Shared decision-making in mental health care : a user perspective on decisional needs in community-based services

BACKGROUND: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. OBJECTIVE: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. METHODS: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. RESULTS: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

Towards a Protocol for the Attachment of Metadata to Service Descriptions and its Use in Semantic Discovery

Service discovery in large scale, open distributed systems is difficult because of the need to filter out services suitable to the task at hand from a potentially huge pool of possibilities. Semantic descriptions have been advocated as the key to expressive service discovery, but the most commonly used service descriptions and registry protocols do not support such descriptions in a general manner. In this paper, we present a protocol, its implementation and an API for registering semantic service descriptions and other task/user-specific metadata, and for discovering services according to these. Our approach is based on a mechanism for attaching structured and unstructured metadata, which we show to be applicable to multiple registry technologies. The result is an extremely flexible service registry that can be the basis of a sophisticated semantically-enhanced service discovery engine, an essential component of a Semantic Grid.

Agents and the Grid: Service Discovery

The Grid is a large-scale computer system that is capable of coordinating resources that are not subject to centralised control, whilst using standard, open, general-purpose protocols and interfaces, and delivering non-trivial qualities of service. In this chapter, we argue that Grid applications very strongly suggest the use of agent-based computing, and we review key uses of agent technologies in Grids: user agents, able to customize and personalise data; agent communication languages offering a generic and portable communication medium; and negotiation allowing multiple distributed entities to reach service level agreements. In the second part of the chapter, we focus on Grid service discovery, which we have identified as a prime candidate for use of agent technologies: we show that Grid-services need to be located via personalised, semantic-rich discovery processes, which must rely on the storage of arbitrary metadata about services that originates from both service providers and service users. We present UDDI-MT, an extension to the standard UDDI service directory approach that supports the storage of such metadata via a tunnelling technique that ties the metadata store to the original UDDI directory. The outcome is a flexible service registry which is compatible with existing standards and also provides metadata-enhanced service discovery.

Principles of Personalisation of Service Discovery

We define personalisation as the set of capabilities that enables a user or an organisation to customise their working environment to suit their specific needs, preferences and circumstances. In the context of service discovery on the Grid, the demand for personalisation comes from individual users, who want their preferences to be taken into account during the search and selection of suitable services. These preferences can express, for example, the reliability of a service, quality of results, functionality, and so on. In this paper, we identify the problems related to personalising service discovery and present our solution: a personalised service registry or View. We describe scenarios in which personsalised service discovery would be useful and describe how our technology achieves them.

A estrutura de decisão do operador de transporte de cargas pelo usuário varejista de pequeno porte

Este trabalho tem por objetivo investigar e identificar a influência dos atributos que estruturam a escolha do transportador de carga geral fracionada pelos usuários, em uma determinada rota nacional, baseado na modelagem da demanda. xii A modelagem da demanda é efetuada com base em Modelos Comportamentais Desagregados, utilizando-se as técnicas de Preferência Declarada (Stated Preference), na obtenção dos dados. A determinação das preferências dos decisores são analisadas, buscandose assim quantificar o valor das variáveis que compõem o nível de serviço desejado pelos varejistas usuários. O estudo enfoca o comportamento do varejista usuário de serviços de transporte de cargas com relação a tomada de decisão sobre a transportadora que executará o serviço de transporte de carga. Esta tomada de decisão do varejista usuário leva em consideração que cada operador valoriza os atributos em diferentes graus e que estes fazem parte do nível de serviço de cada transportadora. As técnicas de Preferência Declarada forneceram dados para estimar as funções de Utilidade levando em consideração os diferentes níveis de atributos de cada transportadora. A partir da função de Utilidade de cada transportadora, é estimada a probabilidade de escolha de cada transportadora. A modelagem permite a realização de simulações, a partir de alterações no grau dos atributos das variáveis do modelo, na qual se determinará a parcela de mercado de cada transportadora e a sua respectiva participação no mercado em estudo. Dentre os principais resultados, pode se observar que a modelagem da demanda em transporte de cargas, apesar de pouco utilizada, é coerente com a realidade analisada, validando a metodologia utilizada neste estudo.

Defining student participation and empowerment in higher education

Customer participation has been studied for decades; however, it gained a postmodern perspective around the year 2000. Customers have become co-creators of personalized experiences, moving from the audience to the stage. In the educational context, students must take responsibility for their learning process and participate in the production of the service. This changing is providing opportunities and challenges for higher education institutions (HEIs) to redefine their relationship with stakeholders, especially with students. This study is based on the service dominant logic (SDL) perspective because students are assumed to take the role of co-creators of knowledge in the educational setting. The research uses adapted frameworks and concepts applied in organizational, knowledge-intensive business services (KIBS) and also medical studies to advance the understanding of value co-creation in the HEI context. The current study addresses a lack of research in the higher education context focusing on defining students’ participation and students’ empowerment in higher education context. An empirical investigation was developed with traditional schools in Brazil. This investigation allowed the description of the constructs in the specific context. The description of student participation in HEIs context reflects the relevance of three dimensions – information sharing, personal interaction and responsible behavior. In the Brazilian context, responsible behavior is the weakest dimension in the construct, because the responsibilities are unbalanced between students and professors. The main reasons identified for this unbalanced relation were cultural issues and local regulation. Student empowerment was described as composed by four dimensions – meaningfulness, competence, impact and choice; however, one of them – choice – was identified as the weakest dimension, facing cultural and bureaucratic barriers for implementation in the Brazilian educational context. Moreover, interviewees spontaneously cited the idea of trust in the faculty as an important antecedent of student participation that must be considered when analyzing student participation and empowerment mechanisms. An additional contribution was the proposal of a theory-based framework for understanding the service dominant logic perspective in the HEI context, in which student participation and student empowerment were explored as mechanisms leading to positive student behavior toward institution.

De touch: extending service channels in an airport through touch technologies

This project aimed to create a communication and interaction channel between Madeira Airport and its passengers. We used the pre-existent touch enabled screens at the terminal since their potential was not being utilised to their full capacity. To achieve our goal, we have followed an agile strategy to create a testable prototype and take advantages of its results. The developed prototype is based on a plugin architecture turning it into a maintainable and highly customisable system. The collected usage data suggests that we have achieved the initially defined goals. There is no doubt that this new interaction channel is an improvement regarding the provided services and, supported by the usage data, there is an opportunity to explore additional developments to the channel.

Competição e regulamentação no transporte de passageiros: Um estúdio no transporte rodoviário intermunicipal

The objective of this research is the verification of the competition in the intecity market, after the entrance of new competitors (vans and microbus) regulated and clandestine. For verification of this new view was effected one research of documentary character for the knowledge of the regulation and exploratory character of the system Natal - territory of the Seridó, for thus in making will know this problematic, well as its characteristics, attractivenesses and development of the territory of the Seridó, and its link with the Capital (Natal). Later, through a descriptive exploratory research of the type survey with the passengers to know as these are being taken care and its satisfaction in relation to the regulated companies. With the drivers if focus effected one group, and with the staff of the of sale ticket a research survey, aiming at to know the strategies used for the only company of bus that takes care of the territory of the Seridó, the implantation of these and the consequence of the user. In accordance with the generic tipologia of Porter and its strategies, were perceived that the bus company adopted the strategy of price leadership being competitive, using to advantage its bigger space in the market, already vans and the microbuses with its limited participation bet in a strategy of "differentiation" in its service, effecting faster trips and in the strategy of "approach" we find the not regulated services earn the service to the taste of the user

Avaliação da saúde bucal na atenção básica: a perspectiva do usuário

Nowadays, the basic attention in health works according to the Health Family Program (HFP), which is responsible for the organization of the health services with view to provide an appropriate attendance to the needs of the population. Its expansion is expressive in whole country and, the oral health, included in this process, has been seen as a possibility of change the health practices centered in the disease. In face of this perspective, the proposal of study is to discover possible changes in the health care model of oral health in a district, made possible through the perception, evaluation and degree of satisfaction of the user s health service. To reach such objectives, the district of Macaíba in the State of Rio Grande do Norte, was chosen for operational subjects, such as time of implantation of HFP and great covering of this program. The current research used interviews structured with objectives and subjectives questions and questionnaires of socioeconomic characterization addressed to two hundred and seventy (270) individuals (ninety users of an Urban PSF, ninety of a Rural PSF and ninety of an unit non PSF). The analysis of the data was accomplished through the software SPSS/99, that made possible a statistical and analytic appreciation. The HFP units and non HFP units has shown to sort the common odontology problems of the community, and this didn't establish a direct relationship with the general satisfaction. On the other hands, the programmed consultation is related with lager satisfaction of the users. The access form to the odontology treatment of the Units, the satisfaction with the attendance rendered by the dentist and the equip, enough dentists for the community and the social class of the user were decisive for the general satisfaction with the service of oral health. On the other hand, variables as age and education, resolution of the problem and physical conditions of the unit didn't influence the general satisfaction. In spite of the progresses in the implantation of the oral health in ESF, preventive activities, visits at home, access and social participation still reproduce the traditional model of attendance, showing a primary change process

Práticas de ensino-aprendizagem com base em cenários reais

O processo ensino-pesquisa-extensão realizado com a imersão dos sujeitos em cenários reais possibilita a integração universidade-comunidade, ampliando a inserção social. O objetivo deste trabalho foi apresentar a experiência de um projeto conduzido em cinco municípios brasileiros, com a participação de docentes, pós-graduandos e acadêmicos, em parceria com prefeituras municipais e trabalhadores de saúde como cenário de ensino-pesquisa no SUS. Foram realizadas oficinas e cursos de capacitação com as equipes de saúde, gestores e conselheiros de saúde, visitas técnicas aos municípios para avaliação situacional e supervisão das atividades, avaliação da satisfação dos usuários e formação de lideranças populares. Observou-se a melhoria na organização dos serviços e estímulo ao fortalecimento do vínculo entre os usuários e prestadores de serviços. Essa experiência serviu como laboratório de aprendizagem e pesquisa, fazendo-se ciência a partir da vivência in loco da realidade do SUS e contribuindo para uma formação professional mais humanitária baseada em cenários reais.

Integrando comunicação, saúde e educação: experiência do UNI-Botucatu

Relata-se experiência inicial de trabalho com as áreas de Comunicação e Educação em Saúde em projeto de cooperação entre universidade, serviços de saúde e organizações comunitárias para o desenvolvimento integrado de modelos inovadores de ensino, de sistemas locais de saúde e de ação comunitária. Apresenta-se proposta de operacionalização de ações de Comunicação e Educação em Saúde, com ênfase na interação serviços-comunidade. Nesta busca-se não só fortalecer as instâncias formais de participação dos usuários, mas ainda desenvolver outros espaços de comunicação e interação serviços-comunidade, procurando, assim, transformar progressivamente pacientes em usuários-cidadãos.

High expectations, varying outcomes: Decentralization and participation in Brazil, Japan, Russia and Sweden

In the past 20 years, decentralization has been proposed as a strategy for enhancing public participation. Aid-providing organizations, such as the World Bank, stimulated decentralization processes in several countries in the hope that this would promote civic empowerment, diminish corruption, enhance efficiency, and improve public service delivery. This assumption forms the basis for a comparative analysis into the relation between decentralization and participation at the local level in Brazil, Japan, Russia and Sweden. A multi-level regression analysis using the data of the Democracy and Local Governance Project was undertaken in order to test the 'one size fits all' and the 'diversity in development' hypotheses. The results show that the second hypothesis was corroborated. Perceived autonomy had a different impact on openness to participation depending on the country considered; in one country (Japan), perceived autonomy diminished public officials' willingness to be open to public participation.

User Manual for the Gender Equality Observatory for Latin America and the Caribbean

Includes bibliography

Barbados: public-private sector partnership

Includes bibliography

The Mexican film industry and its participation in the global value chain

Includes bibliography