Transport infrastructure and economic development in least developed countries: the case of Afghanistan

This PhD thesis tries to show the impact of transport infrastructure in economic development in least developed countries and in particular in the case of Afghanistan. Some least developed countries during 1990 to 1999 experienced lack of investment in transportation. Lack of investment further increased the economic development gap between developed and least developed countries. Moreover, lack of literature and research in poor countries such as Afghanistan encouraged me to do my research in this country in order to unveil the problems, facing poor people who are living in inaccessible places and suffer from lack of economic opportunities and long term unemployment. This thesis shows the effect of inaccessibility and immobility in economic opportunities and basic social services in Afghanistan. This thesis is important because it covers the role of transport infrastructures at the moment that international community promised to rebuild the infrastructures of post conflict Afghanistan.

Partnership fra terzo Settore e Istituzioni Locali nelle Politiche Family Friendly: Il "Distretto famiglia"

L’idea fondamentale da cui prende avvio la presente tesi di dottorato è che sia possibile parlare di una svolta nel modo di concettualizzare e implementare le politiche sociali, il cui fuoco diviene sempre più la costruzione di reti di partnership fra attori pubblici e privati, in cui una serie di soggetti sociali plurimi (stakeholders) attivano fra loro una riflessività relazionale. L’ipotesi generale della ricerca è che, dopo le politiche improntate a modelli statalisti e mercatisti, o un loro mix, nella politica sociale italiana emerga l’esigenza di una svolta riflessiva e relazionale, verso un modello societario, sussidiario e plurale, e che di fatto – specie a livello locale – stiano sorgendo molte iniziative in tal senso. Una delle idee più promettenti sembra essere la creazione di distretti sociali per far collaborare tra loro attori pubblici, privati e di Terzo settore al fine di creare forme innovative di servizi per la famiglia e la persona. La presente tesi si focalizza sul tentativo della Provincia di Trento di distrettualizzare le politiche per la famiglia. Tramite l’analisi del progetto “Trentino – Territorio Amico della Famiglia” e di una sua verticalizzazione, il Distretto Famiglia, si è studiato l’apporto delle partnership pubblico-privato nella formazione di strumenti innovativi di governance che possano determinare una svolta morfogenetica nell’elaborazione di politiche per la famiglia. Le conclusioni del lavoro, attraverso una comparazione tra esperienze territoriali, presentano la differenziazione delle partnership sociali, in base ad alcuni variabili (pluralità di attori, pluralità di risorse, shared project, capitale sociale, decision making, mutual action, logiche di lavoro relazionale, sussidiarietà). Le diverse modalità di gestione delle partnership (capacitante, professionale e generativa) sintetizzano i portati culturali, strutturali e personali coinvolti nelle singole costruzioni. Solo le partnership che interpretano il loro potenziale regolativo e promozionale secondo la riflessività relazionale tendono a generare beni comuni nel contesto sociale.

La giustiziabilità dei diritti sociali nell'ordinamento dell'Unione europea

L’oggetto del lavoro si sostanzia nella verifica del grado di giustiziabilità che i diritti sociali ricevono nell’ordinamento dell’Unione europea. L’indagine si articola in tre capitoli. Il primo è dedicato ad una sintetica ricostruzione dei modelli di welfare state riconosciuti dagli ordinamenti dei diversi paesi membri dell’Unione attraverso cui, la candidata enuclea un insieme di diritti sociali che ricevono tutela in tutti gli ordinamenti nazionali. L’esposizione prosegue, con la ricostruzione dell’evoluzione dei Trattati istitutivi dell’Unione e l’inclusione della sfera sociale tra gli obiettivi di questa. In particolare, il secondo capitolo esamina la giurisprudenza della Corte di Giustizia in relazione alle materie sociali, nonché l’inclusione dei diritti sociali nel testo della Carta dei diritti fondamentali. L’analisi si sofferma sulle tecniche normative adottate nell’area della politica sociale, evidenziando la tendenza ad un approccio di tipo “soft” piuttosto che attraverso il classico metodo comunitario. Esaurita questa analisi il terzo capitolo analizza i rapporti tra il diritto dell’Ue e quello della CEDU in materia di diritti sociali, evidenziano il diverso approccio utilizzato dalle due istanze sovranazionali nella tutela di questi diritti. Sulla base del lavoro svolto si conclude per una sostanziale mancanza di giustiziabilità dei diritti sociali in ambito dell’Unione. In particolare i punti deboli dell’Europa sociale vengono individuati in: un approccio regolativo alla dimensione sociale di tipo sempre più soft; la permanenza di alcuni deficit di competenze; la mancata indicazione di criteri di bilanciamento tra diritti sociali e libertà economiche e dalla compresenza delle due nozioni di economia sociale e di economia di mercato. Le conclusioni mostrano come l’assenza di competenze esclusive dell’Unione in materia di politica sociale non consenta una uniformazione/armonizzazione delle politiche sociali interne, che si riflette nell’incapacità dei modelli sociali nazionali di assorbire i grandi mutamenti macro economici che si sono avuti negli ultimi vent’anni, sia a livello sovranazionale che internazionale.

The informal market of education in Egypt: Private tutoring and its implications /// Arbeitspapiere / Institut für Ethnologie und Afrikastudien ; 88

Education is generally perceived as a public good which should be provided by the state. In Egypt, free and equal access to education has been guaranteed to all citizens since President Nasser’s socialist reforms in the 1950s. However, due to high population growth rates and a lack of financial resources, the public education system has been struggling to accommodate rapidly increasing numbers of students. While enrolment rates have risen steadily, the quality of state-provided services has deteriorated. Teachers and students have to cope with high class densities, insufficient facilities, a rigid syllabus and a centralized examination system. Today, teaching is among the lowest-paying occupations in the public sector. One strategy to cope with this situation is the widespread practice of private tutoring, which usually takes place at students’ homes or in commercial tutoring centers. Based on research carried out in Cairo in 2004/05 and 2006, I use an actor-centered approach to analyze the motivations of Egyptian teachers and students for participating in private tutoring and the impact that this practice has on the relationship between teachers and students. Students of all socio-economic backgrounds resort to tutoring in order to succeed in a highly competitive and exam-oriented education system. However, the form and quality of tutoring that can be accessed depends on the financial means of the family. For teachers, tutoring provides a good opportunity not only to supplement their income, but also, in the case of renowned “star teachers”, to improve their professional status and autonomy. On the informal “market of education” that has developed in Egypt during the last decades, the educational responsibilities of the state are increasingly being taken over by private actors, i.e. the process of teaching and learning is dissociated from the direct control of the state and from school as an institution. At the same time, education is turned into a marketable commodity. Despite the government’s efforts to provide free education to all citizens, the quality of social services that can be accessed in Egypt, thus, depends mainly on the financial means of the individual or the family.

Zwischen Kooperation und Konkurrenz - Europäische Netzwerke Sozialer Arbeit

Im Mittelpunkt der Studie stehen europäische Netzwerke der Sozialen Arbeit als spezifische Akteure der europäischen Zivilgesellschaft. Sie bilden ein „transnationales Feld“ mit spezifischen Strukturen und Handlungsmustern in Europa aus, das mit Blick auf die Kooperationsbeziehungen von Organisationen der Sozialen Arbeit in Deutschland betrachtet wird. Vor dem Hintergrund verschiedener Forschungsperspektiven wird das „Startkapitel“ deutscher Organisationen Sozialer Arbeit analysiert, das im Transnationalisierungsprozess noch unzureichend eingesetzt wird. Ferner wird das transnationale Feld der zivilgesellschaftlichen Netzwerke im Hinblick auf Kapitalstrukturen im „europäischen Spiel“ untersucht. Die europäischen Netzwerke werden als Produzenten von Transnationalität fokussiert; in ihnen verschränkt sich das nationale Kapital der Mitglieder mit dem transnationalen Kapital der zivilgesellschaftlichen Netzwerke. Die Bearbeitung der Spannungsverhältnisse Konkurrenz und Kooperation, Homogenität und Heterogenität, Autonomie und Heteronomie, Dissens und Konsens durch eine diskursive Auseinandersetzung im Feld ermöglicht es, Transnationalität als Handlungsmuster zu generieren.

Servizi relazionali e inclusione sociale: due studi di caso sul coinvolgimento delle famiglie nel Comune di Parma

La presente ricerca muove i suoi primi passi dall’ipotesi generale che il paradigma relazionale possa offrire al mondo dei servizi sociali una configurazione diversa, talora meno utopistica, del community work. Sebbene, infatti, in questi anni il sistema di offerta dei servizi si sia arricchito di principi come la co-progettazione e la co-responsabilità delle azioni, il lavoro di comunità resta ancora molto distante dal lavoro generalmente svolto nei servizi sociali territoriali, incapaci per ragioni strutturali e culturali di accogliere dentro di sé tale funzione. L’idea dalla quale trae origine la presente tesi di dottorato, è pertanto quella di arricchire la definizione di servizi sociali relazionali. Partendo dalle dimensioni che in letteratura sociologica e nei principali modelli teorici di social work definiscono un servizio alla persona quale servizio relazionale, nella prima parte teorica viene ipotizzata una trasformazione parziale del welfare regionale emiliano, poiché ai mutamenti culturali di questi anni non ha fatto seguito un cambiamento reale dei modelli operativi maggiormente basati sullo sviluppo delle competenze. Nella seconda parte della tesi, la ricerca empirica si focalizza sui progetti “family friendly” realizzati nel Comune di Parma, collocati in una logica di welfare societario e basati sull’apporto di soggetti di Terzo Settore, responsabili di ogni fase di realizzazione delle attività. La ricerca si avvale prevalentemente di tecniche qualitative e in alcuni tratti assume le caratteristiche della ricerca-azione. Nelle conclusioni, il contesto territoriale studiato rivela grande ricchezza dei legami strutturali, ma anche necessità di un rafforzamento dei legami interni. La forza dei servizi prodotti si situa, inoltre, nella sovrafunzionalità del legame tra volontari e famiglie, e di questo elemento dovrebbe arricchirsi anche il social work che scelga di adottare una prospettiva metodologica di lavoro relazionale.

La valutazione degli strumenti per la diagnosi sociale della genitorialita'. Uno studio di caso sulla provincia di Bologna

La ricerca dottorale che ho sviluppato si propone di analizzare il percorso di valutazione della genitorialità recentemente delineato dai servizi sociali territoriali della provincia di Bologna attraverso la sperimentazione di strumenti per la diagnosi sociale, valutando gli esiti dell’applicazione, anche in confronto all’utilizzo di metodi tradizionali. Il progetto ha il suo fulcro tematico, nel qualificare le pratiche professionali, con il fine ultimo di giungere ad un percorso di diagnosi sociale scientificamente fondato. Il mio obbiettivo quindi non è stato analizzare in termini astratti e idealtipici le metodologie professionali di riferimento per i 32 operatori coinvolti, quanto piuttosto di formarli all’utilizzo di una serie di strumenti elaborati nelle fasi precedenti del progetto, e condurre una ricerca empirica su un numero, sufficientemente ampio, di “casi concreti” costituito da nuclei familiari in carico ai servizi sociali. Più precisamente l'ambito privilegiato d’analisi è stato individuato nel rapporto tra operatore ed utente, allo scopo di evidenziare pregi e difetti dell'utilizzo di strumenti professionali finalizzati alla diagnosi sociale. Inoltre va sottolineato che l’analisi della letteratura sul tema ha evidenziato l’esistenza di un numero molto limitato di studi empirici sulle metodologie di servizio sociale, condotti peraltro su un numero di casi e di variabili molto ristretto, e per lo più in territorio statunitense, dove il sistema di Welfare si caratterizza per una impostazione tale da rendere veramente difficile la comparazione con la realtà italiana. Quello a cui ho inteso pervenire non è un giudizio ultimo sull’efficacia di questa specifica metodologia tout-court, ma piuttosto analizzare, attraverso l’utilizzo di materiali quanti-qualitativi derivati dalla sperimentazione, quelle che sono le condizioni che si vengono a determinare quando, nel percorso di presa in carico sociale, vengono introdotti strumenti specifici, metodologia chiara e alto coinvolgimento delle componenti relazionali del processo: operatori, familiari e rete sociale allargata.

Landscape and well-being: a scoping study on the health-promoting impact of outdoor environments

OBJECTIVES: The present literature review conceptualises landscape as a health resource that promotes physical, mental, and social well-being. Different health-promoting landscape characteristics are discussed. METHODS: This article is based on a scoping study which represents a special kind of qualitative literature review. Over 120 studies have been reviewed in a five-step-procedure, resulting in a heuristic device. RESULTS: A set of meaningful pathways that link landscape and health have been identified. Landscapes have the potential to promote mental well-being through attention restoration, stress reduction, and the evocation of positive emotions; physical well-being through the promotion of physical activity in daily life as well as leisure time and through walkable environments; and social well-being through social integration, social engagement and participation, and through social support and security. CONCLUSION: This scoping study allows us to systematically describe the potential of landscape as a resource for physical, mental and social well-being. A heuristic framework is presented that can be applied in future studies, facilitating systematic and focused research approaches and informing practical public health interventions.

Working Alliance Inventory-Short Revised (WAI-SR): psychometric properties in outpatients and inpatients

The Working Alliance Inventory-Short Revised (WAI-SR) is a recently refined measure of the therapeutic alliance that assesses three key aspects of the therapeutic alliance: (a) agreement on the tasks of therapy, (b) agreement on the goals of therapy and (c) development of an affective bond. The WAI-SR demonstrated good psychometric properties in an initial validation in psychotherapy outpatients in the USA. The generalizability of these findings is limited because in some countries a substantial portion of individual psychotherapy is delivered in inpatient settings. This study investigated and compared the psychometric properties of the WAI-SR in German outpatients (N = 88) and inpatients (N = 243). In both samples reliability (alpha > 0.80) and convergent validity with the Helping Alliance Questionnaire were good (r > 0.64). Confirmatory factor analysis showed acceptable to good model fit for the proposed Bond-Task-Goal model in both samples. Multi-group analysis demonstrated that the same constructs were measured across settings. Alliance ratings of outpatients and inpatients differed regarding the overlap of alliance components and the magnitude of the alliance ratings: The differentiation of the alliance components was poorer in inpatients and they reported lower alliances. Unique aspects of the alliance in inpatient treatment are discussed and a need for further research on the alliance in inpatient settings is pointed out. Overall, the WAI-SR can be recommended for alliance assessment in both settings.

Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin's lymphoma: a systematic review

Combined modality treatment (CMT) of chemotherapy followed by localized radiotherapy is standard treatment for patients with early stage Hodgkin's lymphoma. However, the role of radiotherapy has been questioned recently and some clinical study groups advocate chemotherapy only for this indication. We thus performed a systematic review with meta-analysis of randomized controlled trials comparing chemotherapy alone with CMT in patients with early stage Hodgkin's lymphoma with respect to response rate, tumor control and overall survival (OS). We searched Medline, EMBASE and the Cochrane Library as well as conference proceedings from January 1980 to February 2009 for randomized controlled trials comparing chemotherapy alone versus the same chemotherapy regimen plus radiotherapy. Progression free survival and similar outcomes were analyzed together as tumor control. Effect measures used were hazard ratios for OS and tumor control as well as relative risks for complete response (CR). Meta-analyses were performed using RevMan5. Five randomized controlled trials involving 1,245 patients were included. The hazard ratio (HR) was 0.41 (95% confidence interval (CI) 0.25 to 0.66) for tumor control and 0.40 (95% CI 0.27 to 0.59) for OS for patients receiving CMT compared to chemotherapy alone. CR rates were similar between treatment groups. In sensitivity analyses another 6 trials were included that did not fulfill the inclusion criteria of our protocol but were considered relevant to the topic. These trials underlined the results of the main analysis. In conclusion, adding radiotherapy to chemotherapy improves tumor control and OS in patients with early stage Hodgkin's lymphoma.

Suicide in HIV-Infected Individuals and the General Population in Switzerland, 1988-2008

Objective High rates of suicide have been described in HIV-infected patients, but it is unclear to what extent the introduction of highly active antiretroviral therapy (HAART) has affected suicide rates. The authors examined time trends and predictors of suicide in the pre-HAART (1988—1995) and HAART (1996—2008) eras in HIV-infected patients and the general population in Switzerland. Method The authors analyzed data from the Swiss HIV Cohort Study and the Swiss National Cohort, a longitudinal study of mortality in the Swiss general population. The authors calculated standardized mortality ratios comparing HIV-infected patients with the general population and used Poisson regression to identify risk factors for suicide. Results From 1988 to 2008, 15,275 patients were followed in the Swiss HIV Cohort Study for a median duration of 4.7 years. Of these, 150 died by suicide (rate 158.4 per 100,000 person-years). In men, standardized mortality ratios declined from 13.7 (95% CI=11.0—17.0) in the pre-HAART era to 3.5 (95% CI=2.5—4.8) in the late HAART era. In women, ratios declined from 11.6 (95% CI=6.4—20.9) to 5.7 (95% CI=3.2—10.3). In both periods, suicide rates tended to be higher in older patients, in men, in injection drug users, and in patients with advanced clinical stage of HIV illness. An increase in CD4 cell counts was associated with a reduced risk of suicide. Conclusions Suicide rates decreased significantly with the introduction of HAART, but they remain above the rate observed in the general population, and risk factors for suicide remain similar. HIV-infected patients remain an important target group for suicide prevention.

Older Breast Cancer Survivors: Geriatric Assessment Domains Are Associated With Poor Tolerance of Treatment Adverse Effects and Predict Mortality Over 7 Years of Follow-Up

Purpose To evaluate geriatric assessment (GA) domains in relation to clinically important outcomes in older breast cancer survivors. Methods Six hundred sixty women diagnosed with primary breast cancer in four US geographic regions (Los Angeles, CA; Minnesota; North Carolina; and Rhode Island) were selected with disease stage I to IIIA, age ≥ 65 years at date of diagnosis, and permission from attending physician to contact. Data were collected over 7 years of follow-up from consenting patients' medical records, telephone interviews, physician questionnaires, and the National Death Index. Outcomes included self-reported treatment tolerance and all-cause mortality. Four GA domains were described by six individual measures, as follows: sociodemographic by adequate finances; clinical by Charlson comorbidity index (CCI) and body mass index; function by number of physical function limitations; and psychosocial by the five-item Mental Health Index (MHI5) and Medical Outcomes Study Social Support Survey (MOS-SSS). Associations were evaluated using t tests, χ2 tests, and regression analyses. Results In multivariable regression including age and stage, three measures from two domains (clinical and psychosocial) were associated with poor treatment tolerance; these were CCI ≥ 1 (odds ratio [OR] = 2.49; 95% CI, 1.18 to 5.25), MHI5 score less than 80 (OR = 2.36; 95% CI, 1.15 to 4.86), and MOS-SSS score less than 80 (OR = 3.32; 95% CI, 1.44 to 7.66). Four measures representing all four GA domains predicted mortality; these were inadequate finances (hazard ratio [HR] = 1.89; 95% CI, 1.24 to 2.88; CCI ≥ 1 (HR = 1.38; 95% CI, 1.01 to 1.88), functional limitation (HR = 1.40; 95% CI, 1.01 to 1.93), and MHI5 score less than 80 (HR = 1.34; 95% CI, 1.01 to 1.85). In addition, the proportion of women with these outcomes incrementally increased as the number of GA deficits increased. Conclusion This study provides longitudinal evidence that GA domains are associated with poor treatment tolerance and predict mortality at 7 years of follow-up, independent of age and stage of disease.

Older Breast Cancer Survivors: Factors Associated with Self-reported Symptoms of Persistent Lymphedema Over 7 years of Follow-up

Lymphedema of the arm is a common complication of breast cancer with symptoms that can persist over long periods of time. For older women (over 50% of breast cancer cases) it means living with the potential for long-term complications of persistent lymphedema in conjunction with the common diseases and disabilities of aging over survivorship. We identified women > or =65 years diagnosed with primary stage I-IIIA breast cancer. Data were collected over 7 years of follow-up from consenting patients' medical records and telephone interviews. Data collected included self-reported symptoms of persistent lymphedema, breast cancer characteristics, and selected sociodemographic and health-related characteristics. The overall prevalence of symptoms of persistent lymphedema was 36% over 7 years of follow-up. Having stage II or III (OR = 1.77, 95% CI: 1.07-2.93) breast cancer and having a BMI >30 (OR = 3.04, 95% CI: 1.69-5.45) were statistically significantly predictive of symptoms of persistent lymphedema. Women > or =80 years were less likely to report symptoms of persistent lymphedema when compared to younger women (OR = 0.44, 95% CI: 0.18-0.95). Women with symptoms of persistent lymphedema consistently reported worse general mental health and physical function. Symptoms of persistent lymphedema were common in this population of older breast cancer survivors and had a noticeable effect on both physical function and general mental health. Our findings provide evidence of the impact of symptoms of persistent lymphedema on the quality of survivorship of older women. Clinical and research efforts focused on risk factors for symptoms of persistent lymphedema in older breast cancer survivors may lead to preventative and therapeutic measures that help maintain their health and well-being over increasing periods of survivorship.

A model for radiofrequency electromagnetic field predictions at outdoor and indoor locations in the context of epidemiological research

We present a geospatial model to predict the radiofrequency electromagnetic field from fixed site transmitters for use in epidemiological exposure assessment. The proposed model extends an existing model toward the prediction of indoor exposure, that is, at the homes of potential study participants. The model is based on accurate operation parameters of all stationary transmitters of mobile communication base stations, and radio broadcast and television transmitters for an extended urban and suburban region in the Basel area (Switzerland). The model was evaluated by calculating Spearman rank correlations and weighted Cohen's kappa (kappa) statistics between the model predictions and measurements obtained at street level, in the homes of volunteers, and in front of the windows of these homes. The correlation coefficients of the numerical predictions with street level measurements were 0.64, with indoor measurements 0.66, and with window measurements 0.67. The kappa coefficients were 0.48 (95%-confidence interval: 0.35-0.61) for street level measurements, 0.44 (95%-CI: 0.32-0.57) for indoor measurements, and 0.53 (95%-CI: 0.42-0.65) for window measurements. Although the modeling of shielding effects by walls and roofs requires considerable simplifications of a complex environment, we found a comparable accuracy of the model for indoor and outdoor points.