France, Italy, and Spain: Culturally Similar Nations, Yet Drastically Different In Their Roles as European Union Nations

Since France, Italy and Spain are neighboring Western European countries, whose languages and cultures have descended from Latin, it is inevitable that these countries share similarities on many levels. France, Italy and Spain share similar lifestyles, religious values and cultural heritages. Throughout history France, Italy and Spain have experienced many of the same historical events because of their geographical proximity. Now that all three countries are members of the European Union they have become further united by occupying a common area without border controls, and sharing a common market, laws, and currency. While France, Italy and Spain share many commonalities, their opinions and relationships within the European Union are diverse. Although each nation struggles to balance its national identity with its European identity and to maintain its sovereignty while at the same time giving some of it up to the EU, each nation has its own ideas about how much its identity should change and how much sovereignty it should give up to the EU government. Each nation also has unique opinions about what it means to part of the European Union and what the requirements for becoming a member nation should be. Each nation has different goals it hopes to accomplish for its own country and for the European Union. The differing ideas amongst France, Italy and Spain are a result of the variance that exists amongst their political and economic relationships and institutions, which have been molded by the historical experiences of each nation. The focus of this paper will be examining why France, Spain and Italy share many cultural similarities, yet differ so greatly in their roles as members of the European Union. After a brief background on the European Union, I will discuss the cultural similarities France, Italy and Spain share. I will then mention several economic and political differences between the three countries and use supporting evidence to explain why and in what context these differences have arisen

Cultural competence in an HIV dedicated dental clinic: Application of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS)

This dissertation investigated perspectives on cultural competence among African-American women patients, staff, and the administrator of a dental clinic serving people living with HIV/AIDS; and evaluated the role of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) in advancing the provision of culturally competent care in the clinic. ^ The study was qualitative with data collection via focus groups and individual interviews with a sample of African-American women patients, and individual interviews with a sample of staff and the clinic administrator. Transcripts were coded and themes identified using the software program ATLAS.ti. A cultural audit template was developed and applied to evaluate cultural competency. ^ Among attitudes and behaviors that contributed to the provision of culturally competent care at the clinic were respect and empathic communication. Formal cultural competency was not featured strongly in the methods by which the staff learned to work with diverse populations. Instead cultural competence among the staff was based on thoughtful hiring practices, natural aptitude and a climate that encouraged learning through informal sharing of experiences. The staff and administrator felt that an African-American dentist would be an asset in improving culturally competent care at the clinic. Previous research and national policy also promote the provider-patient racial/ethnic concordance to improve care. In this study, however, the patients were happy with the care provided regardless of the race/ethnicity of the staff, probably reflecting the well developed cultural competence skills of clinic staff overall. ^ The clinic administrator was unaware of the CLAS standards although the clinic was implicitly operated under their mandates. This occurred because the clinic is supported by federal funding and the CLAS standards were incorporated into the requirements. Incorporation into and monitoring of the CLAS standards in federally funded programs therefore appears to be an effective means for ensuring that they are implemented. ^ This study illustrates that cultural competence, though not universally understood, can be systematically investigated to identify what constitutes appropriate care and the factors that support or inhibit it. Among important elements of culturally competent care are respect and empathic communication. ^

Antiretroviral therapy adherence and the use of condoms among African American HIV-positive crack cocaine users

Safer sex practices, such as consistent condom use, are essential to reduce HIV transmission. Determining causes and/or co-variants related to the likelihood of participating in high-risk sexual behaviors may allow the content of interventions and treatments to minimize HIV transmission to be tailored more effectively. The goal of this study was to examine whether a relationship exists between consistent condom use among African American HIV-positive crack cocaine users and both (1) the use of antiretroviral therapy, and (2) adherence to antiretroviral therapy regimens. The study population consisted of 390 participants. They were at least 18 years old, African American, HIV-positive, and had used crack cocaine within a month prior to an interview conducted sometime between April, 2004, and September, 2007. Bivariate associations were examined using contingency tables and χ2-statistics. The Mantel-Haenszel method was used to control for confounding. This study found neither a significant relationship between use of antiretroviral therapy and consistent condom use (Odds ratio (OR) = 1.38; 95% Confidence interval (95%CI) = 0.86–2.22), nor an association between antiretroviral therapy adherence and consistent condom use (OR = 1.02, 95%CI = 0.60–1.75). The exception was more consistent condom use when sex was traded for money or drugs in those on antiretroviral therapy, compared to those not on such therapy (OR = 2.28, 95%CI = 1.08–4.85). Further studies examining condom use and HIV treatment adherence are recommended. ^

Factors that affect non-adherence to first line antiretroviral medications among HIV infected children and adolescents in Botswana

The aims of the study were to determine the prevalence of and factors that affect non-adherence to first line antiretroviral (ARV) medications among HIV infected children and adolescents in Botswana. The study used secondary data from Botswana-Baylor Children's Clinical Center of Excellence for the period of June 2008 to February 10th, 2010. The study design was cross-sectional and case-comparison between non-adherent and adherent participants was used to examine the effects of socio-demographic and medication factors on non-adherence to ARV medications. A case was defined as non-adherent child with adherence level < 95% based on pill count and measurement of liquid formulations. The comparison group consisted of children with adherence levels ≥95%.^ A total of 842 participants met the eligibility criteria for determination of the prevalence of non-adherence and 338 participants (169 cases and 169 individuals) were used in the analysis to estimate the effects of factors on non-adherence. ^ Univariate and multivariable logistic regression were used to estimate the association between non-adherence (outcome) and socio-demographic and medication factors (exposures). The prevalence of non-adherence for participants on first line ARV medications was 20.0% (169/842).^ Increase in age (OR (95% CI): 1.10 (1.04–1.17) p = 0.001) was associated with nonadherence, while increase in number of caregivers (OR (95% CI): 0.72 (0.56–0.93) p = 0.01) and increase in number of monthly visits (OR (95% CI): 0.92 (0.86–0.99) p = 0.02), were associated with good adherence in both the unadjusted and the adjusted models. For the categorical variables, having more than two caregivers (OR (95% CI): 0.66 (0.28–0.84), p = 0.002) was associated with good adherence even in the adjusted model. ^ Conclusion. The prevalence of non-adherence to antiretroviral medicines among the study population was estimated to be 20.0%. In previous studies, adherence levels of ≥ 95% have been associated with better clinical outcomes and suppression of virus to prevent development of resistance. Older age, fewer numbers of caregivers and fewer monthly visits were associated with non-adherence. Strategies to improve and sustain adherence especially among older children are needed. The role of caregivers and social support should be investigated further.^

An interactive intervention to impact adherence to antiretroviral treatment among treatment-naive HIV-infected adults in Thailand: A pilot randomized controlled study

Background. Consistent adherence to antiretroviral treatment is necessary for a treatment success. Improving and maintaining adherence rate >95% are challenging for health care professionals. This pilot randomized controlled study aimed to evaluate the impact of the interactive intervention on adherence to GPO-VIR, to describe the feasibility of the interactive intervention in Thailand, and to illustrate the adherence self-efficacy concept among HIV treatment-naïve patients in Thailand who were starting antiretroviral treatment. ^ Methods. The study took place at three HIV clinics located in Phayao, Thailand. Twenty-three patients were randomly assigned into the experimental (n=11) and the control groups (n=12). Each participant in the experimental group and a significant person to the patient received 5 educational sessions with a nurse at the clinics and at their homes. They also received 3 follow-up evaluations during the 6-month period of the study. The participants in the control group received the standard of care provided by HIV clinical personnel plus three follow-up evaluations at the clinic. ^ Results. Seventeen patients (7 in the experimental and 10 in the control group) completed the study. The 4-day recall on the Thai ACTG Adherence Scale demonstrated adherence rate >95% for most participants from both groups. After the first measurement, no experimental group patients reporting missing ART, while one control group participant continuously skipped ART. Participants from both groups had significantly increased CD4 cell counts after the study (F(1, 15) = 29.30, p = .000), but no differences were found between two groups (F(1, 15) = .001, p = .98). Examination of the intervention showed limitations and possibilities to implement it in Thailand. Qualitative data demonstrated self-efficacy expectations, resignation and acceptance as related concepts to improve adherence outcomes. ^ Conclusions. This interactive intervention, after appropriate modifications, is feasible to apply for Thai HIV-treatment naïve patients. Because of limitations the study could not demonstrate whether the interactive intervention improved adherence to ART among HIV-treatment naïve in Thailand. A longitudinal study in a larger sample would be required to test the impact of the intervention. ^ Keyword: antiretroviral treatment, adherence, treatment-naïve, Thailand, randomized controlled study ^

COSTS AND EFFECTS OF ARKANSAS' LONG-TERM CARE DEMONSTRATION PROJECT (MEDICAID, CHANELLING, COMMUNITY ASSESSMENT)

The purpose of this study was to assess the impact of the Arkansas Long-Term Care Demonstration Project upon Arkansas' Medicaid expenditures and upon the clients it serves. A Retrospective Medicaid expenditure study component used analyses of variance techniques to test for the Project's effects upon aggregated expenditures for 28 demonstration and control counties representing 25 percent of the State's population over four years, 1979-1982.^ A second approach to the study question utilized a 1982 prospective sample of 458 demonstration and control clients from the same 28 counties. The disability level or need for care of each patient was established a priori. The extent to which an individual's variation in Medicaid utilization and costs was explained by patient need, presence or absence of the channeling project's placement decision or some other patient characteristic was examined by multiple regression analysis. Long-term and acute care Medicaid, Medicare, third party, self-pay and the grand total of all Medicaid claims were analyzed for project effects and explanatory relationships.^ The main project effect was to increase personal care costs without reducing nursing home or acute care costs (Prospective Study). Expansion of clients appeared to occur in personal care (Prospective Study) and minimum care nursing home (Retrospective Study) for the project areas. Cost-shifting between Medicaid and Medicare in the project areas and two different patterns of utilization in the North and South projects tended to offset each other such that no differences in total costs between the project areas and demonstration areas occurred. The project was significant ((beta) = .22, p < .001) only for personal care costs. The explanatory power of this personal care regression model (R('2) = .36) was comparable to other reported health services utilization models. Other variables (Medicare buy-in, level of disability, Social Security Supplemental Income (SSI), net monthly income, North/South areas and age) explained more variation in the other twelve cost regression models. ^

HEALTH MAINTENANCE ORGANIZATION ENVIRONMENT: AN EMPIRICAL STUDY OF THE RELATIONSHIP OF EXTERNAL CONTEXT AND PERFORMANCE

The research project is an extension of a series of administrative science and health care research projects evaluating the influence of external context, organizational strategy, and organizational structure upon organizational success or performance. The research will rely on the assumption that there is not one single best approach to the management of organizations (the contingency theory). As organizational effectiveness is dependent on an appropriate mix of factors, organizations may be equally effective based on differing combinations of factors. The external context of the organization is expected to influence internal organizational strategy and structure and in turn the internal measures affect performance (discriminant theory). The research considers the relationship of external context and organization performance.^ The unit of study for the research will be the health maintenance organization (HMO); an organization the accepts in exchange for a fixed, advance capitation payment, contractual responsibility to assure the delivery of a stated range of health sevices to a voluntary enrolled population. With the current Federal resurgence of interest in the Health Maintenance Organization (HMO) as a major component in the health care system, attention must be directed at maximizing development of HMOs from the limited resources available. Increased skills are needed in both Federal and private evaluation of HMO feasibility in order to prevent resource investment and in projects that will fail while concurrently identifying potentially successful projects that will not be considered using current standards.^ The research considers 192 factors measuring contextual milieu (social, educational, economic, legal, demographic, health and technological factors). Through intercorrelation and principle components data reduction techniques this was reduced to 12 variables. Two measures of HMO performance were identified, they are (1) HMO status (operational or defunct), and (2) a principle components factor score considering eight measures of performance. The relationship between HMO context and performance was analysed using correlation and stepwise multiple regression methods. In each case it has been concluded that the external contextual variables are not predictive of success or failure of study Health Maintenance Organizations. This suggests that performance of an HMO may rely on internal organizational factors. These findings have policy implications as contextual measures are used as a major determinant in HMO feasibility analysis, and as a factor in the allocation of limited Federal funds. ^

Social relations and power

This paper presents an explanatory typology of social relations which moves forward from those habitual and known by social disciplines, and labels the three types: actions - strategies - institutions . We set out to research characteristics, specificities, relevance of and differences between each type, as well as their interactions and interweaving, which make up the complexity of social relations. Moreover, mutual interdependence between the said social categories is established, which corresponds to a new conceptualization of power . This avoids traditional reductionism and rescues rarely taken-into-account capacities and determinations. The pair "social relations and power" makes up a necessary and indispensable framework to tackle the various problems of the social world.

Criteria of election of postgraduate courses in graduated students of technological/ humanistic/ artistic professions : Subjective and contextual involvements to arrive at the conclusion of them

El aumento en la cantidad de estudios de posgrado y de sus cursantes derivados de la demanda por mayores credenciales académicas en lo laboral y por la búsqueda personal para especializarse profesionalmente, es un fenómeno observado en Argentina desde mediados de los años 90. Obtener el título final de estos estudios resulta un porcentaje muy inferior en relación al número de sus inscriptos. Tales motivos focalizaron nuestra atención para analizar tanto los criterios de elección del posgrado como las condiciones contextuales y subjetivas para alcanzar la titulación. Este estudio, de tipo cualitativo, investiga en tres carreras de Especialización que se cursan en diferentes Universidades nacionales , los aspectos de su organización y estilo propuesto para cursar y lograr la finalización de los estudios, así como las motivaciones de la elección de cursantes y egresados en tres ramas diferentes: artística, humanística y tecnológica. El conocimiento sobre la lógica de la organización y la particularidad del objeto de estudio de cada carrera permite analizar diferencias y semejanzas entre ellas aportando algunas propuestas para considerar en programas de formación; mientras que los trayectos de cursantes y egresados explican aspectos subjetivos que intervienen en la finalización o no del posgrado.

Secret and power in social life

Secret and power constitute two fundamental instances of the social world. Secret takes care of the concealment of things and of social processes. Secret is also a power device. Power is the social capacity to do, create, not doing and stop from doing. Secret and power get mutual feedback. Power uses the secret to protect his potential, be it what may, to increment its operative strength. Secret uses the power to achieve its aims and proposals. Social sciences seem to ignore the huge explanatory capacity of these two interrelated concepts, and even more, their powerful intervention in societies.

Social relations and power

This paper presents an explanatory typology of social relations which moves forward from those habitual and known by social disciplines, and labels the three types: actions - strategies - institutions . We set out to research characteristics, specificities, relevance of and differences between each type, as well as their interactions and interweaving, which make up the complexity of social relations. Moreover, mutual interdependence between the said social categories is established, which corresponds to a new conceptualization of power . This avoids traditional reductionism and rescues rarely taken-into-account capacities and determinations. The pair "social relations and power" makes up a necessary and indispensable framework to tackle the various problems of the social world.

Criteria of election of postgraduate courses in graduated students of technological/ humanistic/ artistic professions : Subjective and contextual involvements to arrive at the conclusion of them

El aumento en la cantidad de estudios de posgrado y de sus cursantes derivados de la demanda por mayores credenciales académicas en lo laboral y por la búsqueda personal para especializarse profesionalmente, es un fenómeno observado en Argentina desde mediados de los años 90. Obtener el título final de estos estudios resulta un porcentaje muy inferior en relación al número de sus inscriptos. Tales motivos focalizaron nuestra atención para analizar tanto los criterios de elección del posgrado como las condiciones contextuales y subjetivas para alcanzar la titulación. Este estudio, de tipo cualitativo, investiga en tres carreras de Especialización que se cursan en diferentes Universidades nacionales , los aspectos de su organización y estilo propuesto para cursar y lograr la finalización de los estudios, así como las motivaciones de la elección de cursantes y egresados en tres ramas diferentes: artística, humanística y tecnológica. El conocimiento sobre la lógica de la organización y la particularidad del objeto de estudio de cada carrera permite analizar diferencias y semejanzas entre ellas aportando algunas propuestas para considerar en programas de formación; mientras que los trayectos de cursantes y egresados explican aspectos subjetivos que intervienen en la finalización o no del posgrado.

Secret and power in social life

Secret and power constitute two fundamental instances of the social world. Secret takes care of the concealment of things and of social processes. Secret is also a power device. Power is the social capacity to do, create, not doing and stop from doing. Secret and power get mutual feedback. Power uses the secret to protect his potential, be it what may, to increment its operative strength. Secret uses the power to achieve its aims and proposals. Social sciences seem to ignore the huge explanatory capacity of these two interrelated concepts, and even more, their powerful intervention in societies.

Criteria of election of postgraduate courses in graduated students of technological/ humanistic/ artistic professions : Subjective and contextual involvements to arrive at the conclusion of them

El aumento en la cantidad de estudios de posgrado y de sus cursantes derivados de la demanda por mayores credenciales académicas en lo laboral y por la búsqueda personal para especializarse profesionalmente, es un fenómeno observado en Argentina desde mediados de los años 90. Obtener el título final de estos estudios resulta un porcentaje muy inferior en relación al número de sus inscriptos. Tales motivos focalizaron nuestra atención para analizar tanto los criterios de elección del posgrado como las condiciones contextuales y subjetivas para alcanzar la titulación. Este estudio, de tipo cualitativo, investiga en tres carreras de Especialización que se cursan en diferentes Universidades nacionales , los aspectos de su organización y estilo propuesto para cursar y lograr la finalización de los estudios, así como las motivaciones de la elección de cursantes y egresados en tres ramas diferentes: artística, humanística y tecnológica. El conocimiento sobre la lógica de la organización y la particularidad del objeto de estudio de cada carrera permite analizar diferencias y semejanzas entre ellas aportando algunas propuestas para considerar en programas de formación; mientras que los trayectos de cursantes y egresados explican aspectos subjetivos que intervienen en la finalización o no del posgrado.

Secret and power in social life

Secret and power constitute two fundamental instances of the social world. Secret takes care of the concealment of things and of social processes. Secret is also a power device. Power is the social capacity to do, create, not doing and stop from doing. Secret and power get mutual feedback. Power uses the secret to protect his potential, be it what may, to increment its operative strength. Secret uses the power to achieve its aims and proposals. Social sciences seem to ignore the huge explanatory capacity of these two interrelated concepts, and even more, their powerful intervention in societies.