Impacto de la prestación de servicios de salud bajo el modelo de red en el municipio de Sogamoso

El presente estudio es de tipo analítico, cohorte retrospectiva, tiene como objeto estudiar un modelo de prestación de servicios de salud bajo el concepto de red integrada, conformada por las clínicas privadas de segundo y tercer nivel de complejidad del municipio de Sogamoso (Boyacá). Se analizó el período comprendido entre los años 2012 a 2014, donde se puede evidenciar la implementación y puesta en marcha del modelo. En el mes de agosto del año 2012, la estrategia de asociatividad la adelantaron las tres instituciones de manera libre y autónoma, utilizando como guía la metodología propuesta por la Cepal en el año 2010; las diferencias entre esta metodología y el modelo utilizado se deben a las particularidades de las clínicas y del contexto en el que se desarrolló. Este modelo de atención surgió de la necesidad de prestar los servicios de salud ofertados por las clínicas, acorde con su capacidad instalada, al total de la población de la Nueva EPS en Sogamoso, que en ese momento coyuntural no se estaba cumpliendo en el municipio, y ninguna de las instituciones tenía la infraestructura individual para atender a toda su población. El resultado de la asociación de las tres clínicas se logró gracias a un grado de confianza previo entre los directivos de las instituciones y posterior a varias reuniones, en las que se tomó la determinación de trabajar con el modelo de Unión Temporal, ya que no son una persona jurídica diferente a las que la conforman Se demuestra el impacto de este modelo asociativo de cada una de las organizaciones que la componen evaluando cuatro ámbitos como la capacidad de aprendizaje, capacidad de gestión estratégica, economía de escala y poder de negociación y externalidades. Para la recolección de la información se utilizaron las bases de datos de las instituciones hospitalarias con la información de los indicadores de oportunidad, así como el incremento de la facturación y del recaudo antes y después de la formación de la Unión Temporal; adicionalmente se realizaron encuestas a los directores de las clínicas como fuente de información para desarrollo de nuevos productos, reducción de costos, ampliación de la oferta hospitalaria, establecimientos de alianza, puesta en marcha de servicios comunes y apertura de nuevos mercados. Sumado a lo anterior, se realizó una encuesta adicional a los usuarios del nuevo producto desarrollado. Como resultado de este estudio se encuentra beneficio en todos los ámbitos evaluados para las instituciones que interactúan bajo este modelo y se espera que obtengan los mismos beneficios que los demás actores participantes en él, como las EAPB, los cuales no hacen parte del presente estudio. En Colombia no se observa la existencia de un modelo similar en sistema de salud, a pesar del leve intento de la Ley 1438 del 2011 por iniciar la conformación de redes; por esta razón se puede decir que este estudio marca un derrotero para que las organizaciones de salud tengan un modelo de articulación ante la falta de desarrollos de esquemas de red y por tratarse de un modelo con ausencia de reglamentación.

Avaliação da leitura em crianças do 1.º ano do 1.º ciclo : estudo exploratório

A leitura é a base da apreensão e compreensão de todas as matérias no início da vida escolar. O seu domínio e a sua aprendizagem bem sucedida, definem o êxito de um ser humano, ao longo de toda a sua vida profissional, afetiva e social. Por sua vez, o não domínio da leitura, nomeadamente na descodificação e compreensão de qualquer tipo de código escrito, condiciona toda a existência de um sujeito. Há muita investigação e trabalhos realizados nesta área, não havendo consenso entre os investigadores sobre o método mais eficaz no ensino da leitura, o fónico ou sintético, o global ou analítico, ou o misto. No entanto, antes de escolher o método o docente deve conhecer o seu grupo e as suas características para elaborar o seu próprio método de ensino da leitura, ou seja, deve retirar os traços mais importantes de cada método e aplicá-lo à sua turma, tendo em conta também a predisposição natural dos alunos para aprenderem. Dada a importância da leitura como competência, este estudo visou a compreensão das variáveis que interferem no processo eficaz de ensino da leitura, na fase inicial dessa aprendizagem, através da análise da metodologia e estratégias adotadas pelos professores, assim como a relação pedagógica, a organização/a gestão da sala de aula e o estudo dos contextos familiares. O estudo empírico ocorreu durante seis semanas, em duas escolas do 1.º Ciclo, em duas turmas do 1.º ano, sendo a amostra constituída por quatro alunos por turma, dois do sexo feminino e dois do sexo masculino. Foi solicitado aos professores que escolhessem entre os seus alunos, dois bons leitores e dois menos bons leitores. A recolha de dados fez-se a partir da análise da Ficha de Identificação do Aluno e da Escala de Graffar, preenchidas pelos encarregados de educação, dos registos obtidos nas entrevistas com os professores e alguns alunos, das observações das aulas e na avaliação da leitura de um texto. Esta recolha de dados foi registada em tabelas e em gráficos, que permitiram a análise dos resultados obtidos por cada grupo, nomeadamente no que diz respeito à precisão leitora e à velocidade. Desta análise não registamos grandes diferenças nos contextos familiares (na formação escolar dos pais, na sua profissão, no incentivo à leitura), nem no contexto da sala de aula (método, relação pedagógica, organização das aprendizagens no espaço e no tempo). As pequenas diferenças apontam para a figura do professor e para as dinâmicas e clima de sala de aula por ele criadas a que pode não estar alheio o método de iniciação à leitura adotado, hipóteses para futuras pesquisas.

Implicit memory: intention and awareness revisited

One of the major developments in memory research in the past decade or so has been a growing interest in implicit memory – task performance that is not accompanied by conscious or intentional recollection. In this article, we examine evidence for perceptual and conceptual implicit memory, using the accepted definitions, and suggest that there is in fact a lack of strong evidence for implicit memory in normal subjects. If more convincing evidence cannot be obtained, one solution might be to modify the current terminology. We suggest that the term implicit memory might have outgrown its usefulness as an overall descriptor.

Reality monitoring and visual hallucinations in Parkinson's disease

Between 8 and 40% of Parkinson disease (PD) patients will have visual hallucinations (VHs) during the course of their illness. Although cognitive impairment has been identified as a risk factor for hallucinations, more specific neuropsychological deficits underlying such phenomena have not been established. Research in psychopathology has converged to suggest that hallucinations are associated with confusion between internal representations of events and real events (i.e. impaired-source monitoring). We evaluated three groups: 17 Parkinson's patients with visual hallucinations, 20 Parkinson's patients without hallucinations and 20 age-matched controls, using tests of visual imagery, visual perception and memory, including tests of source monitoring and recollective experience. The study revealed that Parkinson's patients with hallucinations appear to have intact visual imagery processes and spatial perception. However, there were impairments in object perception and recognition memory, and poor recollection of the encoding episode in comparison to both non-hallucinating Parkinson's patients and healthy controls. Errors were especially likely to occur when encoding and retrieval cues were in different modalities. The findings raise the possibility that visual hallucinations in Parkinson's patients could stem from a combination of faulty perceptual processing of environmental stimuli, and less detailed recollection of experience combined with intact image generation. (C) 2002 Elsevier Science Ltd. All fights reserved.

Memory suppression can help people “unlearn” behavioral responses—but only for nonemotional memories

When encountering reminders of memories that we prefer not to think about, we often try to exclude those memories from awareness. Past studies have revealed that such suppression attempts can reduce the subsequent recollection of unwanted memories. In the present study, we examined whether the inhibitory effects extend even to associated behavioral responses. Participants learned cue–target pairs for emotional and nonemotional targets and were additionally trained in behavioral responses for each cue. Afterward, they were shown the cues and instructed either to think or to avoid thinking about the targets without performing any behaviors. In a final test phase, behavioral performance was tested for all of the cues. When the targets were neutral, participants’ attempts to avoid retrieval reduced accuracy and increased reaction times in generating behavioral responses associated with cues. By contrast, behavioral performance was not affected by suppression attempts when the targets were emotional. These results indicate that controlling unwanted recollection is powerful enough to inhibit associated behavioral responses—but only for nonemotional memories.

Nature of autobiographical memory that facilitates improvement of negative moods

Sakaki, M. (2005). Persons in negative moods often recall their positive experiences to alleviate their affective states. This study investigated the nature of autobiographical memories that facilitate improvement of negative moods. More specifically, it examined the relations between participants' subjective moods and the three natures of recalled memories (the current positivity, the past positivity, and the importance). After 67 participants were induced either negative or neutral moods, they were asked to recall five positive experiences and to rate their affective states. Results indicated that the more important memories participants recalled, the more positive moods they reported after recollection, and that these effects of the importance of autobiographical memories were observed in both negative and neutral moods. In contrast, neither the current positivity of memories nor the past positivity of memories significantly influenced participant's moods in both negative and neutral moods. The mechanism by which the importance of autobiographical memory affects moods was discussed.

Want to block earworms from conscious awareness?B(u)y gum!

Three experiments examine the role of articulatory motor planning in experiencing an involuntary musical recollection (an “earworm”). Experiment 1 shows that interfering with articulatory motor programming by chewing gum reduces both the number of voluntary and the number of involuntary—unwanted—musical thoughts. This is consistent with other findings that chewing gum interferes with voluntary processes such as recollections from verbal memory, the interpretation of ambiguous auditory images, and the scanning of familiar melodies, but is not predicted by theories of thought suppression, which assume that suppression is made more difficult by concurrent tasks or cognitive loads. Experiment 2 shows that chewing the gum affects the experience of “hearing” the music and cannot be ascribed to a general effect on thinking about a tune only in abstract terms. Experiment 3 confirms that the reduction of musical recollections by chewing gum is not the consequence of a general attentional or dual-task demand. The data support a link between articulatory motor programming and the appearance in consciousness of both voluntary and unwanted musical recollections.

Consciousness minus retrospective mental time travel

In this paper we apply the concept of mental time travel to introduce the basic features of full-blown conscious experiences (encapsulation in mental models and recollection). We discuss the perspective that Lamme`s `Level 3` experiences can be considered as part of the scope of phenomenological consciousness, in relation to which we emphasize the necessity to consider the different degrees of consciousness and how a particular situation compares to the conscious experiences present in resting states of wakefulness.

Visuellt & Auditivt korttidsminne

The aim of the present study was to investigate the effect of sensory modality on short-term memory recall. An exploratory, cross-sectional study was performed. A total of 119 individuals participated. There were 70 female and 49 male subjects, aged 4 to 80 years (M=34,3). The participants were presented with 12 different objects in auditory, visual or auditory/visual mode over a period of 24 seconds. The participants were then asked to recall as many of the 12 objects as possible in any order. The study took place at a day nursery, junior high schools, meetings with elderly and adults with house calls. Non-probability samples were used. The conclusion was that visual short-term memory generated the highest recollection and that adults had the highest mean on the different stimuli. A visual element is recommended at recollection.

Acupuncture for labour pain

Background: Acupuncture involves puncturing the skin with thin sterile needles at defined acupuncture points. Previous studies are inconclusive regarding the effect of acupuncture on labour pain, but some studies have found a reduction in the use of pharmacological pain relief when acupuncture is administered. The appropriate dose of acupuncture treatment required to elicit a potential effect on labour pain has not been fully explored. The dose is determined by many different factors, including the number of needles used and the intensity of the stimulation. In Sweden, manual stimulation of the needles is common practice when acupuncture is used for labour pain, but electrical stimulation of the needles, which gives a higher dose, could possibly be more effective. The overall aim of this thesis was to evaluate the effectiveness of acupuncture with manual stimulation (MA) of the needles as well as acupuncture with a combination of manual and electrical stimulation (EA) in reducing labour pain, compared with standard care without any form of acupuncture (SC). Methods: The study was designed as a three-armed randomised controlled trial in which 303 nulliparous women with normal pregnancies were randomised to MA, EA, or SC. The primary outcome was labour pain, assessed using the Visual Analogue Scale (VAS). Secondary outcomes were relaxation during labour, use of obstetric pain relief, and associations between maternal characteristics and labour pain and use of epidural analgesia respectively. Also, labour and infant outcomes, recollection of labour pain, and maternal experiences, such as birth experience and experience of the midwife, were investigated two months after the birth. The sample size calculation was based on the potential to discover a difference of 15 mm on the VAS. Data were collected during labour before the interventions, the day after birth, and two months later. Besides using the VAS, information was collected by means of study specific protocol, questionnaires and medical records. Results: The mean VAS scores were 66.4 in the MA group, 68.5 in the EA group, and 69.0 in the SC group (mean differences: MA vs. SC 2.6 95% CI -1.7 to 6.9, and EA vs. SC 0.6 95% CI -3.6 to 4.8). Other methods of pain relief were used less frequently in the EA group, including epidural analgesia, MA 61.4%, EA 46%, and SC 69.9%. (EA vs. SC OR 0.4 95% CI 0.2 to 0.7). No statistically significant differences were found in the recollection of labour pain between the three groups two months after birth (mean VAS score: MA 69.3, EA 68.7 and SC 70.1). A few maternal characteristics were associated with labour pain (age, dysmenorrhea, and cervix dilatation), but none of the investigated characteristics predicted the outcome of the acupuncture treatment in MA or EA. Women in the EA group experienced acupuncture as being effective for labour pain to a higher extent than women who received MA, MA 44.4%, EA 67.1% (EA vs. MA OR 2.4 95% CI 1.2 to 4.8). Women in the EA group also spent less time in labour (mean 500 min) than those who received MA (mean 619 min) and SC (mean 615 min) (EA vs. MA HR 1.4 95% CI 1.0 to1.9, EA vs. SC HR 1.4, 95% CI 1.1 to 2.0), and had less blood loss than women receiving SC, (EA vs. SC OR 0.1 95% CI 0.3 to 0.7). The women’s assessment of the midwife as being supportive during labour (MA 77.2%, EA 83.5%, SC 80%), overall satisfaction with midwife care (MA 100%, EA 97.5%, SC 98.7%), and having an overall positive childbirth experience (MA 64.6%, EA 61.0%, SC 54.3%) did not differ statistically. No serious side effects of the acupuncture treatment were reported. Conclusion: Acupuncture, regardless of type of stimulation, did not differ from standard care without acupuncture in terms of reducing women’s experience of pain during labour, or their memory of pain and childbirth overall two months after the birth. However, other forms of obstetric pain relief were less frequent in women receiving a combination of manual and electrical stimulation, suggesting that this method could facilitate coping with labour pain.

Don't rain on my parade : barriers to ecological tourism

This research investigates the perceived risks and perceptions of visitor experiences associated with visitation to an ecological tourist destination. The research identified a significant consumption barrier which appeared to impact significantly and reflect juxtapositions with regard to tourists’ perceived (reflective) and lived (responsive) experiences with the tourist attraction. The conflicting reports of the “over-commercialisation” of the attraction and the enjoyment of the natural experience recorded at varying recollection periods, provided valuable insight into tourist consumption barriers to the establishment of relational bonds between tourists and ecological tourist attractions.

Telephone-mediated academic discourse

This study investigates the role of spoken language in tertiary teaching and learning as mediated by the telephone. There is recognition also of the mediating role of the tape-recorder and computer in this research. The discourse analysis has avoided the inherent difficulties of restructuring spoken language as written text as, by the use of CD-ROM, the spoken voice has been retained and it has been possible to connect the utterance and the reader. For a thesis that is concerned with the privileging of the written over the spoken in the academy, and the role of communication technologies, the use of CD-ROM is apposite and timely. The study has been conceptualised as the bringing together of three potentially discrete elements (audioteleconferencing, academic discourse and technological mediation) which are framed by distance education/open learning. Set within an interpretive (hermeneutic) paradigm, the research examines tape-recorded ‘teletutorial’ sessions to move towards an understanding of teacher-learner and learner-learner interaction, and to what extent the mediation of the communication technology has impacted on the pedagogy. It draws on data from two minor and two major case studies, using a range of methods. Conceptually, the discussion develops and elaborates the concept of ‘tele’ (as restricted to the telephone) as it engages with the notion of 'telepedagogy’. It articulates the areas of congruence and distinctiveness between teaching and learning by audioteleconference and teaching and learning by correspondence and face-to-face. It examines the relationship between language and technology, with specific reference to distance education/open learning. Empirically, the data support an in-depth discussion of selected excerpts to inform analysis of perceived advantages and restrictions of audioteleconferencing. The study reveals that there are demonstrable occasions when the perceptions of the participants are seen to be at variance from those of the researcher and from other data. This conclusion has relevance to theorists concerned with the validation of qualitative data and to researchers who accept student and tutor feedback as representing an accurate recollection of what eventuated.

Examination of the validity and usefulness of the video suggestibility scale for children

The Video Suggestibility Scale for Children (VSSC) was developed by Scullin and colleagues (Scullin & Ceci, 2000; Scullin & Hembrooke, 1998) as a tool for discriminating between children who have different levels of suggestibility. The scale requires children to view a 5-minute video about a birthday party, and to subsequently participate in an interview consisting of 18 yes/no questions. The VSSC consists of two main subscales; Yield (a measure of children's willingness to respond affirmatively to misleading questions about the video) and Shift (a measure of the children's tendency to change their responses after negative feedback from the interviewer). Preliminary research by Scullin and colleagues suggested that the scale possesses satisfactory internal consistency and that children's scores on the VSSC can predict their performance in another suggestibility paradigm. This thesis presents two studies, which further examine the validity and usefulness of the VSSC in an Australian sample of 3- to-5-year-old children. In Study One, children's performance on the VSSC (N = 77) was compared to their performance using other measures of suggestibility. These measures included children's willingness to assent to a false event as well as the number of false interviewer suggestions and new false details that the children provided in their accounts about an independent true-biased and an independent false (non-experienced) event. An independent samples t-test revealed that those children who assented to the false activity generated higher scores on the Yield measure. This pattern was also observed for the Shift subscale although it was not significant. Hierarchical regression analyses revealed that Yield was a significant predictor of the number of false details reported about the false activity, but not the true-biased activity. There was no significant relationship between the Shift Vlll subscale and any of the dependent variables. Overall this study provided partial support for the construct validity of the VSSC. However, it indicated that children's performance on this scale may not be generalisable across different contexts and interview paradigms, and that the Yield subscale is more generalisable than the Shift subscale. Study Two examined whether various group and individual factors that have previously been shown to relate suggestibility (i.e., age, IQ, memory, socio-economic status, gender, temperament) could predict suggestibility as measured by the VSSC. Two hundred and twenty children were recruited from kindergartens, and were divided into two broad socio-economic categories (based predominantly on income). Hierarchical regression analyses revealed that age, intelligence and memory inversely predicted children's Yield suggestibility. Further, children of low socio-economic backgrounds were more suggestible than children of high socio-economic background, and boys were more suggestible than girls on the Yield measure. Although shyness and other internalised and externalised characteristics were explored, no reliable significant relationships were found with Yield. With regard to the Shift subscale, no reliable relationships were found for any of the independent variables except for SES. Overall, results of Study 2 indicated that the VSSC is a potentially useful measure for discriminating between children's suggestibility on the basis on their individual characteristics, although benefits were observed mainly in relation to the Yield subscale. With reference to the findings of these two studies, the potential contribution of the VSSC for research and applied forensic contexts was discussed.

Investigative interviewing of children with intellectual disabilities

This research was designed to examine two broad issues in relation to the investigative interviewing of children (aged 9 to 13 years) with mild and moderate intellectual disabilities. First, how do children with intellectual disabilities perform (relative to children matched for chronological and mental age) when recalling an event in response to various questions? Second, what question types and interview strategies do police officers and caregivers use to elicit accurate and detailed accounts about an event from children with intellectual disabilities? The rationale for exploring each of these issues was to determine possible ways of improving the elicitation of evidence from children with intellectual disabilities. While children with intellectual disabilities constitute a high proportion of all child victims of abuse (Conway, 1994; Goldman, 1994; Morse, et ah, 1970), they rarely provide formal reports of abuse and of those incidents that are reported, few cases progress to court (Henry & Gudjonsson, 1999). Study 1 used a standard interview protocol containing a variety of questions and an interview structure commonly used in investigative interviews. Specifically, the memory and suggestibility of eighty children with either a mild and moderate intellectual disability (M age = 10.85 years) was examined when recalling an innocuous event that was staged at their school. The children's performance was compared with that of two control groups; a group of mainstream children matched for mental age and a group of mainstream children matched for chronological age. Overall, this study showed that children with both mild and moderate intellectual disabilities can provide accurate and highly specific event-related information hi response to questions recommended in best-practice guidelines. However, their recall was less complete and less clear in response to free-narrative prompts and less accurate in response to specific questions when compared to both mainstream age-matched groups. Study 2 provided an in-depth analysis of the types of questions and strategies used by twenty-eight police officers and caregivers when interviewing children with either mild or moderate intellectual disabilities (M age = 11.13 years) about a repeated event that was staged at their school. The results revealed that while the approach used by the police officers was generally consistent with best-practice recommendations (i.e., their interviews contained few leading, coercive or negative strategies), there were many ways in which their approach could be improved. This study also showed that the caregivers used a high proportion of direct and negative strategies to elicit information from their children. Even when caregivers used open-ended questions, their children provided less event-related information than they did to police interviewers. The results of both studies were discussed in relation to current 'best-practice' guidelines for interviewing children and recommendations were offered for improving the quality of field interviews with children who have intellectual disabilities.

Children's eyewitness memory : participation, presentation media and the disruption effect

This research found that both younger and older children remembered eyewitness events better when presented live rather than on video. Active participation in live events enhanced recall memory. Disruptive incidents were remembered better than irrelevant incidents, but this finding depended on children's age and level of involvement in the event.