Why language matters: insights and challenges in applying a social determination of health approach in a North-South collaborative research program

Focus on “social determinants of health” provides a welcome alternative to the bio-medical illness paradigm. However, the tendency to concentrate on the influence of “risk factors” related to living and working conditions of individuals, rather than to more broadly examine dynamics of the social processes that affect population health, has triggered critical reaction not only from the Global North but especially from voices the Global South where there is a long history of addressing questions of health equity. In this article, we elaborate on how focusing instead on the language of “social determination of health” has prompted us to attempt to apply a more equity-sensitive approaches to research and related policy and praxis.

Strategic significance of the island state of Sri Lanka

The study is focused on an analysis of the major diplomatic documents from the mid eighteenth century to the present as regards Sri Lanka, or Ceylon as it was known till 1972. The objectives of the study are to identify the issues underlying these diplomatic documents. These include the political and strategic factors and other subsidiary issues like trade and commerce relevant at the time these treaties, agreements, and proposed treaties were formulated. It is also a geopolitical study as it relates to Sri Lanka's geographical position in the Indian Ocean, and her possession of the Trincomalee Harbour on its east coast, which is one of the great natural harbours of the world. Over the centuries this harbour has had significant strategic value for naval deployments. The case study of the eighteenth and nineteenth centuries studies the diplomatic documents against the political and strategic background for the French Revolution and actions of Napoleon, and the Anglo/French rivalry, spreading from Europe to North America and Asia. In the twentieth century the environment for studying the place of Sri Lanka in the Indian Ocean was created by the Russian Revolution, the failure to keep the peace of Versailles after World War I, the conflict and horrors of World War II which led to the disintegration of European colonial empires in Asia and Africa, and the tensions generated by the Cold War. A study of the documents would reveal that in international relations what matters is the ability of a party to promote its interests, and this depends on its power. This realist approach contrasts to the idealist approach where policies are based on moral and ethical principles. For the realist the states should follow to protect their interests and to survive. To achieve this is to strive for a ‘balance of power’. To do so is to form a favourable alliance system. As the documents examined cover a period from the mid-eighteenth century to the later part of the twentieth century, they reflect the changing technologies that have had an influence on naval and military matters. For example, this period witnessed great changes in technology of energy utilized to propel warships, from wind, to steam, to fuel and finally to nuclear power. These changes had an influence in determining strategic policies involving weapon systems and communications within a global and regional setting. The period covered was the beginning of the process described a ‘globalisation’. Its idea is not unique to this century; there were many attempts, in various times of history, to integrate societies within a global context. Viewed in this light, the Anglo-French rivalry of the eighteenth and nineteenth centuries was the indication of a global naval strategy, in which Sri Lanka was a major factor in the Indian Ocean region. This process was associated with the phenomena called the ‘expansion of Europe’. It covered all the oceans of the world and in the nineteenth and twentieth centuries led to the founding of the largest maritime empire the world has ever seen: The British Empire. After World War I, the British naval strength (the basis of the British Empire) and her consequent position as a great power, was challenged by other powers like the United States of America and Japan. After World War II, the US Navy was supreme: and there was a close alliance between Britain and the USA. The strength of the US/British alliance was based on the navy and its bases, which were spread throughout the globe; to project power, and act as deterrence and balancing force. Sri Lanka, due to her strategic position, was a part of this evolving process, and was tied to a global strategy (with its regional connotations) from the eighteenth century to the present.

A participação de Conselheiros Municipais de Saúde: solução que se transformou em problema?

A proposta de controle social instituída pela constituição abriu perspectivas para uma prática democrática ímpar no setor saúde. O Sistema Único de Saúde utiliza o Conselho Municipal de Saúde (CMS) como meio de cumprimento do princípio constitucional da participação da comunidade para assegurar o controle social sobre as ações e serviços de saúde do município. O CMS tem competência para examinar e aprovar as diretrizes da política de saúde, para que sejam alcançados seus objetivos. Ao atuar na formulação de estratégias, o Conselho pode aperfeiçoá-las, propor meios aptos para sua execução ou mesmo indicar correções de rumos. em Botucatu (SP), o CMS existe desde 1992 e nossa proposta foi analisar a participação dos conselheiros e sua representatividade. Para esse propósito, utilizamos uma abordagem qualitativa que permitisse uma aproximação e o conhecimento daquela realidade. Os resultados mostraram, entre vários aspectos, que, em média, metade dos conselheiros titulares e um terço dos suplentes comparecem às reuniões. Além de interessados, esses conselheiros trazem reivindicações ou sugestões do grupo que representam, considerando boa a repercussão dessas reivindicações, porém nem sempre obtêm respostas satisfatórias, pois algumas decisões são tomadas fora do âmbito do conselho; percebem dificuldade de integração entre os serviços de saúde; a própria organização das reuniões dificulta a participação e, muitas vezes, a reunião apenas aprova pacotes ministeriais que devem ser implementados. Ouvir os conselheiros permitiu levantar problemas que precisam ser enfrentados e, com isso, fazer avançar o processo democrático, ou seja, um desafio para a vida.

Os movimentos da sensibilidade: o diálogo entre Mário Pedrosa e Alexander Calder no projeto construtivo brasileiro

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

O processo metaficcional em Osman Lins e Maria Gabriela Llansol: recriando a dimensão textual

Pós-graduação em Letras - IBILCE

Análise entoacional acústica e auditiva de alguns enunciados do português brasileiro

The main goal of this work is the analysis of theoretical and methodological aspects of speech melody variation (intonation), with special reference to the pronunciation of one speaker. In order to carry on this study, different types of sentences (declarative, questions, etc.) and the intonational focus as well as the speaker‟s attitude (irony, emphasis, etc.) were observed and analyzed with special acoustic software (PRAAT) and with an auditory analysis of a text read by the subject. The aim of this work is to verify whether the acoustic analysis matches with the auditory perception phonetically, according to M.A.K. Halliday‟s methodology, following Cagliari (2007), who adapted Halliday‟s model to describe the intonation of Portuguese

Um modelo cognitivo baseado na atenção para consciência em robôs inteligentes

Understanding consciousness is one of the most fascinating challenges of our time. From ancient civilizations to modern philosophers, questions have been asked on how one is conscious of his/her own existence and about the world that surrounds him/her. Although there is no precise definition for consciousness, there is an agreement that it is strongly related to human cognitive processes such as: thinking, reasoning, emotions, wishes. One of the key processes to the arising of the consciousness is the attention, a process capable of promoting a selection of a few stimuli from a huge amount of information that reaches us constantly. Machine consciousness is the field of the artificial intelligence that investigate the possibility of the production of conscious processes in artificial devices. This work presents a review about the theme of consciousness - in both natural and artificial aspects -, discussing this theme from the philosophical and computational perspectives, and investigates the feasibility of the adoption of an attentional schema as the base to the cognitive processing. A formal computational model is proposed for conscious agents that integrates: short and long term memories, reasoning, planning, emotion, decision making, learning, motivation and volition. Computer experiments in a mobile robotics domain under USARSim simulation environment, proposed by RoboCup, suggest that the agent can be able to use these elements to acquire experiences based on environment stimuli. The adoption of the cognitive architecture over the attentional model has potential to allow the emergence of behaviours usually associated to the consciousness in the simulated mobile robots. Further implementation under this model could potentially allow the agent to express sentience, selfawareness, self-consciousness, autonoetic consciousness, mineness and perspectivalness. By performing computation over an attentional space, the model also allows the ...

[Inherited alopecia X in Pomeranians]

Four male Pomeranians that showed alopecia with an age of onset between five months and eight years were investigated.The aim of the investigation was to clarify whether the affected dogs had alopecia X and whether their symptoms might be due to a hereditary defect.The four affected dogs showed hairless patches at the root of the tail, at the back, at the limbs from the thigh to the tarsus and at the abdomen. Within the hairless patches some islets with sparse hair were present. In hairless patches the skin was dark pigmented. Besides the alopecia and hyperpigmentation no other symptoms were found according to anamnestic and clinical examination. History, clinical examinations, laboratory diagnostics, and histopathology of skin biopsies allowed the diagnosis of alopecia X in three affected male dogs.The last one of the affected dogs additionally had slightly reduced thyroid hormone levels. Based on identical symptoms and the close relatedness of all four animals, it was assumed that the fourth affected dog also had alopecia X.The available data possibly indicate a monogenic autosomal dominant inheritance, however a recessive inheritance can not be excluded at this time.

Otologic manifestations in Samter's syndrome

OBJECTIVE: It was the aim of this study to investigate the prevalence of otologic manifestations in a cohort of Samter's syndrome patients (nasal polyps with chronic rhinosinusitis, aspirin intolerance and asthma). METHODS: We analyzed a retrospective and prospective case review from 1995 to 2005, performed in the otorhinolaryngology outpatient clinic of a tertiary referral center. Ear history, clinical examinations, treatment and outcome were evaluated using office and hospital records in 23 cases. All subjects completed a questionnaire. RESULTS: In 6 cases (26%), otological manifestations with ear pressure and conductive hearing loss occurred during an advanced stage of Samter's syndrome (>5 years after onset of the first nasal symptoms) partially responsive to systemic steroids. CONCLUSION: Recognition of the association between Samter's syndrome and otological disease is important (26% of the cases) because it could also be responsive to systemic steroids which prevent progression to irreversible hearing loss or infectious otomastoiditis.

Cost-effectiveness analysis of a 2-stage community-based hepatocellular carcinoma screening program in Taiwan

Hepatocellular carcinoma (HCC) has been ranked as the top cause of death due to neoplasm malignancy in Taiwan for years. The high incidence of HCC in Taiwan is primarily attributed to high prevalence of hepatitis viral infection. Screening the subjects with liver cirrhosis for HCC was widely recommended by many previous studies. The latest practice guideline for management of HCC released by the American Association for the Study of Liver Disease (AASLD) in 2005 recommended that the high risk groups, including cirrhotic patients, chronic HBV/HCV carriers, and subjects with family history of HCC and etc., should undergo surveillance.^ This study aims to investigate (1) whether the HCC screening program can prolong survival period of the high risk group, (2) what is the incremental cost-effectiveness ratio of the HCC screening program in Taiwan, as compared with a non-screening strategy from the payer perspective, (3) which high risk group has the lowest ICER for the HCC screening program from the insurer's perspective, in comparison with no screening strategy of each group, and (4) the estimated total cost of providing the HCC screening program to all high risk groups.^ The high risk subjects in the study were identified from the communities with high prevalence of hepatitis viral infection and classified into three groups (cirrhosis group, early cirrhosis group, and no cirrhosis group) at different levels of risk to HCC by status of liver disease at the time of enrollment. The repeated ultrasound screenings at an interval of 3, 6, and 12 months were applied to cirrhosis group, early cirrhosis group, and no cirrhosis group, respectively. The Markov-based decision model was constructed to simulate progression of HCC and to estimate the ICER for each group of subjects.^ The screening group had longer survival in the statistical results and the model outcomes. Owing to the low HCC incidence rate in the community-based screening program, screening services only have limited effect on survival of the screening group. The incremental cost-effectiveness ratio of the HCC screening program was $3834 per year of life saved, in comparison with the non-screening strategy. The estimated total cost of each group from the screening model over 13.5 years approximately consumes 0.13%, 1.06%, and 0.71% of total amount of adjusted National Health Expenditure from Jan 1992 to Jun 2005. ^ The subjects at high risk of developing HCC to undergo repeated ultrasound screenings had longer survival than those without screening, but screening was not the only factor to cause longer survival in the screening group. The incremental cost-effectiveness ratio of the 2-stage community-based HCC screening program in Taiwan was small. The HCC screening program was worthy of investment in Taiwan. In comparison with early cirrhosis group and no cirrhosis group, cirrhosis group has the lowest ICER when the screening period is less than 19 years. The estimated total cost of providing the HCC screening program to all high risk groups consumes approximately 1.90% of total amount of adjusted 13.5-year NHE in Taiwan.^

The evolution of the laws of software evolution. A discussion based on a systematic literature review

After more than 40 years of life, software evolution should be considered as a mature field. However, despite such a long history, many research questions still remain open, and controversial studies about the validity of the laws of software evolution are common. During the first part of these 40 years the laws themselves evolved to adapt to changes in both the research and the software industry environments. This process of adaption to new paradigms, standards, and practices stopped about 15 years ago, when the laws were revised for the last time. However, most controversial studies have been raised during this latter period. Based on a systematic and comprehensive literature review, in this paper we describe how and when the laws, and the software evolution field, evolved. We also address the current state of affairs about the validity of the laws, how they are perceived by the research community, and the developments and challenges that are likely to occur in the coming years.

Documents pertaining to the medicinal supplies within the North American colonies from 1643 to 1780,

Contains a reissue of four numbers (April 1937, June-Dec. 1938, Feb. 1939 and Dec. 1940) of the author's journal, the Badger pharmacist. Each number includes a reprint of the document discussed.

The future in perspective,

"Of further interest: books": p. 385-393.

Novai͡a istorii͡a ...

Mode of access: Internet.