. algorithm use, group care, home care, and provider follow up) in this population, a greater yield in outcome improvements may be accomplished. However, many gaps exist in a review process that stratifies results and focuses on identifying group specific intervention successes and failures. Further research in different populations will aid researchers and practitioners in discovering the best evidence, and identifying models that could be utilized in practice to achieve the best diabetes management for at risk groups.^

Nonpurging binge eaters versus nonbinge eaters and treatment retention for adult obesity

Dropout from obesity treatment has been a major factor associated with weight control failure, with few reliable predictors of dropouts or completers. Previous studies have tended to treat obese people as a homogeneous group with standard behavior modification-based interventions. Current research indicates there may be subgroups within the obese population, binge eaters and nonbinge eaters, who have different dropout rates. Current studies also recommend focusing on the subset of this subgroup that does not engage in purging (vomiting, laxative abuse, or excessive exercise) to compensate for binge eating. This research uses a secondary dataset (N = 156) from a prospective study in which participants were randomized to a Food Dependency (FD) and a Behavioral Self-Management (BSM) group for weight reduction. Criteria for subjects in the original study included (1) scoring higher on the existing Binge Eating Scale (BES) in order to ensure enrollment of more binge eaters and (2) no compensatory purging behavior for binge eating. Subjects were then reclassified in this study as binge eaters or nonbinge eaters using the more stringent proposed 1994 DSM-IV criteria for Binge Eating Disorder (BED). Subjects were followed for dropout. Variables studied were binge status, age at obesity onset, age at study baseline, class instructor, number of previous weight loss attempts, race, marital status, body mass index (BMI kg/m$\sp2$), type of intervention, work status, educational level, and social support. Stepwise backward regression Cox survival analysis indicated binge status had a consistent, statistically significant protective effect on dropout in which binge eaters were half as likely to dropout versus nonbinge eaters (p = 0.04). Cox proportional hazards analysis indicated no statistical difference in dropout by type of intervention (FD, p = 0.13; BSM, p = 0.80) when controlling for binge status. All other variables did not reach significance, which is consistent with the literature. Implications of these findings suggest that (1) the proposed 1994 DSM-IV criteria for BED is a more useful classification that the existing DSM-III-R criteria, and (2) the identification of subgroups among obese subjects is an important step in dropout and weight loss intervention research. Future research can confirm this finding. ^

Attitudes of dental students to hand hygiene practices at a dental school

Objectives. The purpose of this study was to elucidate behavioral determinants (prevailing attitudes and beliefs) of hand hygiene practices among undergraduate dental students in a dental school. ^ Methods. Statistical modeling using the Integrative Behavioral Model (IBM) prediction was utilized to develop a questionnaire for evaluating behavioral perceptions of hand hygiene practices by dental school students. Self-report questionnaires were given to second, third and fourth year undergraduate dental students. Models representing two distinct hand hygiene practices, termed "elective in-dental school hand hygiene practice" and "inherent in-dental school hand hygiene practice" were tested using linear regression analysis. ^ Results. 58 responses were received (24.5%); the sample mean age was 26.6 years old and females comprised 51%. In our models, elective in-dental school hand hygiene practice and inherent in-dental school hand hygiene practice, explained 40% and 28%, respectively, of the variance in behavioral intention. Translation of community hand hygiene practice to the dental school setting is the predominant driver of elective hand hygiene practice. Intended elective in-school hand hygiene practice is further significantly predicted by students' self-efficacy. Students' attitudes, peer pressure of other dental students and clinic administrators, and role modeling had minimal effects. Inherent hand hygiene intent was strongly predicted by students' beliefs in the benefits of the activity and, to a lesser extent, role modeling. Inherent and elective community behaviors were insignificant. ^ Conclusions. This study provided significant insights into dental student's hand hygiene behavior and can form the basis for an effective behavioral intervention program designed to improve hand hygiene compliance.^

Biomedical informatics applications for epilepsy management: A systematic review

Epilepsy is a very complex disease which can have a variety of etiologies, co-morbidities, and a long list of psychosocial factors4. Clinical management of epilepsy patients typically includes serological tests, EEG's, and imaging studies to determine the single best antiepileptic drug (AED). Self-management is a vital component of achieving optimal health when living with a chronic disease. For patients with epilepsy self-management includes any necessary actions to control seizures and cope with any subsequent effects of the condition9; including aspects of treatment, seizure, and lifestyle. The use of computer-based applications can allow for more effective use of clinic visits and ultimately enhance the patient-provider relationship through focused discussion of determinants affecting self-management. ^ The purpose of this study is to conduct a systematic literature review on informatics application in epilepsy self-management in an effort to describe current evidence for informatics applications and decision support as an adjunct to successful clinical management of epilepsy. Each publication was analyzed for the type of study design utilized. ^ A total of 68 publications were included and categorized by the study design used, development stage, and clinical domain. Descriptive study designs comprised of three-fourths of the publications and indicate an underwhelming use of prospective studies. The vast majority of prospective studies also focused on clinician use to increase knowledge in treating patients with epilepsy. ^ Due to the chronic nature of epilepsy and the difficulty that both clinicians and patients can experience in managing epilepsy, more prospective studies are needed to evaluate applications that can effectively increase management activities. Within the last two decades of epilepsy research, management studies have employed the use of biomedical informatics applications. While the use of computer applications to manage epilepsy has increased, more progress is needed.^

Treatment modalities of female Operation Iraqi Freedom/Operation Enduring Freedom Veterans with posttraumatic stress disorder: A systematic review of the literature

Objective. To review professional literature regarding treatment modalities of post-traumatic stress disorder (PTSD) amongst female Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans, to assess the efficacy of these treatment options, and to summarize implications of the findings from this literature. Design. Systematic review of published literature. Data sources. Medline, Pubmed, Psycinfo. Review Methods. Articles selected for the literature review pertain to the treatment options of female OIF or OEF veterans who have a diagnosis of PTSD. In addition, other relevant articles, such as articles that discuss the prevalence of the problem, access to care, and similar treatment modalities for PTSD in other war settings, were selected for background information for the review. Results. The search strategy identified 1,305 potential journal articles, taken from thorough searches in Medline, Pubmed, and Psycinfo. These articles were then imported into Refworks. Following final screening, there were 18 articles included in the systematic review and 28 articles used as background information. The remaining articles were excluded following screening of abstract and/or full text of articles. Treatment modalities presented in these trials include: Exposure Therapy (average of 68% reduction in PTSD symptoms), Imagery Rehearsal Therapy (23% reduction), Body-Oriented Therapy (57% reduction), Electroconvulsive Therapy (35% reduction), Holographic Reprocessing (47% reduction), a self-defense training program (13% reduction), Cognitive Behavioral Therapy (65% reduction) and a variety of pharmacotherapies (antipsychotics at 81% reduction, sympatholytic drug at 100% reduction). Outcomes of the studies included in this systematic review were measured by using personal assessment of whether there was a reduction in symptoms of PTSD, based on the results in each study. Conclusion. Overall, all of the treatment modalities investigated in the systematic review proved to be somewhat effective in relieving the burden of symptoms of PTSD amongst female veterans of OIF/OEF. In addition to pharmacotherapy, which had the highest reduction in PTSD symptoms, both the Exposure Therapy and the Cognitive Behavioral Therapy techniques proved to have the most positive results. As all of the therapies had a positive effect on this population, to some degree, a study needs to be done in the future to compare and contrast the efficacy of each therapy intervention when applied to a standardized population.^

Producción y gestión habitacional de los pobladores : articulación con la política de vivienda y barrio : trayectoria y problemática actual

Esta tesis analiza las acciones de los pobladores en la creación, consolidación y transformación de su hábitat y en su relación con la política pública de vivienda y barrio en Chile. A partir de la observación directa en terreno y de la revisión de material proveniente de diversas fuentes afirmamos que, aunque los pobladores han hecho un trabajo de producción del hábitat de gran magnitud y generalizado, las políticas públicas no han reconocido suficientemente su papel en la construcción de la ciudad, no han incorporado a cabalidad las potencialidades e innovaciones surgidas de sus prácticas y estrategias, y nunca les han abierto un espacio claro en la toma de decisiones y en la puesta en obra de los programas habitacionales. En el contexto latinoamericano, la política habitacional chilena de los últimos 20 años se ha considerado un éxito y un ejemplo a seguir, puesto que ha demostrado ser eficaz en la disminución del déficit habitacional. Sin embargo, ha tenido efectos urbanos y sociales nefastos, como la construcción de extensos bolsones periféricos de pobreza que se degradan aceleradamente, y la desintegración social que genera la expulsión de los sin casa a la periferia, donde pierden sus redes familiares y sociales. Desde una trinchera opuesta, los allegados, los sin casa que viven al alero de otras familias y representan la mayoría de la demanda por vivienda, exigen quedarse en barrios ya consolidados y evitan las periferias, en parte por mantener una red familiar y social que se sustenta en la proximidad física, en parte por los equipamientos y servicios con que cuentan estos barrios y la cercanía a las fuentes de empleo. Al mismo tiempo, los responsables de diseñar la política habitacional no han buscado establecer una forma de colaboración con los pobladores —principales receptores de la política— con el fin ajustar los programas públicos a las necesidades de las familias de bajos ingresos y a las realidades socioculturales de sus barrios. Por el contrario, han privilegiado una alianza con el sector privado, que conoce muy limitadamente las demandas de las familias. Así, en lugar de construir ciudades más justas, la política habitacional ha alimentado un mercado inmobiliario sustentado en la especulación del suelo y fomentado la industria de la construcción. La pregunta que guía esta investigación es cómo incorporar el conocimiento acumulado y los procedimientos probados por los pobladores al diseño y la implementación de programas habitacionales y urbanos que promuevan procesos de regeneración de las poblaciones y mejoren la distribución de la vivienda social en la ciudad. Sostenemos que los pobladores, a lo largo de una trayectoria de más de medio siglo, han adquirido y consolidado todas las competencias para construir vivienda, mejorar sus barrios e incorporarse a la discusión sobre ordenamiento territorial. Así, hoy están capacitados para asumir un papel protagónico en la definición de políticas públicas que apunte a la construcción de ciudades más sostenibles y equitativas. La producción social del hábitat vinculada al derecho a la ciudad y a la participación de los pobladores «desde abajo» está bastante documentada en la literatura latinoamericana. En Chile se han escrito numerosos trabajos y evaluaciones sobre la política habitacional, pero los estudios sobre el movimiento de pobladores, enfocados desde las ciencias sociales o multidisciplinares, tienen un auge primero, durante los años 60 y principios de los 70 y luego, en la segunda mitad de los 80, pero posteriormente dejan de publicarse, a excepción de algunas investigaciones de historia urbana o social. En cuanto a los estudios que abordan las acciones de los pobladores desde una mirada puesta en los resultados de la producción y la gestión habitacional y urbana, estos han sido especialmente escasos y ninguno abarca un período largo. La tesis aborda entonces las acciones específicas que emprenden los pobladores a distintas escalas territoriales —el conjunto, el barrio, la población, la ciudad y el país—, su relación con la política habitacional y su articulación con los demás actores que intervienen en la producción material del hábitat. Lo realizado por los pobladores se estudia a la luz del largo plazo, desde la promulgación de la primera ley de vivienda en 1906 hasta nuestros días, con el énfasis puesto entre los años 1990 y 2010, período de producción masiva y sostenida de vivienda social, financiada por el Estado y construida por el sector privado en la periferia urbana, y más detalladamente entre 2006 y 2010, cuando los pobladores irrumpen con la «gestión vecinal» y la «autogestión» como medios para implementar los programas habitacionales del gobierno. Para ello se recorre toda la trayectoria y se complementa con procesos particulares, a la manera de un lente de acercamiento con el cual se focalizan y amplifican trece casos de estudios, para ilustrar modos de producción y gestión concretos y mostrar cómo estos se inscriben en modos de hacer genéricos de los pobladores. Finalmente, con el lente centrado en el último ciclo de este proceso escribimos el capítulo inédito de los últimos veinte años de esta historia. Primero se realiza la reconstrucción de tres casos de estudio «en profundidad», que incluyen la génesis, la consolidación y las transformaciones del conjunto o barrio. Estos casos de estudio «en profundidad» se ponen en perspectiva reconstruyendo la trayectoria histórica de la producción y gestión realizada por los pobladores. Esta reconstrucción de largo período se profundiza con tres casos de estudio «específicos», de dimensión histórica, que tratan el conflicto del acceso a suelo. Finalmente se analizan las interrogantes que plantean estos procesos hoy en día para la producción y gestión de vivienda y barrio a futuro, a partir de entrevistas a actores claves y de la reconstrucción de siete casos de estudio «específicos» de acceso a suelo ilustrativos del período actual. La tesis sustenta que los pobladores, con las acciones de gestión y autogestión que realizan desde 2006, e interviniendo en la discusión sobre los instrumentos de planificación territorial a partir del mismo año, se sitúan actualmente en una nueva plataforma de acción y negociación desde la cual pueden incorporarse, con todas las competencias necesarias, a la definición de las políticas públicas y así dotarlas de pertinencia y coherencia para contribuir a superar la pobreza con respuestas más acorde a sus realidades. ABSTRACT This thesis analyzes the actions of pobladores in the creation, consolidation and transformation of their habitat and their relationship with Chilean public housing and neighbourhood policy. Through direct observation in the field and the review of material from various sources we can affirm that although the pobladores have undertaken widespread work in the production of their environment, public policies have not sufficiently recognized their role in the construction of the city. Public policy has failed to fully incorporate the potential and innovation arising from practices and strategies employed by social housing recipients and has never opened a clear space for them in decision-making or the commissioning work of the housing programs. Within the Latin America context, the Chilean housing policy of the past 20 years has been considered a success and an example to follow given that it has proven effective in reducing the housing deficit. However it has had disastrous urban and social effects, such as construction of large peripheral pockets of poverty that degrade rapidly, and generates social disintegration through the expulsion of the homeless to the periphery, where they lose their family and social networks. On another front those homeless who live under the roof of relatives and who represent the majority of demand for social housing, request to stay in consolidated neighbourhoods avoiding the periphery, partly to maintain family and social networks based on physical proximity and partly because of the facilities and services available in these neighbourhoods and their adjacency to sources of employment. At the same time, those responsible for designing housing policy have not sought to establish a form of collaboration with the pobladores in order to adjust the public programs to the needs of low-income families and the socio-cultural realities of their neighbourhoods. On the contrary an alliance with the private sector has been favored, a sector which has very limited knowledge of the demands of the recipients. Therefore instead of building more equal cities, housing policy has fueled a housing market which supports land speculation and promotes the construction industry. The question leading this research is how to incorporate the accumulated knowledge and proven procedures of the pobladores in the design and implementation of programs that promote housing and urban regeneration processes and which could improve the distribution of social housing in the city. We maintain that social housing recipients over the course of half a century have acquired and consolidated all the skills to build housing, improve neighborhoods and join the discussion on city planning. These residents are now capable of assuming a leading role in defining public policies that aim to build more sustainable and equitable cities. The social production of the environment linked to the right to the city and resident participation from the «bottom-up» is well documented in Latin American literature. In Chile there are extensive written works and assessments on housing policy with multidisciplinary or social science studies on the movement of the pobladores peaking during the 60’s and early 70’s and then again in the second half of the 80’s but afterwards this stops, with the exception of some research on social or urban history. As for studies that address the actions of the pobladores looking at the results of production and housing and urban management these have been particularly scarce and none of which cover a long period of time. The thesis then addresses the specific actions undertaken by the pobladores at different territorial levels; the housing development, the neighbourhood, the community, the city and State, and their relation to housing policy and its coordination with other actors involved in the production process of the built environment. The accomplishments of the pobladores is studied over the long term, since the enactment of the first housing law in 1906 to the present, with an emphasis between 1990 and 2010, a period of mass production and sustained social housing which was State-funded and built by the private sector in the urban periphery, and in particular between 2006 and 2010, when the pobladores break with the «neighborhood management» and «self-management» as a means to implement the housing programs of the government. To this end the entire process is outlined and is complemented by specific processes which are placed under a lens in order to focus and amplify thirteen case studies illustrating actual ways of production and management and to show how these ways of doing things are generic to the pobladores. Finally, with the lens focused on the last cycle of this process we write the new chapter of the last twenty years of this history. First there is a reconstruction of three case studies «in depth», including their origins, consolidation and the transformation of the sector or neighborhood. These «in depth» case studies are put into perspective reconstructing the historical trajectory of the production and management by the pobladores. This reconstruction over a long period is given great depth by three «specific» case studies, of historical importance, dealing with the conflict of access to land. Finally we analyze the questions raised by these processes for the production and management of housing and neighborhood in the future, based on interviews with key players and the reconstruction of seven case studies specifically regarding access to land and which are illustrative of current practice. The thesis maintains that since 2006 the pobladores through actions of management and selfmanagement and their intervention in the debate on territorial planning has placed them on a new platform for action and negotiation from which they can incorporate themselves, with all the necessary capacities, in the definition of public policy and therefore provide it with a pertinence and coherence to help towards overcoming poverty with answers more according to their realities.