Increased health care utilization and increased antiretroviral use in HIV-infected individuals with mental health disorders

Objectives The aims of the study were to describe the prevalence and associations of mental health disorder (MHD) among a cohort of HIV-infected patients attending the Victorian HIV/AIDS Service between 1984 and 2000, and to examine whether antiretroviral therapy use or mortality was influenced by MHD (defined as a record of service provision by psychiatric services on the Victorian Psychiatric Case Register). It was hypothesized that HIV-positive individuals with MHD would have poorer treatment outcomes, reduced responses to highly active antiretroviral therapy (HAART) and increased mortality compared with those without MHD. Methods This is a retrospective cohort of 2981 individuals (73% of the Victorian population diagnosed with HIV infection) captured on an HIV database which was electronically matched with the public Victorian Psychiatric Case Register (VPCR) (accounting for 95% of public system psychiatry service provision). The prevalence, dates and recorded specifics of mental health disorders at the time of the electronic match on 1 June 2000 are described. The association with recorded MHD, gender, age, AIDS illness, HIV exposure category, duration and type of antiviral therapy, treatment era (prior to 1986, post-1987 and pre-HAART, and post-HAART) on hospitalization and mortality at 1 September 2001 was assessed. Results Five hundred and twenty-five individuals (17.6% of the Victorian HIV-positive population) were recorded with MHD, most frequently coded as attributable to substance dependence/abuse or affective disorder. MHD was diagnosed prior to HIV in 33% and, of those diagnosed after HIV, 93.8% were recorded more than 1 year after the HIV diagnosis. Schizophrenia was recorded in 6% of the population with MHD. Hospitalizations for both psychiatric and nonpsychiatric illness were more frequent in those with MHD (relative risk 5.4; 95% confidence interval 3.7, 8.2). The total number of antiretrovirals used (median 6.4 agents vs 5.5 agents) was greater in those with MHD. When adjusted for antiretroviral treatment era, HIV exposure category, CD4 cell count and antiretroviral therapy, survival was not affected by MHD. Conclusions MHD is frequent in this population with HIV infection and is associated with increased healthcare utilization but not with reduced survival.

AVALIAÇÃO DO GRAU DE SATISFAÇÃO DO USUÁRIO DE SERVIÇOS PÚBLICOS NA REGIÃO DO GRANDE ABCD

No Brasil pesquisadores vêm intensificando suas pesquisas na área da administração e administração pública, procurando rever os modelos antigos (patrimonialista, gerencialista e burocrático), evidenciando uma nova tendência de gestão participativa e a relação destes modelos com o grau de satisfação que os usuários de serviços públicos atribuem ao Estado. Conhecer esse grau de satisfação é um fator relevante na elaboração e implementação das políticas públicas. Neste contexto, este trabalho tem por objetivo avaliar o grau de satisfação do usuário de alguns serviços públicos na região do Grande ABCD. O universo da pesquisa limitase aos moradores dos municípios de Santo André, São Bernardo do Campo, São Caetano e Diadema. A pesquisa, de caráter descritivo, utilizou ferramentas estatísticas para comparar o grau de satisfação entre os municípios estudados. Para a coleta de dados foi aplicado um questionário adaptado de um instrumento de pesquisa utilizado pelo Governo Federal e composto por questões que foram desenvolvidas e agrupadas em quatro dimensões: Transporte, Saúde, Educação e Segurança Pública. Trabalhando com as médias foi possível observar que o município de São Caetano do Sul apresenta algumas diferenças (escores superiores no grau de satisfação) em relação aos demais municípios pesquisados, e também, que alguns desses municípios demonstram, em média, resultados próximos em algumas dimensões.

Building team-based working:a practical guide to organizational transformation

Building Team-based Working is designed for use by managers and consultants who are introducing team-based working into organizations. The book synthesizes knowledge about how to build team-based organizations, focusing particularly on the psychological and social processes that can facilitate or obstruct successful teamwork. Rather than advise managers on how to build effective teams, as most books in this area tend to do, this book instead focuses on how to build organizations structured around teams. The text is divided into six sections describing the six main stages of developing team-based working in an organization. The chapters follow a common structure. Each one opens with a summary of the aims and activities relevant to that stage and concludes with a selection of appropriate support materials and tools. These materials can also be downloaded from the CD accompanying the text. The advice given is based on evidence gathered by the authors over 20 years of practical management experience, research work in organizations, and consultancy across the public, manufacturing and service sectors.

User involvement in UK cancer services:bridging the policy gap

Recent UK government initiatives aim to increase user involvement in the National Health Service (NHS) in two ways: by encouraging service users to take an active role in making decisions about their own care; and by establishing opportunities for wider public participation in service development. The purpose of this study was to examine how UK cancer service users understand and relate to the concept of user involvement. The data were collected through in-depth interviews, which were analysed for content according to the principles of grounded theory. The results highlight the role of information and communication in effective user involvement. Perhaps more importantly, this study suggests that the concept of user involvement is unclear to many cancer service users. This paper argues the need for increased awareness and understanding of what user involvement is and how it can work.

Law Enforcement Actions in Urban Spaces Governed by Violent Non-State Entities: Lessons from Latin America

In response to a crime epidemic afflicting Latin America since the early 1990s, several countries in the region have resorted to using heavy-force police or military units to physically retake territories de facto controlled by non-State criminal or insurgent groups. After a period of territory control, the heavy forces hand law enforcement functions in the retaken territories to regular police officers, with the hope that the territories and their populations will remain under the control of the state. To a varying degree, intensity, and consistency, Brazil, Colombia, Mexico, and Jamaica have adopted such policies since the mid-1990s. During such operations, governments need to pursue two interrelated objectives: to better establish the state’s physical presence and to realign the allegiance of the population in those areas toward the state and away from the non-State criminal entities. From the perspective of law enforcement, such operations entail several critical decisions and junctions, such as: Whether or not to announce the force insertion in advance. The decision trades off the element of surprise and the ability to capture key leaders of the criminal organizations against the ability to minimize civilian casualties and force levels. The latter, however, may allow criminals to go to ground and escape capture. Governments thus must decide whether they merely seek to displace criminal groups to other areas or maximize their decapitation capacity. Intelligence flows rarely come from the population. Often, rival criminal groups are the best source of intelligence. However, cooperation between the State and such groups that goes beyond using vetted intelligence provided by the groups, such as a State tolerance for militias, compromises the rule-of-law integrity of the State and ultimately can eviscerate even public safety gains. Sustaining security after initial clearing operations is at times even more challenging than conducting the initial operations. Although unlike the heavy forces, traditional police forces, especially if designed as community police, have the capacity to develop trust of the community and ultimately focus on crime prevention, developing such trust often takes a long time. To develop the community’s trust, regular police forces need to conduct frequent on-foot patrols with intensive nonthreatening interactions with the population and minimize the use of force. Moreover, sufficiently robust patrol units need to be placed in designated beats for substantial amount of time, often at least over a year. Establishing oversight mechanisms, including joint police-citizens’ boards, further facilities building trust in the police among the community. After disruption of the established criminal order, street crime often significantly rises and both the heavy-force and community-police units often struggle to contain it. The increase in street crime alienates the population of the retaken territory from the State. Thus developing a capacity to address street crime is critical. Moreover, the community police units tend to be vulnerable (especially initially) to efforts by displaced criminals to reoccupy the cleared territories. Losing a cleared territory back to criminal groups is extremely costly in terms of losing any established trust and being able to recover it. Rather than operating on a priori determined handover schedule, a careful assessment of the relative strength of regular police and criminal groups post-clearing operations is likely to be a better guide for timing the handover from heavy forces to regular police units. Cleared territories often experience not only a peace dividend, but also a peace deficit – in the rise new serious crime (in addition to street crime). Newly – valuable land and other previously-inaccessible resources can lead to land speculation and forced displacement; various other forms of new crime can also significantly rise. Community police forces often struggle to cope with such crime, especially as it is frequently linked to legal business. Such new crime often receives little to no attention in the design of the operations to retake territories from criminal groups. But without developing an effective response to such new crime, the public safety gains of the clearing operations can be altogether lost.

Computational evaluation of wind loads on low- and highrise buildings

Buildings and other infrastructures located in the coastal regions of the US have a higher level of wind vulnerability. Reducing the increasing property losses and causalities associated with severe windstorms has been the central research focus of the wind engineering community. The present wind engineering toolbox consists of building codes and standards, laboratory experiments, and field measurements. The American Society of Civil Engineers (ASCE) 7 standard provides wind loads only for buildings with common shapes. For complex cases it refers to physical modeling. Although this option can be economically viable for large projects, it is not cost-effective for low-rise residential houses. To circumvent these limitations, a numerical approach based on the techniques of Computational Fluid Dynamics (CFD) has been developed. The recent advance in computing technology and significant developments in turbulence modeling is making numerical evaluation of wind effects a more affordable approach. The present study targeted those cases that are not addressed by the standards. These include wind loads on complex roofs for low-rise buildings, aerodynamics of tall buildings, and effects of complex surrounding buildings. Among all the turbulence models investigated, the large eddy simulation (LES) model performed the best in predicting wind loads. The application of a spatially evolving time-dependent wind velocity field with the relevant turbulence structures at the inlet boundaries was found to be essential. All the results were compared and validated with experimental data. The study also revealed CFD's unique flow visualization and aerodynamic data generation capabilities along with a better understanding of the complex three-dimensional aerodynamics of wind-structure interactions. With the proper modeling that realistically represents the actual turbulent atmospheric boundary layer flow, CFD can offer an economical alternative to the existing wind engineering tools. CFD's easy accessibility is expected to transform the practice of structural design for wind, resulting in more wind-resilient and sustainable systems by encouraging optimal aerodynamic and sustainable structural/building design. Thus, this method will help ensure public safety and reduce economic losses due to wind perils.

Not getting by: Poverty management and homelessness in Miami

Urban inequality has emerged as one of the dominant themes of modern life and globalization. More than three million people experienced homelessness in the United States last year; in Miami-Dade, more than 15,000 individuals were homeless. Surviving extreme poverty, and exiting or avoiding homelessness, involves negotiating a complex mix of public and private assistance. However, a range of factors influence what types of help are available and how they can be accessed. Frequently, larger social structures determine which resource are available, leaving many choices entirely out of the individual's control. For single men, who are ineligible for many benefits, homelessness can be difficult to avoid and even harder to exit. My study seeks to better understand how adult, minority men living in extreme poverty in Miami-Dade negotiate their daily survival. Specific research questions address: Do black and Hispanic men who are homeless or at risk of homelessness have different personal characteristics and different experiences in avoiding or exiting homelessness? How does Miami's response to extreme poverty/homelessness, including availability of public benefits and public and private service organizations, either maximize or constrain the choices available to this population? And, what is the actual experience of single, adult men who are homeless or at risk of homelessness, in negotiating their daily survival? A mixed methods approach combines quantitative survey data from 7,605 homeless men, with qualitative data from 54 semi-structured interviews incorporating the visual ethnography techniques of Photo Elicitation Interviewing. Results show the differences experienced by black and Hispanic men who are poor and homeless in Miami. Findings also highlight how the community's official and unofficial responses to homelessness intersect with the actual experiences of the persons targeted by the policies and programs, challenging preconceived notions regarding the lives of persons living in extreme poverty. It adds to the existing body of literature by focusing on the urban Miami context, emphasizing disparities amongst racial and ethnic groups. Findings are intended to provide an empirically grounded thesis that humanizes the subjects and illuminates their personal experiences, helping to inform public policy around the needs of extremely poor populations.

Marketing A Hospitality Program And Its Product

In his dialogue entitled - Marketing A Hospitality Program and Its Product - Jürgen Chopard, Dr. es Sciences (Economics) Director, Centre International de Glion, Glion, Switzerland, Dr. Chopard initially offers: “The recruitment of qualified personnel is extremely difficult in an industry with a poor image; where career paths are not well defined. The author discusses the employment of marketing management techniques to improve the positioning of hospitality education and create a more attractive perception of the hotel industry.” As outlined in the above paragraph, Dr. Chopard vectors-in on marketing strategies from two standpoints; the educational side with its focus on curriculum, and the larger, industry side with its emphasis on public perception and service. These are not necessarily, nor should they be viewed as disparate elements. “ Although some professionals may see schools of hospitality education catering to two markets, students on one hand and industry on the other, in fact, their needs should be viewed as the same and hence a single market,” Dr. Chopard says to bolster his assertion. “The marketing concept is a management orientation that holds that the key task of the organization is to determine the needs and wants of target markets and to adapt the organization to delivering the desired satisfactions more effectively and efficiently than its competitor,” the author confides, with an attribution. From these information/definition leanings, Dr. Chopard continues on a path that promotes the Centre International de Glion, Glion, Switzerland, which he is affiliated with. Why, because they endorse the same principles he is explaining to you. That’s not a bad thing. Essentially, what Dr. Chopard wants you to know is, education and business management are synonymous and therefore should share the same marketing designs and goals. “It is hard to believe that as critically important a sector as education does not use for its own management the techniques which it teaches and which have largely been proved in other fields,” the author provides as counterpoint. Since pedagogical needs so closely relate to the more pragmatic needs of the industry in general, these elements should seek to compliment and engage each other, in fact, collaboration is imperative, Dr. Chopard expresses a priori. “The cooperation of future employers is indispensable in the preparation of the product, so that it is capable of providing the expected services. The need for close relations between training establishments and the hotel and catering industry seems obvious,” Dr. Chopard says. The author reveals some flaws in hospitality marketing strategy, and then contrasts these against how a successful strategy could/should be implemented.

A constituição desmilitarizada: democratização e reforma do sistema constitucional de segurança pública

The normative construction of the public security system in the Constituent Assembly of 1987-1988 preserved paradoxical normative space, the military police linked to the Army with a restrictive legal statute of the police offices citizenship through a hierarchical and disciplinary model that is anachronistic. This research originates from the following problem: How is it possible to tailor the constitutional system of public safety, specifically the Military Police, according to the democratic paradigms constructed by the Constituent from 1988 and carry the right to public safety under these molds? The militarists limitations of the Constitution allowed the growing militarization of police departments, organizational culture and authoritarian institutional practices. Underlying this, the problems related to difficulties in realization of Right to Public Safety, the strikes of the military police, the incomplete policy cycle started demanding from the constitutional-legal system appropriate responses. Utilizing the dialogical method and an interdisciplinary approach to the subject, and theoretically grounded in overcoming of the constitutional normativist juspositivism.It was found that the constructed infraconstitutional legislation was insufficient to supply the systemic shortcomings of constitutional law, when looking to create a single system of public security without giving due scope to the federal principle and expand the autonomy the Federated States, and even grant democratic legal status to the military police. Formal legal limits imposed by the Constitution constructed a legal anachronism, the military police. Thus, a democratic reading of military police institutions becomes inconceivable its existence in the constitutional regulatory environment. Thus, reform the Constitution in order to demilitarize the police and conduct a normative redesign of the public security system is fundamental to Brazilian constitutional democracy

Criminalização do porte de drogas para consumo pessoal: uma perspectiva jurídico-constitucional

This dissertation has the main objective to assess the legal and constitutional legitimacy of the legislative state act that criminalizes the conduct of carrying drugs for own consumption - in the case of Brazil, art. 28 of the Federal Law n.º 11.343 of August 23rd, 2006. Therefore, it is done, initially, a contextualization, pointing the main regulatory frameworks, internal and external, of what is conventionally called prohibition in the matter of drugs, as well as the different species of liberalizing initiatives today on an upward trend in the international scenario. Then analyzes the state intervention in question in the light of references of human dignity, freedom and privacy, emphasizing, in the point, among other contributions, the various precedents of foreign constitutional jurisdiction over the theme. Immediately thereafter, confronts the policy in screen with what is perhaps, these days, the main control mechanism of the restrictive measures of fundamental rights, namely the proportionality test, here represented by classical elements of appropriateness, necessity and proportionality in the strict sense. After that, it examines the criminalization on the agenda before the parameter of equality and the general interests of health and public safety. Based on theory and empirical enrolled in the development, it is concluded, finally, the unconstitutionality of the option of the ordinary legislature to impose criminal penalties on users - problematic or not - of substances or products capable of causing physical or psychological dependence.

La place de la relation conjugale dans la réinsertion sociale des délinquants sous l’autorité des Services correctionnels du Québec

Rapport de stage présenté à la Faculté des arts et des sciences en vue de l’obtention du grade de Maître ès sciences (M.Sc.) en criminologie, option intervention

La place de la relation conjugale dans la réinsertion sociale des délinquants sous l’autorité des Services correctionnels du Québec

Rapport de stage présenté à la Faculté des arts et des sciences en vue de l’obtention du grade de Maître ès sciences (M.Sc.) en criminologie, option intervention

Making life better: Monitoring the wider social determinants of health and well being - key indicators 2015

This report monitors progress against the key indicators of Northern Ireland’s public health strategy ‘Making Life Better’ launched by the Department of Health, Social Services & Public Safety (DHSSPS) in 2014. In addition to presenting the revised baseline positions for each of the key indicators of the framework, the report also monitors progress against each indicator by comparing the latest position with the baseline.

Statistics on Smoking Cessation Services in Northern Ireland: 2014/15

This information release, produced by the Department of Health, Social Services and Public Safety’s Information and Analysis Directorate, provides information on smoking cessation services. Data are included on the monitoring of smoking cessation services in Northern Ireland during the period 1st April 2014 to 31st March 2015. This report also provides an analysis of data collected in 2014/15 in respect of clients who set a quit date during 2013/14 (52 week follow-up). Information contained within this report was downloaded from a web based recording system. Figures here are correct as of 1st September 2015. The Ten Year Tobacco Control Strategy for Northern Ireland aims to see fewer people starting to smoke, more smokers quitting and protecting people from tobacco smoke. It is aimed at the entire population of Northern Ireland as smoking and its harmful effects cut across all barriers of class, race and gender. There is a strong relationship between smoking and inequalities, with more people dying of smoking-related illnesses in disadvantaged areas of Northern Ireland than in its more affluent areas. In order to ensure that more focused action is directed to where it is needed the most, three priority groups have been identified. They are: · Children and young people; · Disadvantaged people who smoke; and · Pregnant women, and their partners, who smoke. The Public Health Agency (PHA) is responsible for implementing the strategy and the development of cessation services is a key element of the overall aim to tackle smoking. The 2013/14 Health Survey Northern Ireland reported that 22% of adults currently smoke (23% of males and 21% of females). In addition, in 2013, the Young Persons’ Behaviour and Attitude Survey (YPBAS) found that 6% of pupils aged between and 11 and 16 smoked (7% of males and 5% of females).