National Level Stakeholders’ Perceptions of Facilitators and Barriers in Utilization of World Health Organizations’ Preventing Early Pregnancy Guidelines in National Level Health Policy Creation

Thesis (Master's)--University of Washington, 2016-07

Ação pública na formação e transformação do destino turístico de Porto de Galinhas: um estudo dos referenciais no período de 1970 a 2010

The central interest of this thesis is to comprehend how the public action impels the formation and transformation of the tourist destinies. The research was based on the premise that the public actions are the result of the mediation process of state and non-state actors considered important in a section, which interact aiming for prevailing their interests and world visions above the others. The case of Porto de Galinhas beach, in Pernambuco, locus of the investigation of this thesis, allowed the analysis of a multiplicity of actors on the formation and implementation of local actions toward the development of the tourism between the years 1970 and 2010, as well as permitted the comprehension of the construction of the referential on the interventions made. This thesis, of a qualitative nature, has as theoretical support the cognitive approach of analysis of the public policies developed in France, and it has as main exponents the authors Bruno Jobert and Pierre Muller. This choice was made by the emphasis on the cognitive and normative factors of the politics, which aspects are not very explored in the studies of public policies in Brazil. As the source of the data collection, documental, bibliographic and field researches were utilized to the (re)constitution of the formation and transformation in the site concerned. The analysis techniques applied were the content and the documental analysis. To trace the public action referential, it started by the characterization of the touristic section frontiers and the creation of images by the main international body: the World Tourism Organization, of which analysis of the minutes of the meetings underscored guidelines to the member countries, including Brazil, which compounds the global-sectorial reference of the section. As from the analysis of the evolution of the tourism in the country, was identified that public policies in Brazil passed by transformations in their organization over the years, indicating changes in the referential that guided the interventions. These guidelines and transformations were identified in the construction of the tourist destination of Porto de Galinhas, of which data was systematized and presented in four historical periods, in which were discussed the values, the standard, the algorithms, the images and the important mediators. It has been revealed that the State worked in different roles in the decades analyzed in local tourism. From the 1990s, however, new actors were inserted in the formulation and implementation of policies developed, especially for local hotelkeepers. These, through their association, establishes a leadership relation in the local touristic section, thereby, they could set their hegemony and spread their own interest. The leadership acquired by a group of actors, in the case of Porto de Galinhas, does not mean that trade within the industry were neutralized, but that there is a cognitive framework that confronts the actors involved. In spite of the advances achieved by the work of the mediators in the last decades, that resulted in an amplification and diversification of the activity in the area, as well as the consolidation at the beach, as a tourist destiny of national standout, the position of the place is instable, concerned to the competitiveness, once that there is an situation of social and environmental unsustainability

Ação pública na formação e transformação do destino turístico de Porto de Galinhas: um estudo dos referenciais no período de 1970 a 2010

The central interest of this thesis is to comprehend how the public action impels the formation and transformation of the tourist destinies. The research was based on the premise that the public actions are the result of the mediation process of state and non-state actors considered important in a section, which interact aiming for prevailing their interests and world visions above the others. The case of Porto de Galinhas beach, in Pernambuco, locus of the investigation of this thesis, allowed the analysis of a multiplicity of actors on the formation and implementation of local actions toward the development of the tourism between the years 1970 and 2010, as well as permitted the comprehension of the construction of the referential on the interventions made. This thesis, of a qualitative nature, has as theoretical support the cognitive approach of analysis of the public policies developed in France, and it has as main exponents the authors Bruno Jobert and Pierre Muller. This choice was made by the emphasis on the cognitive and normative factors of the politics, which aspects are not very explored in the studies of public policies in Brazil. As the source of the data collection, documental, bibliographic and field researches were utilized to the (re)constitution of the formation and transformation in the site concerned. The analysis techniques applied were the content and the documental analysis. To trace the public action referential, it started by the characterization of the touristic section frontiers and the creation of images by the main international body: the World Tourism Organization, of which analysis of the minutes of the meetings underscored guidelines to the member countries, including Brazil, which compounds the global-sectorial reference of the section. As from the analysis of the evolution of the tourism in the country, was identified that public policies in Brazil passed by transformations in their organization over the years, indicating changes in the referential that guided the interventions. These guidelines and transformations were identified in the construction of the tourist destination of Porto de Galinhas, of which data was systematized and presented in four historical periods, in which were discussed the values, the standard, the algorithms, the images and the important mediators. It has been revealed that the State worked in different roles in the decades analyzed in local tourism. From the 1990s, however, new actors were inserted in the formulation and implementation of policies developed, especially for local hotelkeepers. These, through their association, establishes a leadership relation in the local touristic section, thereby, they could set their hegemony and spread their own interest. The leadership acquired by a group of actors, in the case of Porto de Galinhas, does not mean that trade within the industry were neutralized, but that there is a cognitive framework that confronts the actors involved. In spite of the advances achieved by the work of the mediators in the last decades, that resulted in an amplification and diversification of the activity in the area, as well as the consolidation at the beach, as a tourist destiny of national standout, the position of the place is instable, concerned to the competitiveness, once that there is an situation of social and environmental unsustainability

Tomorrow’s Silk Road: Assessing an EU-China Free Trade Agreement

The Centre for European Policy Studies (CEPS) is an independent policy research institute in Brussels. Its mission is to produce sound policy research leading to constructive solutions to the challenges facing Europe. The views expressed in this book are entirely those of the authors and should not be attributed to CEPS or any other institution with which they are associated or to the European Union. This book, commissioned by the Foreign Trade Association, aims to provide an independent and in-depth contribution on the status of bilateral economic exchanges and persistent trade barriers between the European Union and China. A second objective is to encourage a frank and open dialogue, based on a scientific evaluation and without prejudice, of the possibility of a preferential trade agreement between the two sides. The study was carried out by CEPS, in cooperation with the World Trade Institute at the University of Bern.

El rol de las redes de apoyo transnacional en la evolución del régimen de trata de personas en la región del mekong, 2004-2015

Con el fin de la unipolaridad no sólo se fortalecieron mecanismos de gobernanza global como los Regímenes Internacionales, sino también se fortalecieron actores no estatales. A pesar de la importancia que tomaron estos dos elementos aún no existe una teoría que explique exhaustivamente la relación que existe entre ellos. Es por lo anterior que, la investigación busca responder de qué manera el rol de las Redes de Apoyo Transnacional ha incidido en la evolución del régimen de tráfico de personas en la Región del Mekong. Asimismo tiene como objetivo comprender las relación entre el Régimen y las Redes de Apoyo Transnacional a través de la formulación de un caso de estudio basado en metodologías cualitativas, específicamente, en el análisis teórico-constructivista y el análisis de contenido de documentos producidos por actores estatales y no estatales.

Healing wounds institutional strength, peacebuilding, and productive entrepreneurship – exploratory analysis on 23 departments of Colombia

Este estudio presenta un análisis exploratorio sobre la correlación entre la fortaleza institucional, las condiciones de paz, y el emprendimiento en una muestra de 23 departamentos en Colombia usando datos de 2014. Para llevar a cabo este objetivo se propusieron y construyeron tres índices siguiendo definiciones conceptuales seminales o estándares de evaluación internacional, a saber: 1) El Índice de Fortaleza Institucional, 2) El Índice de Construcción de Paz (construido a partir del índice de paz negativa y el índice de paz positiva) y 3) El Índice de Emprendimiento Productivo. Los resultados no muestran una correlación significativa entre todos los tres índices. Por un lado, existe una correlación significativa (p<0.05) entre los índices de fortaleza institucional y emprendimiento productivo. Por otro lado, existen correlaciones negativas no significativas entre los índices de paz positiva y fortaleza institucional, emprendimiento productivo y paz positiva y emprendimiento productivo y construcción de paz. En un segundo acercamiento, la población de los departamentos fue la variable con mayor número de correlaciones significativas (p<0.01) entre variables relacionadas con emprendimiento productivo, empleo, producto interno bruto, sofisticación industrial, innovación (patentes) y crimen. Finalmente, se discuten las conclusiones y las futuras investigaciones.

La implementación de la trayectoria de desarrollo sostenible por parte de los pequeños estados insulares en desarrollo del Pacífico frente a su condición de vulnerabilidad

La investigación busca determinar el propósito que persiguen los pequeños Estados insulares en desarrollo del Pacífico al adoptar una trayectoria de desarrollo sostenible. Se plantea que la adopción de una trayectoria de desarrollo sostenible es la estrategia por medio de la cual estos Estados buscan hacer frente a su condición de vulnerabilidad; lo cual logran a través del uso de la diplomacia en distintos escenarios multilaterales, con el fin de modificar tanto sus prácticas como las de otros actores.

EL ANÁLISIS DE LA INTERFASE ENTRE LA BIOÉTICA Y LOS DERECHOS HUMANOS

ResumenEste artículo tiene como objetivo profundizar los estudios concernientes a la interfase entre Bioética y Derechos Humanos, así como contribuir para la solidificación de la interconexión entre los dos campos de saber. Para ello, se investigaron los modos por los cuales la instancia de producción bioéticaque se insiere en el ámbito de la OMS – el Departamento de Ética, Equidad, Comercio y Derechos Humanos – construye la interfase entre Bioética y Derechos Humanos a partir del análisis de los sentidos identificados en los documentos de cuño general producidos por dicha instancia bioética.Para tal fin, se utilizó el abordaje teórico-metodológico que se fundamenta en la acepción de que los sentidos construidos socialmente pueden ser aprehendidos por medio del análisis de las prácticas discursivas. Tal elección metodológica se basó en la percepción de que los documentos producidospor organismos internacionales son prácticas discursivas cuyos sentidos pueden ser identificados mediante el examen de sus repertorios. Como conclusión, se observó que la interconexión entre Bioética y Derechos Humanos se forma de manera compleja, dado que el Departamento de Ética de la OMS al mismo tiempo que se aproxima a la temática, se aleja de ella pues hay elementos que evidencian la incorporación de los principios y normas de los Derechos Humanos en sus documentos y, paradójicamente, se constata la ausencia de la Bioética y sus normativas.Palabras clave: Bioética institucional, derechos humanos, Declaración Universal sobre Bioética y Derechos Humanos, Organización Mundial de la Salud.AbstractThis article aims at intensifying the studies concerning the interface between Bioethics and Human Rights, as well as at contributing to the solidification of the connection between these two fields of knowledge. In order to do so, we investigated the ways through which the instance of bioethics that is part of the scope of the World Health Organization – the Department of Ethics, Equity, Trade and Human Rights – builds the interface between Bioethics and Human Rights by means of the analysis of the meanings identified in the general documents produced by such instance of bioethics. For that end, we used the theoretical-methodological approach that is based on the assumption that the socially constructed meanings can be understood through the analysis of the discourse practices. The choice of such methodology was supported by the perceptionthat the documents elaborated by international organisms are discourse practices whose meanings can be identified through the examination of their repertoires. In sum, it was observed that the interconnection between Bioethics and Human Rights is complex, since the Ethics Department of the WHO deals with this theme by being close to it and far from it, simultaneously, as there are features that constitute evidence of the incorporation of Human Rights norms and principles into the WHO documents, but it is also observed the absence of Bioethics and its norms.Keywords: institutional Bioethics, Human Rights, Universal Declaration on Bioethics and Human Rights,World Health Organization.

Vascular Pattern In Enchondroma And Chondrosarcoma: Clinical And Immunohistologic Study.

Although cartilaginous tumors have low microvascular density, vessels are important for the provision of nutrition so that the tumor can grow and generate metastasis. The aim of this study was to assess the value of the vascular pattern classification as a prognostic tool in chondrosarcomas (CSs) and its relation with vascular endothelial growth factor (VEGF) expression. This was a retrospective study of 21 enchondromas and 57 conventional CSs. Clinical data and outcome were retrieved from medical files. CSs histologic grades (on a scale of 1 to 3) were determined according to the World Health Organization classification. The vascular pattern (on a scale of A to C) was assessed through CD34, according to Kalinski. CD105 and VEGF were also evaluated. Poor outcome was significantly associated with vascular pattern groups B and C. Higher vascular pattern were 6.5 times more frequent in moderate-grade and high-grade CSs than in grade 1 CS. On multivariate analysis, a clear correlation was found between VEGF overexpression and B/C vascular patterns. Only 18 (benign and malignant) tumors stained for CD105. The results point to the use of the vascular pattern classification as a prognostic tool in CSs and to differentiate low-grade from moderate-grade/high-grade CSs. Vascular pattern might be also used to complement histologic grade, VEGF immunostaining, and microvascular density, for indicating a patient's prognosis. Low-grade CSs develop under low neoangiogenesis, which conforms to the slow growth rate of these tumors.

Applying The Maternal Near Miss Approach For The Evaluation Of Quality Of Obstetric Care: A Worked Example From A Multicenter Surveillance Study.

To assess quality of care of women with severe maternal morbidity and to identify associated factors. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.

Obesity Versus Osteoarthritis: Beyond The Mechanical Overload.

Obesity is currently considered a major public health problem in the world, already reaching epidemic characteristics, according to the World Health Organization. Excess weight is the major risk factor associated with various diseases, such as type 2 diabetes mellitus, hypertension, dyslipidemia and osteometabolic diseases, including osteoporosis and osteoarthritis. Osteoarthritis is the most prevalent rheumatic disease and the leading cause of physical disability and reduced quality of life of the population over 65 years. It mainly involves the joints that bear weight - knees and hips. However, along with the cases of obesity, its prevalence is increasing, and even in other joints, such as hands. Thus, it is assumed that the influence of obesity on the development of OA is beyond mechanical overload. The purpose of this review was to correlate the possible mechanisms underlying the genesis and development of these two diseases. Increased fat mass is directly proportional to excessive consumption of saturated fatty acids, responsible for systemic low-grade inflammation condition and insulin and leptin resistance. At high levels, leptin assumes inflammatory characteristics and acts in the articular cartilage, triggering the inflammatory process and changing homeostasis this tissue with consequent degeneration. We conclude that obesity is a risk factor for osteoarthritis and that physical activity and changes in diet composition can reverse the inflammatory and leptin resistance, reducing progression or preventing the onset of osteoarthritis.

A Decade Of Malaria During Pregnancy In Brazil: What Has Been Done Concerning Prevention And Management.

In Brazil, malaria remains a disease of major epidemiological importance because of the high number of cases in the Amazonian Region. Plasmodium spp infections during pregnancy are a significant public health problem with substantial risks for the pregnant woman, the foetus and the newborn child. In Brazil, the control of malaria during pregnancy is primarily achieved by prompt and effective treatment of the acute episodes. Thus, to assure rapid diagnosis and treatment for pregnant women with malaria, one of the recommended strategy for low transmission areas by World Health Organization and as part of a strategy by the Ministry of Health, the National Malaria Control Program has focused on integrative measures with woman and reproductive health. Here, we discuss the approach for the prevention and management of malaria during pregnancy in Brazil over the last 10 years (2003-2012) using morbidity data from Malaria Health Information System. Improving the efficiency and quality of healthcare and education and the consolidation of prevention programmes will be challenges in the control of malaria during pregnancy in the next decade.

[should Pediatric Parenteral Nutrition Be Individualized?].

Parenteral nutrition (PN) formulations are commonly individualized, since their standardization seem inadequate for the pediatric population. This study aimed to evaluate the nutritional state and the reasons for PN individualization in pediatric patients using PN hospitalized in a tertiary hospital in Campinas, São Paulo. This longitudinal study comprised patients using PN followed by up to 67 days. Nutritional status was classified according to the criteria established by the World Health Organization (WHO) (2006) and WHO (2007). The levels of the following elements on blood were analyzed: sodium, potassium, ionized calcium, chloride, magnesium, inorganic phosphorus and triglycerides (TGL). Among the criteria for individualization, were considered undeniable: significant reduction in blood levels of potassium (<3 mEq/L), sodium (<125 mEq/)L, magnesium (<1 mEq/L), phosphorus (<1.5 mEq/L), ionic calcium (<1 mmol) and chloride (<90 mEq/L) or any value above the references. Twelve pediatric patients aged 1 month to 15 years were studied (49 individualizations). Most patients were classified as malnourished. It was observed that 74/254 (29.2%) of examinations demanded individualized PN by indubitable reasons. The nutritional state of patients was considered critical in most cases. Thus, the individualization performed in the beginning of PN for energy protein adequacy was indispensable. In addition, the individualized PN was indispensable in at least 29.2% of PN for correction of alterations found in biochemical parameters.

Qualidade de vida de portadores de Diabetes Mellitus tipo II frente às oscilações no nível de atividade física, aspectos socioeconômicos e presença de comorbidades

Universidade Estadual de Campinas . Faculdade de Educação Física

Crescimento fisico em crianças e adolescentes de moderada altitude

Universidade Estadual de Campinas . Faculdade de Educação Física