786 resultados para Mattila, Mikko: Policy making in Finnish social and health care


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OBJECTIVES: We examined the social distribution of a comprehensive range of cardiovascular risk factors (CVRF) in a Swiss population and assessed whether socioeconomic differences varied by age and gender. METHODS: Participants were 2960 men and 3343 women aged 35-75 years from a population-based survey conducted in Lausanne, Switzerland (CoLaus study). Educational level was the indicator of socioeconomic status used in this study. Analyses were stratified by gender and age group (35-54 years; 55-75 years). RESULTS: There were large educational differences in the prevalence of CVRF such as current smoking (Δ = absolute difference in prevalence between highest and lowest educational group:15.1%/12.6% in men/women aged 35-54 years), physical inactivity (Δ = 25.3%/22.7% in men/women aged 35-54 years), overweight and obesity (Δ = 14.6%/14.8% in men/women aged 55-75 years for obesity), hypertension (Δ = 16.7%/11.4% in men/women aged 55-75 years), dyslipidemia (Δ = 2.8%/6.2% in men/women aged 35-54 years for high LDL-cholesterol) and diabetes (Δ = 6.0%/2.6% in men/women aged 55-75 years). Educational inequalities in the distribution of CVRF were larger in women than in men for alcohol consumption, obesity, hypertension and dyslipidemia (p<0.05). Relative educational inequalities in CVRF tended to be greater among the younger (35-54 years) than among the older age group (55-75 years), particularly for behavioral CVRF and abdominal obesity among men and for physiological CVRF among women (p<0.05). CONCLUSION: Large absolute differences in the prevalence of CVRF according to education categories were observed in this Swiss population. The socioeconomic gradient in CVRF tended to be larger in women and in younger persons.

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Bien que les activités où la compétence est un enjeu (p. ex. : problème académique) prennent souvent place dans des contextes interpersonnels (p. ex. : classe), hiérarchiques (p. ex. : enseignant-e/élèves), et spécifiques en termes de normes et de valeurs (p. ex. : culture), l'étude des buts de performance-le désir de se montrer compétent-e relativement à autrui-a le plus souvent été conduite au seul niveau intrapersonnel. S'appuyant sur le modèle transactionnel du stress et du coping, le modèle circumplexe des comportements interpersonnels, ainsi que sur la théorie de l'élaboration du conflit, la première partie de cette thèse révèle les conséquences interpersonnelles des buts de performance sur la régulation d'un comportement spécifique, à savoir le conflit sociocognitif (c.-à-d., une situation de confrontation avec un intéractant en désaccord) : les buts de performance-approche-le désir d'être meilleur-e qu'autrui-prédisent une régulation du conflit fortement agentique (dominante), soit la validation de son point de vue au détriment de celui de l'intéractant (que nous désignons régulation compétitive) ; alors que les buts de performance-évitement-le désir de ne pas être moins bon-ne qu'autrui-prédisent une régulation du conflit faiblement agentique (soumise), soit l'invalidation de son point de vue au bénéfice de celui de l'intéractant (que nous désignons régulation protective). De plus, les effets susmentionnés augmentent à mesure que l'intéractant est présenté comme supérieurement (vs. similairement) compétent. S'appuyant sur la littérature sur les structures de buts de groupe, et celle sur la socialisation des valeurs, la seconde partie de cette thèse révèle les antécédents interpersonnels des buts de performance, et plus spécifiquement le rôle du superviseur dans la socialisation des buts de performance : les buts de performance-approche d'un superviseur sont positivement associés avec l'émergence au cours du temps des buts de performance-approche de ses subordonnés (particulièrement lorsqu'ils se perçoivent comme compétents) et celle de leurs buts de performance-évitement (particulièrement lorsqu'ils se perçoivent comme incompétents). En outre, ce phénomène consistant en un processus de socialisation, les effets susmentionnés augmentent lorsque l'identification à l'endogroupe des subordonnées augmente, et lorsque l'adhésion aux valeurs culturelles occidentales dominantes (c.-à-d., rehaussement de soi) du superviseur augmente. Dans leur ensemble, ces résultats soulignent la nécessité d'étudier les buts dans leur plenum social, autrement dit, en adoptant une perspective interpersonnelle (c.-à-d., étudier les effets des buts entre les individus), positionnelle (c.-à-d., entre des individus de différentes positions sociales), et idéologique (c.- à-d., entre des individus se conformant à des normes spécifiques et adhérant à des valeurs spécifiques). -- Although competence-relevant activities (e.g., solving an academic problem) are often embedded in interpersonal (e.g., classroom), hierarchical (e.g., teacher/pupils), and norm-/value-specific (e.g., culture) settings, the study of performance goals-the desire to demonstrate competence relative to others-has mostly been conducted at the intrapersonal level alone. Drawing on the transactional model of stress and coping, the circumplex model of interpersonal behaviors, as well as on the conflict elaboration theory, the first part of this thesis reveals the interpersonal consequences of performance goals on the regulation of a specific behavior, namely socio-cognitive conflict (i.e., a situation of confrontation with a disagreeing interactant): Performance-approach goals-the desire to outperform others- predicted a highly agentic (dominant) conflict regulation, that is, the validation of one's point of view at the expense of that of the interactant (which we labeled competitive regulation); whereas performance-avoidance goals-the desire not to be outperformed by others- predicted a poorly agentic (submissive) conflict regulation, that is, the invalidation of one's point of view to the benefit of that of the interactant (which we labeled protective regulation). Furthermore, both the aforementioned effects were found to increase when the interactant was presented as being superiorly (vs. equally) in competence. Drawing on the literature on group goal structure, as well as on research on socialization of supervisors-based values, the second part of this thesis reveals the interpersonal antecedents of performance-based goals endorsement, focusing-more specifically-on the role of group-supervisors in performance goals socialization: Supervisor's performance-approach goals were positively associated with the emergence over time of subordinates' performance-approach (especially when perceiving themselves as competent) and -avoidance goals (especially when perceiving themselves as incompetent). Furthermore, providing evidence that this phenomenon essentially reflects a socialization process, both the aforementioned effects were found to increase as subordinates' in-group identification increased, and as supervisors' adherence to dominant Western values (i.e., self-enhancement values) increased. Taken together, these results advocate the need to study performance goals in their social plenum, that is, adopting an interpersonal (i.e., studying the effects of goals between individuals), positional (i.e., between individuals from different social positions), and ideological (i.e., between individuals following specific norms and endorsing specific values) perspective.

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The influence of social factors on birthweight and fetal and infant mortality was investigated in the Swiss birth cohort from 1979-85 (N = 519,933). The proportion of newborns with low-birthweight (less than 2500 g) was higher in lower social classes. Stillbirth-rate, neonatal and postneonatal mortality were higher in lower social classes, too. When controlling for birthweight, the increase in mortality in the lower social classes became somewhat less striking. Marked social differences in perinatal mortality were found in the newborns with normal weight, whereas almost no difference could be detected in the low-birthweight-group.

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We herein present a preliminary practical algorithm for evaluating complementary and alternative medicine (CAM) for children which relies on basic bioethical principles and considers the influence of CAM on global child healthcare. CAM is currently involved in almost all sectors of pediatric care and frequently represents a challenge to the pediatrician. The aim of this article is to provide a decision-making tool to assist the physician, especially as it remains difficult to keep up-to-date with the latest developments in the field. The reasonable application of our algorithm together with common sense should enable the pediatrician to decide whether pediatric (P)-CAM represents potential harm to the patient, and allow ethically sound counseling. In conclusion, we propose a pragmatic algorithm designed to evaluate P-CAM, briefly explain the underlying rationale and give a concrete clinical example.

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This article employs a unique data set - covering 25 popular votes on foreign, European and immigration/asylum policy held between 1992 and 2006 in Switzerland - in order to examine the conditional impact of context upon utilitarian, cultural, political and cognitive determinants of individual attitudes toward international openness. Our results reveal clear patterns of cross-level interactions between individual determinants and the project-related context of the vote. Thus, although party cues and political competence have a strong impact on individuals' support for international openness, this impact is substantially mediated by the type of coalition that is operating within the party elite. Similarly, subjective utilitarian and cultural considerations influence the voters' decision in interaction with the content of the proposal submitted to the voters as well as with the framing of the voting campaign.

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Ant colonies are known for their complex and efficient social organization that com-pletely lacks hierarchical structure. However, due to methodological difficulties in follow¬ing all ants of a colony, it was until now impossible to investigate the social and temporal organization of colonies. We developed a tracking system that allows tracking the posi¬tions and orientations of several hundred individually labeled ants continuously, providing for the first time quantitative long term data on all individuals of a colony. These data permit reconstructing trajectories, activity patterns and social networks of all ants in a colony and enable us to investigate ant behavior quantitatively in previously unpreceded ways. By analyzing the spatial positions and social interactions of all ants in six colonies for 41 days we show that ant colonies are organized in groups of nurses, nest patrollers and foragers. Workers of each group were highly interconnected and occupied similar spa¬tial locations in the nest. Groups strongly segregated spatially, and were characterized by unique behavioral signatures. Nurses spent most of their time on the brood. Nest patrollers frequently visited the rubbish pile, and foragers frequently visited the forag¬ing arena. In addition nurses were on average younger than nest patrollers who were, in turn, younger than foragers. We further show that workers had a preferred behav¬ioral trajectory and moved from nursing to nest patrolling, and from nest patrolling to foraging. By analyzing the activity patterns of all ants we show that only a third of all workers in a colony exhibit circadian rhythms and that these rhythms shortened by on av¬erage 42 minutes in constant darkness, thereby demonstrating the presence of a functional endogenous clock. Most rhythmic workers were foragers suggesting that rhythmicity is tightly associated with task. Nurses and nest patrollers were arrhythmic which most likely reflects plasticity of the circadian clock, as isolated workers in many species exhibit circadian rhythmicity. Altogether our results emphasize that ant colonies, despite their chaotic appearance, repose on a strong underlying social and temporal organization. - Les colonies de fourmis sont connues pour leur organisation sociale complexe et effi-cace, charactérisée par un manque absolu de structure hiérarchique. Cependant, puisqu'il est techniquement très difficile de suivre toutes les fourmis d'une colonie, il a été jusqu'à maintenant impossible d'étudier l'organisation sociale et temporelle des colonies de four-mis. Nous avons développé un système qui permet d'extraire en temps réel à partir d'images vidéo les positions et orientations de plusieurs centaines de fourmis marquées individuellement. Nous avons pu ainsi générer pour la première fois des données quanti-tatives et longitudinales relatives à des fourmis appartenant à une colonie. Ces données nous ont permis de reconstruire la trajectoire et l'activité de chaque fourmi ainsi que ses réseaux sociaux. Ceci nous a permis d'étudier de manière exhaustive et objective le com-portement de tous les individus d'une colonie. En analysant les données spatiales et les interactions sociales de toutes les fourmis de six colonies qui ont été filmées pendant 41 jours, nous montrons que les fourmis d'une même colonie se répartissent en trois groupes: nourrices, patrouilleuses et approvisionneuses. Les fourmis d'un même groupe interagis-sent fréquemment et occupent le même espace à l'intérieur du nid. L'espace propre à un groupe se recoupe très peu avec celui des autres. Chaque groupe est caractérisé par un comportement typique. Les nourrices s'affairent surtout autour du couvain. Les pa-trouilleuses font de fréquents déplacements vers le tas d'ordures, et les approvisionneuses sortent souvent du nid. Les nourrices sont en moyenne plus jeunes que les patrouilleuses qui, à leur tour, sont plus jeunes que les approvisionneuses. De plus, nous montrons que les ouvrières changent de tâche au cours de leur vie, passant de nourrice à patrouilleuse puis à approvisionneuse. En analysant l'activité de chaque fourmi, nous montrons que seulement un tiers des ouvrières d'une colonie présente des rythmes circadiens et que ces rythmes diminuent en moyenne de 42 minutes lorsqu'il y a obscurité constante, ce qui démontre ainsi la présence d'une horloge endogène. De plus, la plupart des approvi¬sionneuses ont une activité rythmique alors que les nourrices et patrouilleuses présentent une activité arythmique, ce qui suggère que la rythmicité est étroitement associée à la tâche. L'arythmie des nourrices et patrouilleuses repose probablement sur une plasticité de l'horloge endogène car des ouvrières de nombreuses espèces font preuve d'une ryth¬micité circadienne lorsqu'elles sont isolées de la colonie. Dans l'ensemble nos résultats révèlent qu'une colonie de fourmis se fonde sur une solide organisation sociale et tem¬porelle malgré son apparence chaotique.

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This paper investigates the prevalence of incapacity in performing daily activities and the associations between household composition and availability of family members and receipt of care among older adults with functioning problems in Spain, England and the United States of America (USA). We examine how living arrangements, marital status, child availability, limitations in functioning ability, age and gender affect the probability of receiving formal care and informal care from household members and from others in three countries with different family structures, living arrangements and policies supporting care of the incapacitated. Data sources include the 2006 Survey of Health, Ageing and Retirement in Europe for Spain, the third wave of the English Longitudinal Study of Ageing (2006), and the eighth wave of the USA Health and Retirement Study (2006). Logistic and multinomial logistic regressions are used to estimate the probability of receiving care and the sources of care among persons age 50 and older. The percentage of people with functional limitations receiving care is higher in Spain. More care comes from outside the household in the USA and England than in Spain. The use of formal care among the incapacitated is lowest in the USA and highest in Spain.