Prospective memory rehabilitation for adults with traumatic brain injury: A compensatory training programme

Primary objective: To describe a prospective memory rehabilitation programme based on a compensatory training approach and report the results of three case studies. Research design: Programme evaluation using pre-and post-intervention assessments and telephone follow-up. Methods and procedures: Three participants with traumatic brain injury completed 8 weeks of training with 1 - 2 hour individual sessions. Assessments were formal prospective memory assessment, self-report and measures of diary use. Experimental interventions: Intervention aimed to identify potential barriers, establish self-awareness of memory deficits, introduce a customized compensatory tool, a cueing system and organizational strategies. A significant other was involved in training to assist generalization. Main outcomes and results: All three participants improved on formal prospective memory assessment and demonstrated successful diary use after the programme. Self-report of prospective memory failure fluctuated and may reflect increased self-awareness. Conclusion: A compensatory approach may be useful in improving prospective memory performance following TBI.

Sustainable Tourism and Eradication of Poverty (Step): impact assessment of a tourism development program in Brazil

This paper aims to evaluate the social impacts of the Tourism Development Program (Prodetur) in the northeastern town of Porto Seguro, Bahia, Brazil. The method used is based on the difference in difference technique applied to the 1991 and 2000 Census microdata. The results suggest social advances following from poverty relief based on income - where the benefits are distributed, generally, in a relatively equal manner between the native and migrant population. There is a relative deterioration in the sanitary situation, which consists of a very serious problem in the mid- and long-term, whose costs are mostly borne by the native population. Therefore, maintaining the natural capital is the main aspect that distances Porto Seguro’s tourism supply from the concept of sustainability. The article also relies on difference in difference estimators to assess the impacts of local public policies related to the sector.

Assessment of a strategy for the control of respiratory diseases in children

A programme for the control of respiratory diseases in children was conceived for the State of S. Paulo, Brazil, in 1986. Its progress thereafter and the epidemiology of the diseases concerned are examined. Apart from an inquiry into the 64 existing State local health authorities, a sample of 18,255 cases of children assisted by the programme at different levels, including both in-patient and outpatient care, is analysed. Each case record included information about identification (child, doctor and health facility), reasons for calling, diagnoses made and outcome of treatment. Further data were also sought from hospitals and from State mortality records. The programme was found to be poorly implemented in the State but, where implemented, it showed itself capable of resolving problems (only 0.5% of the cases could not be handled) as also of changing ongoing trends (more than 50% reduction in hospital admission rates). Individual assessment of each item of the programme indicated its bottlenecks. Regarding the epidemiology of respiratory diseases, it is observed that the major burden to health services comes from children aged less than five, and that the most important diseases are wheezing illnesses and pneumonia. Morevoer, they were found to be significantly associated (p = 0.000) so that a child in the community presenting wheezing diseases is 5 times more likely to develop pneumonia than a child with any other respiratory diagnosis. Similarly, among the under five deaths it was found that the risk for pneumonia is 3 times greater for children who died presenting wheezing diseases than it is for children with any other sort of diagnosis. In conclusion, the programme is deemed to be efficient and effective but its efficacy is marred by administrative flaws. The successful control of respiratory problems in childhood is related to a proper appreciation of the importance of wheezing diseases.

Sistemas de buenas prácticas en desarrollo económico local: una revisión preliminar de la experiencia

Incluye Bibliografía

Manual on economic development projects

In this study, projects are not regarded as isolated economic units; they are considered within the context of the entire economic system of which they will form a part. Thus the Manual presents both macroeconomic and microeconomic concepts. From this it must not be inferred that the Manual attempts to offer a combined microeconomic and macroeconomic theory. It seeks to contribute more to an appreciation of the problem than to its solution, thus widening the outlook of those who prepare projects so that they may make the greatest possible compilation of useful data for their economic appraisal.

La planificación participativa para lograr un cambio estructural con igualdad: las estrategias de participación ciudadana en los procesos de planificación multiescalar

Este manual, que el ILPES coloca a disposición de funcionarios públicos y agentes no gubernamentales que trabajan en la comunidad, tiene el propósito de compartir una breve reflexión teórica sobre el contexto socio-político actual y un conjunto de instrumentos metodológicos que acercarán al usuario a la práctica social de un proceso de participación ciudadana en la construcción de un instrumento de gestión pública. El manual se estructura en dos capítulos. El primero conceptualiza la planificación multiescalar participativa, a la vez que realiza una breve introducción a tres temas de suma relevancia a incorporar en todo proceso de planificación participativa y construcción de instrumentos de gestión pública: la perspectiva de género, el uso del Convenio 169 y del Principio 10. El segundo capítulo sistematiza un conjunto de instrumentos metodológicos que describen las etapas de una estrategia de participación ciudadana para incorporar a los instrumentos de gestión pública multiescalar. El manual cierra con dos anexos, el último de los cuales incorpora un conjunto de herramientas que podrán ser utilizadas en las etapas de la construcción de una estrategia de participación ciudadana

Portfolio: Objective structured examination for the assessment of essential competences at graduation

[EN] This porfolio is an Objective Structured Competence Examination (OSCE) designed for the Assessment of essentian competences defined by The European Asociation of Establishments for Veterinay Education (EAEVE) in its programme Evaluation of Veterinary Training in Europe

Patient satisfaction and side effects in primary care: An observational study comparing homeopathy and conventional medicine

Background This study is part of a nationwide evaluation of complementary medicine in Switzerland (Programme Evaluation of Complementary Medicine PEK) and was funded by the Swiss Federal Office of Public Health. The main objective of this study is to investigate patient satisfaction and perception of side effects in homeopathy compared with conventional care in a primary care setting. Methods We examined data from two cross-sectional studies conducted in 2002–2003. The first study was a physician questionnaire assessing structural characteristics of practices. The second study was conducted on four given days during a 12-month period in 2002/2003 using a physician and patient questionnaire at consultation and a patient questionnaire mailed to the patient one month later (including Europep questionnaire). The participating physicians were all trained and licensed in conventional medicine. An additional qualification was required for medical doctors providing homeopathy (membership in the Swiss association of homeopathic physicians SVHA). Results A total of 6778 adult patients received the questionnaire and 3126 responded (46.1%). Statistically significant differences were found with respect to health status (higher percentage of chronic and severe conditions in the homeopathic group), perception of side effects (higher percentage of reported side effects in the conventional group) and patient satisfaction (higher percentage of satisfied patients in the homeopathic group). Conclusion Overall patient satisfaction was significantly higher in homeopathic than in conventional care. Homeopathic treatments were perceived as a low-risk therapy with two to three times fewer side effects than conventional care

A meta-avaliação como instrumento para a qualificação da avaliação de políticas públicas de saúde

Trata-se da meta-avaliação de um processo avaliativo desenvolvido por secretários e assessores técnicos municipais de uma região de saúde do estado de São Paulo, com foco nos critérios de utilidade e participação. É uma pesquisa qualitativa, cuja base empírica foi 1) o material produzido em sete oficinas realizadas com os representantes municipais, com vistas à avaliação de um aspecto da linha de cuidados em saúde sob a ótica da integralidade; e 2) as entrevistas semiestruturadas realizadas com os mesmos atores após a finalização do processo avaliativo. Para a avaliação do critério de utilidade, utilizou-se principalmente o referencial de KIRKHART (2000), com o objetivo de ampliar a análise para além do uso instrumental dos achados avaliativos e focá-la na identificação de influências múltiplas exercidas por um fenômeno complexo como um processo avaliativo. A análise do critério participação se deu com base no referencial de COUSINS e WHITMORE (1998), buscando a identificação no material empírico de decisões ou aspectos contextuais que fizeram com que a opção participativa fosse aprofundada ou limitada no processo em foco. O trabalho destaca a importância de explicitar pressupostos que baseiam a metodologia da avaliação/ meta-avaliação escolhida, e a necessidade de se buscar referenciais teóricos de análise compatíveis com a opção realizada, frisando a inexistência de posturas neutras ou estudos totalmente objetivos; e a importância de capacitar avaliadores a acompanharem a demanda dos participantes de um processo participativo com a flexibilidade necessária para conferir-lhe o maior aproveitamento possível. Conclui-se pela viabilidade, com vantagens, da realização de processos participativos locais com gestores na Saúde Pública, destacando a possibilidade de ganhos em formação e o enriquecimento dos processos de negociação em nível do território, de forma coerente à política de construção das regiões de saúde no SUS.

Assessing the effectiveness of a mammography screening service

Background: Trials have shown that mammography screening reduces mortality and probably decreases morbidity related to breast cancer. Methods: We assessed whether the major mammography service in Western Australia (BreastScreen WA) is likely to reduce mortality by comparing prognostic variables between screen-detected and other cases of breast cancer diagnosed in 1999. We assessed likely reductions in morbidity by comparing treatments received by these two groups. To confirm mortality and morbidity reduction, we also compared prognostic variables and treatments with targets. Information on demographic variables, tumour characteristics at presentation and treatments were collected from medical records for all incident cases of breast cancer in Western Australia in 1999. We matched cases with the Western Australian Cancer Registry records to determine which cases had been detected by BreastScreen WA. Results: BreastScreen WA achieved the targets for mortality reduction. Tumours detected by BreastScreen WA were smaller in size, less likely to have vascular invasion, of lower histological grade and were more likely to be ductal carcinoma in situ alone without invasive carcinoma. Oestrogen receptor status was more likely to be positive, the difference in progesterone status was not significant, and lymph node involvement tended to be lower. BreastScreen WA patients were treated more often with local therapy and less often with systemic therapy, and the proportion of patients treated with breast-conserving surgery was close to the target for minimizing morbidity in breast cancer. Conclusion: Mammographic detection of breast cancer by BreastScreen WA is associated with reduced breast cancer morbidity and a more favourable prognosis.

Community-based programmes to prevent falls in children: A systematic review

Objective: We systematically reviewed the literature to examine the evidence for the effectiveness of community-based interventions to reduce fall-related injury in children aged 0-16 years. Methods: We performed a comprehensive search of the literature using the following study selection criteria: community-based intervention study; target population was children aged 0-16 years; outcome measure was fall-related injury rates; and either a community control or historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Results: Only six studies fitting the inclusion criteria were identified in our search and only two of these used a trial design with a contemporary community control. Neither of the high quality evaluation studies showed an effect from the intervention and while authors of the remaining studies reported effective falls prevention programmes, the pre- and post-intervention design, uncontrolled for background secular trends, makes causal inferences from these studies difficult. Conclusion: There is a paucity of research studies from which evidence regarding the effectiveness of community-based intervention programmes for the prevention of fall-related injury in children could be based.

Physical activity measurement - a primer of health promotion

As the importance of physical activity is recognised in health promotion, the task of measuring it becomes a central research and practice challenge. Measurement of physical activity is important to policy makers interested in population surveillance, as well as to practitioners interested in programme evaluation and research. This review outlines 'best practice' in physical activity measurement, and provides an inventory of established physical activity and related measures for use in health promotion programme evaluation, research and surveillance at the national and local level. [PUBLICATION ABSTRACT]