Integrated care approaches and skills mix policies in Europe

ABSTRACT - Background: Integration of health care services is emerging as a central challenge of health care delivery, particularly for patients with elderly and complex chronic conditions. In 2003, the World Health Organization (WHO) already began to identify it as one of the key pathways to improve primary care. In 2005, the European Commission declared integrated care as vital for the sustainability of social protection systems in Europe. Nowadays, it is recognized as a core component of health and social care reforms across European countries. Implementing integrated care requires coordination between settings, organizations, providers and professionals. In order to address the challenge of integration in such complex scenario, an effective workforce is required capable of working across interdependent settings. The World Health Report 2006 noted that governments should prepare their workforce and explore what tasks the different levels of health workers are trained to do and are capable of performing (skills mix). Comparatively to other European countries, Portugal is at an early stage in what integrated care is concerned facing a growing elderly population and the subsequent increase in the pressure on institutions and professionals to provide social and medical care in the most cost-effective way. In 2006 the Portuguese government created the Portuguese Network for Integrated Care Development (PNICD) to solve the existing long-term gap in social support and healthcare. On what concerns health workforce, the Portuguese government already recognized the importance of redefine careers keeping professional motivation and satisfaction. Aim of the study: This study aims to contribute new evidence to the debate surrounding integrated care and skills mix policies in Europe. It also seeks to provide the first evidence that incorporates both the current dynamics of implementing integrated care in Portugal and the developments of international literature. The first ambition of our study is to contribute to the growing interest in integrated care and to the ongoing research in this area by identifying its different approaches and retrieve a number of experiences in some European countries. Our second goal of this research is to produce an update on the knowledge developed on skills mix to the international healthcare management community and to policy makers involved in reforming healthcare systems and organizations. To better inform Portuguese health policies makers in a third stage we explore the current dynamics of implementing integrated care in Portugal and contextualize them with the developments reported in the international literature. Methodology: This is essentially an exploratory and descriptive study using qualitative methodology. In order to identify integrated care approaches in Europe, a systematic literature review was undertaken which resulted in a paper published in the Journal of Management and Marketing in Health care titled: Approaches to developing integrated care in Europe: a systematic literature review. This article was recommended and included into a list of references identified by The King's Fund Library. A second systematic literature review was undertaken which resulted in a paper published in the International Journal of Healthcare Management titled: Skills mix in healthcare: An international update for the management debate. Semi-structured interviews were performed on experts representing the regional coordination teams of the Portuguese Network for Integrated Care Development. In a last stage a questionnaire survey was developed based on the findings of both systematic literature reviews and semi-structured interviews. Conclusions: Even though integrated care is a worldwide trend in health care reforms, there is no unique definition. Definitions can be grouped according to their sectorial focus: community-based care, combined health and social care, combined acute and primary care, the integration of providers, and in a more comprehensive approach the whole health system. Indeed, models that seek to apply the principles of integrated care have a similar background and are continually evolving and depend on the different initiatives taken at national level. . Despite the fact that we cannot argue that there is one single set typology of models for integrated care, it is possible to identify and categorize some of the basic approaches that have been taken in attempts to implement integrated care according to: changes in organizational structure, workforce reconfiguring, and changes in the financing system. The systematic literature review on skills mix showed that despite the widely acknowledged interest on skills mix initiatives there is a lack of evidence on skills mix implications, constraints, outcomes, and quality impact that would allow policy makers to take sustained and evidence-based decisions. Within the Portuguese health system, the integrated care approach is rather organizational and financial, whereas little attention is given to workforce integration. On what concerns workforce planning Portugal it is still in the stage of analyzing the acceptability of health workforce skills mix. In line with the international approaches, integration of health and social services and bridging primary and acute care are the main goals of the national government strategy. The findings from our interviews clarify perceptions which show no discrepancy with the related literature but are rather scarce comparing to international experience. Informants hold a realistic but narrow view of integrated care related issues. They seem to be limited to the regional context, requiring a more comprehensive perspective. The questionnaire developed in this thesis is an instrument which, when applied, will allow policy makers to understand the basic set of concepts and managerial motivations behind national and regional integrated care programs. The instrument developed can foster evidence on the three essential components of integrated care policies: organizational, financial, and human resources development, and can give additional input on the context in which integrated care is being developed, the type of providers and organizations involved, barriers and constraints, and the workforce skills mix planning related strategies. The thesis was successful in recognizing differences between countries and interventions and the instrument developed will allow a better comprehension of the international options available and how to address the vital components of integrated care programs.

The Impact of income support programs on transitions to employment

The income support programs are created with the purpose of fighting both, the poverty trap and the inactivity trap. The balance between both is fragile and hard to find. Thus, the goal of this work is to contribute to solve this issue by finding how income support programs, particularly the Portuguese RSI, affect transitions to employment. This is made through duration analysis, namely using Cox and Competing Risks models. A particular feature is introduced in this work as it incorporates the possibility of Defective Risks. The estimated hazard elasticity with respect to the amount of RSI received for individuals who move to employment is -0,41. More than a half of RSI receivers stays for more than a year and the probability of never leaving to employment is 44%. The results appear to indicate that RSI has affected negatively transitions to employment.

Treatment of American tegumentary leishmaniasis in special populations: a summary of evidence

We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fill in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making.

Integrative literature review of the reported uses of serological tests in leprosy management

Abstract: An integrative literature review was conducted to synthesize available publications regarding the potential use of serological tests in leprosy programs. We searched the databases Literatura Latino-Americana e do Caribe em Ciências da Saúde, Índice Bibliográfico Espanhol em Ciências da Saúde, Acervo da Biblioteca da Organização Pan-Americana da Saúde, Medical Literature Analysis and Retrieval System Online, Hanseníase, National Library of Medicine, Scopus, Ovid, Cinahl, and Web of Science for articles investigating the use of serological tests for antibodies against phenolic glycolipid-I (PGL-I), ML0405, ML2331, leprosy IDRI diagnostic-1 (LID-1), and natural disaccharide octyl-leprosy IDRI diagnostic-1 (NDO-LID). From an initial pool of 3.514 articles, 40 full-length articles fulfilled our inclusion criteria. Based on these papers, we concluded that these antibodies can be used to assist in diagnosing leprosy, detecting neuritis, monitoring therapeutic efficacy, and monitoring household contacts or at-risk populations in leprosy-endemic areas. Thus, available data suggest that serological tests could contribute substantially to leprosy management.

Contribution to drug discovery and development for tauopathies using yeast as a model

This work aimed to contribute to drug discovery and development (DDD) for tauopathies, while expanding our knowledge on this group of neurodegenerative disorders, including Alzheimer’s disease (AD). Using yeast, a recognized model for neurodegeneration studies, useful models were produced for the study of tau interaction with beta-amyloid (Aβ), both AD hallmark proteins. The characterization of these models suggests that these proteins co-localize and that Aβ1-42, which is toxic to yeast, is involved in tau40 phosphorylation (Ser396/404) via the GSK-3β yeast orthologue, whereas tau seems to facilitate Aβ1-42 oligomerization. The mapping of tau’s interactome in yeast, achieved with a tau toxicity enhancer screen using the yeast deletion collection, provided a novel framework, composed of 31 genes, to identify new mechanisms associated with tau pathology, as well as to identify new drug targets or biomarkers. This genomic screen also allowed to select the yeast strain mir1Δ-tau40 for development of a new GPSD2TM drug discovery screening system. A library of unique 138 marine bacteria extracts, obtained from the Mid-Atlantic Ridge hydrothermal vents, was screened with mir1Δ-tau40. Three extracts were identified as suppressors of tau toxicity and constitute good starting points for DDD programs. mir1Δ strain was sensitive to tau toxicity, relating tau pathology with mitochondrial function. SLC25A3, the human homologue of MIR1, codes for the mitochondrial phosphate carrier protein (PiC). Resorting to iRNA, SLC25A3 expression was silenced in human neuroglioma cells, as a first step towards the engineering of a neural model for replicating the results obtained in yeast. This model is essential to understand the mechanisms of tau toxicity at the mitochondrial level and to validate PiC as a relevant drug target. The set of DDD tools here presented will foster the development of innovative and efficacious therapies, urgently needed to cope with tau-related disorders of high human and social-economic impact.

Implementation of integral viscoelastic constitutive models in OpenFOAM® computational library

This work reports the implementation and verification of a new so lver in OpenFOAM® open source computational library, able to cope with integral viscoelastic models based on the integral upper-convected Maxwell model. The code is verified through the comparison of its predictions with analytical solutions and numerical results obtained with the differential upper-convected Maxwell model

From software extensions to product lines of dataflow programs

Abstract Dataflow programs are widely used. Each program is a directed graph where nodes are computations and edges indicate the flow of data. In prior work, we reverse-engineered legacy dataflow programs by deriving their optimized implementations from a simple specification graph using graph transformations called refinements and optimizations. In MDE-speak, our derivations were PIM-to-PSM mappings. In this paper, we show how extensions complement refinements, optimizations, and PIM-to-PSM derivations to make the process of reverse engineering complex legacy dataflow programs tractable. We explain how optional functionality in transformations can be encoded, thereby enabling us to encode product lines of transformations as well as product lines of dataflow programs. We describe the implementation of extensions in the ReFlO tool and present two non-trivial case studies as evidence of our work’s generality

Response of blood pressure to maximum exercise in hypertensive patients under different therapeutic programs

OBJECTIVE: To evaluate the behavior of blood pressure during exercise in patients with hypertension controlled by frontline antihypertension drugs. METHODS: From 979ergometric tests we retrospectively selected 49 hipertensive patients (19 males). The age was 53±12 years old and normal range rest arterial pressure (<=140/90 mmHg) all on pharmacological monotherapy. There were 12 on beta blockers; 14 on calcium antagonists, 13 on diuretics and 10 on angiotensin converting enzyme inhibitor. Abnormal exercise behhavior of blood pressure was diagnosed if anyone of the following criteria was detected: peak systolic pressure above 220 mmHg, raising of systolic pressure > or = 10 mmHg/MET; or increase of diastolic pressure greater than 15 mmHg. RESULTS: Physiologic response of arterial blood pressure occurred in 50% of patients on beta blockers, the best one (p<0.05), in 36% and 31% on calcium antagonists and on diuretics, respectively, and in 20% on angiotensin converting enzyme inhibitor, the later the leastr one (p<0.05). CONCLUSION: Beta-blockers were more effective than calcium antagonists, diuretics and angiotensin-converting enzyme inhibitors in controlling blood pressure during exercise, and angiotensin converting enzyme inhibitors the least effective drugs.

Métodos para el análisis de programas probabilistas y no-deterministas utilizando probadores de teoremas. Methods for the analysis of probabilistic and nondeterministic programs using theorem provers.

La verificación y el análisis de programas con características probabilistas es una tarea necesaria del quehacer científico y tecnológico actual. El éxito y su posterior masificación de las implementaciones de protocolos de comunicación a nivel hardware y soluciones probabilistas a problemas distribuidos hacen más que interesante el uso de agentes estocásticos como elementos de programación. En muchos de estos casos el uso de agentes aleatorios produce soluciones mejores y más eficientes; en otros proveen soluciones donde es imposible encontrarlas por métodos tradicionales. Estos algoritmos se encuentran generalmente embebidos en múltiples mecanismos de hardware, por lo que un error en los mismos puede llegar a producir una multiplicación no deseada de sus efectos nocivos.Actualmente el mayor esfuerzo en el análisis de programas probabilísticos se lleva a cabo en el estudio y desarrollo de herramientas denominadas chequeadores de modelos probabilísticos. Las mismas, dado un modelo finito del sistema estocástico, obtienen de forma automática varias medidas de performance del mismo. Aunque esto puede ser bastante útil a la hora de verificar programas, para sistemas de uso general se hace necesario poder chequear especificaciones más completas que hacen a la corrección del algoritmo. Incluso sería interesante poder obtener automáticamente las propiedades del sistema, en forma de invariantes y contraejemplos.En este proyecto se pretende abordar el problema de análisis estático de programas probabilísticos mediante el uso de herramientas deductivas como probadores de teoremas y SMT solvers. Las mismas han mostrado su madurez y eficacia en atacar problemas de la programación tradicional. Con el fin de no perder automaticidad en los métodos, trabajaremos dentro del marco de "Interpretación Abstracta" el cual nos brinda un delineamiento para nuestro desarrollo teórico. Al mismo tiempo pondremos en práctica estos fundamentos mediante implementaciones concretas que utilicen aquellas herramientas.

Programa de capacitación y de ejecución de acciones para favorecer el desarrollo del potencial exportador de las empresas pequeñas y medianas de Río Cuarto y región.Capacitation Programs to Encouraged Development of Rio Cuarto and Region Exports Potential.

Identificación: Programa de capacitación y de ejecución de acciones para favorecer el desarrollo del potencial exportador de las empresas pequeñas y medianas de Río Cuarto y región. Caracterización del problema objeto de estudio: La zona de influencia de la ciudad de Río Cuarto posee, por su ubicación y características naturales, un potencial exportador no explotado, considerando la actual dinámica de los mercados internacionales. La ciudad está en el cruce de rutas nacionales que la conecta a las principales ciudades del MERCOSUR, con salida al Pacífico y al Atlántico y conexión rápida a rutas que van hacia la frontera norte del país. A modo de presentación de situaciones favorables, en el caso de Bolivia es para aprovechar el prestigio de los productos argentinos en ese mercado y las ventajas que las empresas chicas y medianas pueden disponer al no existir barreras idiomáticas, razonables requisitos de calidad y una gran necesidad de productos elaborados que pueden ser ofertados por PYMES regionales.En el caso de Chile importan tres aspectos: primero, la cercanía geográfica a la zona de Río Cuarto, ya que se accede en forma directa por vía terrestre, con una distancia de sólo 900 Km. respecto a la zona metropolitana de ese país; segundo, es el mercado regional con mayores niveles de exigencia para acceder al mismo, constituyendo por lo tanto una buena plataforma de aprendizaje para lograr el acceso luego al mundo desarrollado; tercero, al tener Chile firmado acuerdos de libre comercio con mercados que suman 3500 millones de habitantes, con acceso directo al cinturón del Pacífico, que es la zona más dinámica del comercio mundial actual, ese país necesita complementarse con sus vecinos para poder aprovechar las demandas potenciales de esos mercados.Con el proyecto se pretende contribuir a acentuar la internacionalización económica de la ciudad de Río Cuarto y su región circundante. Hipótesis:Se puede generar un polo exportador pyme a partir de la actividad sistemática de un programa de difusión de conocimientos sobre el comercio exterior, lo que contribuirá a profundizar la sustentabilidad económica de Río Cuarto y su región circundante.Objetivos: -a) Crear, desde el programa, una oferta de capacitación y asesoramiento que satisfaga los interrogantes y necesidades de las empresas pequeñas y medianas que busquen iniciarse en la actividad de exportación. b) Promover la formación de consorcios y formas asociativas, sobre todo de pequeñas y medianas empresas, para expandir el comercio exterior regional. c) Difundir las posibilidades de inserción internacional de las pymes regionales y sus requerimientos en los aspectos productivos y de comercialización. Estos últimos suelen constituir puntos críticos en el desarrollo exportador de las firmas. d) Analizar las posibilidades competitivas en el comercio internacional, en especial en el área del MERCOSUR, de cluster Materiales y Métodos a Utilizar: - Elaboración de un Monitor de Expectativas Empresariales con el objetivo de cuantificar la actual y la potencial Oferta Exportadora Regional. - Desarrollo de Análisis Sectoriales para determinar las posibilidades de incrementar las ventas al exterior de productos regionales. - Creación de Informes Especiales sobre Productos Regionales, los cuales le permitirán a Pequeños y Medianos Productores conocer en detalle, las oportunidades y exigencias para ingresar a los mercados externos, especialmente al área del MERCOSUR. - Organización de Viajes y Rondas de Negocios con el fin de fortalecer los lazos comerciales y culturales del empresariado local y extranjero. Resultados Esperados: - Profundizar conocimientos sobre las posibilidades que poseen los productos regionales de ingresar a los mercados externos. - Lograr una difusión generalizada de conocimientos sobre el Comercio Exterior, brindándole a las Pymes las herramientas básicas y fundamentales para que puedan desarrollar su potencial exportador.

Sistemas de Tipos para Verificación de Programas Concurrentes. Type Systems for Concurrent Programs Verification.

La programación concurrente es una tarea difícil aún para los más experimentados programadores. Las investigaciones en concurrencia han dado como resultado una gran cantidad de mecanismos y herramientas para resolver problemas de condiciones de carrera de datos y deadlocks, problemas que surgen por el mal uso de los mecanismos de sincronización. La verificación de propiedades interesantes de programas concurrentes presenta dificultades extras a los programas secuenciales debido al no-determinismo de su ejecución, lo cual resulta en una explosión en el número de posibles estados de programa, haciendo casi imposible un tratamiento manual o aún con la ayuda de computadoras. Algunos enfoques se basan en la creación de lenguajes de programación con construcciones con un alto nivel de abstración para expresar concurrencia y sincronización. Otros enfoques tratan de desarrollar técnicas y métodos de razonamiento para demostrar propiedades, algunos usan demostradores de teoremas generales, model-checking o algortimos específicos sobre un determinado sistema de tipos. Los enfoques basados en análisis estático liviano utilizan técnicas como interpretación abstracta para detectar ciertos tipos de errores, de una manera conservativa. Estas técnicas generalmente escalan lo suficiente para aplicarse en grandes proyectos de software pero los tipos de errores que pueden detectar es limitada. Algunas propiedades interesantes están relacionadas a condiciones de carrera y deadlocks, mientras que otros están interesados en problemas relacionados con la seguridad de los sistemas, como confidencialidad e integridad de datos. Los principales objetivos de esta propuesta es identificar algunas propiedades de interés a verificar en sistemas concurrentes y desarrollar técnicas y herramientas para realizar la verificación en forma automática. Para lograr estos objetivos, se pondrá énfasis en el estudio y desarrollo de sistemas de tipos como tipos dependientes, sistema de tipos y efectos, y tipos de efectos sensibles al flujo de datos y control. Estos sistemas de tipos se aplicarán a algunos modelos de programación concurrente como por ejemplo, en Simple Concurrent Object-Oriented Programming (SCOOP) y Java. Además se abordarán propiedades de seguridad usando sistemas de tipos específicos. Concurrent programming has remained a dificult task even for very experienced programmers. Concurrency research has provided a rich set of tools and mechanisms for dealing with data races and deadlocks that arise of incorrect use of synchronization. Verification of most interesting properties of concurrent programs is a very dificult task due to intrinsic non-deterministic nature of concurrency, resulting in a state explosion which make it almost imposible to be manually treat and it is a serious challenge to do that even with help of computers. Some approaches attempts create programming languages with higher levels of abstraction for expressing concurrency and synchronization. Other approaches try to develop reasoning methods to prove properties, either using general theorem provers, model-checking or specific algorithms on some type systems. The light-weight static analysis approach apply techniques like abstract interpretation to find certain kind of bugs in a conservative way. This techniques scale well to be applied in large software projects but the kind of bugs they may find are limited. Some interesting properties are related to data races and deadlocks, while others are interested in some security problems like confidentiality and integrity of data. The main goals of this proposal is to identify some interesting properties to verify in concurrent systems and develop techniques and tools to do full automatic verification. The main approach will be the application of type systems, as dependent types, type and effect systems, and flow-efect types. Those type systems will be applied to some models for concurrent programming as Simple Concurrent Object-Oriented Programming (SCOOP) and Java. Other goals include the analysis of security properties also using specific type systems.

Derechos de participación e información en programas dirigidos a adolescentes en escuelas secundarias de la Ciudad de Córdoba: cumplimiento progresivo y estrategias de promoción. Participation and information rights in programs for adolescents in secondary schools in Cordoba City: progressive implementation and promotion strategies.

Abordar la infancia desde el enfoque de derechos (ED) implica una lectura de los derechos de los cuales los niños, niñas y adolescentes (NNA) son titulares y de las acciones estatales que se implementan para viabilizar el ejercicio concreto de ellos. Esta perspectiva exige comprender los contenidos de las políticas púb,el grado de participación que se les asigna y los sentidos que ellas toman en términos de progresividad de los derechos. Los cambios de concepción de la infancia desde la Convención Internacional de los Derechos del Niño (CIDN) y los cambios legislativos interpelan al Estado y la sociedad a modificar la visión hegemónica. Nuestra hipótesis gira alrededor de las siguientes considerac.: se han producido algunas modificaciones en las políticas y acciones estatales, aún no se dan las transformaciones necesarias de las lógicas institucionales y de los operadores que estimulen la participación de NNA en el ámbito escolar. Esto se visualiza en la ausencia de análisis cuali de los contenidos de las acc. y la falta de ftes estadísticas específicas, que muestren la orientac.de los contenidos en los principios de la protecc.integral. Estos presupuestos plantean interrogantes que delimitan el problema de investigación: ¿cómo se construye y reconstruye el ejercicio de la ciudadanía a través de la participación de los NNA, en su paso por la escuela, y cuáles son las lógicas institucionales que habilitan u obstaculizan ese ejercicio? Y ¿cuáles son los recursos institucionales que permitan que los programas y acciones redunden en el ejercicio efectivo de los derechos?.Obj.gral: Describir, analizar e interpretar la progresividad en el ejercicio de los derechos de participación e informacióin que tienen los adolescentes en escuelas secundarias de la cd de Cba, durante 2005 / 2010, para promover espacios públicos de construcción de ciudadanía. Se analizarán tres escuelas de Córdoba, escuela pública provincial, púb. nacional y privada. Obj. Espec.: Analizar las prácticas participativas formales e informales en las escuelas seleccionadas.- Aplicar indicadores cuanti y cualitativos del “Sistema de Indicadores para los derechos de la Infancia” Describir y analizar los recursos materiales y humanos. Elaborar y proponer procedim. para la confec. de registros de datos estadísticos - Elaborar y proponer lineamientos para la elaborac.e implementac.de acciones. Diseñar herramientas de difusión sobre los ds de participación e información.Esta investigac. es de carácter descriptivo e interpretativo, analizará diferentes ftes de informac.con técnicas cuanti y cualitativas, durante período la promulgación de la Ley 26061/05 y la adhesión prov. 9396/07. Se tomarán del Sistema de Indicadores, el derecho a la educación, el tema transversal “Acceso a la información y participación”, y las categorías de análisis “Recepción del Derecho y Capacidades estatales”. Se trabajaran indicadores cuanti y señales de progreso (cualitativos): estructurales, proceso y resultados. Serán analizados los Programas implementados durante el período de estudio. Estrategias cuali observac. participante, entrevistas, grupos focales, talleres de sensibilización, etc .Otras ftes de info: doc. institucionales, registros, evaluac, contenidos de programas y campañas y de difusión, prensa escrita, legislaciones, etc. La info se analizará a través Programa Atlas Ti, y del análisis estadístico. Algunos resultados esperados: Evaluac.y ajuste del Sistema de indicadores, la sensibilizac. desde el EF de autorid. escol. para la formulac. de planes y programas para el monitoreo adecuado de los mismos y para la rendic. de ctas de su gestión. Estimular la participac. de NNA en la escuela. Realizac.de documental. Brindar herramientas al Edo para superv de la aplicación progresiva del ejercicio de los derechos de participación e información de NNA Promov la continua evaluac. de los programas y acc.desde el ED para estimular el reconoc. de la nec.de ajuste de la política. The issue of children from the rights focus implies a reading of the rights in which children and adolescents are the holders and the state actions that are implemented to enable the exercise of them. This perspective requires understanding the contents of the public policies, the participation level that is assigned, and the senses that they take in terms of rights progressivity of. The conception changes about children since the International Convention on the Rights of the Child and legislative changes challenge to the State and society to modify hegemony vision. Our hypothesis revolves around the following considerations: there have been some public policies and state actions changes, but they not turn out, yet, transformations in logical institutional and actors whose are encourages children participation in school. This could be reflects in the absence of qualitative analysis in the actions contents and the lack of sources specific statistics, that will be showing the control of the principal contents of integral protection. These, raise the questions that delimit our problem research: how is built citizenship exercise through children and adolescent’s participation in the school, and what are the institutional logical that empowers or turns difficult that exercise? And What are the institutional resources that make possible the effective exercise of the rights, through different programs and actions?. General Objective: To describe, analyze and interpret exercise progressivity participation and information rights that have the adolescents in secondary schools in Córdoba City during 2005 / 2010, in order to promote public spaces for the construction of citizenship. It will analyze three schools in Cordoba, provincial public school, national public school and private school. . Obj. Specifics: To analyze the formal and informal participative practices in the schools selected. - To apply quantitative and qualitative indicators of the “Indicators System for Infa

Effects of Yoga in Patients with Chronic Heart Failure: A Meta-Analysis

The use of yoga as an effective cardiac rehabilitation in patients with chronic heart failure (CHF) remains controversial. We performed a meta-analysis to examine the effects of yoga on exercise capacity and health-related quality of life (HRQOL) in patients with CHF. Methods: We searched MEDLINE, Cochrane Central Register of Controlled Trials, Excerpta Medica database, LILACS, Physiotherapy Evidence Database, The Scientific Electronic Library Online, and Cumulative Index to Nursing and Allied Health (from the earliest date available to December 2013) for randomized controlled trials (RCTs) examining the effects of yoga versus exercise and/or of yoga versus control on exercise capacity (peakVO2) and quality-of-life (HRQOL) in CHF. Two reviewers selected studies independently. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test. Two studies met the selection criteria (total: 30 yoga and 29 control patients). The results suggested that yoga compared with control had a positive impact on peak VO2 and HRQOL. Peak VO2, WMD (3.87 95% CI: 1.95 to 5.80), and global HRQOL standardized mean differences (-12.46 95% CI: -22.49 to -2.43) improved in the yoga group compared to the control group. Yoga enhances peak VO2 and HRQOL in patients with CHF and could be considered for inclusion in cardiac rehabilitation programs. Larger RCTs are required to further investigate the effects of yoga in patients with CHF.

Objectives of social entrepreneurs and federal lending programs, and the optimal allocation of external funds

Magdeburg, Univ., Fak. für Wirtschaftswiss., Diss., 2010