Perceptions par divers acteurs d'une politique éventuelle de promotion de santé nutritionnelle en milieu scolaire libanais

Thesis (French) including 3 main articles (English)

Facteurs socioéconomiques associés à l’usage des médicaments psychotropes chez les hommes et les femmes âgés de 65 à 74 ans vivant dans la communauté : l’étude internationale sur la mobilité des personnes âgées (IMIAS).

Objectif de l’étude : Estimer l'association entre la position socioéconomique et l'utilisation des médicaments psychotropes dans cinq populations différentes chez les personnes âgées de 65-74 ans. Méthode : L'échantillon d'étude était composé de 1995 personnes avec des données issues de la première vague de collecte de 2012 faite par l’International Mobility in Aging Study (IMIAS). Il se composait de 401 participants de Saint- Hyacinthe (Québec), 398 de Kingston (Ontario), 394 personnes âgées de Tirana (Albanie), 400 de Manizales (Colombie) et 402 de Natal (Brésil). Tous les médicaments psychotropes consommés pendant les 15 derniers jours ont été identifiés au cours d'une visite à domicile et codés selon la classification ATC. Les médicaments psychotropes inclus étaient les anxiolytiques, sédatifs et hypnotiques (ASH), les antidépresseurs (ADP) et les analgésiques/antiépileptiques/antiParkinson (AEP). Les associations entre la prévalence de la consommation des médicaments psychotropes et l'éducation, le revenu et l’occupation ont été estimés avec des ratios de prévalence (RP) obtenus en ajustant une régression de Poisson et en utilisant le modèle comportemental de Andersen et Newman sur l'utilisation des services de santé et en contrôlant les besoins (les maladies chroniques et la dépression), les facteurs prédisposants (âge et sexe) ainsi que les facteurs facilitants (en utilisant le site d'étude en tant que mandataire des facteurs lié au système de santé et à l'environnement). Résultats : Les personnes âgées vivant dans les sites canadiens consommaient plus de médicaments psychotropes que celles vivant dans les sites à l'extérieur du Canada, elles consommaient moins d’ASH à Manizales et ne consommaient pas d’ADP en Albanie. Les inégalités socioéconomiques varient selon les sites. Dans les sites canadiens, le faible niveau socioéconomique était associée à une plus grande consommation de médicaments psychotropes : en particulier, les personnes à faible niveau d’instruction consommaient plus d’antidépresseurs et celles à faible revenu consommaient plus d’AEP. Dans les sites de recherche d'Amérique latine, les personnes âgées de niveau d’instruction et de revenu élevé consommaient plus antidépresseurs et celles avec des occupations manuelles consommaient plus d’analgésiques/antiépileptiques/antiParkinson. À Tirana (Albanie), il n'y avait pas de consommation de médicaments antidépresseurs, mais la consommation d’ASH était plus élevée chez les personnes à faible revenu. Les analyses multivariées du modèle final cache les différences entre les sites qui se sont révélées dans les analyses spécifiques au niveau du Canada, de l’Amérique Latine et d’Albanie. Conclusion : Il existe des inégalités socioéconomiques liées à la consommation des médicaments psychotropes chez les personnes âgées. Ces inégalités varient selon les sites. L'utilisation des médicaments psychotropes était plus fréquente chez les personnes les moins instruites et les plus pauvres au Canada alors que l'inverse était vrai dans les sites d'Amérique latine. L'Albanie était caractérisée par une absence de consommation d'antidépresseurs alors qu’il y avait une plus grande utilisation des anxiolytiques, sédatifs et hypnotiques dans les groupes à faible revenu.

La evaluación y el cambio institucional en la sociedad del conocimiento : un estudio de caso en la Universidad del Valle - Colombia

Les sociétés contemporaines affrontent le défi de s’intégrer et s’adapter à un processus de transformation qui vise la construction de sociétés du savoir. Ce processus doit notamment son élan aux institutions d’enseignement supérieur qui constituent un espace privilégié où on bâtit l’avenir d’une société à partir des savoirs et celles-ci doivent faire face aux nouveaux enjeux sociaux, économiques et politiques qui affectent tous les pays du monde. La quête de la qualité devient donc un processus constant d’amélioration et surgit l’intérêt par l’évaluation au niveau universitaire. Par conséquent, cette recherche s’attache au sujet de l’évaluation à l’enseignement supérieur et s’enfonce dans le débat actuel sur les changements provoqués par les évaluations institutionnelles produisant un défi puisqu’il s’agit d’une prise de conscience fondée sur la culture de la qualité. L’autoévaluation est une stratégie permettant aux institutions d’enseignement supérieur mener des processus intégraux de valorisation dont le but est d’identifier les faiblesses des facteurs qui ont besoin d’améliorer. Le résultat conduit à l’élaboration et à la mise en œuvre d’un plan d’amélioration pour l'institution, programme académique ou plan d’études. À travers l’orientation du modèle d’évaluation systémique CIPP de Stufflebeam (1987), on a pu analyser de façon holistique la mise en place de l’autoévaluation depuis son contexte, planification, processus et produit. Ainsi les objectifs de la thèse visent l’identification du développement de la deuxième autoévaluation afin d’obtenir une reconnaissance de haute qualité et effectuer la mise en œuvre du plan d’amélioration auprès des programmes académiques de Licence en Comptabilité et Gestion de l’entreprise de la Faculté de Sciences de l’Administration de l’Université du Valle en Colombie. À travers l’appropriation de la théorie Neo-institutionnelle les changements apparus après l’autoévaluation ont été également analysés et interprétés et ont ainsi permis l’achèvement des fins de la recherche. La méthodologie développe la stratégie de l’étude de cas dans les deux programmes académiques avec une approche mixte où la phase qualitative des entretiens semi-structurés est complémentée par la phase quantitative des enquêtes. Des documents institutionnels des programmes et de la faculté ont aussi été considérés. Grâce à ces trois instruments ont pu obtenir plus d’objectivité et d’efficacité pendant la recherche. Les résultats dévoilent que les deux programmes ciblés ont recouru à des procédés et à des actions accordées au modèle de l’Université du Valle quoiqu’il ait fallu faire des adaptations à leurs propres besoins et pertinence ce qui a permis de mener à terme la mise en œuvre du processus d’autoévaluation et ceci a donné lieu à certains changements. Les composantes Processus Académiques et Enseignants sont celles qui ont obtenu le plus fort développement, parmi celles-ci on trouve également : Organisation, Administration et Gestion, Ressources Humaines, Physiques et Financières. D’autre part, parmi les composantes moins développées on a : Anciens Étudiants et Bienêtre Institutionnel. Les conclusions ont révélé que se servir d’un cadre institutionnel fort donne du sens d’identité et du soutien aux programmes. Il faut remarquer qu’il est essentiel d’une part élargir la communication de l’autoévaluation et ses résultats et d’autre part effectuer un suivi permanent des plans d’amélioration afin d’obtenir des changements importants et produire ainsi un enracinement plus fort de la culture de la qualité et l’innovation auprès de la communauté académique. Les résultats dégagés de cette thèse peuvent contribuer à mieux comprendre tant la mise en œuvre de l’autoévaluation et des plans d’amélioration aussi que les aspects facilitateurs, limitants, les blocages aux processus d’évaluation et la génération de changements sur les programmes académiques. Dans ce sens, la recherche devient un guide et une réflexion à propos des thèmes où les résultats sont très faibles. Outre, celle-ci révèle l’influence des cadres institutionnels ainsi que les entraves et tensions internes et externes montrant un certain degré d’agencement par le biais de stratégies de la part des responsables de la prise de décisions dans les universités. On peut déduire que la qualité, l’évaluation, le changement et l’innovation sont des concepts inhérents à la perspective de l’apprentissage organisationnel et à la mobilité des savoirs.

Inter- State Variations in Productivity trends and Technological Change in Indian industry

The present study entitled ‘Inter-State Variations in Manufacturing Productivity and Technological Changes in India’ covers a period of 38 years from l960 tol998-99. The study is mainly based on ASI data. The study starts with a discussion of the major facilitating factors of industrialization, namely, historical forces, public policy and infrastructure facilities. These are discussed in greater details in the context of our discussion on Perrox’s (1998) ‘growth pole’ and ‘development pole’, Hirschman’s (1958) ‘industrial centers’ and Myrdal’s ‘spread effect’ Most of the existing literature more or less agrees that the process of industrialization has not been unifonn in all Indian states. There has been a decline in inter-state industrial disparities over time. This aspect is dealt at some length in the third chapter. An important element that deserves detailed attention is the intra-regional differences in industrialisation. Regional industrialisation implies the emergence of a few focal points and industrial regions. Calcutta, Bombay and Madras were the initial focal points. Later other centers like Bangalore, Amritsar, Ahemedabad etc. emerged as nodal points in other states. All major states account for focal points. The analysis made in the third chapter shows that industrial activities generally converge to one or two focal points and industrial regions have emerged out of the focal points in almost all states. One of the general features of these complexes and regions is that they approximately accommodate 50 to 75 percent of the total industrial units and workers in the state. Such convergence is seen hands in glow with urbanization. It was further seen that intra-regional industrial disparity comes down in industrial states like Maharashtra, Gujarat and Uttar Pradesh.

Kvinnors och mäns återhämtning från psykisk ohälsa

The overall aim with this thesis is to describe and analyze women’s and men’s recovery processes. More specifically, the aim is to determine what women and men with experience of mental illness describe as contributing to the personal recovery process. The point of departure for the studies was 30 in-depth interviews conducted with 15 men and 15 women. The selection of interview subjects was limited to individuals who had been treated in 24-hour psychiatric care and diagnosed as having schizophrenia, psychosis, a personality disorder, or a bipolar disorder.   Four studies have been carried.  Study 1 was a baseline article that examined what people in recovery from mental illness outline as facilitating factors to their recovery. The results that emerged from that study indicated areas for further analysis to condense the understanding of the recovery process. In study 2 the similarities and the differences in recovery described by women and men were examined. In Study 3 women’s and men’s meaning-making with reference to severe mental illness facilitate the recovery process were studied. The forth study explored how peer-support contribute to women’s and men’s recovery from mental illness.   The results emphasize recovery from mental illness as a social process in which relationships play a key role in creating new identities beside the mental illness. For a majority of the participants meeting peers facilitated the recovery process. The participants described how peer support meant an end to isolation and became an arena for identification, connection, and being important to others. Throughout these recovery processes the impact of gender has been emphasized. The results from this thesis provide new insight into gender as an important factor in understanding the recovery processes. The results from the four studies emphasize the mental patient, the psychiatric interventions and the individual recovery strategies as being influenced by gender constructions.

Främjande faktorer för sjuksköterskor att bedriva en evidensbaserad vård

Bakgrund Evidensbaserad vård (EBV) är ett välkänt begrepp som används för att tillförsäkra patienter en säker vård som vilar på bästa tillgängliga bevis, beprövad erfarenhet och patientens individuella preferenser. Många studier har tidigare undersökt hinder för sjuksköterskor att bedriva och/eller implementera EBV för att förklara gapet som kan uppstå mellan teori och praktik. Färre studier har undersökt vilka faktorer som främjar sjuksköterskors användande av EBV. Syfte Att genom en litteraturöversikt beskriva vilka faktorer som främjar sjuksköterskors möjligheter att bedriva en evidensbaserad vård. Metod Studien genomfördes som en litteraturöversikt. Databaserna CINAHL, PubMed och Web of Science genomsöktes och 15 artiklar valdes ut (8 kvalitativa, 4 kvantitativa och 3 mixedmethod). Resultat Fem kategorier identifierades som främjande faktorer för sjuksköterskor att bedriva och/eller implementera EBV; arbetsmiljö, stöd, kunskap, sjuksköterskans inställning och organisation. Stöd i form utav underlättare var den mest framträdande faktorn. Slutsats Sjuksköterskan har ett individuellt ansvar att bedriva EBV och kan genom sin egen inställning påverka att en sådan vård bedrivs. De flesta främjande faktorer som framkom var dock tydligare kopplade till ledningen och chefens del i att främja användandet av EBV.

Mudança em instituições hospitalares: análise do processo e estudo da ação do administrador hospitalar

O projeto consiste em identificar e caracterizar os processos de mudança estratégica em instituições hospitalares complexas e de grande porte do município de São Paulo, a fim de analisar os fatores internos limitadores e impulsionadores do processo, bem como discutir a ação e o papel efetivo do gestor hospitalar nesse contexto.

As organizações sociais de saúde em São Paulo, 1998-2002: uma visão institucional

O presente trabalho tem por objetivo descrever o processo de implantação Organizações Sociais de Saúde na Secretaria de Estado da Saúde de São Paulo enquanto caso especial de reforma do Estado no setor da saúde, identificando os fatores motivadores e as justificativas referidas por parte do Estado e dos parceiros envolvidos, e descrever o processo de negociação e implantação das Organizações Sociais de Saúde caracterizando, a) regulamentação/legislação específica; b) negociação e formalização das parcerias; c) etapas de implantação; d) mecanismos de financiamento; e) fatores facilitadores e dificuldades; f) considerações sobre os processo obtidos por parte dos envolvidos. A revisão bibliográfica sobre o tema é seguida de estudo de caso envolvendo a Secretaria de Estado da Saúde e sete organizações sem fins lucrativos com quem constituem parceria para gerenciar hospitais públicos na Região Metropolitana de São Paulo. As organizações, com diferentes perfis assistenciais, constituem parceria mediante contrato de gestão. Identificam-se as diferenças entre este contrato e os propostos pela Reforma do Aparelho do Estado, as motivações que orientaram os parceiros. os mecanismos de financiamento utilizados e o cuidadoso processo de negociação desenvolvido que permitiu dar estabilidade à parceria. A percepção dos dirigentes das Organizações Sociais de Saúde, da Secretaria de Estado da Saúde e dos diretores dos hospitais sobre o desenvolvimento da parceria, seus pontos fortes, os problemas identificados e as perspectivas de municipalização são relatados e analisados. A parceria implicou em significativos ganhos institucionais para ambos os lados, bem como propiciou condições para o desenvolvimento de modalidades assistenciais diversificadas e outras parcerias com a comunidade envolvida. Entretanto, faz-se necessário o contínuo aprimoramento do contrato de gestão e da articulação entre os gestores do sistema para permitir que as eventuais melhorias de desempenho alcançadas se reflitam no restante da rede e sejam sustentáveis ao longo do tempo.

Internacionalização da empresa Marcopolo S.A. : um estudo de caso

A experiência internacional de empresas de países em desenvolvimento é relativamente nova, assim como os estudos sobre o desenvolvimento dessas atividades por esses países e, em particular, pelo Brasil. Esta pesquisa visou contribuir para o conhecimento sobre como as empresas brasileiras se internacionalizam e, para tanto, foi realizado um estudo de caso em profundidade com a Marcopolo S. A., uma organização em estágio avançado de operações internacionais. Apoiando-se em vertentes comportamentais e econômicas da literatura sobre o tema, buscou-se investigar o processo de internacionalização dessa empresa – suas motivações, como ela expandiu seus negócios no exterior, quais foram os principais obstáculos enfrentados e fatores facilitadores do processo. Também se estudou a relação entre internacionalização e resultados financeiros obtidos e a influência de políticas públicas. Atuar em mercados externos foi uma forma de ampliação de mercados e de diversificação de riscos para a empresa e hoje é o foco de sua estratégia de crescimento. O processo se desenvolveu de forma incremental, evoluindo de operações de menor comprometimento e em países mais próximos do Brasil, até a instalação de unidades em mercados mais distantes. Obstáculos de natureza econômica e cultural influenciaram suas atividades e o domínio tecnológico de produtos e de processos, assim como parcerias com montadoras, foram facilitadores do seu desenvolvimento internacional. Os resultados da pesquisa confirmaram os pressupostos da abordagem comportamental, reforçando a hipótese gradualista sustentada pela Teoria de Uppsala. O Paradigma Eclético também explicou os investimentos diretos realizados pela empresa, o que levou à constatação de que as duas linhas teóricas se complementam para explicar o caso. As operações da companhia em mercados externos foram historicamente mais rentáveis do que no mercado doméstico e esses resultados tornaram-se mais expressivos com a instalação de unidades no exterior. Por fim, constatou-se que algumas medidas de apoio governamental geraram efeitos positivos para as exportações, mas que não houve influência de políticas públicas para instalação de fábricas em territórios estrangeiros.

Police Interviews with Victims and Suspects of Violent and Sexual Crimes : Interviewee's experiences and interview outcomes

The police interview is one of the most important investigative tools that law enforcement has close at hand, and police interview methods have changed during the twentieth century. A good police interview is conducted in the frame of the law, is governed by the interview goal, and is influenced by facilitating factors that may affect the elicited report. The present doctoral dissertation focuses on police interviews in cases of very serious crimes of violence and sexual offences. Results reveal crime victims’ and perpetrators’ experiences of being interviewed and police officers’ attitudes towards conducting interviews related to traumatizing crimes. Study 1 revealed that when police officers interviewed murderers and sexual offenders, the interviewees perceived attitudes characterized by either dominance or humanity. Police interviews marked by dominance and suspects’ responses of anxiety were mainly associated with a higher proportion of denials, whereas an approach marked by humanity, and responses of being respected were significantly associated with admissions. In line with Study 1, the victims of rape and aggravated assault in Study 2 also revealed the experience of two police interview styles, where an interviewing style marked by dominance and responses of anxiety was significantly associated with crime victims’ omissions of information. Moreover, a humanitarian interviewing style, and crime victims’ feelings of being respected and co-operative, was significantly related to crime victims providing all information from painful events. Special squad police officers’ attitudes towards interviewing crime victims, in Study 3, also showed a humanitarian approach and two dominant approaches, one affective and the other refusing. The attitude towards interviewing suspects of crimes in focus revealed humanitarian and dominant interviewing attitudes, and an approach marked by kindness. The present thesis shows that, during their entire career, an overwhelming majority of the special squad police officers have experienced stressful events during patrol as well as investigative duty. Results show that symptoms from stressful event exposures and coping mechanisms are associated with negative attitudes towards interviewing suspects and supportive attitudes towards crime victim interviews. Thus, experiences from stressful exposures may automatically activate ego-defensive functions that automatically generate dominant attitudes. Moreover, it is important to offer police officers who have been exposed to stressful events the opportunity to work through their experiences, for example, through debriefing procedures. After debriefings, police officers are better prepared to meet crime victims and suspects and, through conscious closed-loop processes, to conduct police interviews without awaking ego-defensive functions.

Understanding Impediments and Enablers to Physical Activity among African American Adults: A Systematic Review of Qualitative Studies

Objective: To systematically assess and summarize impediments and facilitating factors impacting physical activity participation among African American Adults. ^ Method: A systematic search of the literature was conducted, which included electronic databases, as well as reference list of relevant papers. Only qualitative studies which measured race and ethnicity and had African American as adult participants were included. The main themes and categories from the qualitative studies pertaining to impediments and facilitators to physical activity were identified and summarized, through descriptive meta-synthesis. ^ Result: Twenty nine qualitative studies were included. Twenty-one of the studies only focused on adult African American women, and the barriers and facilitators to physical activity as perceived by them. The biggest individual enabler towards physical activity was the positive health benefits associated with regular physical activity. Social support and easy access to parks and facilities were also identified as enablers. Barriers toward physical activity were lack of time, lack of motivation, long work hours, and physical disabilities. ^ Conclusions: The findings of this review study should be useful to those planning an intervention in African American communities. There is also a need for qualitative studies conducted only among African American men, to better understand their perspective on the facilitators and barriers to physical activity.^

IT Clusters in India

One of the facilitating factors that enabled the rise of IT industry in India is the evolution of IT clusters. A study of these clusters can provide interesting insights. The rise of the Banglaore IT cluster was due, among other things, to some of the policies the Indian government took three decades or earlier. It would be difficult to talk of "benign neglect" of the government towards this sector. Different factors worked in the case of Hyderabad. A comparison between the IT clusters in India has much to tell the new emerging IT clusters in India as well as those outside of it.

Desintegración vertical en la industria del automóvil en España: un caso de estudio = Vertical disintegration in the automotive industry in Spain: a case study

En los años recientes se ha producido un rápido crecimiento del comercio internacional en productos semielaborados que son diseñados, producidos y ensamblados en diferentes localizaciones a lo largo de diferentes países, debido principalmente a los siguientes motivos: el desarrollo de las tecnologías de la información, la reducción de los costes de transporte, la liberalización de los mercados de capitales, la armonización de factores institucionales, la integración económica regional que implica la reducción y la eliminación de las barreras al comercio, el desarrollo económico de los países emergentes, el uso de economías de escala, así como una desregulación del comercio internacional. Todo ello ha incrementado la competencia a nivel mundial en los mercados y ha posibilitado a las compañías tener más facilidad de acceso a potenciales mercados, así como a la adquisición de capacidades y conocimientos en otros países y a la realización de alianzas estratégicas internacionales con terceros, creando un entorno con mayor incertidumbre y más exigente para las compañías que componen una industria, y que tiene consecuencias directas en las operaciones de las compañías y en la organización de su producción. Las compañías, para adaptarse, ser competitivas y beneficiarse de este nuevo escenario globalizado y más competitivo, han externalizado partes del proceso productivo hacia proveedores especializados, creando un nuevo mercado intermedio que divide el proceso productivo, anteriormente integrado en las compañías que conforman una industria, entre dos conjuntos de empresas especializadas en esa industria. Dicho proceso suele ocurrir conservando la industria en que tiene lugar, los mismos servicios y productos, la tecnología empleada y las compañías originales que la conformaban previamente a la desintegración vertical. Todo ello es así debido a que es beneficioso tanto para las compañías originales de la industria como para las nuevas compañías de este mercado intermedio por diversos motivos. La desintegración vertical en una industria tiene unas consecuencias que la transforman completamente, así como la forma de operar de las compañías que la integran, incluso para aquellas que permanecen verticalmente integradas. Una de las características más importantes de esta desintegración vertical en una industria es la posibilidad que tiene una compañía de adquirir a una tercera la primera parte del proceso productivo o un bien semielaborado, que posteriormente será finalizado por la compañía adquiriente con la práctica del outsourcing; así mismo, una compañía puede realizar la primera parte del proceso productivo o un bien semielaborado, que posteriormente será finalizado por una tercera compañía con la práctica de la fragmentación. El principal objetivo de la presente investigación es el estudio de los motivos, los facilitadores, los efectos, las consecuencias y los principales factores significativos, microeconómicos y macroeconómicos, que desencadenan o incrementan la práctica de la desintegración vertical en una industria; para ello, la investigación se divide en dos líneas completamente diferenciadas: el estudio de la práctica del outsourcing y, por otro lado, el estudio de la fragmentación por parte de las compañías que componen la industria del automóvil en España, puesto que se trata de una de las industrias más desintegradas verticalmente y fragmentadas, y este sector posee una gran importancia en la economía del país. En primer lugar, se hace una revisión de la literatura existente relativa a los siguientes aspectos: desintegración vertical, outsourcing, fragmentación, teoría del comercio internacional, historia de la industria del automóvil en España y el uso de las aglomeraciones geográficas y las tecnologías de la información en el sector del automóvil. La metodología empleada en cada uno de ellos ha sido diferente en función de la disponibilidad de los datos y del enfoque de investigación: los factores microeconómicos, utilizando el outsourcing, y los factores macroeconómicos, empleando la fragmentación. En el estudio del outsourcing, se usa un índice basado en las compras externas sobre el valor total de la producción. Así mismo, se estudia su correlación y significación con las variables económicas más importantes que definen a una compañía del sector del automóvil, utilizando la técnica estadística de regresión lineal. Aquellas variables relacionadas con la competencia en el mercado, la externalización de las actividades de menor valor añadido y el incremento de la modularización de las actividades de la cadena de valor, han resultado significativas con la práctica del outsourcing. En el estudio de la fragmentación se seleccionan un conjunto de factores macroeconómicos, comúnmente usados en este tipo de investigaciones, relacionados con las principales magnitudes económicas de un país, y un conjunto de factores macroeconómicos, no comúnmente usados en este tipo de investigaciones, relacionados con la libertad económica y el comercio internacional de un país. Se emplea un modelo de regresión logística para identificar qué factores son significativos en la práctica de la fragmentación. De entre todos los factores usados en el modelo, los relacionados con las economías de escala y los costes de servicio han resultado significativos. Los resultados obtenidos de los test estadísticos realizados en el modelo de regresión logística han resultado satisfactorios; por ello, el modelo propuesto de regresión logística puede ser considerado sólido, fiable y versátil; además, acorde con la realidad. De los resultados obtenidos en el estudio del outsourcing y de la fragmentación, combinados conjuntamente con el estado del arte, se concluye que el principal factor que desencadena la desintegración vertical en la industria del automóvil es la competencia en el mercado de vehículos. Cuanto mayor es la demanda de vehículos, más se reducen los beneficios y la rentabilidad para sus fabricantes. Estos, para ser competitivos, diferencian sus productos de la competencia centrándose en las actividades que mayor valor añadido aportan al producto final, externalizando las actividades de menor valor añadido a proveedores especializados, e incrementando la modularidad de las actividades de la cadena de valor. Las compañías de la industria del automóvil se especializan en alguna o varias de estas actividades modularizadas que, combinadas con el uso de factores facilitadores como las economías de escala, las tecnologías de la información, las ventajas de la globalización económica y la aglomeración geográfica de una industria, incrementan y motivan la desintegración vertical en la industria del automóvil, desencadenando la coespecialización en dos sectores claramente diferenciados: el sector de fabricantes de vehículos y el sector de proveedores especializados. Cada uno de ellos se especializa en unas actividades y en unos productos o servicios específicos de la cadena de valor, lo cual genera las siguientes consecuencias en la industria del automóvil: se reducen los costes de transacción en los productos o servicios intercambiados; se incrementan la relación de dependencia entre fabricantes de vehículos y proveedores especializados, provocando un aumento en la cooperación y la coordinación, acelerando el proceso de aprendizaje, posibilitando a ambos adquirir nuevas capacidades, conocimientos y recursos, y creando nuevas ventajas competitivas para ambos; por último, las barreras de entrada a la industria del automóvil y el número de compañías se ven alteradas cambiando su estructura. Como futura línea de investigación, los fabricantes de vehículos tenderán a centrarse en investigar, diseñar y comercializar el producto o servicio, delegando el ensamblaje en manos de nuevos especialistas en la materia, el contract manufacturer; por ello, sería conveniente investigar qué factores motivantes o facilitadores existen y qué consecuencias tendría la implantación de los contract manufacturer en la industria del automóvil. 1.1. ABSTRACT In recent years there has been a rapid growth of international trade in semi-finished products designed, produced and assembled in different locations across different countries, mainly due to the following reasons: development of information technologies, reduction of transportation costs, liberalisation of capital markets, harmonisation of institutional factors, regional economic integration, which involves the reduction and elimination of trade barriers, economic development of emerging countries, use of economies of scale and deregulation of international trade. All these factors have increased competition in markets at a global level and have allowed companies to gain easier access to potential markets and to the acquisition of skills and knowledge in other countries, as well as to the completion of international strategic alliances with third parties, thus creating a more demanding and uncertain environment for these companies constituting an industry, which has a direct impact on the companies' operations and the organization of their production. In order to adapt, be competitive and benefit from this new and more competitive global scenario, companies have outsourced some parts of their production process to specialist suppliers, generating a new intermediate market which divides the production process, previously integrated in the companies that made up the industry, into two sets of companies specialized in that industry. This process often occurs while preserving the industry where it takes place, its same services and products, the technology used and the original companies that formed it prior to vertical disintegration. This is because it is beneficial for both the industry's original companies and the companies belonging to this new intermediate market, for various reasons. Vertical disintegration has consequences which completely transform the industry where it takes place as well as the modus operandi of the companies that are part of it, even of those who remain vertically integrated. One of the most important features of vertical disintegration of an industry is the possibility for a company to acquire from a third one the first part of the production process or a semi-finished product, which will then be finished by the acquiring company through the practice of outsourcing; also, a company can perform the first part of the production process or a semi-finish product, which will then be completed by a third company through the practice of fragmentation. The main objective of this research is to study the motives, facilitators, effects, consequences and major significant microeconomic and macroeconomic factors that trigger or increase the practice of vertical disintegration in a certain industry; in order to do so, research is divided into two completely differentiated lines: on the one hand, the study of the practise of outsourcing and, on the other, the study of fragmentation by companies constituting the automotive industry in Spain, since this is one of the most vertically disintegrated and fragmented industries and this particular sector is of major significance in this country's economy. First, a review is made of the existing literature, on the following aspects: vertical disintegration, outsourcing, fragmentation, international trade theory, history of the automobile industry in Spain and the use of geographical agglomeration and information technologies in the automotive sector. The methodology used for each of these aspects has been different depending on the availability of data and the research approach: the microeconomic factors, using outsourcing, and the macroeconomic factors, using fragmentation. In the study on outsourcing, an index is used based on external purchases in relation to the total value of production. Likewise, their significance and correlation with the major economic variables that define an automotive company are studied, using the statistical technique of linear regression. Variables related to market competition, outsourcing of lowest value-added activities and increased modularisation of the activities of the value chain have turned out to be significant with the practice of outsourcing. In the study of fragmentation, a set of macroeconomic factors commonly used for this type of research, is selected, related to the main economic indicators of a country, as well as a set of macroeconomic factors, not commonly used for this type of research, which are related to economic freedom and the international trade of a certain country. A logistic regression model is used to identify which factors are significant in the practice of fragmentation. Amongst all factors used in the model, those related to economies of scale and service costs have turned out to be significant. The results obtained from the statistical tests performed on the logistic regression model have been successful; hence, the suggested logistic regression model can be considered to be solid, reliable and versatile; likewise, it is in line with reality. From the results obtained in the study of outsourcing and fragmentation, combined with the state of the art, it is concluded that the main factor that triggers vertical disintegration in the automotive industry is competition within the vehicle market. The greater the vehicle demand, the lower the earnings and profitability for manufacturers. These, in order to be competitive, differentiate their products from the competition by focusing on those activities that contribute with the highest added value to the final product, outsourcing the lower valueadded activities to specialist suppliers, and increasing the modularity of the activities of the value chain. Companies in the automotive industry specialize in one or more of these modularised activities which, combined with the use of enabling factors such as economies of scale, information technologies, the advantages of economic globalisation and the geographical agglomeration of an industry, increase and encourage vertical disintegration in the automotive industry, triggering co-specialization in two clearly distinct sectors: the sector of vehicle manufacturers and the specialist suppliers sector. Each of them specializes in certain activities and specific products or services of the value chain, generating the following consequences in the automotive industry: reduction of transaction costs of the goods or services exchanged; growth of the relationship of dependency between vehicle manufacturers and specialist suppliers, which causes an increase in cooperation and coordination, accelerates the learning process, enables both to acquire new skills, knowledge and resources, and creates new competitive advantages for both; finally, barriers to entry the automotive industry and the number of companies are altered, changing their structure. As a future line of research, vehicle manufacturers will tend to focus on researching, designing and marketing the product or service, delegating the assembly in the hands of new specialists in the field, the contract manufacturer; for this reason, it would be useful to investigate what motivating or facilitating factors exist in this respect and what consequences would the implementation of contract manufacturers have in the automotive industry.

The Determinants of Investment in Information and Communication Technologies. Bruges European Economic Research (BEER) Papers 16/March 2010

In this paper we investigate the determinants of ICT investment at the macro level for a panel of ten countries over the period 1992-2005. We argue that, since ICT is a General Purpose Technology, its diffusion can be understood only considering the interaction with institutional and structural factors. The empirical results are in line with this view: facilitating factors such as changes in regulation, human capital and the sectoral composition of the economy are relevant determinants for increasing ICT investment.

Perceções dos enfermeiros sobre os erros de medicação no pré-hospitalar

Quase metade da totalidade de eventos adversos evitáveis é consequência de erros de medicação (EM), contudo, não sendo possível evitá-los completamente, estes podem ser minorados. Esta problemática em contexto pré-hospitalar (PH) tem sido pouco estudada a nível internacional e nunca foi abordada em Portugal. O objetivo deste estudo é relacionar as variáveis sociodemográficas, socioprofissionais, formação, conhecimentos e experiências com EM com a perceção dos enfermeiros que exercem no PH relativamente à frequência da ocorrência dos tipos e causas de EM, dos obstáculos ao relato de EM, dos fatores facilitadores do relato de EM e com o grau de concordância sobre divulgação de EM. Métodos: Trata-se de um estudo analítico, descritivo, transversal e correlacional. A amostra é composta por 107 enfermeiros do PH (método snowball), dos quais 56.1% são do sexo masculino. Foi aplicado um questionário eletrónico constituído por uma componente sociodemográfica, escala de conhecimentos, perceções e experiência com erros de medicação (Raimundo, 2011; Maurer, 2010; Bohomol & Ramos, 2006; Mayo & Duncan, 2004; Osborne, Blais & Hayes, 1999; Gladstone, 1995). Resultados: Dos inquiridos 60.7% apresentam fracos a razoáveis conhecimentos sobre EM; mais de 54% perceciona a sua formação académica/contínua sobre EM como sendo inexistente/insuficiente e 52.3% não recebe formação sobre farmacologia há pelo menos 6 anos; 45.8% diz ter experienciado no PH um ou mais EM sem dano para o doente e apenas 14.9% relatou um ou mais EM sem dano para o doente. Os tipos e as causas de EM identificadas ocorrem com uma frequência elevada para mais de 39% dos inquiridos. A maioria dos inquiridos (47.7%) considera que no PH existem grandes obstáculos ao relato de EM e os fatores facilitadores do relato de EM apresentados são considerados por 49.5% dos enfermeiros como altamente prováveis de facilitar o relato. 52,3% dos enfermeiros do PH discordam de uma forma global com a divulgação de EM. O sexo feminino apresenta uma perceção mais elevada da ocorrência das causas primárias de EM (MF=2.68, Dp= 0.60 vs MM=2.36, Dp=0.66) e uma perceção mais elevada dos fatores facilitadores ao relato dos EM (MF=4.40, Dp= 0.64 vs MM=4.12, Dp=0.74). Os enfermeiros que exercem exclusivamente no PH possuem uma melhor perceção da frequência de ocorrência das causas primárias de EM. Quanto maior o conhecimento dos enfermeiros sobre EM, maior é a perceção destes relativamente aos tipos de erros e maior o grau de concordância com a divulgação dos EM. Existe evidência estatisticamente significativa (p<0.05) de que os enfermeiros que experienciaram a ocorrência de pelo menos 1 erro com dano para o doente possuem melhor perceção dos tipos, causas primárias e obstáculos ao relato dos EM, assim como apresenta um maior grau de concordância com a divulgação de EM. Conclusão: A perceção dos enfermeiros sobre a frequência dos tipos e das causas de EM, assim como dos obstáculos e dos fatores facilitadores do relato de EM por parte dos enfermeiros no PH não tem, de uma forma geral, relação com as características sociodemográficas e socioprofissionais, o que demonstra a transversalidade desta problemática. Tão ou mais importante do que avaliar a dimensão e caracterizar a tipologia, causas, obstáculos e fatores facilitadores ao relato dos EM será, com base no conhecimento obtido, definir e implementar ações de gestão de risco que permitam a sua redução ou mesmo a sua supressão. PALAVRAS-CHAVE: Erros de Medicação, Perceção dos Enfermeiros, Pré- Hospitalar.