728 resultados para health promotion program impacts and outcomes


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Aims Climate and human impacts are changing the nitrogen (N) inputs and losses in terrestrial ecosystems. However, it is largely unknown how these two major drivers of global change will simultaneously influence the N cycle in drylands, the largest terrestrial biome on the planet. We conducted a global observational study to evaluate how aridity and human impacts, together with biotic and abiotic factors, affect key soil variables of the N cycle. Location Two hundred and twenty-four dryland sites from all continents except Antarctica widely differing in their environmental conditions and human influence. Methods Using a standardized field survey, we measured aridity, human impacts (i.e. proxies of land uses and air pollution), key biophysical variables (i.e. soil pH and texture and total plant cover) and six important variables related to N cycling in soils: total N, organic N, ammonium, nitrate, dissolved organic:inorganic N and N mineralization rates. We used structural equation modelling to assess the direct and indirect effects of aridity, human impacts and key biophysical variables on the N cycle. Results Human impacts increased the concentration of total N, while aridity reduced it. The effects of aridity and human impacts on the N cycle were spatially disconnected, which may favour scarcity of N in the most arid areas and promote its accumulation in the least arid areas. Main conclusions We found that increasing aridity and anthropogenic pressure are spatially disconnected in drylands. This implies that while places with low aridity and high human impact accumulate N, most arid sites with the lowest human impacts lose N. Our analyses also provide evidence that both increasing aridity and human impacts may enhance the relative dominance of inorganic N in dryland soils, having a negative impact on key functions and services provided by these ecosystems.

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The aim of this study was to examine the association between determinants of access to healthcare and preventable hospitalizations, based on Davidson et al.'s framework for evaluating the effects of individual and community determinants on access to healthcare. The study population consisted of the low income, non-elderly, hospitalized adults residing in Harris County, Texas in 2004. The objectives of this study were to examine the proportion of the variance in preventable hospitalizations at the ZIP-code level, to analyze the association between the proximity to the nearest safety net clinic and preventable hospitalizations, to examine how the safety net capacity relates to preventable hospitalizations, to compare the relative strength of the associations of health insurance and the proximity to the nearest safety net clinic with preventable hospitalizations, and to estimate and compare the costs of preventable hospitalizations in Harris County with the average cost in the literature. The data were collected from Texas Health Care Information Collection (2004), Census 2000, and Project Safety Net (2004). A total of 61,841 eligible individuals were included in the final data analysis. A random-intercept multi-level model was constructed with two different levels of data: the individual level and the ZIP-code level. The results of this study suggest that ZIP-code characteristics explain about two percent of the variance in preventable hospitalizations and safety net capacity was marginally significantly associated with preventable hospitalizations (p= 0.062). Proximity to the nearest safety net clinic was not related to preventable hospitalizations; however, health insurance was significantly associated with a decreased risk of preventable hospitalization. The average direct cost was $6,466 per preventable hospitalization, which is significantly different from reports in the literature. ^

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This study examines Hispanic levels of incorporation and access to health care. Applying the Aday and Andersen framework for the study of access, the study examined the relationship between two levels of Hispanic incorporation into U.S. society, i.e., mainstream versus ethnic, and potential and realized measures of access to health care. Data for the study were drawn from a 1992 telephone survey of 600 randomly selected Hispanics in Houston and Harris County.^ The hypotheses tested were: (1) Hispanics who are incorporated into mainstream society are more likely to have better potential and realized access to health care than those who are incorporated into ethnic-group enclaves regardless of their socioeconomic status (SES), health status and health needs, and (2) there is no interaction between the levels of incorporation (mainstream or ethnic) and SES, health status, and health needs in predicting potential and realized access.^ The data analysis supported Hypothesis One for the two measures of potential access. The results of bivariate and multiple logistic regression analyses indicated that for Hispanics in Houston and Harris County, being in the "mainstream" incorporation category increased their potential access to care, having "health insurance" and a "regular place of care". For the selected measure of realized access, having a "regular check-up", the analysis did not demonstrate statistically significant differences in having a regular check-up among Hispanics incorporated in the ethnic or mainstream incorporation categories.^ Hypothesis Two, that there is no interaction between the levels of incorporation and socioeconomic characteristics, health status, and health needs in predicting potential and realized access among Hispanics was supported by the data. The results of the logistic regression analysis showed that, after adjusting for socioeconomic status, health status, and health needs, the association between "level of incorporation" and the two measures of potential access ("health insurance" and having a "usual place of care") was not modified by the control variables nor by their interaction with level of incorporation. That is, the effect of incorporation on Hispanics' health insurance coverage, and having a usual place of care, was homogenous across Hispanics with different SES and health status.^ The main research implication of this dissertation is the employment of a theoretical framework for the assessment of cultural factors essential to research on migrating heterogeneous subpopulations. It also provided strategies to solve practical and methodological difficulties in the secondary analyses of data on these populations. ^

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Almost three years have passed since the 'Arab Spring' began in late 2010. In the major sites of popular uprisings, political conditions remain unsettled or violent. Despite similarities in their original opposition to authoritarian rule, the outcomes differed from country to country. In Tunisia and Egypt, processes of transiting from authoritarian rule produced contrasting consequences for democratic politics. Uprisings led to armed rebellion in Libya and Syria, but whereas Gaddafi was overthrown, Asad was not. What explains the different trajectories and outcomes of the Arab Spring? How were these shaped by the power structure and levels of social control of the pre-uprising regimes and their state institutions, on the one hand, and by the character of the societies and oppositional forces that rose against them? Comparing Tunisia with Egypt, and Libya with Syria, this paper discusses various factors that account for variations in the trajectories and outcomes of the Arab Spring, namely, the legacy of the previous regime, institutional and constitutional choices during "transition" from authoritarian rule, socioeconomic conditions, and the presence of absence of ethnic, sectarian and geographic diversity.

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In the face of likely climate change impacts policy makers at different spatial scales need access to assessment tools that enable informed policy instruments to be designed. Recent scientific advances have facilitated the development of improved climate projections, but it remains to be seen whether these are translated into effective adaptation strategies. This paper uses existing databases on climate impacts on European agriculture and combines them with an assessment of adaptive capacity to develop an interdisciplinary approach for prioritising policies. It proposes a method for identifying relevant policies for different EU countries that are representative of various agroclimatic zones. Our analysis presents a framework for integrating current knowledge of future climate impacts with an understanding of the underlying socio-economic, agricultural and environmental traits that determine a region’s capacity for adapting to climate change.

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The technique of Abstract Interpretation [11] has allowed the development of sophisticated program analyses which are provably correct and practical. The semantic approximations produced by such analyses have been traditionally applied to optimization during program compilation. However, recently, novel and promising applications of semantic approximations have been proposed in the more general context of program validation and debugging [3,9,7].

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We present a generic preprocessor for combined static/dynamic validation and debugging of constraint logic programs. Passing programs through the preprocessor prior to execution allows detecting many bugs automatically. This is achieved by performing a repertoire of tests which range from simple syntactic checks to much more advanced checks based on static analysis of the program. Together with the program, the user may provide a series of assertions which trigger further automatic checking of the program. Such assertions are written using the assertion language presented in Chapter 2, which allows expressing a wide variety of properties. These properties extend beyond the predefined set which may be understandable by the available static analyzers and include properties defined by means of user programs. In addition to user-provided assertions, in each particular CLP system assertions may be available for predefined system predicates. Checking of both user-provided assertions and assertions for system predicates is attempted first at compile-time by comparing them with the results of static analysis. This may allow statically proving that the assertions hold (Le., they are validated) or that they are violated (and thus bugs detected). User-provided assertions (or parts of assertions) which cannot be statically proved ñor disproved are optionally translated into run-time tests. The implementation of the preprocessor is generic in that it can be easily customized to different CLP systems and dialects and in that it is designed to allow the integration of additional analyses in a simple way. We also report on two tools which are instances of the generic preprocessor: CiaoPP (for the Ciao Prolog system) and CHIPRE (for the CHIP CLP(FL>) system). The currently existing analyses include types, modes, non-failure, determinacy, and computational cost, and can treat modules separately, performing incremental analysis.

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We discuss a framework for the application of abstract interpretation as an aid during program development, rather than in the more traditional application of program optimization. Program validation and detection of errors is first performed statically by comparing (partial) specifications written in terms of assertions against information obtained from (global) static analysis of the program. The results of this process are expressed in the user assertion language. Assertions (or parts of assertions) which cannot be checked statically are translated into run-time tests. The framework allows the use of assertions to be optional. It also allows using very general properties in assertions, beyond the predefined set understandable by the static analyzer and including properties defined by user programs. We also report briefly on an implementation of the framework. The resulting tool generates and checks assertions for Prolog, CLP(R), and CHIP/CLP(fd) programs, and integrates compile-time and run-time checking in a uniform way. The tool allows using properties such as types, modes, non-failure, determinacy, and computational cost, and can treat modules separately, performing incremental analysis.