Le rôle de l’évaluation économique dans la pratique des médecins de famille = The role of economic evaluation in the practice of family physicians

L’évaluation économique en santé consiste en l’analyse comparative d’alternatives de services en regard à la fois de leurs coûts et de leurs conséquences. Elle est un outil d’aide à la décision. La grande majorité des décisions concernant l’allocation des ressources sont prises en clinique; particulièrement au niveau des soins primaires. Puisque chaque décision est associée à un coût d’opportunité, la non-prise en compte des considérations économiques dans les pratiques des médecins de famille peut avoir un impact important sur l’efficience du système de santé. Il existe peu de connaissances quant à l’influence des évaluations économiques sur la pratique clinique. L’objet de la thèse est de comprendre le rôle de l’évaluation économique dans la pratique des médecins de famille. Ses contributions font l’objet de quatre articles originaux (philosophique, théorique, méthodologique et empirique). L’article philosophique suggère l’importance des questions de complexité et de réflexivité en évaluation économique. La complexité est la perspective philosophique, (approche générale épistémologique) qui sous-tend la thèse. Cette vision du monde met l’attention sur l’explication et la compréhension et sur les relations et les interactions (causalité interactive). Cet accent sur le contexte et le processus de production des données souligne l’importance de la réflexivité dans le processus de recherche. L’article théorique développe une conception nouvelle et différente du problème de recherche. L’originalité de la thèse réside également dans son approche qui s’appuie sur la perspective de la théorie sociologique de Pierre Bourdieu; une approche théorique cohérente avec la complexité. Opposé aux modèles individualistes de l’action rationnelle, Bourdieu préconise une approche sociologique qui s’inscrit dans la recherche d’une compréhension plus complète et plus complexe des phénomènes sociaux en mettant en lumière les influences souvent implicites qui viennent chaque jour exercer des pressions sur les individus et leurs pratiques. L’article méthodologique présente le protocole d’une étude qualitative de cas multiples avec niveaux d’analyse imbriqués : les médecins de famille (niveau micro-individuel) et le champ de la médecine familiale (niveau macro-structurel). Huit études de cas furent réalisées avec le médecin de famille comme unité principale d’analyse. Pour le niveau micro, la collecte des informations fut réalisée à l’aide d’entrevues de type histoire de vie, de documents et d’observation. Pour le niveau macro, la collecte des informations fut réalisée à l’aide de documents, et d’entrevues de type semi-structuré auprès de huit informateurs clés, de neuf organisations médicales. L’induction analytique fut utilisée. L’article empirique présente l’ensemble des résultats empiriques de la thèse. Les résultats montrent une intégration croissante de concepts en économie dans le discours officiel des organisations de médecine familiale. Cependant, au niveau de la pratique, l'économisation de ce discours ne semble pas être une représentation fidèle de la réalité puisque la très grande majorité des participants n'incarnent pas ce discours. Les contributions incluent une compréhension approfondie des processus sociaux qui influencent les schèmes de perception, de pensée, d’appréciation et d’action des médecins de famille quant au rôle de l’évaluation économique dans la pratique clinique et la volonté des médecins de famille à contribuer à une allocation efficiente, équitable et légitime des ressources.

Systematics and biology of Fishes of family of the hemiramphidae of Cochin coast

This overall focus of the thesis involves the systematics and biology of fishes of the family hemiramphidae of cochin coast.India is one of the leading fish producing nations in the world with an average annual production of 6.1 million tonnes of fish and shell fish from capture and culture fisheries in 2001 (Ayyappan and Biradar, 2002).Fisheries play a very significant role in the Indian economy by providing employment to nearly 7 million people directly or indirectly, supplying rich protein food and earning valued foreign exchange.Fishes of the family Hemiramphidae are commonly called ‘half beaks‘.In India, studies on hemiramphids commenced with the work of Day (1878,1889) who recorded thirteen species of hemiramphids from the Indian waters.The study area, which is part of Cochin coast is located between Lat.9°28’ and 10° N and Long.76° 13’ and 76° 31 E. Lying parallel to it is an estuary which is commonly called the Cochin backwaters which has a total area of about 200 sq.miles.The study area is subjected to wide variations in salinity from place to place, season and surface to bottom.The Cochin coast and the adjacent back water system of Kerala has a rich and diversified fish fauna. The hemiramphid fishes constitute a minor fishery of this area.The study on the distribution and availability of hemiramphid fishes present in the Cochin coast shows that they evince different patterns of distribution.In the present study it is noticed that fecundity has high correlation with weight than length of the fish.Histological studies revealed that the spermatogenesis in both H. (H) limbatus and H.(H) xanthopterus, consists of spermatogonia, primary spermatocytes secondary, spermatocytes, spermatids and spermatozoa whereas in the oogenesis of both the species.biological study will be useful in implementation of proper measures of conservation and management so that further devastation of the hemiramphids of Cochin Coast can be controlled.

The recognition of rights to same-sex couples: the path towards a pluralistic concept of family

This paper presents the final results of the research project undertaken in 2010 and 2011 by the legal research group “Filius”, affiliated with Corporación Universitaria Empresarial Alexander von Humboldt of Armenia, (Quindío). The project’s general objective is “to establish the concept of family used by the Colombian legal system based on the judgments of the Constitutional Court granting rights to same-sex couples”. To this end, a line of jurisprudence was developed from the Court’s rulings that discussed the rights of same-sex couples, concluding that despite the great progress made in Colombia on the recognition of rights to these couples following Decision C-075/2007, in all these judgments the Court had always refused to recognize their family status, and it was not until 2011, in Decision C-577, that the Court accepted that same-sex couples constitute a family, thereby dramatically changing the constitutional doctrine that had maintained the criteria of heterosexuality as defining family.

A sociological view of family law in Colombia. Radicalism-1945

This paper affirms that the economic and political failure of the Radical Period provided opportunities for those who proposed Regeneration as a means of defending authority. Family law became an important tool in that process. During the period studied by this article, the equality clause remained in Colombian constitutions without any practical affect for the majority of the people. Discrimination was imposed through family law over those who had born outside of a Catholic marriage and/or had not previously legitimized their union through a Catholic ceremony. By the middle of the 20th century, the dramatic situation of the nation’s children led to efforts to change the social prejudices through legislation, that is, in the same way the prejudices had been imposed.

Impact of family language and testing language on reading performance in a bilingual educational context

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Acceptance of deafness: a study of family strategies and needs

This paper studies the acceptance strategies used by family members of hearing-impaired children. The study looks at how parents view conferences, counseling and meetings with hearing professionals and other parents of deaf children.

Children's representation of family mealtime in the context of maternal eating disorders

Background Recent research provides evidence for specific disturbance in feeding and growth in children of mothers with eating disorders. Aim To investigate the impact of maternal eating disorders during the post-natal year on the internal world of children, as expressed in children's representations of self and their mother in pretend mealtime play at 5 years of age. Methods Children of mothers with eating disorders (n = 33) and a comparison group (n = 24) were videotaped enacting a family mealtime in pretend play. Specific classes of children's play representations were coded blind to group membership. Univariate analyses compared the groups on representations of mother and self. Logistic regression explored factors predicting pretend play representations. Results Positive representations of the mother expressed as feeding, eating or body shape themes were more frequent in the index group. There were no other significant group differences in representations. In a logistic regression analysis, current maternal eating psychopathology was the principal predictor of these positive maternal representations. Marital criticism was associated with negative representations of the mother. Conclusions These findings suggest that maternal eating disorders may influence the development of a child's internal world, such that they are more preoccupied with maternal eating concerns. However, more extensive research on larger samples is required to replicate these preliminary findings.

The causal effect of family size on child labor and education

This paper investigates the causal relationship between family size and child labor and education among brazilian children. More especifically, it analyzes the impact of family size on child labor, school attendance, literacy and school progression. It explores the exogenous variation in family size driven by the presence of twins in the family. The results are consistent under the reasonable assumption that the instrument is a random event. Using the nationally representative brazilian household survey (Pnad), detrimental effects are found on child labor for boys. Moreover, significant effects are obtained for school progression for girls caused by the exogenous presence of the young siblings in the household.

The family role on the internationalization process of family businesses: a two-case study

Essa dissertação procura identificar o papel da família no processo de internacionalização de dois negócios familiares: JBS, a maior empresa de proteína animal do mundo e Cutrale um dos líderes mundiais no mercado de suco de laranja. Empresas familiares possuem características que são intrínsecas a esse tipo de empresa. Muitos dos motivos de se internacionalizar ou mesmo o modo como eles se internacionalizam podem ser extremamente característicos. Assim, através de uma pesquisa qualitativa, os dois estudos de caso foram analisados baseados em teorias de internacionalização de empresas familiares. Porém, nessas companhias estudadas, a família não desempenhou um papel relevante no processo de internacionalização das mesmas. Com esses resultados, questões surgiram, como por exemplo, se o tamanho ou segmento da empresa tiveram um impacto na importância do papel que a família possui no processo de internacionalização. Essas questões não eram o foco do estudo porém fornecem muitos subsídios para uma próxima pesquisa.