779 resultados para Family physicians (or general practitioners)
Resumo:
La recerca s'ha desenvolupat a través d'un estudi que ha interrelacionat el procés d'integració social i cultural de la comunitat marroquina en la societat d'assentament amb la integració escolar dels infants i joves en els centres d'educació obligatòria. El que suposa una anàlisi del paper integrador que l'escola desenvolupa i pot desenvolupar, i també una reflexió sobre la interculturalitat i l' educació intercultural com a posicionament que afavoreix la integració plural. Tot aquest treball s'ha desenvolupat des d' una perspectiva articulada, ja que permet una major comprensió del fet migratori que es viu a una i altra banda de la Mediterrània. La investigació s 'ha desenvolupat en un paradigma sociocrític i a través d'un procés etnogràfic (observació, relats de vida, entrevistes ... ) al llarg de quasi tres anys, que ha estudiat i ha analitzat des d' una perspectiva comprensiva i transformadora, com la comunitat marroquina valora l'escolarització dels infants i joves des de les concepcions d'educació i d'escola que ha construït a través: 1. El procés migratori, entenent-lo mitjançant l' emigració i la immigració, en una perspectiva articulada. 2. El procés d'integració sociocultural en la societat d'arribada. El treball realitzat ha plantejat un marc teòric de tipus interdisciplinar -que s'ha estès al llarg de la investigació- per tal de situar el procés migratori, el concepte d'integració en la societat d'avui, des d'una perspectiva habermasiana i el paper de l'educació i de l'escola des d'una posicionament comunicatiu. Un cop presentat el marc teòric s'ha estudiat el procés migratori situant-se primer en el context de partida, el Marroc, realitzant una anàlisi que s'ha desenvolupat mitjançant factors socioculturals i educatius que en aquest darrer cas s'han ubicat sobre: l'educació en l'islam i en l'actual sistema d'ensenyament nacional. Posteriorment s'ha estudiat el context d'immigració a través d'aspectes demogràfics, jurídics, socioculturals i educatius. Presentant en aquest darrers un perfil socioformatiu de l'alumnat d'origen marroquí a través d'un estudi realitzat a la província de Girona. En els últims capítols s'exposen, primer situant-se en el Rif Oriental (Marroc), la ciutat de Nador i el seu entorn, de forma mes breu, i després amb extensió sobre l'espai de les comunitats marroquines d'Angles i Palafrugell a Catalunya, localitats de les comarques gironines, les característiques del context sociocutural i escolar, com a elements sobre el quals analitzar el procés d'integració sociocultural i escolar en el context d'assentament. La recerca també ha recollit l'opinió i l'experiència dels treballadors i famílies d'origen marroquí sobre l'escolarització dels infants i joves de la comunitat marroquina i sobre les expectatives que els pares i adults tenen de l'escola corn a institució formativa i integradora. Finalment es presenta una anàlisi, partint de la inforrnació obtinguda, que interrelaciona el procés d'integració sociocultural i escolar en el país d' assentament que ha aportat els següents referents i orientacions: 1. El procés d'integració de la comunitat marroquina mostra que es dóna un replegament sobre si mateixa que dificulta la integració plural. Aquest replegament es dóna mitjançant els valors de la tradició i de l'islam que són simultàniament, elements de cultura i de control. 2. Cal analitzar la integració en funció del model d' integració dominant en la societat d'arribada que es basa sobretot en aspectes funcionals: econòmics, jurídics i productius. 3. La integració en els àmbits morals: drets i deures, i en els aspectes simbòlics: identitats i identificacions són dominats en el primer cas per l'assimilació en els aspectes socials, culturals i productius, i pels estereotips en els aspectes identitaris i d'identificació. Aquesta situació comporta la necessitat de desenvolupar un model d'integració escolar que ha de tenir corn a referent que l'escola no pot integrar ni l'alumnat pot integrar-se si viu un procés de marginació o exclusió fora del centre i si el centre educatiu no és conscient d'allò que succeeix al seu entorn i a l'alumnat més enllà del context escolar. 1- Ha de procurar la integració de l'alumnat en la xarxa relacional i formativa del centre. 2- Ha d'aconseguir la integració de l'alumnat a l'aula. 3- Ha de tenir present que les accions integradores, abans esmentades, han d'afavorir la integració de l'alumnat fora de l'espai escolar i en una perspectiva de futur, ha d' afavorir la integració sociolaboral. Per tant, l'escola ha de plantejar-se que és necessari establir un diàleg amb totes les famílies a través d'un nou model de participació en el qual l'escola passi de ser un lloc de pas a un lloc de trobada. Aquesta dinàmica també replanteja ara les actuals fronteres entre allò públic i privat, entre l'escola i la família, amb l' objectiu de descobrir les coincidències entre els projectes social, cultural i educatiu d'ambdues institucions.
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O estudo realizado abriu discursão sobre a gestão de processos de ativação e recuperação e o conhecimento dos gestores desses processos relacionados com o uso das tecnologias. A análise objetivou observar a qualidade no atendimento das empresas de Telecom aos clientes da região Oeste do Pará, foi observado as estratégias empregadas por essas empresas para que seus serviços pudessem se tornar mais viáveis, certamente que o compromisso e responsabilidade dos gestores das empresas de Telecom tem sido bastante árdua, as problemáticas geográficas da região em estudo são muitas. Um dos problemas impactantes é a via de acesso da cidade mãe até as cidades vizinhas, depende de barcos, lanchas, balsas ou via terrestre; as adversidades são inúmeras e podem modificar comportamento e forma estratégica de se trabalhar nos processos analisados, inclusive em tempos de chuva a situação fica mais comprometedora aos técnicos de ativação e recuperação. Percebe que esses fatores alteram resultados estipulados pelas empresas, isso faz com que os gestores repensem e refaçam suas estratégias nos dois processos. O trabalho avaliou a estratégia usada pelos gestores de TI (Tecnologia da Informação) ou gestores geral das empresas usuárias para melhor atender sua clientela interna, e conseguir discernir as práticas dos serviços Telecom, melhorando o diálogo com os gestores Telecom, aumentando a qualidade e satisfação de seus clientes internos, tendo um equilíbrio de conhecimento nos conceitos tecnológicos.
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Las causas por las cuales se puede decretar el estado de emergencia han variado en el tiempo según las circunstancias de cada época y de cada país. Dichas situaciones de emergencia pueden obedecer a causas naturales o humanas. Pueden producirse por fenómenos físicos o climatológicos, por conmociones interiores, ataques exteriores, o incluso por desequilibrios económicos o sociales sectoriales o generales. Y, para hacer frente a estos estados excepcionales, el derecho internacional ha delimitado una serie de principios que deben ser respetados por los gobiernos locales.
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Introduction Health promotion (HP) aims to enhance good health while preventing ill-health at three levels of activity; primary (preventative), secondary (diagnostic) and tertiary (management).1 It can range from simple provision of health education to ongoing support, but the effectiveness of HP is ultimately dependent on its ability to influence change. HP as part of the Community Pharmacy Contract (CPC) aims to increase public knowledge and target ‘hard-to-reach’ individuals by focusing mainly on primary and tertiary HP. The CPC does not include screening programmes (secondary HP) as a service. Coronary heart disease (CHD) is a significant cause of morbidity and mortality in the UK. While there is evidence to support the effectiveness of some community pharmacy HP strategies in CHD, there is paucity of research in relation to screening services.2 Against this background, Alliance Pharmacy introduced a free CHD risk screening programme to provide tailored HP advice as part of a participant–pharmacist consultation. The aim of this study is to report on the CHD risk levels of participants and to provide a qualitative indication of consultation outcomes. Methods Case records for 12 733 people who accessed a free CHD risk screening service between August 2004 and April 2006 offered at 217 community pharmacies were obtained. The service involved initial self-completion of the Healthy Heart Assessment (HHA) form and measurement of height, weight, body mass index, blood pressure, total cholesterol and highdensity lipoprotein levels by pharmacists to calculate CHD risk.3 Action taken by pharmacists (lifestyle advice, statin recommendation or general practitioner (GP) referral) and qualitative statements of advice were recorded, and a copy provided to the participants. The service did not include follow-up of participants. All participants consented to taking part in evaluations of the service. Ethical committee scrutiny was not required for this service development evaluation. Results Case records for 10 035 participants (3658 male) were evaluable; 5730 (57%) were at low CHD risk (<15%); 3636 (36%) at moderate-to-high CHD risk (≥15%); and 669 (7%) had existing heart disease. A significantly higher proportion of male (48% versus 30% female) participants were at moderate- to-high risk of CHD (chi-square test; P < 0.005). A range of outcomes resulted from consultations. Lifestyle advice was provided irrespective of participants’ CHD risk or existing disease. In the moderate-to-high-risk group, of which 52% received prescribed medication, lifestyle advice was recorded for 62%, 16% were referred and 34% were advised to have a re-assessment. Statin recommendations were made in 1% of all cases. There was evidence of supportive and motivational statements in the advice recorded. Discussion Pharmacists were able to identify individuals’ level of CHD risk and provide them with bespoke advice. Identification of at-risk participants did not automatically result in referrals or statin recommendation. One-third of those accessing the screening service had moderate-to-high risk of CHD, a significantly higher proportion of whom were men. It is not known whether these individuals had been previously exposed to HP but presumably by accessing this service they may have contemplated change. As effectiveness of HP advice will depend among other factors on ability to influence change, future consultations may need to explore patients’ attitude towards change in relation to the Trans Theoretical Model4 to better tailor HP advice. The high uptake of the service by those at moderate-to-high CHD risk indicates a need for this type of screening programme in community pharmacy, perhaps specifically to reach men who access medical services less.
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We argue that population modeling can add value to ecological risk assessment by reducing uncertainty when extrapolating from ecotoxicological observations to relevant ecological effects. We review other methods of extrapolation, ranging from application factors to species sensitivity distributions to suborganismal (biomarker and "-omics'') responses to quantitative structure activity relationships and model ecosystems, drawing attention to the limitations of each. We suggest a simple classification of population models and critically examine each model in an extrapolation context. We conclude that population models have the potential for adding value to ecological risk assessment by incorporating better understanding of the links between individual responses and population size and structure and by incorporating greater levels of ecological complexity. A number of issues, however, need to be addressed before such models are likely to become more widely used. In a science context, these involve challenges in parameterization, questions about appropriate levels of complexity, issues concerning how specific or general the models need to be, and the extent to which interactions through competition and trophic relationships can be easily incorporated.
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Objectives: To determine the incidence and clinical relevance of newly diagnosed cases of prostate cancer in a group of men who had an elevated PSA and benign prostate biopsy 7 years previously. Patients and Method: Patients under the age of 80 years with an elevated PSA who had had a benign prostate biopsy in the 12 months between March 1, 1994 and February 28, 1995 were studied. One hundred and sixty four patients with a mean age of 66.8 years (range 47-79 years) were identified. The mean PSA for this group was 10.3 ng/ml (range 4.1-81 ng/ml). One hundred and fifty nine of the 164 (97%) hospital records were available for review and all but 21 (12.8%) of the General Practitioners were contacted. Results: Eighteen (11%) of the original 164 patients were subsequently diagnosed with prostate cancer, 2 died from their disease. Conclusions: In a population where the follow-up of patients with a benign biopsy was arranged on clinical grounds alone, 11% of the study group were diagnosed with prostate cancer during a seven-year follow-up. Although some of these cancers appear to be slow growing, most of those diagnosed in the initial follow-up period were deemed to be clinically significant and a small proportion progressed rapidly to metastases. All patients who have an elevated PSA, but benign biopsy, should undergo a period of PSA monitoring until it is clear that their PSA is not rising. We propose an initial intensive monitoring period to avoid missing those with clinically aggressive disease. (C) 2003 Elsevier Science B.V. All rights reserved.
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The potential of clarification questions (CQs) to act as a form of corrective input for young children's grammatical errors was examined. Corrective responses were operationalized as those occasions when child speech shifted from erroneous to correct (E -> C) contingent on a clarification question. It was predicted that E -> C sequences would prevail over shifts in the opposite direction (C -> E), as can occur in the case of nonerror-contingent CQs. This prediction was tested via a standard intervention paradigm, whereby every 60s a sequence of two clarification requests (either specific or general) was introduced into conversation with a total of 45 2- and 4-year-old children. For 10 categories of grammatical structure, E -> C sequences predominated over their C -> E counterparts, with levels of E -> C shifts increasing after two clarification questions. Children were also more reluctant to repeat erroneous forms than their correct counterparts, following the intervention of CQs. The findings provide support for Saxton's prompt hypothesis, which predicts that error-contingent CQs bear the potential to cue recall of previously acquired grammatical forms.
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Nurses have successfully adopted the role of prescriber in numerous health care settings in the UK. Existing research has not addressed how Nurse Independent and Nurse Supplementary Prescribers compare with doctors in terms of the perceived advantages and disadvantages of nurse prescribing, nor has the perceived importance of nurses providing patients with an explanation about their medicines been established. The current study utilized a random sample of 31 qualified Nurse Independent and Nurse Supplementary Prescribers and 30 general practitioners who self-completed a written questionnaire in an independent groups design. The study establishes nurses’ and doctors’ perceptions of the advantages and disadvantages of independent and supplementary nurse prescribing and provides some indication of the importance that nurses and doctors place on nurses providing an explanation about medicines, and the categories of information perceived to be important.
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This study has explored the underlying causes of preventable drug-related admissions to hospital, from primary care through semi-structured interviews and review of patients’ medical records. Analysis of the data has revealed that communication failures between different groups of healthcare professionals and between healthcare professionals and patients contribute to preventable drug-related admissions, as do knowledge gaps about medication in both healthcare professionals and patients. In addition, working conditions for community pharmacists severely limit their ability to effectively act as a safety barrier to patients receiving inappropriate medication. Limitations include heavy workloads, lack of access to patients’ clinical information, poor relationships with general practitioners and time restrictions. The results of this study represent an important addition to our understanding of the contribution of human error as an underlying cause of preventable drug-related morbidity, and the factors which contribute to errors occurring in the primary healthcare setting.
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The concept of being ‘patient-centric’ is a challenge to many existing healthcare service provision practices. This paper focuses on the issue of referrals, where multiple stakeholders, i.e. general practitioners and patients, are encouraged to make a consensual decision based on patient needs. In this paper, we present an ontology-enabled healthcare service provision, which facilitates both patients and GPs in jointly deciding upon the referral decision. In the healthcare service provision model, we define three types of profile, which represents different stakeholders’ requirements. This model also comprises of a set of healthcare service discovery processes: articulating a service need, matching the need with the healthcare service offerings, and deciding on a best-fit service for acceptance. As a result, the healthcare service provision can carry out coherent analysis using personalised information and iterative processes that deal with requirements change over time.
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Background Autism Spectrum Conditions (ASC) are neurodevelopmental conditions characterized by difficulties in communication and social interaction, alongside unusually repetitive behaviours and narrow interests. Asperger Syndrome (AS) is one subgroup of ASC and differs from classic autism in that in AS there is no language or general cognitive delay. Genetic, epigenetic and environmental factors are implicated in ASC and genes involved in neural connectivity and neurodevelopment are good candidates for studying the susceptibility to ASC. The aryl-hydrocarbon receptor nuclear translocator 2 (ARNT2) gene encodes a transcription factor involved in neurodevelopmental processes, neuronal connectivity and cellular responses to hypoxia. A mutation in this gene has been identified in individuals with ASC and single nucleotide polymorphisms (SNPs) have been nominally associated with AS and autistic traits in previous studies. Methods In this study, we tested 34 SNPs in ARNT2 for association with AS in 118 cases and 412 controls of Caucasian origin. P values were adjusted for multiple comparisons, and linkage disequilibrium (LD) among the SNPs analysed was calculated in our sample. Finally, SNP annotation allowed functional and structural analyses of the genetic variants in ARNT2. We tested the replicability of our result using the genome-wide association studies (GWAS) database of the Psychiatric Genomics Consortium (PGC). Results We report statistically significant association of rs17225178 with AS. This SNP modifies transcription factor binding sites and regions that regulate the chromatin state in neural cell lines. It is also included in a LD block in our sample, alongside other genetic variants that alter chromatin regulatory regions in neural cells. Conclusions These findings demonstrate that rs17225178 in the ARNT2 gene is associated with AS and support previous studies that pointed out an involvement of this gene in the predisposition to ASC.
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Background: Attention deficit hyperactivity disorder (ADHD) can be treated with stimulant medication such as methylphenidate. Although effective, methylphenidate can cause serious side-effects, including suppressed appetite, growth retardation and sleep problems. A drug holiday is a deliberate interruption of pharmacotherapy for a defined period of time and for a specific clinical purpose, for example for appeasing side-effects. Whilst some international guidelines recommend introducing drug holidays in ADHD treatment, this is not practised routinely. Our aim was to examine the views and experiences of planned drug holidays from methylphenidate with adults who have responsibility for treatment decisions in children and adolescents with ADHD. Method: In-depth interviews were carried out. Child and Adolescent Mental Health Services (CAMHS) practitioners (n=8), General Practitioners (n=8), teachers (n=5), and mothers of children with ADHD (n=4) were interviewed in a UK setting. Interview transcripts were analysed using grounded theory. Results: Methylphenidate eases the experience of the child amid problems at home and at school and once started is mostly continued long-term. Some families do practise short-term drug holidays at weekends and longer-term ones during school holidays. The decision to introduce drug holidays is influenced by the child’s academic progress, the parents’ ability to cope with the child, as well as medication beliefs. Trialling a drug holiday is thought to allow older children to self-assess their ability to manage without medication when they show signs of wanting to discontinue treatment prematurely. Conclusions: Planned drug holidays could address premature treatment cessation by enabling adolescents to assess repercussions under medical supervision.
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Experts from six Latin American countries met to discuss critical issues and needs in the diagnosis and management of primary immunodeficiency diseases (PIDD). The diagnosis of PIDD is generally made following referral to an immunology centre located in a major city, but many paediatricians and general practitioners are not sufficiently trained to suspect PIDD in the first place. Access to laboratory testing is generally limited, and only some screening tests are typically covered by government health programmes. Specialised diagnostic tests are generally not reimbursed. Access to treatment varies by country reflecting differences in healthcare systems and reimbursement policies. An online PIDD Registry Programme for Latin America has been available since 2009, which will provide information about PIDD epidemiology in the region. Additional collaboration across countries appears feasible in at least two areas: a laboratory network to facilitate the diagnosis of PIDD, and educational programmes to improve PIDD awareness. In total, these collaborations should make it possible to advance the diagnosis and management of PIDD in Latin America. (C) 2010 SEICAP. Published by Elsevier Espana, S.L. All rights reserved.
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Föreliggande studie syftar till att genom en visuell innehållsanalys kartlägga gemensamma drag i 120 universitetslogotypers visuella utformning, samt undersöka samband mellan dessa karaktärsdrag och universitetens internationella rankningsposition.Med utgångspunkt från topprankningslistan Times Higher Education World University Rankings med 400 internationella universitet, indelade i fyra grupper i intervaller om 100 (d.v.s. rankningsposition 1–100, 101–200 etc.), valdes 30 universitet ut per grupp genom ett obundet slumpmässigt urval. Logotyperna för universiteten inhämtades främst från deras grafiska manualer.I studien presenteras förekomsten av generella drag med avseende på färg, typografi, typologi, detaljrikedom samt innehåll och form. Resultatet visade på tydliga gemensamma drag med i regel en till två dominerande karaktärsdrag per kategori. Resultaten tyder dock inte på att universitetens rakningsposition påverkar den visuella utformningen.
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Intresset för kriminalitet och individerna bakom de kriminella handlingarna ökar i samhället och återges i media dagligen. Det är just individen bakom brottet, hen som fängslas och får avtjäna sitt straff som denna studie riktar sitt fokus på. När fängelsegrindarna öppnas och återinträdet till samhället blir ett faktum; Hur tar då dessa individer sig tillbaka till samhället för att åter bli en del av det? Syftet med denna studie är att undersöka vilka återanpassningsstrategier som frigivna använder sig av samt hur samhällets bemötande påverkar strategierna. Studien baseras på självbiografier skrivna av fyra författare som alla levt ett kriminellt liv och som sedermera avtjänat ett eller flera fängelsestraff. Resultatet visar att det finns flera anpassningsstrategier som tas i bruk. Däribland att söka hjälp och stöd hos familj, vänner eller andra sociala grupper. Vidare återfinns det i strävan efter en ”ny identitet” vilket ofta sker med hjälp av tro. Att sysselsätta sig, ge något tillbaka till samhället, visa sin kreativitet i syfte att återfå sin kredibilitet kan ses som strategier som leder fram till det slutliga målet, kredibiliteten. Slutligen kunde ett samband mellan samhällets bemötande och återanpassningsstrategierna utrönas. Ju mer negativt bemötandet är desto fler återanpassningsstrategier behövs och arbetet för att uppnå dem blir mer krävande. Givet blir då att ett bemötande som fyllts av uppmuntran till individens förändring medför att färre strategier behövs och risken för återfall blir mindre.