The Temporal Landscape of Residential Aged Care Facilities – Implications for Context-Sensitive Health Technology

Health information technology (IT) can have a profound effect on the temporal flow and organisation of work. Yet research into the context, meaning and significance of temporal factors remains limited, most likely because of its complexity. This study outlines the role of communications in the context of the temporal and organizational landscape of seven Australian residential aged care facilities displaying a range of information exchange practices and health IT capacity. The study used qualitative and observational methods to identify temporal factors associated with internal and external modes of communication across the facilities and to explore the use of artifacts. The study concludes with a depiction of the temporal landscape of residential aged care particularly in regards to the way that work is allocated, prioritized, sequenced and coordinated. We argue that the temporal landscape involves key context-sensitive factors that are critical to understanding the way that humans accommodate to, and deal with health technologies, and which are therefore important for the delivery of safe and effective care.

Microbial communities in Pb contaminated boreal forest soil

Lead contamination in the environment is of particular concern, as it is a known toxin. Until recently, however, much less attention has been given to the local contamination caused by activities at shooting ranges compared to large-scale industrial contamination. In Finland, more than 500 tons of Pb is produced each year for shotgun ammunition. The contaminant threatens various organisms, ground water and the health of human populations. However, the forest at shooting ranges usually shows no visible sign of stress compared to nearby clean environments. The aboveground biota normally reflects the belowground ecosystem. Thus, the soil microbial communities appear to bear strong resistance to contamination, despite the influence of lead. The studies forming this thesis investigated a shooting range site at Hälvälä in Southern Finland, which is heavily contaminated by lead pellets. Previously it was experimentally shown that the growth of grasses and degradation of litter are retarded. Measurements of acute toxicity of the contaminated soil or soil extracts gave conflicting results, as enchytraeid worms used as toxicity reporters were strongly affected, while reporter bacteria showed no or very minor decreases in viability. Measurements using sensitive inducible luminescent reporter bacteria suggested that the bioavailability of lead in the soil is indeed low, and this notion was supported by the very low water extractability of the lead. Nevertheless, the frequency of lead-resistant cultivable bacteria was elevated based on the isolation of cultivable strains. The bacterial and fungal diversity in heavily lead contaminated shooting sectors were compared with those of pristine sections of the shooting range area. The bacterial 16S rRNA gene and fungal ITS rRNA gene were amplified, cloned and sequenced using total DNA extracted from the soil humus layer as the template. Altogether, 917 sequenced bacterial clones and 649 sequenced fungal clones revealed a high soil microbial diversity. No effect of lead contamination was found on bacterial richness or diversity, while fungal richness and diversity significantly differed between lead contaminated and clean control areas. However, even in the case of fungi, genera that were deemed sensitive were not totally absent from the contaminated area: only their relative frequency was significantly reduced. Some operational taxonomic units (OTUs) assigned to Basidiomycota were clearly affected, and were much rarer in the lead contaminated areas. The studies of this thesis surveyed EcM sporocarps, analyzed morphotyped EcM root tips by direct sequencing, and 454-pyrosequenced fungal communities in in-growth bags. A total of 32 EcM fungi that formed conspicuous sporocarps, 27 EcM fungal OTUs from 294 root tips, and 116 EcM fungal OTUs from a total of 8 194 ITS2 454 sequences were recorded. The ordination analyses by non-parametric multidimensional scaling (NMS) indicated that Pb enrichment induced a shift in the EcM community composition. This was visible as indicative trends in the sporocarp and root tip datasets, but explicitly clear in the communities observed in the in-growth bags. The compositional shift in the EcM community was mainly attributable to an increase in the frequencies of OTUs assigned to the genus Thelephora, and to a decrease in the OTUs assigned to Pseudotomentella, Suillus and Tylospora in Pb-contaminated areas when compared to the control. The enrichment of Thelephora in contaminated areas was also observed when examining the total fungal communities in soil using DNA cloning and sequencing technology. While the compositional shifts are clear, their functional consequences for the dominant trees or soil ecosystem remain undetermined. The results indicate that at the Hälvälä shooting range, lead influences the fungal communities but not the bacterial communities. The forest ecosystem shows apparent functional redundancy, since no significant effects were seen on forest trees. Recently, by means of 454 pyrosequencing , the amount of sequences in a single analysis run can be up to one million. It has been applied in microbial ecology studies to characterize microbial communities. The handling of sequence data with traditional programs is becoming difficult and exceedingly time consuming, and novel tools are needed to handle the vast amounts of data being generated. The field of microbial ecology has recently benefited from the availability of a number of tools for describing and comparing microbial communities using robust statistical methods. However, although these programs provide methods for rapid calculation, it has become necessary to make them more amenable to larger datasets and numbers of samples from pyrosequencing. As part of this thesis, a new program was developed, MuSSA (Multi-Sample Sequence Analyser), to handle sequence data from novel high-throughput sequencing approaches in microbial community analyses. The greatest advantage of the program is that large volumes of sequence data can be manipulated, and general OTU series with a frequency value can be calculated among a large number of samples.

Molecular background of three lethal fetal syndromes

This study identified the molecular defects underlying three lethal fetal syndromes. Lethal Congenital Contracture Syndrome 1 (LCCS1, MIM 253310) and Lethal Arthrogryposis with Anterior Horn Cell Disease (LAAHD, MIM 611890) are fetal motor neuron diseases. They affect the nerve cells that control voluntary muscle movement, and eventually result in severe atrophy of spinal cord motor neurons and fetal immobility. Both LCCS1 and LAAHD are caused by mutations in the GLE1 gene, which encodes for a multifunctional protein involved in posttranscriptional mRNA processing. LCCS2 and LCCS3, two syndromes that are clinically similar to LCCS1, are caused by defective proteins involved in the synthesis of inositol hexakisphosphate (IP6), an essential cofactor of GLE1. This suggests a common mechanism behind these fetal motor neuron diseases, and along with accumulating evidence from genetic studies of more late-onset motor neuron diseases such as Spinal muscular atrophy (SMA) and Amyotrophic lateral sclerosis (ALS), implicates mRNA processing as a common mechanism in motor neuron disease pathogenesis. We also studied gle1-/- zebrafish in order to investigate whether they would be a good model for studying the pathogenesis of LCCS1 and LAAHD. Mutant zebrafish exhibit cell death in their central nervous system at two days post fertilization, and the distribution of mRNA within the cells of mutant zebrafish differs from controls, encouraging further studies. The third lethal fetal syndrome is described in this study for the first time. Cocoon syndrome (MIM 613630) was discovered in a Finnish family with two affected individuals. Its hallmarks are the encasement of the limbs under the skin, and severe craniofacial abnormalities, including the lack of skull bones. We showed that Cocoon syndrome is caused by a mutation in the gene encoding the conserved helix-loop-helix ubiquitous kinase CHUK, also known as IκB kinase α (IKKα). The mutation results in the complete lack of CHUK protein expression. CHUK is a subunit of the IκB kinase enzyme that inhibits NF-κB transcription factors, but in addition, it has an essential, independent role in controlling keratinocyte differentiation, as well as informing morphogenetic events such as limb and skeletal patterning. CHUK also acts as a tumor suppressor, and is frequently inactivated in cancer. This study has brought significant new information about the molecular background of these three lethal fetal syndromes, as well as provided knowledge about the prerequisites of normal human development.

Analysis and evaluation of public health policy in Cuba : progress on millennium development goals

[EN] The main objective of this project is to analyze Cuban public health policy and the Millennium Development Goals, especially those linked to the issue of health, presenting their potential and strengths with a well-defined time horizon (2000-2015). The Millennium Development Goals are the international consensus on development and was signed as an international minimum agreement, with which began the century. The MDGs promote various goals and targets, with the corresponding monitoring indicators, which should be achieved by all countries for the present year. Health is an area that is at the center of the Millennium Development Goals, which reinforce each other to get a true human development itself. The research was done through theoretical frameworks of social production of health and disease, social justice and the power structure. A retrospective analysis of Cuban economic and social context is performed in order to study whether health-related MDGs are likely to be completed by the deadline on the island and likewise, the main parameters related to health compared with those of the neighboring countries in the Americas.

Neonatal intensive care and late preterm infants:Health and family functioning at three years

Background: Late preterm infants (LPIs), born at 34 + 0 to 36 + 6 weeks of gestation contribute a significant proportion of all neonatal intensive care (NIC) admissions and are regarded as being at risk of adverse outcomes compared to term-born infants.

Aim: To explore the health outcomes and family functioning of LPIs who required neonatal intensive care, at three years of age.

Study design and subjects: This cohort study included 225 children born late preterm, between 1 January and 31 December 2006 in Northern Ireland. Children admitted for NIC (study group, n = 103) were compared with children who did not require NIC or who required special care only for up to three days (comparison group, n = 122).

Outcome measures
Health outcomes were measured using the Health Status Questionnaire, health service usage by parent report and family functioning using the PedsQL™ Family Impact Module.

Results: LPIs who required NIC revealed similar health outcomes at three years in comparison to those who did not. Despite this, more parents of LPIs who required NIC reported visiting their GP and medical specialists during their child's third year of life. Differences in family functioning were also observed with mothers of LPIs who required NIC reporting, significantly lower levels of social and physical functioning, increased difficulties with communication and increased levels of worry.

Conclusions: LPIs were observed to have similar health outcomes at three years of age regardless of NIC requirement. The increase in GP and medical specialist visits and family functioning difficulties observed among those infants who required NIC merits further investigation.

Abbreviations: LPI, late preterm infant; NIC, neonatal intensive care; HSQ, Health Status Questionnaire; GP, general practitioner

The essence of a tacit intersection : a heuristic inquiry into nature-based leisure and personal transformation

There are a considerable number of programs and agencies that count on the existence of a unique relationship between nature and human development. In addition, there are significant bodies of literature dedicated to understanding developmentally focused nature-based experiences. This research project was designed to flirther the understanding of this phenomenon. Consequently, the purpose of this research endeavour was to discover the essence ofthe intersection ofpersonal transformation and nature-based leisure, culminating in a rich and detailed account of this otherwise tacit phenomenon. As such, this research built on the assumption of this beneficial intersection of nature and personal transformation and contributes to the understanding ofhow this context is supporting or generating of selfactualization and positive development. Heuristic methods were employed because heuristics is concerned with the quality and essence of an experience, not causal relationships (Moustakas, 1990). Heuristic inquiry begins with the primary researcher and her personal experience and knowledge of the phenomenon. This study also involved four other coresearchers who had also experienced this phenomenon intensely. Co-researchers were found through purposeful and snowball sampling. Rich narrative descriptions of their experiences were gathered through in-depth, semi-structured interviews, and artifact elicitation was employed as a means to get at co-researchers' tacit knowledge. Each coresearcher was interviewed twice (the first interview focused on personal transformation, the second on nature) for approximately four and a half hours in total. Transcripts were read repeatedly to discern patterns that emerged from the study of the narratives and were coded accordingly. Individual narratives were consolidated to create a composite narrative of the experience. Finally, a creative synthesis was developed to represent the essence of this tacit experience. In conclusion the essence of the intersection of nature-based leisure and personal transformation was found to lie in the convergence of the lived experience of authenticity. The physical environment of nature was perceived and experienced to be a space and context of authenticity, leisure experiences were experienced as an engagement of authenticity, and individuals themselves encountered a true or authentic self that emanated from within. The implications of these findings are many, offering suggestions, considerations and implications from reconsidered approaches to environmental education to support for selfdirected human development.

Electronic waste governance: sustainable solutions to a global dilemma

Le présent mémoire a pour objet les formes, les caractéristiques et les défis de la gouvernance des déchets électroniques. L’auteure explore les impactes socioéconomiques et environnementales de divers types d’instruments conçus pour mitiger les risques à la santé humaine et à l’environnement que présentent les produits électroniques en fin de vie, notamment: les traités multilatéraux qui visent à prohiber le transfert des déchets hasardeux au pays en développement, les législations régionales, nationales et provinciales mettant en vigueur des systèmes de recyclage obligatoire des déchets électroniques, ainsi que d’autres initiatives, publics et privées, basées sur le principe de la responsabilité élargie des producteurs (REP). L’objectif de ce travail est de comprendre comment les acteurs impliqués dans le commerce de l’équipement électronique peuvent modeler les systèmes de production, d’usage et du traitement fin de vie des technologies contemporaines pour que ces dernières puissent continuer à faire élever les standards de vie et à avancer le développement des communautés humaines, en respectant simultanément le principe international de l’équité globale, l’environnement naturel et la qualité de vie des générations futures.

Morbilidad laboral en el sector agrícola en trabajadores afiliados a una administradora de riesgos laborales (ARL) de Colombia, durante el periodo 2011-2012.

Este estudio muestra la prevalencia por enfermedad laboral de un grupo de trabajadores afiliados a una ARL en Colombia. Compara la morbilidad laboral entre dos grupo de trabajadores expuestos y no expuestos al trabajo agrícola y al interior del grupo de trabajadores agrícolas agrupados en las actividades de corte de caña, cultivo de banano y flores. Se realizó un estudio descriptivo de tipo transversal durante el periodo 2011-2012, mediante la revisión de una base de datos de morbilidad laboral. Se realizó un análisis uni-variado y Bi-variado y se comparó la morbilidad con datos sociodemográficos, grupos de trabajadores agrícolas y no agrícolas, y actividad productiva del sector agrícola. Se revisaron 3129 diagnósticos de enfermedad profesional durante el periodo de estudio, 433 diagnósticos fueron trabajadores agrícolas y 2696 pertenecieron a otros grupos de trabajadores. Los desórdenes Osteomusculares fueron los diagnósticos más prevalentes en el grupo Agro 92% y No Agro 86% y en las actividades de corte de caña, cultivo de banano y flores. Entre el grupo Agrícola y no agrícola se encontraron diferencias significativas en los siguientes diagnósticos: Síndrome del túnel del carpo, Síndrome de manguito rotador, Otras sinovitis y tenosinovitis, Lumbago no Especificado, Hipoacusia Neurosensorial Bilateral y epicondilitis lateral; de igual manera se encontraron diferencias entre las actividades de corte de caña y cultivo de banano y flores en los diagnósticos de: Epicondilitis, Sinovitis, Síndrome del túnel del Carpo y Trastorno lumbar. El factor de riesgo más prevalente en el grupo agrícola fue el Ergonómico con el 92.8% de los casos

Métodos de análisis de las comunidades de clientes mediante la relación estratégica comunitaria y el marketing.

En este proyecto analizaremos como las organizaciones se relacionan con el medio y marketing. La idea es determinar cuáles son los métodos de análisis de las comunidades de clientes mediante la relación estratégica comunitaria y el marketing. Por medio del mercadeo se puede conocer el entorno y determinar qué métodos de análisis utilizar para conocer a la comunidad de clientes. Las personas de mercadeo se ocupan de todo lo que ocurre en el entorno, de estar al tanto para saber cuándo hay oportunidades que puedan ser provechosas para la organización o por otro lado cuando hay amenazas de las que debe tener cuidado. Dependiendo del entorno, la organización diseña sus actividades de mercadeo enfocadas en satisfacer las necesidades del consumidor. Las actividades del consumidor se conceptualizan en producto, precio, promoción y plaza que se definen y diseñan basados en la comunidad en la que este inmersa la organización. Es importante buscar información confiable sobre el grupo objetivo al cual se le va ofrecer el producto o servicio, ya que toca analizarlos y comprender a estas personas para diseñar una buena oferta que satisfaga sus necesidades y deseos. Esta persona que recibe el producto o servicio por parte de la organización es el cliente. Los clientes son las personas que llegan a una organización en búsqueda de satisfacer necesidades a través de los bienes y servicios que las empresas ofrecen. Es esencial determinar que los clientes viven en comunidad, es decir comparten ideas por la comunicación tan estrecha que tienen y viven en conjunto bajo las mismas costumbres. Debido a estos es que hoy en día, los consumidores se conglomeran en comunidades de clientes, y para saberles llegar a estos clientes, toca analizarlos por medio de diversos métodos. El uso de las estrategias comunitarias es necesario ya que por medio del marketing se analiza el entorno y se buscan los métodos para analizar a la comunidad de clientes, que comparten características y se analizan en conjunto no por individuo. Es necesario identificar los métodos para relacionarse con la comunidad de clientes, para poder acercarnos a estos y conocerlos bien, saber sus necesidades y deseos y ofrecerles productos y servicios de acuerdo a éstos. En la actualidad estos métodos no son muy comunes ni conocidos, es por esto que nuestro propósito es indagar e identificar estos métodos para saber analizar a las comunidades. En este proyecto se utilizara una metodología de estudio tipo teórico-conceptual buscando las fuentes de información necesarias para llevar a cabo nuestra investigación. Se considera trabajar con El Grupo de Investigación en Perdurabilidad Empresarial y se escogió la línea de gerencia ya que permite entrar en la sociedad del conocimiento, siendo capaces de identificar oportunidades gerenciales en el entorno. Es interesante investigar sobre estos métodos, ya que los clientes esperan un servicio excelente, atento y que se preocupe por ellos y sus necesidades.

Actitudes hacia el VIH/SIDA, el cáncer y la enfermedad de Alzheimer

Esta revisión de la literatura tuvo como objetivo describir las actitudes hacia el VIH/SIDA, el cáncer y la Enfermedad de Alzheimer desde el modelo tripartito. Se revisaron 109 artículos publicados entre 2005 y 2015 en algunas bases de datos especializadas y herramientas de análisis de impacto. También se incluyeron fuentes secundarias ampliándose la búsqueda a los últimos 20 años (1995-2015). Los resultados mostraron que la mayoría de los estudios realizados sobre las actitudes hacia estas tres enfermedades son de tipo cuantitativo y la información se analizó con base en los componentes del modelo tripartito. Algunos aspectos sociodemográficos como el sexo y la edad están asociados con las actitudes hacia las tres enfermedades y predominan las creencias erróneas sobre ellas respecto a sus causas, curso y tratamiento. También predominan actitudes negativas hacia las tres enfermedades y las conductas e intenciones conductuales son diversas hacia cada una de ellas. No se hallaron antecedentes empíricos del estudio de la estructura de las actitudes propuesta por el modelo tripartito hacia las tres enfermedades. La Salud Pública ha liderado la investigación con base en el modelo de conocimientos, actitudes y prácticas propuesto por la OMS.