The Role of Non-Governmental Organizations in International Cooperation in Public Health

This article discusses the possibility of the NGOs acting on international health cooperation and how this acting is regulated. Firstly, the international cooperation and its relation with public health is presented. After that, data on Brazilian bilateral health cooperation are brought in, in which it is possible to find the formal recognition of NGOs as partners of States. This allows the consideration of the role of NGOs in health cooperation. Although the action of NGOs is legitimated by international law, their regulation is just beginning. This suggests important issues to be improved in the legal relation between NGOs and States in the field of public health.

Socioeconomic and psychosocial predictors of dental healthcare use among Brazilian preschool children

Abstract Background Disparities in utilization of oral healthcare services have been attributed to socioeconomic and individual behavioral factors. Parents’ socioeconomic status, demographics, schooling, and perceptions of oral health may influence their children’s use of dental services. This cross-sectional study assessed the relationships between socioeconomic and psychosocial factors and the utilization of dental health services by children aged 1–5 years. Methods Data were collected through clinical exams and a structured questionnaire administered during the National Day of Children’s Vaccination. A Poisson regression model was used to estimate prevalence ratios and 95% confidence intervals. Results Data were collected from a total of 478 children. Only 112 (23.68%) were found to have visited a dentist; 67.77% of those had seen the dentist for preventive care. Most (63.11%) used public rather than private services. The use of dental services varied according to parental socioeconomic status; children from low socioeconomic backgrounds and those whose parents rated their oral health as “poor” used dental services less frequently. The reason for visiting the dentist also varied with socioeconomic status, in that children of parents with poor socioeconomic status and who reported their child’s oral health as “fair/poor” were less likely to have visited the dentist for preventive care. Conclusion This study demonstrated that psychosocial and socioeconomic factors are important predictors of the utilization of dental care services.

Learning Democracy Together in School? : Student and Teacher Attitudes in Bosnia and Herzegovina

The principal aim of this study is to examine attitudes and values, through questionnaires, among students and teachers in the last grade of primary school (grade 8) regarding issues related to authoritarianism, democracy, human rights, children rights, conflict resolution and legislation in Bosnia and Herzegovina. A second aim is to explore and analyze the role of the international community in the democratization and education processes in the light of globalization in this country through secondary sources of data, site visits and observations. Analysis of the student sample reveals suspicion towards democracy, especially when democracy was associated with politics and politicians. When the issue of democracy was de-contextualized from Bosnia and Herzegovina realities in the questionnaire, students showed more positive attitudes towards it. Students generally agreed with very strong authoritarian statements. High achieving students were more democratic, more socially responsible, more tolerant regarding attitudes towards religion, race and disabilities, and less authoritarian compared to low achievers. High achievers felt that they had influence over daily events, and were positive towards social and civil engagement. High achievers viewed politics negatively, but had high scores on the democracy scale. High achievers also agreed to a larger extent that it is acceptable to break the law. The more authoritarian students were somewhat more prone to respond that it is not acceptable to break the law. The major findings from the teacher sample show that teachers who agreed with non-peaceful mediation, and had a non-forgiving and rigid approach to interpersonal conflicts, also agreed with strong authoritarian statements and were less democratic. In general, teachers valued students who behave respectfully, have a good upbringing and are obedient. They were very concerned about the general status of education in society, which they felt was becoming marginalized. Teachers were not happy with the overloaded curricula and they showed an interest in more knowledge and skills to help children with traumatic war experiences. When asked about positive reforms, teachers were highly critical of, and dissatisfied with, the educational situation. Bosnia and Herzegovina is undergoing a transition from a state-planned economy and one party system to a market economy and a multi party system. During this transition, the country has become more involved in the globalization process than ever. Today the country is a semi-protectorate where international authorities intervene when necessary. The International community is attempting to introduce western democracy and some of the many complexities in this process are discussed in this study. Globalization processes imply contradictory demands and pressures on the education system. On one hand, economic liberalization has affected education policies —a closer alignment between education and economic competitiveness. On the other hand, there is a political and ideological globalization process underlying the importance of human rights, and the inclusiveness of education for all children. Students and teachers are caught between two opposing ideals — competition and cooperation.

Ni una más. International cooperation against gender-based discrimination: the femicide case in Ciudad Juárez, Chihuahua, Mexico

The femicide in Ciudad Juárez is a story made of extreme violence against women for different reasons, by different actors, under different circumstances, and following different behavioural patterns. All within a gender discrimination frame based on the idea that women are inferior, interchangeable and disposable according to the patriarchal hierarchy still present in Mexico, but strongly reinforced by a sort of conspiracy of silence provoked either by the high impunity rate, the governmental incompetence to solve the crimes, or the general indifference of the population. It is the story of hundreds of kidnapped, raped, in many cases tortured, and murdered young women in the border between Mexico and the United States. The murders first came into light in 1993 and up to now young women continue to “disappear” without any hope of bringing the perpetrators to justice, stopping impunity, convicting the assassins, and bringing justice to the families of the deceased girls and women. The main questions about femicide in Ciudad Juárez seem to be: why were they brutally assassinated?, why most of the crimes have not been solved yet?, why and how is Ciudad Juárez different from other border cities with the same characteristics?, which powers are behind those crimes in a city that implies mainly women as its labor force, and which has the lowest unemployment rate in the whole country? But there are also many other questions dealing more with the context, the Juarences’ lifestyles, the eventual hidden powers behind the crimes, the possible murderers’ reasons, the response of the local civil society, or the international community actions to fight against femicide there, among many other things, that are still waiting for an answer and that this paper will ‘narrate’ in order to provide a holistic panorama for the readers. But above all there is the need to remember that every single woman or girl assassinated there had a name, an identity, a family, a story to be told time after time and as many times as necessary, in order to avoid accepting these crimes just as statistics, as cold numbers that might make us forget the human tragedy that has been flagellating the city since 1993. We must remember as well that their deaths express gender oppression, the inequality of the relations between what is male and what is female, a manifestation of domination, terror, social extermination, patriarchal hegemony, social class and impunity. The city is the perfect mirror where all the contradictions of globalization get reflected. It is there where all the globalization evils are present and survive by sucking their women’s blood. It is a city where some concepts such as gender, migration and power are closely related with a negative connotation.

International cooperation in endourology: percutaneous and flexible ureteroscopic treatment of lower pole kidney stones

Introduction Lower pole kidney stones represent at time a challenge for the urologist. The gold standard treatment for intrarenal stones <2 cm is Extracorporeal Shock Wave Lithotripsy (ESWL) while for those >2 cm is Percutaneous Nephrolithotomy (PCNL). The success rate of ESWL, however, decreases when it is employed for lower pole stones, and this is particularly true in the presence of narrow calices or acute infundibular angles. Studies have proved that ureteroscopy (URS) is an efficacious alternative to ESWL for lower pole stones <2 cm, but this is not reflected by either the European or the American guidelines. The aim of this study is to present the results of a large series of flexible ureteroscopies and PCNLs for lower pole kidney stones from high-volume centers, in order to provide more evidences on the potential indications of the flexible ureteroscopy for the treatment of kidney stones. Materials and Methods A database was created and the participating centres retrospectively entered their data relating to the percutaneous and flexible ureteroscopic management of lower pole kidney stones. Patients included were treated between January 2005 and January 2010. Variables analyzed included case load number, preoperative and postoperative imaging, stone burden, anaesthesia (general vs. spinal), type of lithotripter, access location and size, access dilation type, ureteral access sheath use, visual clarity, operative time, stone-free rate, complication rate, hospital stay, analgesic requirement and follow-up time. Stone-free rate was defined as absence of residual fragments or presence of a single fragment <2 mm in size at follow-up imaging. Primary end-point was to test the efficacy and safety of flexible URS for the treatment of lower pole stones; the same descriptive analysis was conducted for the PCNL approach, as considered the gold standard for the treatment of lower pole kidney stones. In this setting, no statistical analysis was conducted owing to the different selection criteria of the patients. Secondary end-point consisted in matching the results of stone-free rates, operative time and complications rate of flexible URS and PCNL in the subgroup of patients harbouring lower pole kidney stones between 1 and 2 cm in the higher diameter. Results A total 246 patients met the criteria for inclusion. There were 117 PCNLs (group 1) and 129 flexible URS (group 2). Ninety-six percent of cases were diagnosed by CT KUB scan. Mean stone burden was 175±160 and 50±62 mm2 for groups 1 and 2, respectively. General anaesthesia was induced in 100 % and 80% of groups 1 and 2, respectively. Pneumo-ultrasonic energy was used in 84% of cases in the PCNL group, and holmium laser in 95% of the cases in the flexible URS group. The mean operative time was 76.9±44 and 63±37 minutes for groups 1 and 2 respectively. There were 12 major complications (11%) in group 1 (mainly Grade II complications according to Clavidien classification) and no major complications in group 2. Mean hospital stay was 5.7 and 2.6 days for groups 1 and 2, respectively. Ninety-five percent of group 1 and 52% of group 2 required analgesia for a period longer than 24 hours. Intraoperative stone-free rate after a single treatment was 88.9% for group 1 and 79.1% for group 2. Overall, 6% of group 1 and 14.7% of group 2 required a second look procedure. At 3 months, stone-free rates were 90.6% and 92.2% for groups 1 and 2, respectively, as documented by follow-up CT KUB (22%) or combination of intra-venous pyelogram, regular KUB and/or kidney ultrasound (78%). In the subanalysis conducted comparing 82 vs 65 patients who underwent PCNL and flexible URS for lower pole stones between 1 and 2 cm, intreoperative stone-free rates were 88% vs 68% (p= 0.03), respectively; anyway, after an auxiliary procedure which was necessary in 6% of the cases in group 1 and 23% in group 2 (p=0.03), stone-free rates at 3 months were not statistically significant (91.5% vs 89.2%; p=0.6). Conversely, the patients undergoing PCNL maintained a higher risk of complications during the procedure, with 9 cases observed in this group versus 0 in the group of patients treated with URS (p=0.01) Conclusions These data highlight the value of flexible URS as a very effective and safe option for the treatment of kidney stones; thanks to the latest generation of flexible devices, this new technical approach seems to be a valid alternative in particular for the treatment of lower pole kidney stones less than 2 cm. In high-volume centres and in the hands of skilled surgeons, this technique can approach the stone-free rates achievable through PCNL in lower pole stones between 1 and 2 cm, with a very low risk of complications. Furthermore, the results confirm the high success rate and relatively low morbidity of modern PCNL for lower pole stones, with no difference detectable between the prone and supine position.

Birth, Development and Progressive Institutionalization of the Ombudsman in the Russian Legal and Political System

One of the current trends in governance and legal development in Russia is aimed at establishing a modern, efficient and internationally harmonised system of safeguards of human rights and civil liberties. A fairly recent addition to this system has been the institution of ombudsman as a public authority specialised in promoting and protecting human rights and civil liberties. The introduction of this institution as well as its formalisation at the constitutional and legislative levels has been increasingly relevant and important, as it raises the dealings between the state and the individual to a new level. As an independent public institution resolving conflicts between citizens and government authorities, the ombudsman makes steps, within the scope of his jurisdiction, to restitute individual rights, and helps to enhance the reputation of government. The present work describes and assesses the birth, development and institutionalization process of the Ombudsman Office in the Russian Federation, at federal and regional levels, with a particular emphasis on the role of international references and cooperation for institution building. Ombudsmen have done a magnificent job in demonstrating value with the resolution of individual and systemic complaints; subsequent improvements to government; and economic savings by mitigating litigation costs.

Building Peace and/or Gender Equality. Changing Attitudes around Peace, Development and Security in International Cooperation in Rwanda.

The times following international or civil conflicts but also violent revolutions often come with unequal share of the peace dividend for men and women. Delusions for women who gained freedom of movement and of roles during conflict but had to step back during reconstruction and peace have been recorded in all regions of the world. The emergence of peacebuilding as a modality for the international community to ensure peace and security has slowly incorporated gender sensitivity at the level of legal and policy instruments. Focusing on Rwanda, a country that has obtained significant gender advancement in the years after the genocide while also obtaining to not relapse into conflict, this research explores to what extent the international community has contributed to this transformation. From a review of evaluations, findings are that many of the interventions did not purse gender equality, and overall the majority understood gender and designed actions is a quite superficial way which would hardly account for the significative advancement in combating gender discrimination that the Government, for its inner political will, is conducting. Then, after a critique from a feminist standpoint to the concept of human security, departing from the assumption (sustained by the Governemnt of Rwanda as well) that domestic violence is a variable influencing level of security relevant at the national level, a review of available secondary data on GBV is conducted an trends over the years analysed. The emerging trends signal a steep increase in prevalence of GBV and in domestic violence in particular. Although no conclusive interpretation can be formulated on these data, there are elements suggesting the increase might be due to augmented reporting. The research concludes outlining possible further research pathways to better understand the link in Rwanda between the changing gender norms and the GBV.

La promozione dell'inclusione nei sistemi scolastici attraverso l'intervento di cooperazione internazionale: l'esperienza di El Salvador

La ricerca si colloca all’interno di un complesso intervento di cooperazione internazionale realizzato in El Salvador tra il 2009 e il 2014. Il Progetto di cooperazione è stato promosso dal Dipartimento di Scienze dell’Educazione dell’Università di Bologna e finanziato dalla Cooperazione Italiana. L’esperienza studiata rappresenta un esempio di promozione dell’inclusione nei sistemi scolastici di Paesi del Sud del mondo e si propone due obiettivi: 1) analizzare il processo di cambiamento della prospettiva di intervento promossa dalla cooperazione internazionale, evidenziando la dimensione educativa che sostiene processi di empowerment e ownership delle istituzioni locali; 2) contribuire al dibattito sull’ “inclusive education”, sostenendo processi di inclusione scolastica e sociale rivolti a tutti coloro che si trovano in situazione di svantaggio psico-fisico e/o socio-culturale. Le politiche locali del Ministero dell’Educazione dal 2009 hanno promosso un modello educativo con l’obiettivo di garantire il diritto all’educazione per tutti nella scuola pubblica. Lo studio costituisce un'indagine di tipo valutativo sul processo di sviluppo della scuola inclusiva in El Salvador, supportato dall’intervento di cooperazione internazionale. La ricerca utilizza in modo integrato strumenti di natura quantitativa (questionari) e qualitativa (interviste). Dai dati raccolti emerge come il processo di cooperazione sia stato caratterizzato dal principio della pari dignità tra esperti internazionali e autorità politiche e tecniche locali. Inoltre, la ricerca ha consentito di verificare come la cultura dell'inclusione si sia radicata in modo diffuso nella percezione della missione della scuola e il suo ruolo tra i protagonisti del sistema scolastico. Alla luce dei risultati, appare fondamentale continuare a investire sulla formazione tecnica delle figure chiave del sistema educativo; facilitare il processo di inclusione dei disabili nelle scuole regolari con una parallela trasformazione delle scuole speciali in centri di supporto all’integrazione; promuovere una sinergia di azione formativa tra il ministero, mondo accademico e della formazione professionale.

Acute basilar artery occlusion in the Basilar Artery International Cooperation Study: does gender matter?

Randomized trials suggested a different benefit of intravenous thrombolysis (IVT) and intra-arterial thrombolysis (IAT) between men and women with anterior circulation stroke because of a worse outcome of women in the control group.

Cooperation after war: International development in Bosnia, 1995 to 1999

This paper discusses how predispositions, incentives, the number and heterogeneity of participants, and leadership (Faerman et al. 2001) jointly influenced the international effort to develop Bosnia and Herzegovina. International coalitions, task forces, and advisory groups are increasingly charged with implementing reforms following civil conflict. This requires a complex web of interorganizational relationships among NGOS, donors and host nations at both global and ‘ground’ levels. To better understand development assistance, attention must be paid to the relationships between these varied players. We find that four factors influenced relationships between policy, donor, and implementing organizations; and those strained relationships, in turn, affected development success. The paper draws on interviews, conducted in Bosnia, with 43 development professionals, observation of development meetings in Tuzla and Sarajevo, and review of related documents from international development programs.

Nation building in Bosnia and Herzegovina: Cooperation, coordination and collaboration

Cross-sectoral interorganizational relationships in post-conflict situations occur regularly. Whether formal task forces, advisory groups or other ad hoc arrangements, these relations take place in chaotic and dangerous situations with urgent and turbulent political, economic and social environments. Furthermore, they typically involve a large number of players from many different nations, operating across sectors, and between multiple layers of bureaucracy and diplomacy. The organizational complexity staggers many participants and observers, as do the tasks they are charged with completing. Reform efforts in Bosnia and Herzegovina starting in 1995 may serve as the archetype model of conflict, transition and development for the 21st century. It wins this honor due not to its particular programmatic successes and failures, rather to the interorganizational complexity of the International Community. From the massive response to the crisis, to the modern nation-building policies it spawned, and the development assistance practices and institutional arrangements it created, the Bosnian development experience has much to offer by way of lessons learned. This manuscript frames the unique Bosnian development situation, and provides lessons learned from the experience of nation building given local realities. Pettigrew (1992) called this "contextualizing." While network and/or organizational structure, strategy and process explain many interorganizational relationship issues, the development variables identified in this manuscript prove equally important, yet elusive and difficult to measure despite their very real and overt presence.

IMPULSE CONTROL AND COOPERATION IN CAPUCHIN MONKEYS (Cebus apella)

The benefits animals derive from living in social groups have produced the evolution of many forms of cooperative behavior. To cooperate, two or more individuals coordinate their actions to accomplish a common goal. One cognitive process that has the potential to influence cooperation is self control. Individuals delaying their impulsive choice for an immediate reward may potentially receive a larger reward later by cooperating with others. In this study, I measured whether brown capuchin monkeys (Cebus apella) were capable of impulse control and whether impulse control was related to cooperation. Impulse control and cooperation were measured using a lazy susan-like apparatus, on which animals could turn a wheel to receive food rewards. The capuchins went through two training phases that taught them how to turn the wheel efficiently to obtain rewards and how to turn the wheel to obtain the larger of two rewards. After training, I tested impulse control by giving the capuchins a choice between a smaller and a larger reward placed at shorter or more distant locations on the wheel. The capuchins demonstrated impulse control in that they tended to inhibit the impulse to select the smaller reward when it was closer and easier to reach and instead selected the larger reward when it was farther away. Cooperation was tested in all possible dyads of seven individuals, a total of 21 dyads, by allowing each dyad 10 trials to work together with effort on the lazy-susan so that each would obtain a reward. Seventeen out of 21 dyads cooperated by simultaneously moving the wheel in the same direction. The correlation between how often a particular dyad cooperated and their average impulse control score was not statistically significant, r(21) = -.125, p = .591. Capuchins demonstrated impulse control and cooperation using this novel apparatus but the two abilities were not related. Other factors such as the unique social relationship between two individuals may play a more prominent role in the motivation to cooperate rather than the cognitive capacity to inhibit behavior.

Patient satisfaction of primary care for musculoskeletal diseases: A comparison between Neural Therapy and conventional medicine

Background The main objective of this study was to assess and compare patient satisfaction with Neural Therapy (NT) and conventional medicine (COM) in primary care for musculoskeletal diseases. Methods A cross-sectional study in primary care for musculoskeletal disorders covering 77 conventional primary care providers and 18 physicians certified in NT with 241 and 164 patients respectively. Patients and physicians documented consultations and patients completed questionnaires at a one-month follow-up. Physicians documented duration and severity of symptoms, diagnosis, and procedures. The main outcomes in the evaluation of patients were: fulfillment of expectations, perceived treatment effects, and patient satisfaction. Results The most frequent diagnoses belonged to the group of dorsopathies (39% in COM, 46% in NT). We found significant differences between NT and COM with regard to patient evaluations. NT patients documented better fulfilment of treatment expectations and higher overall treatment satisfaction. More patients in NT reported positive side effects and less frequent negative effects than patients in COM. Also, significant differences between NT and COM patients were seen in the quality of the patient-physician interaction (relation and communication, medical care, information and support, continuity and cooperation, facilities availability, and accessibility), where NT patients showed higher satisfaction. Differences were also found with regard to the physicians' management of disease, with fewer work incapacity attestations issued and longer consultation times in NT. Conclusion Our findings show a significantly higher treatment and care-related patient satisfaction with primary care for musculoskeletal diseases provided by physicians practising Neural Therapy.

The coevolution of cooperation and dispersal in social groups and its implications for the emergence of multicellularity

Background Recent work on the complexity of life highlights the roles played by evolutionary forces at different levels of individuality. One of the central puzzles in explaining transitions in individuality for entities ranging from complex cells, to multicellular organisms and societies, is how different autonomous units relinquish control over their functions to others in the group. In addition to the necessity of reducing conflict over effecting specialized tasks, differentiating groups must control the exploitation of the commons, or else be out-competed by more fit groups. Results We propose that two forms of conflict – access to resources within groups and representation in germ line – may be resolved in tandem through individual and group-level selective effects. Specifically, we employ an optimization model to show the conditions under which different within-group social behaviors (cooperators producing a public good or cheaters exploiting the public good) may be selected to disperse, thereby not affecting the commons and functioning as germ line. We find that partial or complete dispersal specialization of cheaters is a general outcome. The propensity for cheaters to disperse is highest with intermediate benefit:cost ratios of cooperative acts and with high relatedness. An examination of a range of real biological systems tends to support our theory, although additional study is required to provide robust tests. Conclusion We suggest that trait linkage between dispersal and cheating should be operative regardless of whether groups ever achieve higher levels of individuality, because individual selection will always tend to increase exploitation, and stronger group structure will tend to increase overall cooperation through kin selected benefits. Cheater specialization as dispersers offers simultaneous solutions to the evolution of cooperation in social groups and the origin of specialization of germ and soma in multicellular organisms.

Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study

BACKGROUND: Treatment strategies for acute basilar artery occlusion (BAO) are based on case series and data that have been extrapolated from stroke intervention trials in other cerebrovascular territories, and information on the efficacy of different treatments in unselected patients with BAO is scarce. We therefore assessed outcomes and differences in treatment response after BAO. METHODS: The Basilar Artery International Cooperation Study (BASICS) is a prospective, observational registry of consecutive patients who presented with an acute symptomatic and radiologically confirmed BAO between November 1, 2002, and October 1, 2007. Stroke severity at time of treatment was dichotomised as severe (coma, locked-in state, or tetraplegia) or mild to moderate (any deficit that was less than severe). Outcome was assessed at 1 month. Poor outcome was defined as a modified Rankin scale score of 4 or 5, or death. Patients were divided into three groups according to the treatment they received: antithrombotic treatment only (AT), which comprised antiplatelet drugs or systemic anticoagulation; primary intravenous thrombolysis (IVT), including subsequent intra-arterial thrombolysis; or intra-arterial therapy (IAT), which comprised thrombolysis, mechanical thrombectomy, stenting, or a combination of these approaches. Risk ratios (RR) for treatment effects were adjusted for age, the severity of neurological deficits at the time of treatment, time to treatment, prodromal minor stroke, location of the occlusion, and diabetes. FINDINGS: 619 patients were entered in the registry. 27 patients were excluded from the analyses because they did not receive AT, IVT, or IAT, and all had a poor outcome. Of the 592 patients who were analysed, 183 were treated with only AT, 121 with IVT, and 288 with IAT. Overall, 402 (68%) of the analysed patients had a poor outcome. No statistically significant superiority was found for any treatment strategy. Compared with outcome after AT, patients with a mild-to-moderate deficit (n=245) had about the same risk of poor outcome after IVT (adjusted RR 0.94, 95% CI 0.60-1.45) or after IAT (adjusted RR 1.29, 0.97-1.72) but had a worse outcome after IAT compared with IVT (adjusted RR 1.49, 1.00-2.23). Compared with AT, patients with a severe deficit (n=347) had a lower risk of poor outcome after IVT (adjusted RR 0.88, 0.76-1.01) or IAT (adjusted RR 0.94, 0.86-1.02), whereas outcomes were similar after treatment with IAT or IVT (adjusted RR 1.06, 0.91-1.22). INTERPRETATION: Most patients in the BASICS registry received IAT. Our results do not support unequivocal superiority of IAT over IVT, and the efficacy of IAT versus IVT in patients with an acute BAO needs to be assessed in a randomised controlled trial. FUNDING: Department of Neurology, University Medical Center Utrecht.