Metropolitan and regional health planning: dilemmas of the Pact for Health in the Baixada Santista Metropolitan Area, Sao Paulo State, Brazil

This paper focuses on the relationship between metropolitan and regional health planning based on the processes of regionalization and the Pact for Health in the Baixada Santista Metropolitan Area, Sao Paulo State, Brazil. The method used was a case study in two stages, namely during initial implementation of the Pact for Health (2007) and the Regional Administration Committees (CGR) and in 2010. Municipal and regional health systems managers and the director of the Metropolitan Agency were interviewed, and records were analyzed from ten years of meetings of the Regional Inter-Administration Committee and the Regional Development Council. Four issues emerged: financing and infrastructure; health services utilization; inefficiency of the Regional Health Administration's instruments and decision-making levels; and the relationship between different levels in the Administration. Metropolitan health management remained as an underlying issue, appearing only incidentally or tangentially to regional management. Despite some limitations, the CGR has been legitimized as a space for regional health management.

Burden of maternal bipolar disorder on at-risk offspring: A controlled study on family planning and maternal care

Introduction: Bipolar disorder (BD) is a highly incapacitating disease typically associated with high rates of familial dysfunction. Despite recent literature suggesting that maternal care is an important environmental factor in the development of behavioral disorders, it is unclear how much maternal care is dysfunctional in BD subjects. Objective: The objective of this study was to characterize maternal care in DSM-IV/SCID diagnosed BD type I subjects compared to healthy controls with (PD) and without (NPD) other psychiatric diagnoses. Materials and methods: Thirty-four BD mothers and 106 controls underwent an interview about family planning and maternal care, obstetrical complications, and mother-child interactions. K-SADS-PL questions about violence exposure were used to ascertain domestic violence and physical/sexual abuse. Results: BD mothers were less likely to have stable unions (45.5%; p < 0.01) or to live with the biological father of their children (33.3%; p < 0.01), but had higher educational level and higher rates of social security use/retirement. They also had fewer children and used less contraceptive methods than controls. Children of BD women had higher rates of neonatal anoxia, and reported more physical abuse (16.1%; p = 0.02) than offspring of NPD mothers. Due to BD mothers' symptoms, 33.3% of offspring suffered physical and/or psychological abuse. Limitations: Post hoc analysis, and the use of questions as a surrogate of symptoms as opposed to validated instruments. Conclusion: This is one of few reports confirming that maternal care given by BD women is dysfunctional. BD psychopathology can lead to poor maternal care and both should be considered important environmental risk factors in BD, suggesting that BD psychoeducation should include maternal care orientation. (C) 2012 Elsevier B.V. All rights reserved.

Impact of a self-developed planning and self-constructed navigation system on skull base surgery: 10 years experience

CONCLUSION: Our self-developed planning and navigation system has proven its capacity for accurate surgery on the anterior and lateral skull base. With the incorporation of augmented reality, image-guided surgery will evolve into 'information-guided surgery'. OBJECTIVE: Microscopic or endoscopic skull base surgery is technically demanding and its outcome has a great impact on a patient's quality of life. The goal of the project was aimed at developing and evaluating enabling navigation surgery tools for simulation, planning, training, education, and performance. This clinically applied technological research was complemented by a series of patients (n=406) who were treated by anterior and lateral skull base procedures between 1997 and 2006. MATERIALS AND METHODS: Optical tracking technology was used for positional sensing of instruments. A newly designed dynamic reference base with specific registration techniques using fine needle pointer or ultrasound enables the surgeon to work with a target error of < 1 mm. An automatic registration assessment method, which provides the user with a color-coded fused representation of CT and MR images, indicates to the surgeon the location and extent of registration (in)accuracy. Integration of a small tracker camera mounted directly on the microscope permits an advantageous ergonomic way of working in the operating room. Additionally, guidance information (augmented reality) from multimodal datasets (CT, MRI, angiography) can be overlaid directly onto the surgical microscope view. The virtual simulator as a training tool in endonasal and otological skull base surgery provides an understanding of the anatomy as well as preoperative practice using real patient data. RESULTS: Using our navigation system, no major complications occurred in spite of the fact that the series included difficult skull base procedures. An improved quality in the surgical outcome was identified compared with our control group without navigation and compared with the literature. The surgical time consumption was reduced and more minimally invasive approaches were possible. According to the participants' questionnaires, the educational effect of the virtual simulator in our residency program received a high ranking.

Integrating periurban agrarian ecosystem services into spatial planning to cope with urban pressure

According to Corine Land Cover databases, in Europe between 1990 and 2000,77% of new artificial surfaces were built on previous agrarian areas. Urban sprawl ¡s far from being under control, between 2000 and 2006 new artificial land has grown in larger proportion than the decade before. In Spain, like in most countries, the impact of urban sprawl during the last decades has been especially significant in periurban agrarian spaces: between 2000 and 2006, 73% of new artificial surfaces were built on previous agrarian areas. The indirect impact of this trend has been even more relevant, as the expectations of appreciation in the value of land after new urban developments reinforce the ongoing trend of abandonment of agricultural land. In Madrid between 1980 and 2000 the loss of agricultural land due to abandonment of exploitation was 2-fold that due to transformation into urban areas. By comparing four case studies: Valladolild, Montpellier.Florence and Den Haag, this paper explores if urban and territorial planning may contribute to reduce urban pressure on the hinterland. In spite of their diversity, these regions have in common a relative prosperity arising from their territorial endowments, though their landscapes are still under pressure. The three last ones have been working for years on mainstream concepts like multifunctional agriculture. The systematic comparison and the analysis of successful approaches provide some clues on how to reconsider urban planning in order to preserve agricultural land. The final remarks highlight the context in which public commitment, legal protection instruments and financial strategies may contribute to the goals of urban, peri-urban or regional planning about fostering agrarian ecosystem services

Illinois Quality Schools Index : manual and instruments.

On cover: IQSI manual.

A pénzügyi eszközök szerepe az Európai Unió kohéziós politikájában (Cohesion policy - The role of financial instruments)

A tanulmány az Európai Unió strukturális és kohéziós alapjaiból létrehozott pénzügyi eszközök szerepét és perspektíváit elemzi. A téma aktualitását adja, hogy jelenleg zajlik a 2014–2020-as uniós költségvetési és programozási időszak előkészítése, amelynek során a pénzügyi eszközök az uniós elképzelések szerint az eddigieknél lényegesen jelentősebb szerepet játszanak majd. A szerző áttekinti a kohéziós politika keretében működő pénzügyi eszközök jelenlegi rendszerének legfőbb jellemzőit, bemutatja azokat a gyökeres változásokat, amelyek 2014-től kezdődően várhatóan jellemezni fogják a kapcsolódó szabályozási környezetet, végül pedig ismerteti a gyakorlatban működő jelentősebb programokat, amelyek referenciapontként is használhatók a programok tervezése során. _____ The paper examines the role and perspectives of financial instruments established from the structural and cohesion funds of the European Union. Hungary is one of the most significant beneficiaries of the structural and cohesion funds, therefore the interested national actors should know well the new support forms, in order to use them successfully in the next programming period. The article gives an overview about the current structure of financial instruments in the framework of the cohesion policy. The comprehensive changes of the regulatory environment expected from 2014 are also presented, and finally the major instruments in practice will be reviewed, that can serve as reference points in planning of future programmes.

The impact of information technology on organizations: A study of enterprise resource planning system influences on job design and organizational culture

The primary purpose of this research is to study the linkage between perceived job design characteristics and information system environment characteristics before and after the replacement of a legacy information system with a new type of information system (referred to as an Enterprise Resource Planning or ERP system). A public state University implementing an academic version of an ERP system was selected for the study. Three survey instruments were used to examine the perception of the information system, the job characteristics, and the organizational culture before and after the system implementation. The research participants included two large departments resulting in a sample of 130 workers. Research questions were analyzed using multivariate procedures including factor analysis, path analysis, step-wise regression, and matched pair analysis. ^ Results indicated that the ERP system has introduced new elements into the working environment that has changed the perception of how the job design characteristics and organization culture dimensions are viewed by the workers. The understanding of how the perceived system characteristics align with an individual's perceived job design characteristics is supported by each of the system characteristics significantly correlated in the proposed direction. The stronger support of this relationship becomes visible in the causal flow of the effects seen in the path diagram and in the step-wise regression. The perceived job design characteristics aligning with dimensions of organizational culture are not as strong as the literature suggests. Although there are significant correlations between the job and culture variables, only one relationship can be seen in the causal flow. ^ This research has demonstrated that system characteristics of ERP do contribute to the perception of change in an organization and do support organizational culture behaviors and job characteristics. ^

Measurability characteristics mapping for large volume metrology instruments selection

Measurement and verification of products and processes during the early design is attracting increasing interest from high value manufacturing industries. Measurement planning is deemed as an effective means to facilitate the integration of the metrology activity into a wider range of production processes. However, the literature reveals that there are very few research efforts in this field, especially regarding large volume metrology. This paper presents a novel approach to accomplish instruments selection, the first stage of measurement planning process, by mapping measurability characteristics between specific measurement assignments and instruments.

Landscape and planning: strengthening discussions in the decision-making process

Since the emergence of the European Landscape Convention (ELC) in 2000, the important link between landscape and planning has greatly intensified. Now, more than ever, the fundamental role of the planning system in delivering the ELC’s requirements is recognised. This has been further substantiated within Ireland’s recently published National Landscape Strategy. However it has continually been suggested that decision-making processes need to adapt better to the holistic, valueladen and multidimensional approaches underpinning the ELC. In light of these milestones for the preservation, management and planning of landscape, this research sets out to establish synergies and disparities in the existing relationship between landscape and planning. It investigates detailed evidence of the presence and manifestations of landscape in key processes of day-to-day planning practice in Ireland, from individual planning appeals and ‘special’ cases, to the major strategic instruments that inform the making of landscape policies within development plans. This is set within wider theoretical and policy contexts where the compatibility of landscape and planning is subjected to critical scrutiny and then explored through these practical case studies. Driving this research is the intention to make a case for the planning domain to be an ideal ‘home’ for landscape – in all its deep, multidimensional meaning – and for enhancing landscape arguments and objectives in the face of conflict, competing values and power-plays in the real world. Emerging out of this research is a set of recommendations for how, at a national level, new approaches for decision making for and about landscape can be more effective and meaningful.

Testing a gravity-based accessibility instrument to engage stakeholders into integrated LUT planning

The paper starts from the concern that while there is a large body of literature focusing on the theoretical definitions and measurements of accessibility, the extent to which such measures are used in planning practice is less clear. Previous reviews of accessibility instruments have in fact identified a gap between the clear theoretical assumptions and the infrequent applications of accessibility instruments in spatial and transport planning. In this paper we present the results of a structured-workshop involving private and public stakeholders to test usability of gravity-based accessibility measures (GraBaM) to assess integrated land-use and transport policies. The research is part of the COST Action TU1002 “Accessibility Instruments for Planning Practice” during which different accessibility instruments where tested for different case studies. Here we report on the empirical case study of Rome.

Comparing children's self-report instruments for health-related quality of life using the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY)

Children with chronic conditions often experience a long treatment which can be complex and negatively impacts the child's well-being. In planning treatment and interventions for children with chronic conditions, it is important to measure health-related quality of life (HrQoL). HrQoL instruments are considered to be a patient-reported outcome measure (PROM) and should be used in routine practice. Purpose: The aim of this study was to compare the content dimensions of HrQoL instruments for children's self-reports using the framework of ICF-CY. Method: The sample consist of six instruments for health-related quality of life for children 5 to 18 years of age, which was used in the Swedish national quality registries for children and adolescents with chronic conditions. The following instruments were included: CHQ-CF, DCGM-37, EQ-5D-Y, KIDSCREEN-52, Kid-KINDL and PedsQL 4.0. The framework of the ICF-CY was used as the basis for the comparison. Results: There were 290 meaningful concepts identified and linked to 88 categories in the classification ICF-CY with 29 categories of the component body functions, 48 categories of the component activities and participation and 11 categories of the component environmental factors. No concept were linked to the component body structures. The comparison revealed that the items in the HrQoL instruments corresponded primarily with the domains of activities and less with environmental factors. Conclusions: In conclusion, the results confirm that ICF-CY provide a good framework for content comparisons that evaluate similarities and differences to ICF-CY categories. The results of this study revealed the need for greater consensus of content across different HrQoL instruments. To obtain a detailed description of children's HrQoL, DCGM-37 and KIDSCREEN-52 may be appropriate instruments to use that can increase the understanding of young patients' needs.

Waste prevention: policy instruments and business model innovation

Waste prevention (WP) is a strategy which helps societies and individuals to strive for sufficiency in resource consumption within planetary boundaries alongside sustainable and equitable well-being and to decouple the concepts of well-being and life satisfaction from materialism. Within this dissertation, some instruments to promote WP are analysed, by adopting two perspectives: firstly, the one of policymakers, at different governance levels, and secondly, the one of business in the electrical and electronic equipment (EEE) sector. At a national level, the role of WP programmes and market-based instruments (extended producer responsibility, pay-as-you-throw schemes, deposit-refund systems, environmental taxes) in boosting prevention of municipal solid waste is investigated. Then, focusing on the Emilia-Romagna Region (Italy), the performances of the waste management system are assessed over a long period, including some years before and after an institutional reform of the waste management governance regime. The impact of a centralisation (at a regional level) of both planning and economic regulation of the waste services on waste generation and WP is analysed. Finally, to support the regional decision-makers in the prioritisation of publicly funded projects for WP, a framework for the sustainability assessment, the evaluation of success, and the prioritisation of WP measures was applied to some projects implemented by Municipalities in the Region. Trying to close the research gap between engineering and business, WP strategies are discussed as drivers for business model (BM) innovation in EEE sector. Firstly, an innovative approach to a digital tracking solution for professional EEE management is analysed. New BMs which facilitate repair, reuse, remanufacturing, and recycling are created and discussed. Secondly, the impact of BMs based on servitisation and on producer ownership on the extension of equipment lifetime is analysed, by performing a review of real cases of organizations in the EEE sector applying result- and use-oriented BMs.

The green finance apparatus. How ideology and planning steer sustainable capital flows

By investigating the inner working of leading financial institutions, and their dense interconnections, this thesis explores the evolution of traditional financial instruments like bonds to tackle sustainability issues. Building on fieldwork among green financiers, the thesis is based upon participant observation of working groups appointed to define standards for sustainable bonds. Engaging critical theory, one claim is that investors are increasingly recruited or interpellated by an emerging global green ideological apparatus, aimed at ensuring the reproduction of existing social relations. Taking stock of the proliferation of both public and private actors in the definition of green standards and practices, the thesis proposes that this green ideology is becoming hegemonic. Focusing on the case of green bond pricing, it suggests that environmental and climate labels and other financial green signifiers for financial products take on brand-like qualities. Crystallizing imaginaries, meanings, and forms of personhood, they play a fundamental role in what is defined as a dual process of valuation-cum-subjectivation. Identifying themselves as “green”, financiers valuate differently green and brown assets allowing a ‘green’ financial value to slowly come to matter. Yet, alongside their ideological role, green labels have come to be almost exclusively standardized with reference to specific Climate Scenarios (e.g. Net Zero). These scenarios coordinate the optimal path towards achieving a carbon neutral world and represent the quintessential example of socioeconomic planning, crucially undermining neoliberal ideas of ‘the market’ as the ultimate calculative device.

[construction Of Measurement Instruments In The Area Of Health].

Measurement instruments are an integral part of clinical practice, health evaluation and research. These instruments are only useful and able to present scientifically robust results when they are developed properly and have appropriate psychometric properties. Despite the significant increase of rating scales, the literature suggests that many of them have not been adequately developed and validated. The scope of this study was to conduct a narrative review on the process of developing new measurement instruments and to present some tools which can be used in some stages of the development process. The steps described were: I-The establishment of a conceptual framework, and the definition of the objectives of the instrument and the population involved; II-Development of the items and of the response scales; III-Selection and organization of the items and structuring of the instrument; IV-Content validity, V-Pre-test. This study also included a brief discussion on the evaluation of the psychometric properties due to their importance for the instruments to be accepted and acknowledged in both scientific and clinical environments.

Quality Of Life Of Coronary Artery Disease Patients After The Implementation Of Planning Strategies For Medication Adherence.

to compare the general and specific health-related quality of life (HRQoL) between the Intervention (IG) and Control (CG) groups of coronary artery disease patients after the implementation of Action Planning and Coping Planning strategies for medication adherence and to verify the relationship between adherence and HRQoL. this was a controlled and randomized study. the sample (n=115) was randomized into two groups, IG (n=59) and CG (n=56). Measures of medication adherence and general and specific HRQoL were obtained in the baseline and after two months of monitoring. the findings showed that the combination of intervention strategies - Action Planning and Coping Planning for medication adherence did not affect the HRQoL of coronary artery disease patients in outpatient monitoring.