Professional development programs in health promotion : tools and processes to favor new practices

Developing innovative interventions that are in sync with a health promotion paradigm often represents a challenge for professionals working in local public health organizations. Thus, it is critical to have both professional development programs that favor new practices and tools to examine these practices. In this case study, we analyze the health promotion approach used in a pilot intervention addressing children’s vulnerability that was developed and carried out by participants enrolled in a public health professional development program. More specifically, we use a modified version of Guichard and Ridde’s (Une grille d’analyse des actions pour lutter contre les inégalités sociales de santé. In Potvin, L., Moquet, M.-J. and Jones, C. M. (eds), Réduire les Inégalités Sociales en Santé. INPES, Saint-Denis Cedex, pp. 297– 312, 2010) analytical grid to assess deductively the program participants’ use of health promotion practices in the analysis and planning, implementation, evaluation, sustainability and empowerment phases of the pilot intervention. We also seek evidence of practices involving (empowerment, participation, equity, holism, an ecological approach, intersectorality and sustainability) in the intervention. The results are mixed: our findings reveal evidence of the application of several dimensions of health promotion (equity, holism, an ecological approach, intersectorality and sustainability), but also a lack of integration of two key dimensions; that is, empowerment and participation, during various phases of the pilot intervention. These results show that the professional development program is associated with the adoption of a pilot intervention integrating multiple but not all dimensions of health promotion. We make recommendations to facilitate a more complete integration. This research also shows that the Guichard and Ridde grid proves to be a thorough instrument to document the practices of participants.

The Promise of Access: Hope and Inequality in the Information Economy

In 2013, a series of posters began appearing in Washington, DC’s Metro system. Each declared “The internet: Your future depends on it” next to a photo of a middle-aged black Washingtonian, and an advertisement for the municipal government’s digital training resources. This hopeful discourse is familiar but where exactly does it come from? And how are our public institutions reorganized to approach the problem of poverty as a problem of technology? The Clinton administration’s ‘digital divide’ policy program popularized this hopeful discourse about personal computing powering social mobility, positioned internet startups as the ‘right’ side of the divide, and charged institutions of social reproduction such as schools and libraries with closing the gap and upgrading themselves in the image of internet startups. After introducing the development regime that builds this idea into the urban landscape through what I call the ‘political economy of hope’, and tracing the origin of the digital divide frame, this dissertation draws on three years of comparative ethnographic fieldwork in startups, schools, and libraries to explore how this hope is reproduced in daily life, becoming the common sense that drives our understanding of and interaction with economic inequality and reproduces that inequality in turn. I show that the hope in personal computing to power social mobility becomes a method of securing legitimacy and resources for both white émigré technologists and institutions of social reproduction struggling to understand and manage the persistent poverty of the information economy. I track the movement of this common sense between institutions, showing how the political economy of hope transforms them as part of a larger development project. This dissertation models a new, relational direction for digital divide research that grounds the politics of economic inequality with an empirical focus on technologies of poverty management. It demands a conceptual shift that sees the digital divide not as a bug within the information economy, but a feature of it.

The socioeconomic gradient in health: The role of intra-household resource allocation

This paper aims to analyse the impact of different household financial regimes on the health status of males and females in a number of European countries. Using the EU-SILC 2010 on intra-household sharing of resources, we find that each member of the couple is worse off if his/her partner has most decision-making responsibilities. Additionally, the presence of children in the household plays a role in the effect that household financial regimens exert on individual self-assessed health, especially among females. We conclude that family arrangements regarding resource allocation and decision-making have important consequences and should be given some attention in the task of identifying individuals predisposed to health problems.

Political ideologies and attitudes towards income inequality in the US: a critical discourse analysis of CNN and Fox News opinion articles

The topic of the thesis is media discourse about current state if income inequality in the US, and political ideologies as influences behind the discourse. The data consists of four opinion articles, two from CNN and two from Fox News. The purpose of the study was to examine how media represents income inequality as an issue, and if the attitudes conveyed are concerned or indifferent. Previous studies have indicated that the level of income is often seen as a personal responsibility, and such perspective can be linked with Republican ideology. In contrast, the Democrats typically express more concern about the consequences of inequality. CNN has been previously considered to have a Democratic bias, and Fox News has been considered to have Republican bias, which is one reason why these two news channels were chosen as the sources of the data. The study is a critical discourse analysis, and the methods applied were sociocognitive approach, which analyzes the social and cognitive factors affecting the discourse, and appraisal framework, which was applied to scrutinize the expressed attitudes more closely by identifyind specific linguistic features. The appraisal framework includes studying such features as affect, judgment and appreciation, which offer a more detailed analysis on the attitudes present in the articles. The sociocognitive approach, additionally, offers a way of analyzing a more broad context affecting the articles. The findings were then compared, to see if there are differences between the articles, or between the news sites with alleged bias. The findings showed that CNN, with alleged Democratic bias, had a more symphatetic attitude towards income inequality, whereas Fox News, with more Republican views, showed clearly less concern towards the issue. Moreover, the Fox News articles had such dubious claims that the underlying ideology behind the articles could be even supporting of income inequality, as it allows the rich to pursue all the wealth they can without having to give anything away. The results, thus, suggest that the political ideologies may a significant effect on media discourse, which, in turn, may have a significant effect on the attitudes of the public towards great issues that could require prompt measures.

The politicization of a sociofact: exploring economic inequality in the global age

La comunicación aborda la pregunta acerca de si la desigualdad socioeconómica es no un problema de naturaleza política. Por el camino, se ocupa de las causas de la desigualdad en la era global, así como de atender a los efectos del resentimiento sobre la democracia en lo que a la demanda de igualdad se refiere.

Transdiscipline and research in health: Science, society and decision making

Significant advances in science should be given to addressing the needs of society and the historical context of the territories. Although technological developments that began with modernity and the industrial revolution allowed human beings to control the resources of nature to put to your service without limits, it is clear that the crisis of the prevailing development models manifest themselves in many ways but with three common denominators: environmental degradation, social injustice and extreme poverty. Consequently, today should not be possible to think a breakthrough in the development of science without addressing global environmental problems and the deep social injustices that increase at all scales under the gaze, impassively in many occasions, of formal science.

Retinal Macroglial Responses in Health and Disease

Due to their permanent and close proximity to neurons, glial cells perform essential tasks for the normal physiology of the retina. Astrocytes andM¨uller cells (retinal macroglia) provide physical support to neurons and supplement them with several metabolites and growth factors.Macroglia are involved in maintaining the homeostasis of extracellular ions and neurotransmitters, are essential for information processing in neural circuits, participate in retinal glucose metabolism and in removing metabolic waste products, regulate local blood flow, induce the blood-retinal barrier (BRB), play fundamental roles in local immune response, and protect neurons from oxidative damage. In response to polyetiological insults, glia cells react with a process called reactive gliosis, seeking to maintain retinal homeostasis. When malfunctioning, macroglial cells can become primary pathogenic elements. A reactive gliosis has been described in different retinal pathologies, including age-related macular degeneration (AMD), diabetes, glaucoma, retinal detachment, or retinitis pigmentosa. A better understanding of the dual, neuroprotective, or cytotoxic effect of macroglial involvement in retinal pathologies would help in treating the physiopathology of these diseases.The extensive participation of the macroglia in retinal diseases points to these cells as innovative targets for new drug therapies.

Ethical-moral courses of action and active citizenship in health students

Abstract Introduction: The practice of active citizenship, ethical-moral courses of action and civic, moral and ethics education are essentials for ethical decision making in health. Objetive: To determine if gender influences students’ ethical- moral course of action. Methods: Descriptive study with a non-probabilistic sample of 85 students enrolled in the 1st cycle of the health degree. Results: Of the participants surveyed 61.2% were found to say that action should take into account their moral principles, with ethical/ moral subjectivism prevailing; 44.7% consider that one should “Do what will have the best consequences for the greatest number of people”, with the principle of utilitarianism being significant; 55.3% think that “An action is ethically good” if “It is in accordance with morality”, thereby highlighting subjectivism/relativism; 45.9% believe that “ethical-moral values” “are relative and vary from society to society” agreeing with relativism as an explanatory principle for action. Males showed a greater tendency to support their decision-making with the principle of objectivism, (Fischer=.010). Conclusion: The results suggest that students’ ethical-moral education is required to promote an ethical-moral course of action in their professional practice. Thus, universities with their health courses should be at the forefront of this education, making their graduates ambassadors/interveners of a way of knowing and of being as well as promoters of the dignity of the citizen of the modern world.

MEF2C: expression, regulation and interaction with target genes in health and diseases

Tese de doutoramento, Ciências Biomédicas, Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 2015

Research, development, and innovations in health risk assessment for brazilian agriculture.

Agriculture and livestock are key sectors of the Brazilian economy, which are essential for the country?s economic growth and for the equality between the domestic currency?s supply and demand. Agribusiness answered for about 23% of the gross domestic product (GDP) in 2015, according to Confederação Nacional da Agricultura (CNA), and reached 50.3% of total exports in February 2016, according to Secretaria de Relações Internacionais do Agronegócio (SRI) of Ministério da Agricultura, Pecuária e Abastecimento (Mapa) (Brasil, 2016). Currently, this sector is recognized as the most competitive and efficient in Brazil, considering the global scenario.

Multi-Principal Agency and the Compliance with Professional Guidelines in Health Systems: Economic and Regulatory Perspectives

Amid the trend of rising health expenditure in developed economies, changing the healthcare delivery models is an important point of action for service regulators to contain this trend. Such a change is mostly induced by either financial incentives or regulatory tools issued by the regulators and targeting service providers and patients. This creates a tripartite interaction between service regulators, professionals, and patients that manifests a multi-principal agent relationship, in which professionals are agents to two principals: regulators and patients. This thesis is concerned with such a multi-principal agent relationship in healthcare and attempts to investigate the determinants of the (non-)compliance to regulatory tools in light of this tripartite relationship. In addition, the thesis provides insights into the different institutional, economic, and regulatory settings, which govern the multi-principal agent relationship in healthcare in different countries. Furthermore, the thesis provides and empirically tests a conceptual framework of the possible determinants of (non-)compliance by physicians to regulatory tools issued by the regulator. The main findings of the thesis are first, in a multi-principal agent setting, the utilization of financial incentives to align the objectives of professionals and the regulator is important but not the only solution. This finding is based on the heterogeneity in the financial incentives provided to professionals in different health markets, which does not provide a one-size-fits-all model of financial incentives to influence clinical decisions. Second, soft law tools as clinical practice guidelines (CPGs) are important tools to mitigate the problems of the multi-principal agent setting in health markets as they reduce information asymmetries while preserving the autonomy of professionals. Third, CPGs are complex and heterogeneous and so are the determinants of (non-)compliance to them. Fourth, CPGs work but under conditions. Factors such as intra-professional competition between service providers or practitioners might lead to non-compliance to CPGs – if CPGs are likely to reduce the professional’s utility. Finally, different degrees of soft law mandate have different effects on providers’ compliance. Generally, the stronger the mandate, the stronger the compliance, however, even with a strong mandate, drivers such as intra-professional competition and co-management of patients by different professionals affected the (non-)compliance.

Big data in health IoE in emergency situations: between the right to privacy and digital health innovation

The chapters of the thesis focus on a limited variety of selected themes in EU privacy and data protection law. Chapter 1 sets out the general introduction on the research topic. Chapter 2 touches upon the methodology used in the research. Chapter 3 conceptualises the basic notions from a legal standpoint. Chapter 4 examines the current regulatory regime applicable to digital health technologies, healthcare emergencies, privacy, and data protection. Chapter 5 provides case studies on the application deployed in the Covid-19 scenario, from the perspective of privacy and data protection. Chapter 6 addresses the post-Covid European regulatory initiatives on the subject matter, and its potential effects on privacy and data protection. Chapter 7 is the outcome of a six-month internship with a company in Italy and focuses on the protection of fundamental rights through common standardisation and certification, demonstrating that such standards can serve as supporting tools to guarantee the right to privacy and data protection in digital health technologies. The thesis concludes with the observation that finding and transposing European privacy and data protection standards into scenarios, such as public healthcare emergencies where digital health technologies are deployed, requires rapid coordination between the European Data Protection Authorities and the Member States guarantee that individual privacy and data protection rights are ensured.

Equidade na saúde e nos cuidados de saúde : migrantes e não migrantes na infecção de VIH/SIDA em Portugal

RESUMO - Este estudo tem como objectivo analisar a questão da equidade em saúde e nos cuidados de saúde entre migrantes e não migrantes no contexto da infecção de VIH/SIDA. A equidade em saúde e nos cuidados de saúde são valores de justiça distributiva. Este princípio representa um direito essencial para atingir uma melhor saúde e preocupa-se com a redução das desigualdades injustas em saúde e nos cuidados de saúde entre classes socioeconómicas. Os migrantes podem ser mais propensos a piores níveis de saúde do que os não migrantes devido a desigualdades sociais, na infecção por VIH/SIDA. Há escassez de estudos sobre a equidade em saúde e nos cuidados de saúde entre migrantes e não migrantes, aplicado ao contexto de VIH/SIDA em Portugal. Este é um país recente de migração e apresenta um aumento do número de casos de VIH/SIDA. O desenvolvimento deste estudo é importante para uma melhor compreensão da realidade da equidade em saúde e cuidados de saúde entre migrantes e não migrantes. Para a metodologia deste estudo, foram utilizados os dados da notificação obrigatória dos casos de VIH/SIDA em Portugal. A nacionalidade foi utilizada como aproximação ao estatuto de migrante. Através deste estudo empírico, foi possível constatar que os não nacionais estão sobre-representados nos casos notificados com um aumento no número de casos nos últimos anos. Estes dados sugerem uma iniquidade na saúde e nos cuidados de saúde a favor dos nacionais. Os portugueses representam. ----- ABSTRACT - The main goal of this work was to analyze the equity in health and health care between migrants and non migrants in the HIV/AIDS context. Equity in health and health care is a value of distributive justice. Is a primary right in order to achieve a better health and is concerned with a reduction in unfair inequality in health and health care between socioeconomic classes. Migrants are more susceptible to worse health levels due to socio inequalities, especially in the HIV/AIDS disease, when compared to non migrants. There is a scarcity of studies about health and health care between migrants and non migrants applied to the HIV/AIDS context in Portugal. Migration in Portugal is a recent, but increasing, phenomenon regarding the number of HIV/AIDS cases. This study brings a new overview over the equity of health and health care between migrants and non migrants. The methodology of this study uses mandatory notification of the HIV/AIDS cases detected in Portugal, and the nationality was used as a proxy to the migrant status. This empirical study allowed, detect that non nationals are overrepresented among notified cases, although the number has increased in the last years. This data suggests an inequity in health and health care in favor of nationals. Portuguese people’s represent the majority of notified cases, and the PALOP citizens come in second place.

Transplante renal : desigualdades no acesso

RESUMO - Em Portugal estima-se que existam cerca de 14 mil insuficientes renais crónicos e estima-se que em 2025 sejam 24 mil. As alternativas de tratamento são: hemodiálise, diálise peritoneal ou o transplante renal. Das alternativas de tratamento, o transplante renal é considerado a melhor alternativa terapêutica proporcionando melhor qualidade de vida, aumentando a sobrevida dos doentes, caracterizando-se por ser menos oneroso e por apresentar melhor custo- efectivo, quando comparado com hemodiálise ou diálise peritoneal. Portugal situa-se entre os primeiros da Europa, relativo ao número de transplantes renais efectuados (56,1 por milhão de habitante), em 2010 efectuaram-se 573 transplantes renais. Apesar disso, muitos são os doentes que continuam em lista de espera a aguardar transplante, em média os doentes esperam cerca de dois a três anos por um transplante renal, quando o tempo ideal seria três a seis meses. Por outro lado, estudos internacionais demonstram que existem desigualdades no acesso ao transplante renal, assim à semelhança de outros países torna-se pertinente estudar a realidade portuguesa em relação à temática da desigualdade no acesso, dado o objectivo primordial do Serviço Nacional de Saúde de garantir a equidade nos cuidados de saúde. Este trabalho tem como objectivo principal avaliar se factores como o sexo, idade a localização geográfica influenciam o acesso ao transplante renal, contribuindo para desigualdades no acesso. Este trabalho baseou-se na base de dados dos doentes inscritos em lista de espera para transplante renal, respeitante à área de abrangência do Centro de Histocompatibilidade do Sul. Caracterizou-se a população quanto ao sexo, idade, concelho, região de saúde e unidade de transplantação. Determinou-se ainda, os tempos médios de espera para inscrição em lista activa e para transplante por sexo, idade, região de saúde e unidade de transplantação.Dos resultados obtidos salienta-se que as desigualdades encontradas no acesso ao transplante renal verificam-se entre o início do tratamento até à inscrição em lista activa para transplante. Depois dos doentes em lista activa, o tempo de espera médio não é influenciado significativamente pelo sexo, idade ou localização geográfica.