Intervening to reach adolescents and affect health

Background. Assessing the health status of adolescents is challenging for health care providers. Personal disclosure has been associated with improved health outcomes. Story-centered care was examined as an intervention for promoting adolescent disclosure during an urgent care visit. ^ Objectives. This study explored: (1) the effectiveness of story-centered care for promoting adolescent disclosure; (2) health-associated words used by adolescents to describe pressing concerns after an urgent care visit when they had standard care (SC) or story-centered care (SCC) conducted by a Nurse Practitioner (NP). ^ Methods. Subjects were randomly assigned to SC or SCC. In SC, adolescent presenting concerns were identified and treated. In SCC, presenting concerns were treated and NP-adolescent dialogue, facilitated through a screening tool, queried matters of importance to adolescent life. After the visit, adolescents wrote about pressing concerns for 15 minutes. Written words were analyzed with Linguistic Inquiry and Word Count, a software program for analyzing narrative. Ratios were calculated for the number of words (adolescent: NP) used during the urgent care visit. Analysis of variance (ANOVA) was used to evaluate gender-intervention differences in health-associated words. ^ Results. One hundred and six adolescents [Hispanic (65%), White (35%)] completed the study. Fifty-five were female; the average age was 17 (sd = 2.1) years. ^ Adolescents in the story intervention used more words (adolescent: NP, 1:1.3) than those in standard intervention (adolescent: NP, 1:2.7) in proportion to the number of words used by the NP during the urgent care visit. There were gender-intervention differences (p < .01) in positive emotion words and past-tense words in writings about pressing concerns. Males who received the story intervention used more positive emotion and less past-tense words than adolescent males with standard care. Females used more social words (p < .01) in their writings regardless of intervention group. ^ Conclusion. SCC enhanced adolescent disclosure during an urgent care visit. Adolescents will talk to health care providers during episodic visits and males may benefit more than girls may from this approach. Evidence suggests there is value in attending to both presenting and pressing concerns of adolescents. ^

A study to determine the association between medical decision-making and the performance of an institutional ethics committee

This study developed proxy measures to test the independent effects of medical specialty, institutional ethics committee (IEC) and the interaction between the two, upon a proxy for the dependent variable of the medical decision to withhold/withdraw care for the dying--the resuscitation index (R-index). Five clinical vignettes were constructed and validated to convey the realism and contextual factors implicit in the decision to withhold/withdraw care. A scale was developed to determine the range of contact by an IEC in terms of physician knowledge and use of IEC policy.^ This study was composed of a sample of 215 physicians in a teaching hospital in the Southwest where proxy measures were tested for two competing influences, medical specialty and IEC, which alternately oppose and support the decision to withhold/withdraw care for the dying. A sub-sample of surgeons supported the hypothesis that an IEC is influential in opposing the medical training imperative to prolong life.^ Those surgeons with a low IEC score were 326 percent more likely to continue care than were surgeons with a high IEC score when compared to all other specialties. IEC alone was also found to significantly predict the decision to withhold/withdraw care. Interaction of IEC with the specialty of surgery was found to be the best predictor for a decision to withhold/withdraw care for the dying. ^

MEASURING THE EFFECT OF ILLNESS ON THE EXPECTED REMAINING SERVICE TIME FOR THE ACTIVE DUTY ARMY: A LIFE TABLE APPROACH

A life table methodology was developed which estimates the expected remaining Army service time and the expected remaining Army sick time by years of service for the United States Army population. A measure of illness impact was defined as the ratio of expected remaining Army sick time to the expected remaining Army service time. The variances of the resulting estimators were developed on the basis of current data. The theory of partial and complete competing risks was considered for each type of decrement (death, administrative separation, and medical separation) and for the causes of sick time.^ The methodology was applied to world-wide U.S. Army data for calendar year 1978. A total of 669,493 enlisted personnel and 97,704 officers were reported on active duty as of 30 September 1978. During calendar year 1978, the Army Medical Department reported 114,647 inpatient discharges and 1,767,146 sick days. Although the methodology is completely general with respect to the definition of sick time, only sick time associated with an inpatient episode was considered in this study.^ Since the temporal measure was years of Army service, an age-adjusting process was applied to the life tables for comparative purposes. Analyses were conducted by rank (enlisted and officer), race and sex, and were based on the ratio of expected remaining Army sick time to expected remaining Army service time. Seventeen major diagnostic groups, classified by the Eighth Revision, International Classification of Diseases, Adapted for Use In The United States, were ranked according to their cumulative (across years of service) contribution to expected remaining sick time.^ The study results indicated that enlisted personnel tend to have more expected hospital-associated sick time relative to their expected Army service time than officers. Non-white officers generally have more expected sick time relative to their expected Army service time than white officers. This racial differential was not supported within the enlisted population. Females tend to have more expected sick time relative to their expected Army service time than males. This tendency remained after diagnostic groups 580-629 (Genitourinary System) and 630-678 (Pregnancy and Childbirth) were removed. Problems associated with the circulatory system, digestive system and musculoskeletal system were among the three leading causes of cumulative sick time across years of service. ^

De cada labrador un soldado y de cada agricultor un propietario : Economía, sociedad y política en el ejido de la Guardia de Luján (Mercedes), 1810-1870

En la siguiente investigación analizamos uno de los aspectos menos conocidos de la historia rural bonaerense: los ejidos de los pueblos de campaña. Estos espacios se conformaron a medida que la colonización avanzaba, primero de manera espontánea y luego por iniciativa estatal, con el objetivo de asentar a los pobladores alrededor de los centros poblados y fomentar el cultivo. Así, a diferencia de otros espacios de colonización española, los ejidos constituyeron las áreas donde se establecieron los solares, las quintas y las chacras. La historiografía tradicional reparó muy poco en ellos y cuando lo hizo, fue desde una óptica que contraponía la primera parte del siglo XIX con la expansión posterior a Pavón. Dentro de esta lógica, los pueblos rurales fueron descriptos como espacios rudimentarios y sus habitantes casi no fueron tenidos en cuenta puesto que la mirada centrada en la "estancia" opacó cualquier interés sobre los labradores y pastores que habitaban en estos espacios. En contrapartida, el período posterior fue caracterizado como de despegue de la economía exportadora y desarrollo de las instituciones. Desde ese momento los poblados habrían cobrado nueva vida convirtiéndose en importantes núcleos de población incentivados por la llegada de la inmigración. Para desandar estos supuestos, estudiamos específicamente la historia del ejido de la Guardia de Luján (Mercedes) desde el momento en que se creó el fuerte hasta 1870. Cada uno de los capítulos se estructuró en torno a núcleos problemáticos generales que fueron abordados desde lo local: la propiedad, los labradores, el mercado de tierras, la estructura productiva y la construcción del estado. El estudio demuestra la imposibilidad de definir la estructura productiva de un partido completamente sin tener en cuenta a los ejidos puesto que se puede incurrir en generalizaciones erróneas. Además, el período abarcado y los temas seleccionados permitieron reconocer los cambios y continuidades que se produjeron en estos espacios durante la transición a la Argentina Moderna.

Perspectives on guidance and social inclusion in a global society

The world is changing rapidly. People today face numerous challenges in achieving a meaningful and fulfilling life. In many countries, there are enormous systemic barriers to address, such as: massive unemployment, HIV/AIDS, social disintegration, and inadequate infrastructure. One job for life is over. For many it never existed. Old metaphors and old models of career development no longer apply. New ways of thinking about careers are necessary, that take into account the context in which people are living, the reality of today's labour market, and the fact people's career-life journey contains many branching paths, barriers, and obstacles, but also allies and sources of assistance. Flexibility is important, as is keeping options open and making sure the journey is meaningful. Guidance professionals need to begin early, working with other professionals and those seeking assistance to develop attitudes that facilitate people taking charge of their own career-life paths. People need a vision for their life that will drive a purposeful approach to career-life planning and avoid floundering. Helping people achieve that direction can be most effectively accomplished when policy makers and practitioners work together to ensure that effective and accessible services are available for those who need them and when a large part of focus in on addressing the context in which marginalized people work and live.

El dispositivo saludable y la definición de la salud : El ejemplo del Plan Nacional de Vida Saludable

El Plan Nacional de Vida Saludable resulta de la composición de tres programas que alientan la producción de hábitos denominados saludables en los individuos. A ser llevado a cabo en el período 2007-2010 por el Ministerio de Salud de la Nación, no se trata de un caso único en su tipo, sino que el Plan Nacional de Vida Saludable presenta la oportunidad para meditar sobre el lugar que ocupa la salud en la sociedad contemporánea. En el contexto moderno de una transición que migra de una medicina curativa a una concepción de la medicina como ciencia eminentemente preventiva y a partir de una lectura desde el concepto de biopolítica propuesto por el filósofo francés Michel Foucault, se sugiere la existencia de un dispositivo saludable que ordena los discursos sobre la salud y produce discursos verdaderos sobre ella. La presencia de este dispositivo sería una posible explicación de la omnipresencia de la salud en la sociedad contemporánea, la preocupación constante por prolongar la vida y la instigación al autocontrol, el cuidado y el aumento de la salud en los individuos

De cada labrador un soldado y de cada agricultor un propietario : Economía, sociedad y política en el ejido de la Guardia de Luján (Mercedes), 1810-1870

En la siguiente investigación analizamos uno de los aspectos menos conocidos de la historia rural bonaerense: los ejidos de los pueblos de campaña. Estos espacios se conformaron a medida que la colonización avanzaba, primero de manera espontánea y luego por iniciativa estatal, con el objetivo de asentar a los pobladores alrededor de los centros poblados y fomentar el cultivo. Así, a diferencia de otros espacios de colonización española, los ejidos constituyeron las áreas donde se establecieron los solares, las quintas y las chacras. La historiografía tradicional reparó muy poco en ellos y cuando lo hizo, fue desde una óptica que contraponía la primera parte del siglo XIX con la expansión posterior a Pavón. Dentro de esta lógica, los pueblos rurales fueron descriptos como espacios rudimentarios y sus habitantes casi no fueron tenidos en cuenta puesto que la mirada centrada en la "estancia" opacó cualquier interés sobre los labradores y pastores que habitaban en estos espacios. En contrapartida, el período posterior fue caracterizado como de despegue de la economía exportadora y desarrollo de las instituciones. Desde ese momento los poblados habrían cobrado nueva vida convirtiéndose en importantes núcleos de población incentivados por la llegada de la inmigración. Para desandar estos supuestos, estudiamos específicamente la historia del ejido de la Guardia de Luján (Mercedes) desde el momento en que se creó el fuerte hasta 1870. Cada uno de los capítulos se estructuró en torno a núcleos problemáticos generales que fueron abordados desde lo local: la propiedad, los labradores, el mercado de tierras, la estructura productiva y la construcción del estado. El estudio demuestra la imposibilidad de definir la estructura productiva de un partido completamente sin tener en cuenta a los ejidos puesto que se puede incurrir en generalizaciones erróneas. Además, el período abarcado y los temas seleccionados permitieron reconocer los cambios y continuidades que se produjeron en estos espacios durante la transición a la Argentina Moderna.

Perspectives on guidance and social inclusion in a global society

The world is changing rapidly. People today face numerous challenges in achieving a meaningful and fulfilling life. In many countries, there are enormous systemic barriers to address, such as: massive unemployment, HIV/AIDS, social disintegration, and inadequate infrastructure. One job for life is over. For many it never existed. Old metaphors and old models of career development no longer apply. New ways of thinking about careers are necessary, that take into account the context in which people are living, the reality of today's labour market, and the fact people's career-life journey contains many branching paths, barriers, and obstacles, but also allies and sources of assistance. Flexibility is important, as is keeping options open and making sure the journey is meaningful. Guidance professionals need to begin early, working with other professionals and those seeking assistance to develop attitudes that facilitate people taking charge of their own career-life paths. People need a vision for their life that will drive a purposeful approach to career-life planning and avoid floundering. Helping people achieve that direction can be most effectively accomplished when policy makers and practitioners work together to ensure that effective and accessible services are available for those who need them and when a large part of focus in on addressing the context in which marginalized people work and live.

El dispositivo saludable y la definición de la salud : El ejemplo del Plan Nacional de Vida Saludable

El Plan Nacional de Vida Saludable resulta de la composición de tres programas que alientan la producción de hábitos denominados saludables en los individuos. A ser llevado a cabo en el período 2007-2010 por el Ministerio de Salud de la Nación, no se trata de un caso único en su tipo, sino que el Plan Nacional de Vida Saludable presenta la oportunidad para meditar sobre el lugar que ocupa la salud en la sociedad contemporánea. En el contexto moderno de una transición que migra de una medicina curativa a una concepción de la medicina como ciencia eminentemente preventiva y a partir de una lectura desde el concepto de biopolítica propuesto por el filósofo francés Michel Foucault, se sugiere la existencia de un dispositivo saludable que ordena los discursos sobre la salud y produce discursos verdaderos sobre ella. La presencia de este dispositivo sería una posible explicación de la omnipresencia de la salud en la sociedad contemporánea, la preocupación constante por prolongar la vida y la instigación al autocontrol, el cuidado y el aumento de la salud en los individuos

Perspectives on guidance and social inclusion in a global society

The world is changing rapidly. People today face numerous challenges in achieving a meaningful and fulfilling life. In many countries, there are enormous systemic barriers to address, such as: massive unemployment, HIV/AIDS, social disintegration, and inadequate infrastructure. One job for life is over. For many it never existed. Old metaphors and old models of career development no longer apply. New ways of thinking about careers are necessary, that take into account the context in which people are living, the reality of today's labour market, and the fact people's career-life journey contains many branching paths, barriers, and obstacles, but also allies and sources of assistance. Flexibility is important, as is keeping options open and making sure the journey is meaningful. Guidance professionals need to begin early, working with other professionals and those seeking assistance to develop attitudes that facilitate people taking charge of their own career-life paths. People need a vision for their life that will drive a purposeful approach to career-life planning and avoid floundering. Helping people achieve that direction can be most effectively accomplished when policy makers and practitioners work together to ensure that effective and accessible services are available for those who need them and when a large part of focus in on addressing the context in which marginalized people work and live.

El dispositivo saludable y la definición de la salud : El ejemplo del Plan Nacional de Vida Saludable

El Plan Nacional de Vida Saludable resulta de la composición de tres programas que alientan la producción de hábitos denominados saludables en los individuos. A ser llevado a cabo en el período 2007-2010 por el Ministerio de Salud de la Nación, no se trata de un caso único en su tipo, sino que el Plan Nacional de Vida Saludable presenta la oportunidad para meditar sobre el lugar que ocupa la salud en la sociedad contemporánea. En el contexto moderno de una transición que migra de una medicina curativa a una concepción de la medicina como ciencia eminentemente preventiva y a partir de una lectura desde el concepto de biopolítica propuesto por el filósofo francés Michel Foucault, se sugiere la existencia de un dispositivo saludable que ordena los discursos sobre la salud y produce discursos verdaderos sobre ella. La presencia de este dispositivo sería una posible explicación de la omnipresencia de la salud en la sociedad contemporánea, la preocupación constante por prolongar la vida y la instigación al autocontrol, el cuidado y el aumento de la salud en los individuos

Simulated agricultural subsistence, timing of transition, and percentage of immigrant farmers

Farming and herding were introduced to Europe from the Near East and Anatolia; there are, however, considerable arguments about the mechanisms of this transition. Were it the people who moved and either outplaced, or admixed with, the indigenous hunter-gatherer groups? Or was it material and information that moved---the Neolithic Package---consisting of domesticated plants and animals and the knowledge of their use? The latter process is commonly referred to as cultural diffusion and the former as demic diffusion. Despite continuous and partly combined efforts by archaeologists, anthropologists, linguists, palaeontologists and geneticists, a final resolution of the debate has not yet been reached. In the present contribution we interpret results from the Global Land Use and technological Evolution Simulator (GLUES). GLUES is a mathematical model for regional sociocultural development, embedded in the geoenvironmental context, during the Holocene. We demonstrate that the model is able to realistically hindcast the expansion speed and the inhomogeneous space-time evolution of the transition to agropastoralism in western Eurasia. In contrast to models that do not resolve endogenous sociocultural dynamics, our model describes and explains how and why the Neolithic advanced in stages. We uncouple the mechanisms of migration and information exchange and also of migration and the spread of agropastoralism. We find that: (1) An indigenous form of agropastoralism could well have arisen in certain Mediterranean landscapes, but not in Northern and Central Europe, where it depended on imported technology and material. (2) Both demic diffusion by migration and cultural diffusion by trade may explain the western European transition equally well. (3) Migrating farmers apparently contribute less than local adopters to the establishment of agropastoralism. Our study thus underlines the importance of adoption of introduced technologies and economies by resident foragers.

Agricultural Policies and Development of Myanmar's Agricultural Sector: An Overview

This paper reviews the development of the agricultural sector in Myanmar after the transition to an open economy in 1988 and analyzes the nature as well as the performance of the agricultural sector. The avoidance of social unrest and the maintenance of control by the regime are identified as the two key factors that have determined the nature of agricultural policy after 1988. A major consequence of agricultural policy has been a clear difference in development paths among the major crops. Production of crops that had a potential for development showed sluggish growth due to policy constraints, whereas there has been a self-sustaining increase in the output of those crops that have fallen outside the remit of agricultural policy.

Stunted and Distorted Industrialization in Myanmar

More than 15 years have passed since Myanmar embarked on its transition from a centrally planned economy to a market-oriented one. The purpose of this paper is to provide a bird-eye's view of industrial changes from the 1990s up to 2005. The industrial sector showed a preliminary development in the first half of the 1990s due to an "open door" policy and liberalization measures. However, a brief period of growth failed to effect any changes in the economic fundamentals. The industrial sector still suffers from poor power supplies, limited access to imported raw materials and machinery, exchange rate instability, limited credit, and frequent changes of government regulation. Public ownership is still high in key infrastructure sectors, and has failed to provide sufficient services to private industries. What the government must do first is to get the fundamentals right.

Sustainable Development and Poverty Reduction under Mubarak's Program

This paper describes and analyzes the major features of economic development and poverty reduction in Egypt during its transition to a market Economy. It focuses on the changes in the situation of poverty and economic policies pursued as remedies by the government of Egypt and the ruling NDP. Sustainable development and poverty reduction is the core of the President Mubarak’s election campaign for his fifth term for the presidency. We attempt to explain the obstacles encountered by the Egyptian economy in terms of adjustments and general economic arguments on poverty. Finally, we refer to the necessity for enhanced accountability in the society to accomplish the goal.