942 resultados para Intervention practices


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Este artículo tiene por objetivo reinterpretar la relación abierta en la Segunda Internacional entre la cuestión nacional y la lucha de clases, planteando que las causas de la posición triunfante en 1914 deben ser buscadas en los años anteriores al estallido bélico. El análisis de textos fundamentales producidos antes y durante la Gran Guerra por los teóricos más influyentes del socialismo europeo en torno de las naciones y las nacionalidades permite captar en toda su significación de qué manera en dicha coyuntura se jugó la concepción socialista de "revolución social", indisolublemente atravesada por el carácter sociopolítico que se estuvo dispuesto a conceder a las masas proletarias y a sus formas de intervención práctica

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Este artículo tiene por objetivo reinterpretar la relación abierta en la Segunda Internacional entre la cuestión nacional y la lucha de clases, planteando que las causas de la posición triunfante en 1914 deben ser buscadas en los años anteriores al estallido bélico. El análisis de textos fundamentales producidos antes y durante la Gran Guerra por los teóricos más influyentes del socialismo europeo en torno de las naciones y las nacionalidades permite captar en toda su significación de qué manera en dicha coyuntura se jugó la concepción socialista de "revolución social", indisolublemente atravesada por el carácter sociopolítico que se estuvo dispuesto a conceder a las masas proletarias y a sus formas de intervención práctica

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Este artículo tiene por objetivo reinterpretar la relación abierta en la Segunda Internacional entre la cuestión nacional y la lucha de clases, planteando que las causas de la posición triunfante en 1914 deben ser buscadas en los años anteriores al estallido bélico. El análisis de textos fundamentales producidos antes y durante la Gran Guerra por los teóricos más influyentes del socialismo europeo en torno de las naciones y las nacionalidades permite captar en toda su significación de qué manera en dicha coyuntura se jugó la concepción socialista de "revolución social", indisolublemente atravesada por el carácter sociopolítico que se estuvo dispuesto a conceder a las masas proletarias y a sus formas de intervención práctica

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Thesis (Ph.D.)--University of Washington, 2016-06

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Background
The OPTI-SCRIPT cluster randomised controlled trial (RCT) found that a three-phase multifaceted intervention including academic detailing with a pharmacist, GP-led medicines reviews, supported by web-based pharmaceutical treatment algorithms, and tailored patient information leaflets, was effective in reducing potentially inappropriate prescribing (PIP) in Irish primary care. We report a process evaluation exploring the implementation of the intervention, the experiences of those participating in the study and lessons for future implementation.

Methods
The OPTI-SCRIPT trial included 21 GP practices and 196 patients. The process evaluation used mixed methods. Quantitative data were collected from all GP practices and semi-structured interviews were conducted with GPs from intervention and control groups, and a purposive sample of patients from the intervention group. All interviews were transcribed verbatim and analysed using a thematic analysis.

Results
Despite receiving a standardised academic detailing session, intervention delivery varied among GP practices. Just over 70 % of practices completed medicines review as recommended with the patient present. Only single-handed practices conducted reviews without patients present, highlighting the influence of practice characteristics and resources on variation. Medications were more likely to be completely stopped or switched to another more appropriate medication when reviews were conducted with patients present. The patient information leaflets were not used by any of the intervention practices. Both GP (32 %) and patient (40 %) recruitment rates were modest. For those who did participate, overall, the experience was positively viewed, with GPs and patients referring to the value of medication reviews to improve prescribing and reduce unnecessary medications. Lack of time in busy GP practices and remuneration were identified as organisational barriers to future implementation.

Conclusions
The OPTI-SCRIPT intervention was positively viewed by both GPs and patients, both of whom valued the study’s objectives. Patient information leaflets were not a successful component of the intervention. Academic detailing and medication reviews are important components in changing PIP, and having patients present during the review process seems to be a more effective approach for decreasing PIP.

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Au Québec, la médiation familiale en contexte de violence conjugale est controversée, mais la pratique est très peu documentée et est donc mal connue. L’objectif principal de ce mémoire est de comprendre comment les médiateurs familiaux composent avec la présence de violence conjugale dans le cadre de leur pratique. Les objectifs spécifiques sont les suivants : (1) connaître comment les médiateurs familiaux dépistent la violence conjugale ; (2) savoir comment ils interviennent en présence de violence conjugale une fois cette violence dépistée ; et (3) identifier les défis et les préoccupations rencontrées par les médiateurs dans ces dossiers. Cette étude qualitative fut menée auprès de 8 médiateurs issus des domaines juridique et psychosocial. Les participants furent rencontrés dans le cadre d’entrevues semi-dirigées. Les médiateurs rencontrés insistent sur l’importance d’offrir une formation avancée portant sur la problématique de la violence conjugale et sur les outils de dépistage à tous les médiateurs au Québec et de bonifier la formation actuelle en adressant la dangerosité, le risque de récidive et d'aggravation de la violence et l’appréciation du risque d’homicide conjugal. Les résultats de l’étude suggèrent également l’importance de bien différencier le terrorisme conjugal de la violence situationnelle et de mettre en place des pratiques d’interventions spécifiques à chacun de ces types de violence. La médiation familiale en présence de violence conjugale devrait être un champ de pratique spécialisé et le travail de collaboration avec les ressources spécialisées en violence conjugale nécessiterait d’être renforcé.

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Au Québec, la médiation familiale en contexte de violence conjugale est controversée, mais la pratique est très peu documentée et est donc mal connue. L’objectif principal de ce mémoire est de comprendre comment les médiateurs familiaux composent avec la présence de violence conjugale dans le cadre de leur pratique. Les objectifs spécifiques sont les suivants : (1) connaître comment les médiateurs familiaux dépistent la violence conjugale ; (2) savoir comment ils interviennent en présence de violence conjugale une fois cette violence dépistée ; et (3) identifier les défis et les préoccupations rencontrées par les médiateurs dans ces dossiers. Cette étude qualitative fut menée auprès de 8 médiateurs issus des domaines juridique et psychosocial. Les participants furent rencontrés dans le cadre d’entrevues semi-dirigées. Les médiateurs rencontrés insistent sur l’importance d’offrir une formation avancée portant sur la problématique de la violence conjugale et sur les outils de dépistage à tous les médiateurs au Québec et de bonifier la formation actuelle en adressant la dangerosité, le risque de récidive et d'aggravation de la violence et l’appréciation du risque d’homicide conjugal. Les résultats de l’étude suggèrent également l’importance de bien différencier le terrorisme conjugal de la violence situationnelle et de mettre en place des pratiques d’interventions spécifiques à chacun de ces types de violence. La médiation familiale en présence de violence conjugale devrait être un champ de pratique spécialisé et le travail de collaboration avec les ressources spécialisées en violence conjugale nécessiterait d’être renforcé.

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Neste estudo, parte-se dos discursos dos educadores sociais, produzidos no grupo de discussão, para se conhecer as suas representações face à relação de ajuda que desenvolvem com as populações. Problematizou-se o conceito, analisaram-se os discursos buscando os paradigmas que orientam as intervenções, as definições de relação de ajuda, os seus objectivos, e o perfil dos educadores sociais que desenvolvem esta modalidade de intervenção. As conclusões apontam para a necessidade de a reflexão acompanhar a acção do educador social; para a coexistência de diferentes concepções sobre a relação de ajuda, variando de acordo com as orientações paradigmáticas do educador, a sua própria experiência profissional, o eu perfil pessoal e profissional. Surge reforçada a ideia de que é na relação teoria-prática que se vão configurando as práticas de intervenção, adequando-as aos sujeitos com quem se desenvolvem e activando processos internos, ao nível das capacidades e competências, pessoais e interpessoais, dos educadores sociais. /ABSTRACT: The starting point in this study is the social educators' speeches produced in the discussion group, to let us know how they view the helping relationship they develop with the populations. The concept was held as a problem needing clarification, and the speeches were analysed with a view to making understandable the paradigms, the objectives and the definitions of the helping relationship that guide their interventions; the profiles of the professionals in the group that develop this modality of intervention were also analysed. The conclusions point to the need of reflection going along with the social educator's acting. They also point to the presence in the group of different conceptions of the helping relationship, varying with the educator's paradigmatic orientation, her/his own professional experience, her/his personal and professional profile. One strong idea emerges: the intervention practices get their configuration in the relation theory-practice, in the process of making them adequate to the subjects with whom they are developed, and also because they activate the social educators' internal processes, at the level of capacities and competences, both personal and interpersonal.

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OBJECTIVE: To evaluate a universal obesity prevention intervention, which commenced at infant age 4-6 months, using outcome data assessed 6-months after completion of the first of two intervention modules and 9 months from baseline. DESIGN: Randomised controlled trial of a community-based early feeding intervention. SUBJECTS AND METHODS: 698 first-time mothers (mean age 30±5 years) with healthy term infants (51% male) aged 4.3±1.0 months at baseline. Mothers and infants were randomly allocated to self-directed access to usual care or to attend two group education modules, each delivered over three months, that provided anticipatory guidance on early feeding practices. Outcome data reported here were assessed at infant age 13.7±1.3 months. Anthropometrics were expressed as z-scores (WHO reference). Rapid weight gain was defined as change in weight-for-age z-score (WAZ) > +0.67. Maternal feeding practices were assessed via self-administered questionnaire. RESULTS: There were no differences according to group allocation on key maternal and infant characteristics. At follow up (n=598 [86%]) the intervention group infants had lower BMIZ (0.42±0.85 vs 0.23±0.93, p=0.009) and infants in the control group were more likely to show rapid weight gain from baseline to follow up (OR=1.5 CI95%1.1-2.1, p=0.014). Mothers in the control group were more likely to report using non- responsive feeding practices that fail to respond to infant satiety cues such as encouraging eating by using food as a reward (15% vs 4%, p=0.001) or using games ( 67% vs 29%, p<0.001). CONCLUSIONS: These results provide early evidence that anticipatory guidance targeting the ‘when, what and how’ of solid feeding can be effective in changing maternal feeding practices and, at least in the short term, reducing anthropometric indicators of childhood obesity risk. Analyses of outcomes at later ages are required to determine if these promising effects can be sustained.

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Objective Use a randomised controlled trial (RCT) to evaluate outcomes of a universal intervention to promote protective feeding practices, which commenced in infancy and aimed to prevent childhood obesity Subjects and Methods The NOURISH RCT enrolled 698 first-time mothers (mean age 30.1 years, SD=5.3) with healthy term infants (51% female) aged 4.3 (SD=1.0) months at baseline. Mothers were randomly allocated to self-directed access to usual care or to attend two 6-session interactive group education modules that provided anticipatory guidance on early feeding practices. Outcomes were assessed six months after completion of the second information module, 20 months from baseline and when the children were two years old. Maternal feeding practices were self-reported using validated questionnaires and study-developed items. Study-measured child height and weight were used to calculate BMI Z-score. Results Retention at follow-up was 78%. Mothers in the intervention group reported using responsive feeding more frequently on 6/9 subscales and 8/8 items (Ps ≤.03) and overall less ‘controlling feeding practices’ (P<.001). They also more frequently used feeding practices (3/4 items; Ps <.01) likely to enhance food acceptance. No statistically significant differences were noted in anthropometric outcomes (BMI Z-score: P=.11), nor in prevalence of overweight/obesity (control 17.9% vs. intervention 13.8%, P=.23). Conclusions Evaluation of NOURISH at child age two years found that anticipatory guidance on complementary feeding, tailored to developmental stage, increased use by first-time mothers of 'protective' feeding practices that potentially support the development of healthy eating and growth patterns in young children.

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Da Nang Airbase in Viet Nam served as a bulk storage and supply facility for Agent Orange and other herbicides during Operation Ranch Hand 1961-1971[1]. Studies have shown that environmental and biological samples taken around the airbase site have elevated levels of dioxin [1-3]. Residents living in the vicinity of the airbase are at risk of exposure to dioxin in soil, water and mud and particularly through the consumption of local contaminated food. In 2009, a pre-intervention cross sectional survey was undertaken. This survey examined the knowledge, attitudes and practices (KAP) of householders living near Da Nang Airbase, relevent to reducing dioxin exposure through contaminated food. The results showed that despite living near a severe dioxin hot spot, the residents had very limited knowledge of both exposure risk and measures to reduce exposure to dioxin[4]. In response, the Vietnam Public Health Association (VPHA) and Da Nang Public Health Association implemented a risk reduction program at four residential wards in the vicinities of the Da Nang Airbase in 2010. A post intervention KAP survey was under taken in 2011, and the results showed that knowledge of the existence of dioxin in food, dioxin exposure pathways, potential high risk foods, and preventive measures was significantly enhanced. This new study monitored KAP 2.5 years after the intervention through a 2013 survey of food handlers from 400 households that were randomly selected from the four intervention wards. The results show that most of the positive outcomes remained stable or had increased; some KAP indicators decreased compared to those in the post-intervention survey, but were still significantly higher than the pre-intervention levels. In 2014, these findings will be incorporated with qualitative assessments and the results of laboratory analysis of dioxin concentrations in foods in Da Nang and Bien Hoa dioxin hot spots to comprehensively assess the sustained effects of the intervention.

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Introduction Environmental and biological samples taken around Da Nang Air Base have shown elevated levels of dioxin over many years [1-3]. A pre-intervention knowledge, attitudes and practices (KAP) survey (2009), a risk reduction program (2010) and a post intervention KAP survey (2011) were undertaken in four wards surrounding Danang Airbase. A follow-up evaluation was undertaken in 2013. Methods A KAP survey was implemented among 400 randomly selected food handlers. Eleven indepth interviews and four focus group discussions were also undertaken. Results The knowledge of respondents remained positive and/or improved at 2.5 years follow-up. There were no significant differences in attitudes toward preventing dioxin exposure across surveys; most respondents were positive in all three surveys. An increase in households (69.5%) undertaking measures to prevent exposure was observed, which was higher than in the pre-intervention survey (39.6%) and post- intervention survey (60.4%) (χ2 = 95.6; p < 0.001). The proportion of respondents practicing appropriate preventive measures was also significantly improved. Conclusions Despite most of the intervention program’s activities ceasing in 2010, the risk reduction program has resulted in positive outcomes over the longer-term, with many knowledge and attitude measures remaining stable or imporving. Some KAP indicators decreased, but these KAP indicators were still significantly higher than the pre-intervention levels.

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Objective - Report long term outcomes of the NOURISH randomized controlled trial (RCT) that evaluated a universal intervention commencing in infancy to provide anticipatory guidance to first-time mothers on ‘protective’ complementary feeding practices which were hypothesized to reduce childhood obesity risk. Subjects and Methods - The NOURISH RCT enrolled 698 mothers (mean age 30.1 years, SD=5.3) with healthy term infants (51% female). Mothers were randomly allocated to usual care or to attend two 6-session, 12-week group education modules. Outcomes were assessed five times: baseline (infants 4.3 months); 6 months after module 1 (infants 14 months); 6 months after module 2 (infants 2 years) and at 3.5 and 5 years of age. Maternal feeding practices were self-reported using validated questionnaires. BMI Z-score was calculated from measured child height and weight. Linear Mixed Models evaluated intervention (group) effect across time. Results - Retention at 5 years of age was 61%. Across ages 2-5 years, intervention mothers reported less frequent use of non-responsive feeding practices on 6/9 scales. At 5 years they also reported more appropriate responses to food refusal on 7/12 items (Ps ≤.05). No statistically significant group effect was noted for anthropometric outcomes (BMI Z-score: P=.06), or the prevalence of overweight/obesity (control 13.3% vs. intervention 11.4%, P=.66). Conclusions - Anticipatory guidance on complementary feeding resulted in first-time mothers reporting increased use of protective feeding practices. These intervention effects were sustained up to five years of age and were paralleled by a non-significant trend for lower child BMI Z-scores at all post-intervention assessment points.

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Bien Hoa Airbase was one of the bulk storage and supply facilities for defoliants during the Vietnam War. Environmental and biological samples taken around the airbase have elevated levels of dioxin. In 2007, a pre-intervention knowledge, attitude and practice (KAP) survey of local residents living in Trung Dung and Tan Phong wards was undertaken regarding appropriate strategies to reduce dioxin exposure. A risk reduction programme was implemented in 2008 and post-intervention KAP surveys were undertaken in 2009 and 2013 to evaluate the longer term impacts. Quantitative assessment was undertaken via a KAP survey in 2013 among 600 local residents randomly selected from the two intervention wards and one control ward (Buu Long). Eight in-depth interviews and two focus group discussions were also undertaken for qualitative assessment. Most programme activities had ceased and dioxin risk communication activities had not been integrated into local routine health education programmes; however, main results generally remained and were better than that in Buu Long. In total, 48.2% of households undertook measures to prevent exposure, higher than those in pre- and post-intervention surveys (25.8% and 39.7%) and the control ward (7.7%). Migration and the sensitive nature of dioxin issues were the main challenges for the programme's sustainability

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Background Recruitment and retention of patients and healthcare providers in randomised controlled trials (RCTs) is important in order to determine the effectiveness of interventions. However, failure to achieve recruitment targets is common and reasons why a particular recruitment strategy works for one study and not another remain unclear. We sought to describe a strategy used in a multicentre RCT in primary care, to report researchers’ and participants’ experiences of its implementation and to inform future strategies to maximise recruitment and retention. Methods In total 48 general practices and 903 patients were recruited from three different areas of Ireland to a RCT of an intervention designed to optimise secondary prevention of coronary heart disease. The recruitment process involved telephoning practices, posting information, visiting practices, identifying potential participants, posting invitations and obtaining consent. Retention involved patients attending reviews and responding to questionnaires and practices facilitating data collection. Results We achieved high retention rates for practices (100%) and for patients (85%) over an 18-month intervention period. Pilot work, knowledge of the setting, awareness of change in staff and organisation amongst participant sites, rapid responses to queries and acknowledgement of practitioners’ contributions were identified as being important. Minor variations in protocol and research support helped to meet varied, complex and changing individual needs of practitioners and patients and encouraged retention in the trial. A collaborative relationship between researcher and practice staff which required time to develop was perceived as vital for both recruitment and retention. Conclusions Recruiting and retaining the numbers of practices and patients estimated as required to provide findings with adequate power contributes to increased confidence in the validity and generalisability of RCT results. A continuous dynamic process of monitoring progress within trials and tailoring strategies to particular circumstances, whilst not compromising trial protocols, should allow maximal recruitment and retention.