Percepción de las trabajadoras inmigrantes del servicio doméstico sobre los efectos de la regulación del sector en España

Objetivo: Explorar las percepciones de las mujeres inmigrantes trabajadoras del servicio doméstico sobre la puesta en vigor en España del Real Decreto 1620/2011, que regula la relación laboral del servicio del hogar familiar, y su efecto en sus condiciones de empleo. Métodos: Estudio exploratorio mediante análisis de contenido cualitativo. Se realizaron tres grupos de discusión con mujeres inmigrantes (colombianas, ecuatorianas y marroquíes). Resultados: A pesar de valorar positivamente los beneficios teóricos de la nueva normativa, las mujeres inmigrantes han identificado barreras legales y económicas para conseguir un contrato, ser dadas de alta en la seguridad social y que las personas empleadoras asuman su coste, en especial en el caso de las trabajadoras contratadas por horas. Estas dificultades influyen en la posibilidad de legalizar su situación. La confluencia con la crisis económica ha emergido como un problema que dificulta su cumplimiento. Conclusiones: Aunque el nuevo régimen ha favorecido la creación de puestos de trabajo con mayores derechos laborales en el sector, las mujeres inmigrantes perciben que su puesta en marcha en el actual contexto de crisis económica no ha contribuido a mejorar sus condiciones de empleo.

El discurso profesional en servicios sociales comunitarios: una aproximación desde la identificación de repertorios interpretativos

Introducción: la presente investigación está orientada a ofrecer un análisis donde se establezcan los recursos lingüísticos utilizados por los participantes sobre el contenido y alcance de la prestación básica de información y orientación en los servicios sociales comunitarios, tal como la desarrollan los trabajadores sociales. Material y métodos: siguiendo una metodología cualitativa y la utilización del análisis del discurso en la propuesta de Wetherell y Potter (1996) con el empleo de la herramienta analítica de los repertorios interpretativos, se intentarán resaltar aquellos elementos definitorios, estrategias profesionales, valores, normas, prácticas organizacionales, elementos de la cultura institucional, entre otros, que dan forma a los escenarios donde desarrollan su labor los profesionales y que configuran el sistema de servicios sociales comunitarios. Resultados: las entrevistas realizadas a veinticinco trabajadores sociales de la provincia de Málaga muestran cuatro repertorios interpretativos que reflejan la construcción del sistema de servicios sociales por parte de los profesionales implicados: el olvido de lo comunitario, la eterna indefinición del sistema, el elefante encadenado y la escasez agudiza el ingenio. Discusión: se pone de manifiesto cómo se construye un modelo de intervención distante a lo establecido en las normas y códigos éticos a causa de los comportamientos organizacionales e institucionales, que los profesionales intentan minimizar mediante la puesta en práctica de habilidades personales.

From the boom to the crisis: changes in employment conditions of immigrants in Spain and their effects on mental health

Background: Migrant workers have been one of the groups most affected by the economic crisis. This study evaluates the influence of changes in employment conditions on the incidence of poor mental health of immigrant workers in Spain, after a period of 3 years, in context of economic crisis. Methods: Follow-up survey was conducted at two time points, 2008 and 2011, with a reference population of 318 workers from Colombia, Ecuador, Morocco and Romania residing in Spain. Individuals from this population who reported good mental health in the 2008 survey (n = 214) were interviewed again in 2011 to evaluate their mental health status and the effects of their different employment situations since 2008 by calculating crude and adjusted odds ratios (aORs) for sociodemographic and employment characteristics. Findings: There was an increased risk of poor mental health in workers who lost their jobs (aOR = 3.62, 95%CI: 1.64–7.96), whose number of working hours increased (aOR = 2.35, 95%CI: 1.02–5.44), whose monthly income decreased (aOR = 2.75, 95%CI: 1.08–7.00) or who remained within the low-income bracket. This was also the case for people whose legal status (permission for working and residing in Spain) was temporary or permanent compared with those with Spanish nationality (aOR = 3.32, 95%CI: 1.15–9.58) or illegal (aOR = 17.34, 95%CI: 1.96–153.23). In contrast, a decreased risk was observed among those who attained their registration under Spanish Social Security system (aOR = 0.10, 95%CI: 0.02–0.48). Conclusion: There was an increase in poor mental health among immigrant workers who experienced deterioration in their employment conditions, probably influenced by the economic crisis.

Normas de orientação clínica portuguesas : abordagem terapêutica de doenças e factores de risco cardiovasculares : que evidência, que método e que impacto?

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Rotas federativas para a promoção de capacidades estatais municipais: uma análise da experiência brasileira

Esta tese discute como o federalismo brasileiro promoveu, entre 1997 e 2014, iniciativas voltadas a desenvolver capacidades estatais nos municípios. Este tema foi retomado na agenda federal no primeiro governo Fernando Henrique Cardoso (1995-1998), prosseguiu nas duas gestões Lula (2003-2010) e, finalmente, no primeiro mandato de Dilma Rousseff (2011-2014). A descentralização de políticas iniciadas em 1998 constitui o contexto político e institucional que, diante das novas atribuições assumidas pelos municípios, demandam modernizar a sua gestão. Apresenta-se de que forma evolui a qualificação gerencial e administrativa nos municípios para situar que o desafio do federalismo cooperativo brasileiro possui para apoiar esses entes. A pesquisa foi organizada em três dimensões teóricas e analisou cinco casos. A primeira dimensão trata da cooperação por meio de arranjos de cooperação territorial, tendo o Comitê de Articulação Federativa (CAF), criado em 2003, como objeto de análise, pois reuniu representantes do governo federal e do municipalismo. Uma de suas áreas de ação foi o desenvolvimento de capacidades estatais municipais. A segunda dimensão aborda a cooperação federativa por meio de sistemas de políticas públicas. Comparou-se o Sistema Único de Assistência Social (SUAS), criado em 2005, como a área da educação, que é desprovida desse tipo de arranjo intergovernamental sistêmico. Na educação a análise recai sobre o Plano de Ações Articuladas (PAR), que foi instituído em 2007. O SUAS possui uma ampla legislação e normatização voltada para os entes municipais nas quais se destacam exigências de modernização dos órgãos que localmente respondem por essa política. O objetivo é comparar se sistemas de políticas são mais eficazes para promover capacidades estatais que outras modalidades de relações federativas. A terceira dimensão teórica diz respeito aos programas federais criados para apoiar a qualificação das gestões municipais. Foram selecionados dois programas: o Programa de Modernização da Administração Tributária e da Gestão de Setores Sociais Básicos (PMAT), administrado pelo BNDES desde 1997, e o Programa Nacional de Apoio à Modernização Administrativa e Fiscal dos Municípios Brasileiros (PNAFM), gerenciado pelo Ministério da Fazenda e Caixa Econômica Federal desde 2001. A análise das três dimensões mostra que, com base na experiência comparada em nível internacional e na literatura sobre federalismo e relações intergovernamentais que, diante da forma como se organizou a cooperação territorial e a implantação de programas federais no Brasil, essas duas modalidades não são rotas viáveis para apoiar a modernização das gestões municipais. A pesquisa concludes que um sistema nacional e articulado de políticas, tanto por razões teóricas como empíricas, é o tipo de institucionalidade de cooperação federativa mais adequado para promover capacidades estatais municipais em realidades como a brasileira. Nessa linha, finaliza-se a Tese propondo um modelo analítico que considera sistemas articulados de políticas como o formato mais adequado para lidar com esse desafio federativo em um contexto caracterizado pela descentralização de políticas, mas que ao mesmo tempo convive com uma enorme heterogeneidade e desigualdade de capacidades estatais entre os governos locais.

Cost-Effectiveness Analysis of Adaptive Monitoring Strategies for Depression Treatment

Thesis (Master's)--University of Washington, 2016-06

Self-help organisations: A qualitative study of successful collaboration with general practice

Thousands of self-help organisations (SHOs) exist in Australia but little is known about how they relate to the mainstream health care system. This qualitative study, based in south-east Queensland, aimed to identify examples of collaboration between general practitioners (GPs) and SHOs in order to examine the attributes of successful partnerships. Representatives of six SHOs, identified by key informants as having good collaborative links with GPs, and seven GPs with whom they collaborated, completed semi-structured interviews. The interviews focused on evidence of collaboration and perceptions of benefits and barriers experienced. Maximum variation sampling enabled a cross-section of SHOs in terms of size, funding, and health issue. Although GPs readily identified SHO benefits, they referred patients to them only rarely. SHO credibility, evidence of tangible benefits for patients, ease of contacting the SHO, and correspondence between the SHO?s focus and the GP?s personal and professional interests appear to contribute to the success of partnerships. We conclude that mutually beneficial partnerships between GPs and SHOs exist but are under-utilised. A more coordinated effort is needed to strengthen links between the two sectors.

A perspective on Australia's national medicines policy

There is international interest in Australia's health care system for prescription medicines. The issue is particularly topical in Canada with the debate following publication of the Romanow Report into the future of health care in Canada. This Report recommended a new National Drug Agency. Australia has a National Medicines Policy with four arms-quality, safety and efficacy of medicines; equity of access; a viable and responsible pharmaceutical industry; quality use of medicines. The four arms of the Policy are interlinked and interdependent for optimal functioning. In this paper, an overview of how the prescription drug system in Australia works is presented. The manuscript focuses upon specific aspects of the Policy, describing how it functions and some of the processes integral to success, from the viewpoint of the author. The discussion includes some of the advantages of Australia's system for pharmaceuticals as well as some of the problems, as these present opportunities for development and change

The psychoeducation needs of parents who have an adult son or daughter with a mental illness

Since deinstitutionalisation, parents of adults with mental disorders are increasingly utilised as a resource for their relatives’ care. This study used a general phenomenological perspective to capture people’s experiences. Semi-structured in-depth interviews were conducted with eight parents who were members of the Schizophrenia Fellowship of Southern Queensland to explore their perceptions of their psychoeducation needs. The themes that emerged included the usefulness of past experiences with psychoeducation, educational needs, barriers to accessing information and support, and other unmet carer needs, including the need for managing stress and emotional needs, recognition and inclusion of family members in decision-making, and negotiating the best care for their family member within the health care system. This study adds to an increasing body of knowledge that advocates for the greater inclusion and involvement of families in the care and treatment of their relatives. Further research into the needs of families, in particular barriers and supports in accessing information and services, is recommended.

A cost-effectiveness analysis of two rehabilitation support services for women with breast cancer

The purpose of this research was to estimate the cost-effectiveness of two rehabilitation interventions for breast cancer survivors, each compared to a population-based, non-intervention group (n = 208). The two services included an early home-based physiotherapy intervention (DAART, n = 36) and a group-based exercise and psychosocial intervention (STRETCH, n = 31). A societal perspective was taken and costs were included as those incurred by the health care system, the survivors and community. Health outcomes included: (a) 'rehabilitated cases' based on changes in health-related quality of life between 6 and 12 months post-diagnosis, using the Functional Assessment of Cancer Therapy - Breast Cancer plus Arm Morbidity (FACT-B+4) questionnaire, and (b) quality-adjusted life years (QALYs) using utility scores from the Subjective Health Estimation (SHE) scale. Data were collected using self-reported questionnaires, medical records and program budgets. A Monte-Carlo modelling approach was used to test for uncertainty in cost and outcome estimates. The proportion of rehabilitated cases was similar across the three groups. From a societal perspective compared with the non-intervention group, the DAART intervention appeared to be the most efficient option with an incremental cost of $1344 per QALY gained, whereas the incremental cost per QALY gained from the STRETCH program was $14,478. Both DAART and STRETCH are low-cost, low-technological health promoting programs representing excellent public health investments.

Effectiveness of screening for risk of medical emergencies in the elderly

Study objective: UK government policy mandates the introduction of 'intermediate care services' to reduce emergency admissions to hospital from the population aged 75 years or more. We evaluated one of these initiatives-the Keep Well At Home (KWAH) Project-in a West London Primary Care Trust. Design: KWAH involves a two-phase screening process, including a home visit by a community nurse. We employed cohort methods to determine whether KWAH resulted in fewer emergency attendances and admissions to hospital in the target population, from October 1999 to December 2002. Results: estimated levels of coverage in the two phases of screening were 61 and 32%, respectively. The project had not maintained records of which additional health and social care services had been delivered following screening. The rates of emergency admissions to hospital in the 9 months before screening were similar in practices that did and did not join the project (rate ratio (RR) = 1.05; 95% CI 0.95-1.17), suggesting absence of volunteer bias. Over the first 37 months of the project, there was no significant impact on either attendances at Accident & Emergency departments (RR = 1.02; 95% CI 0.97-1.06) or emergency admissions of elderly patients (RR = 0.98; 95% CI 0.93-1.05). Conclusion: the KWAH Project has been ineffective in reducing emergency admissions among the elderly. Significant questions arise in relation to selection of the screening instruments, practicality of achieving higher coverage of the eligible population, and creation of a new postcode lottery.

Patient self-efficacy and health locus of control: relationships with health status and arthritis-related expenditure

Objective. To explore the relationship between measures of self-efficacy, health locus of control, health status and direct medical expenditure among community-dwelling subjects with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods. This analysis is part of a larger ongoing study of the costs and outcomes of arthritis and its treatments. Community-dwelling RA and OA respondents completed questionnaires concerning arthritis-related expenditure, health status, arthritis related self-efficacy and health locus of control. Results. Data were obtained from 70 RA respondents and 223 OA respondents. The majority of respondents were female with a mean age of 63 yr for RA respondents and 68 yr for OA respondents. Among the RA respondents, those with higher self-efficacy reported better health status and lower overall costs. Health locus of control was not consistently correlated with health status. OA respondents with higher self-efficacy reported better health status and lower costs. Health locus of control had more influence. OA respondents with higher external locus of control reported worse pain and function. A higher belief in chance as a determinant of health was correlated with more visits to general practitioners and a higher cost to both the respondent and the health system. Conclusion. Higher self-efficacy, which is amenable to change through education programmes, was associated with better health status and lower costs to the respondent and the health system in this cross-sectional study. Locus of control had less of an influence; however, the tendency was for those with higher external locus of control to have higher costs and worse health status. As the measurement of these constructs is simple and the outcome potentially affects health status, these results have implications for future intervention studies to improve quality of life and reduce the financial impact of arthritis on both the health-care system and patients.

Error recovery in a hospital pharmacy

A field study was performed in a hospital pharmacy aimed at identifying positive and negative influences on the process of detection of and further recovery from initial errors or other failures, thus avoiding negative consequences. Confidential reports and follow-up interviews provided data on 31 near-miss incidents involving such recovery processes. Analysis revealed that organizational culture with regard to following procedures needed reinforcement, that some procedures could be improved, that building in extra checks was worthwhile and that supporting unplanned recovery was essential for problems not covered by procedures. Guidance is given on how performance in recovery could be measured. A case is made for supporting recovery as an addition to prevention-based safety methods.

The variable colours of the fiddler crab Uca vomeris and their relation to background and predation

Colour changes in fiddler crabs have long been noted, but a functional interpretation is still lacking. Here we report that neighbouring populations of Uca vomeris in Australia exhibit different degrees of carapace colours, which range from dull mottled to brilliant blue and white. We determined the spectral characteristics of the mud substratum and of the carapace colours of U. vomeris and found that the mottled colours of crabs are cryptic against this background, while display colours provide strong colour contrast for both birds and crabs, but luminance contrast only for a crab visual system. We tested whether crab populations may become cryptic under the influence of bird predation by counting birds overflying or feeding on differently coloured colonies. Colonies with cryptically coloured crabs indeed experience a much higher level of bird presence, compared to colourful colonies. We show in addition that colourful crab individuals subjected to dummy bird predation do change their body colouration over a matter of days. The crabs thus appear to modify their social signalling system depending on their assessment of predation risk.

General practice in Australia 2020: "robust and ready" or "rudderless and reeling"?

The future role and structure of Australian general practice remains uncertain, despite a decade of seemingly constant change following the release of the National Health Strategy papers. Some of the suggested change strategies (such as rural Practice Incentive Payments and practice accreditation) have been implemented; others (such as general practitioner involvement with area health authorities in delivering national goals and targets for communities) still await attention. An overarching vision for our health care system in 2020 and general practice's role within it are still to be clearly enunciated. Australia is at variance with other Western countries, such as the United Kingdom, Canada and New Zealand, which have spent significant time refocusing their health systems to deal with an ageing population with an increased burden of chronic disease. Health bureaucrats and governments need to invest strategically in operational primary care now. This will require the active commitment of general practice's national bodies to articulate and actively promote a shared vision for Australian general practice.