Home Accident Prevention Strategy

The overall aim of the strategy is “To reduce the number of accidental deaths and injuries in the home.” OBJECTIVES OF THE STRATEGY The key objectives are: • to reduce home accidents, particularly in those most at risk; • to raise awareness of the causes of home accidents and promote effective preventative measures to reduce such accidents; • to promote and facilitate effective training, skills and knowledge in home accident prevention across all relevant organisations, groups and individuals. These objectives will be met through integrated and effective approaches including: • education and information programmes to promote home safety, and promote a change in public behaviour towards home accident prevention; and • the use of evidence based practice, models of good practice, and by evaluating home accident prevention initiatives. OUTCOMES If successful, implementation of this strategy will lead to a reduction in the number of home accidents and contribute to the outcome “reduction in preventable deaths and diseases and improvement in wellbeing” set out in the Northern Ireland Priorities and Budget 2004-2006.

Can You Home Again? Desertion and Control of Hometowns in Civil Wars

What allows an armed group in a civil war to prevent desertion? This paper addresses this question with a focus on control in the rearguard. Most past studies focus on motivations for desertion. They explain desertion in terms of where soldiers stand in relation to the macro themes of the war, or in terms of an inability to provide positive incentives to overcome the collective action problem. However, since individuals decide whether and how to participate in civil wars for multiple reasons, responding to a variety of local conditions in an environment of threat and violence, a focus only on macro-level motivations is incomplete. The opportunities side of the ledger deserves more attention. I therefore turn my attention to how control by an armed group eliminates soldiers’ opportunities to desert. In particular, I consider the control that an armed group maintains over soldiers’ hometowns, treating geographic terrain as an important exogenous indicator of the ease of control. Rough terrain at home affords soldiers and their families and friends advantages in ease of hiding, the difficulty of using force, and local knowledge. Based on an original dataset of soldiers from Santander Province in the Spanish Civil War, gathered from archival sources, I find statistical evidence that the rougher the terrain in a soldier’s home municipality, the more likely he is to desert. I find complementary qualitative evidence indicating that soldiers from rough-terrain communities took active advantage of their greater opportunities for evasion. This finding has important implications for the way observers interpret different soldiers’ decisions to desert or remain fighting, for the prospect that structural factors may shape the cohesion of armed groups, and for the possibility that local knowledge may be a double-edged sword, making soldiers simultaneously good at fighting and good at deserting.

Family-based affirmative action? Subversion and resilience strategies of gay father families

The present doctoral dissertation is aimed at analyzing how and with what consequences gay father families and their children’s schools negotiate possible differences in the construction of family and gender at home and in the families’ social milieus. This objective fits in with the broader goal of researching how family-school interactons are influenced by the social context such as hegemonic masculinity (Connell, 2002). The thesis is based on qualitative fieldwork carried out with 18 nonheterosexual parent families in Spain, comprising 30 interviews with 44 people. The principal participant group were 14 de novo (adoptive and surrogacy) gay father families with resident preadolescent children. The findings revealed that all the de novo families assumed open communication strategies at school with inclusive consequences: apart from incidental questions and reactions of surprise, the children did not suffer homophobic bullying. The analisis showed that the necessary condition for inclusion was not the open communication but rather illocutionary orientation (Habermas, 1984; Soler & Flecha, 2010), understood as the parents’ sensitivity to the attitudes of their children and schools. The schools received the families in an inclusive manner, which, however, was only receptive and not proactive, therefore some of the families (reconstituted ones), coerced by the social context, got excluded. Gender relations at home were predominantly androgynous, and outside home predominantly traditional, yet the children negotiated this difference with inclusive consequences. They participated in hegemonic collective practices, thus confirming the thesis on the similarity between homo- and heterosexual-parent families (Golombok, 2006). Consistently, also the families’ identity politics was “assimilationist” and non-queer. Admittedly, the analisis showed that such a politics was increased by social expectations. Still, the findings suggest that educational and other family policies should draw on broad agendas of gender and family diversity rather than on the politics of difference and the unique status of LGB families.

Specialized pediatric palliative home care: a prospective evaluation.

Abstract Objectives: In Germany since 2007 children with advanced life-limiting diseases are eligible for Pediatric Palliative Home Care (PPHC), which is provided by newly established specialized PPHC teams. The objective of this study was to evaluate the acceptance and effectiveness of PPHC as perceived by the parents. Methods: Parents of children treated by the PPHC team based at the Munich University Hospital were eligible for this prospective nonrandomized study. The main topics of the two surveys (before and after involvement of the PPHC team) were the assessment of symptom control and quality of life (QoL) in children; and the parents' satisfaction with care, burden of patient care (Häusliche Pflegeskala, home care scale, HPS), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), and QoL (Quality of Life in Life-Threatening Illness-Family Carer Version, QOLLTI-F). Results: Of 43 families newly admitted to PPHC between April 2011 and June 2012, 40 were included in the study. The median interval between the first and second interview was 8.0 weeks. The involvement of the PPHC team led to a significant improvement of children's symptoms and QoL (P<0.001) as perceived by the parents; and the parents' own QoL and burden relief significantly increased (QOLLTI-F, P<0.001; 7-point change on a 10-point scale), while their psychological distress and burden significantly decreased (HADS, P<0.001; HPS, P<0.001). Conclusions: The involvement of specialized PPHC appears to lead to a substantial improvement in QoL of children and their parents, as experienced by the parents, and to lower the burden of home care for the parents of severely ill children.

La constitució de la naturalesa moral de l'home

En aquest treball filosòfic pretenem reflexionar sobre l'origen natural del fet moral, tot fent una comparació amb fets culturals, com ara, els Drets Humans o la mutilació genital femenina. La conclusió és que la moral es basa en el sentit dels comportaments més que no els comportaments en si mateixos.

Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study

Background Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). Methods Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. Results Base-line differences in functional capacity – significantly lower in the intervention group (RR: 1.52 95%CI: 1.05–2.21; p = 0.0016) – disappeared at six months (RR: 1.31 95%CI: 0.87–1.98; p = 0.178). At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77–59.34 vs. 60.50 95%CI: 53.63–67.37; p = 0.264), (Zarit Test at six months: 53.79 95%CI: 49.67–57.92 vs. 66.26 95%CI: 60.66–71.86 p = 0.002). Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22–10.62 vs. 3.24 95%CI: 1.37–5.310; p = 0.0001) and, on average, required fewer home care visits (9.40 95%CI: 7.89–10.92 vs.11.30 95%CI: 9.10–14.54). No differences were found in terms of frequency of visits to A&E or hospital re-admissions. Furthermore, patients in the control group perceived higher levels of satisfaction (16.88; 95%CI: 16.32–17.43; range: 0–21, vs. 14.65 95%CI: 13.61–15.68; p = 0,001). Conclusion A home care service model that includes nurse-led case management streamlines access to healthcare services and resources, while impacting positively on patients' functional ability and caregiver burden, with increased levels of satisfaction.

Enterprise Architecture Management Design: Towards Understanding Organizational Contingencies, Design Principles and Effectiveness

Despite the increasing popularity of enterprise architecture management (EAM) in practice, many EAM initiatives either do not fully meet the expected targets or fail. Several frameworks have been suggested as guidelines to EA implementation, but companies seldom follow prescriptive frameworks. Instead, they follow very diverse implementation approaches that depend on their organizational contingencies and the way of adopting and evolving EAM over time. This research strives for a broader understanding of EAM by exploring context-dependent EAM adoption approaches as well as identifying the main EA principles that affect EA effectiveness. Based on two studies, this dissertation aims to address two main questions: (1) EAM design: Which approaches do companies follow when adopting EAM? (2) EA principles and their impact: What impact does EA principles have on EA effectiveness/quality? By utilizing both qualitative and quantitative research methods, this research contributes to exploring different EAM designs in different organizational contingencies as well as using EA principles as an effective means to achieve principle-based EAM design. My research can help companies identify a suitable EAM design that fits their organizational settings and shape their EA through a set of principles.

The selective migration of young graduates : which of them return to their rural home region and which do not?

This paper addresses the migration behaviours of young university graduates from a rural region in Switzerland. Based on a questionnaire survey, it compares graduates' current place of residence (i.e. whether or not they returned to their home region) with characteristics related to their socio-familial, migration and professional trajectories. The propensity to return varies not only according to labour market variables (employment opportunities), but also to other factors, some of which have even more influence than job opportunities. The graduates' life course position (kind of household), their partners' characteristics (level of education and home region) and their family background (socio-economic status and history of migration) all play a central role. On the whole, results show that migration appears as a selective and complex process embedded in the life course of graduates.

Association between GIS-based exposure to urban air pollution during pregnancy and birth weight in the INMA Sabadell Cohort

Background: There is growing evidence that traffic-related air pollution reduces birth weight. Improving exposure assessment is a key issue to advance in this research area.Objective: We investigated the effect of prenatal exposure to traffic-related air pollution via geographic information system (GIS) models on birth weight in 570 newborns from the INMA (Environment and Childhood) Sabadell cohort.Methods: We estimated pregnancy and trimester-specific exposures to nitrogen dioxide and aromatic hydrocarbons [benzene, toluene, ethylbenzene, m/p-xylene, and o-xylene (BTEX)] by using temporally adjusted land-use regression (LUR) models. We built models for NO2 and BTEX using four and three 1-week measurement campaigns, respectively, at 57 locations. We assessed the relationship between prenatal air pollution exposure and birth weight with linear regression models. We performed sensitivity analyses considering time spent at home and time spent in nonresidential outdoor environments during pregnancy.Results: In the overall cohort, neither NO2 nor BTEX exposure was significantly associated with birth weight in any of the exposure periods. When considering only women who spent < 2 hr/day in nonresidential outdoor environments, the estimated reductions in birth weight associated with an interquartile range increase in BTEX exposure levels were 77 g [95% confidence interval (CI), 7–146 g] and 102 g (95% CI, 28–176 g) for exposures during the whole pregnancy and the second trimester, respectively. The effects of NO2 exposure were less clear in this subset.Conclusions: The association of BTEX with reduced birth weight underscores the negative role of vehicle exhaust pollutants in reproductive health. Time–activity patterns during pregnancy complement GIS-based models in exposure assessment.

Home visitors and child health in England: advances and challenges

There is increasing interest in the early years as a focus for reducing health inequalities as well as one that is important for the children themselves. This paper describes the introduction in England of Sure Start Local Programmes, which included home visiting within a community development approach, and an intensive home visiting programme, the Nurse-Family partnership, for disadvantaged teenage mothers. It reflects on changes and challenges in service provision to mothers and their pre-school children in England, explaining that a long tradition of home visiting was, paradoxically, reduced as attention focused on the newer initiatives. This is now being addressed, with attention to a range of evidence based programmes and a specific focus on heath visitor provision.

Prise en charge du patient avec bronchopneumopathie obstructive: ambulatoire ou hospitalière [Management of the patient with COPD: home case or hospitalization].

Acute exacerbation of COPD is one of the most common causes of hospital admission in patients affected with this disease. In most cases, consideration of differential diagnoses and assessment of important comorbidities will allow to make the decision whether or not the patient needs to be hospitalized. A decision to hospitalize will be based on specific symptoms and signs, as well on the patient's history. Contrary to bronchial asthma, a systematic action plan strategy is lacking for COPD. However, a disease management plan involving all the health care providers may have the potential to improve the patient's well being and to decrease costs related to these exacerbations.

Violence against adolescents: an analysis based on the categories gender and generation

Exploratory and descriptive study based on quantitative and qualitative methods that analyze the phenomenon of violence against adolescents based on gender and generational categories. The data source was reports of violence from the Curitiba Protection Network from 2010 to 2012 and semi-structured interviews with 16 sheltered adolescents. Quantitative data were analyzed using SPSS software version 20.0 and the qualitative data were subjected to content analysis. The adolescents were victims of violence in the household and outside of the family environment, as victims or viewers of violence. The violence was experienced at home, mostly toward girls, with marked overtones of gender violence. More than indicating the magnitude of the issue, this study can give information to help qualify the assistance given to victimized people and address how to face this issue.

Domestic radon exposure and risk of childhood cancer: a prospective census-based cohort study

BACKGROUND: In contrast with established evidence linking high doses of ionizing radiation with childhood cancer, research on low-dose ionizing radiation and childhood cancer has produced inconsistent results. OBJECTIVE: We investigated the association between domestic radon exposure and childhood cancers, particularly leukemia and central nervous system (CNS) tumors. METHODS: We conducted a nationwide census-based cohort study including all children < 16 years of age living in Switzerland on 5 December 2000, the date of the 2000 census. Follow-up lasted until the date of diagnosis, death, emigration, a child's 16th birthday, or 31 December 2008. Domestic radon levels were estimated for each individual home address using a model developed and validated based on approximately 45,000 measurements taken throughout Switzerland. Data were analyzed with Cox proportional hazard models adjusted for child age, child sex, birth order, parents' socioeconomic status, environmental gamma radiation, and period effects. RESULTS: In total, 997 childhood cancer cases were included in the study. Compared with children exposed to a radon concentration below the median (< 77.7 Bq/m3), adjusted hazard ratios for children with exposure ≥ the 90th percentile (≥ 139.9 Bq/m3) were 0.93 (95% CI: 0.74, 1.16) for all cancers, 0.95 (95% CI: 0.63, 1.43) for all leukemias, 0.90 (95% CI: 0.56, 1.43) for acute lymphoblastic leukemia, and 1.05 (95% CI: 0.68, 1.61) for CNS tumors. CONCLUSIONS: We did not find evidence that domestic radon exposure is associated with childhood cancer, despite relatively high radon levels in Switzerland.

Implementação do abc (activity-based costing) numa empresa prestação de serviços de saúde

O presente trabalho cujo título é Implementação do ABC numa empresa prestadora de serviços de Saúde, tem como finalidade a obtenção do grau de licenciatura em Contabilidade e Administração e tem como principal objectivo a implementação do método ABC numa pequena e média empresa de prestação de serviços de saúde, como um instrumento de apoio á gestão. Para a introdução da Contabilidade de Gestão na empresa, há que se escolher um método/sistema de apuramento de gastos que espelha a realidade da empresa, e de uma certa forma o ABC é o método ideal para apuramento de resultados sem distorções. O ABC (Activity-Based Cost) apura os resultados através da relação de causa-efeito, considerando que as actividades é que geram gastos e os objectos de custeio é que consomem as actividades. É aplicável tanto nas empresas industriais como nas empresas prestadoras de serviços, apesar de inicialmente ter sido concebido para as empresas industrias, isto é, para as grandes empresas devido aos avultados recursos financeiros e humanos como também pelo tempo necessário para a sua implementação. Mas o modelo matricial apresentado por Roztcki et al (1999) permite a aplicação deste método nas PME com poucos recursos financeiros e de tempo, utilizando uma folha de cálculo no Excel. Será este modelo a ser proposto e poderá ser implementado na clínica. O modelo apresentado foi testado num estudo de caso realizado numa clínica. Com a realização dos testes foi detectado algumas dificuldades e limitações, as maiores dificuldades encontradas foram a identificação das actividades e dos cost drivers, devido à complexidade do sector. A implementação foi concluída com sucesso, proporcionando informações detalhadas dos gastos dos produtos/serviços prestados em toda a clínica. This work was done as a requisite for obtaining a degree in Accounting and Administration, and is titled “The Implementation of ABC – Activity Based Cost in a company that provides health services”. Its main purpose is to analyze the implementation of ABC method in a small and medium-sized enterprise which provides health services to support decision making by the Managers. To adopt management accounting in a company, it’s necessary to choose a cost qualifying system that reflects the reality of the company and in a certain way ABC is the method which can determine the results without any distortion. ABC (Activity-Based Cost) determines the results through cause-and-effect relationship, whereas the activities generate spending while costing objects consume the activities. It’s applicable both in industrial companies as in services providers, although it was initially designed for industrial companies, that is, to large companies, due to the huge financial and human resources existent as well as by the time required for its implementation. But the matrix model presented by Roztckiet al (1999) allows application of this method in small and medium-sized enterprises with limited financial resources and time, using a spreadsheet in Excel. This model will be proposed and could be implemented in any clinic. The model was tested in a case study, undertaken in a private clinic. With the realization of the tests, some problems and limitations were detected, and the major difficulties encountered were the identification of activities and cost drivers, due to the complexity of the sector. The implementation was completed successfully, providing detailed information of the products services spending throughout the clinic.

Peroxisome proliferator-activated receptors: finding the orphan a home.

The peroxisome proliferator-activated receptor (PPAR) is a member of the steroid hormone receptor superfamily and is activated by a variety of fibrate hypolipidaemic drugs and non-genotoxic rodent hepatocarcinogens that are collectively termed peroxisome proliferators. A key marker of peroxisome proliferator action is the peroxisomal enzyme acyl CoA oxidase, which is elevated about ten fold in the livers of treated rodents. Additional peroxisome proliferator responsive genes include other peroxisomal beta-oxidation enzymes and members of the cytochrome P450 IVA family. A peroxisome proliferator response element (PPRE), consisting of an almost perfect direct repeat of the sequence TGACCT spaced by a single base pair, has been identified in the upstream regulatory sequences of each of these genes. The retinoid X receptor (RXR) forms a heterodimer with PPAR and binds to the PPRE. Furthermore, the RXR ligand, 9-cis retinoic acid, enhances PPAR action. Retinoids may therefore modulate the action of peroxisome proliferators and PPAR may interfere with retinoid action, perhaps providing one mechanism to explain the toxicity of peroxisome proliferators. Interestingly, a variety of fatty acids can activate PPAR supporting the suggestion that fatty acids, or their acyl CoA derivatives, may be the natural ligands of PPAR and that the physiological role of PPAR is to regulate fatty acid homeostasis. Taken together, the discovery of PPAR has opened up new opportunities in understanding how lipid homeostasis is regulated, how the fibrate hypolipidaemic drugs may act and should lead to improvements in the assessment of human risk from peroxisome proliferators based upon a better understanding of their mechanism of action.