Équité d’utilisation des services de santé et de disponibilité des ressources en matière de santé dans la province de Québec

Objectif : L’objectif général de cette étude est de comprendre en quoi l’utilisation des services de santé et de disponibilité des ressources en santé au Québec sont équitables. Méthodes : De type transversal et corrélationnel, cette étude intéresse les 95 territoires CSSS du Québec, et couvre les années 2006-2007 et 2008-2009. L’indice de défavorisation matérielle et sociale de Pampalon est mis en lien avec deux séries de variables, soit celles d’utilisation des services par CSSS (services hospitaliers; services médicaux; services CLSC) et celles de disponibilité des ressources (capacité financière; capacité matérielle, capacité humaine; viabilité). Pour ce faire, des analyses de variance ont été effectuées. Le modèle intégrateur de la performance des services de santé EGIPSS et celui de l’utilisation des services de santé de Donabedian servent de cadre d’analyse. Résultats : L’utilisation des services de santé est équitable en ce qui concerne la défavorisation matérielle, mais pas en ce qui a trait à la défavorisation sociale. L’utilisation des services médicaux dispensés par les omnipraticiens est plus élevée chez les populations les plus favorisées socialement comparativement aux populations les plus défavorisées. Toutefois, l’utilisation des médecins spécialistes est plus équitable que celle des omnipraticiens, cela, chez les populations défavorisées autant matériellement que socialement. Les hospitalisations évitables sont plus élevées chez les populations les défavorisées socialement comparativement aux populations les plus favorisées. En termes de disponibilité des ressources, les populations défavorisées disposent de plus de ressources que les plus favorisées, sauf en ce qui concerne la répartition du personnel. Conclusion : En général, il existe très peu d’iniquités dans l’utilisation des services de santé au Québec. Par ailleurs, la disponibilité des ressources en santé est relativement équitable au Québec, exception faite de la disponibilité du personnel.

Mobilités de travail et (re)construction des rapports sociaux au sein d’une communauté Hmong de Chine (province du Guizhou)

La mobilité rurale-urbaine est sans contredit l’un des phénomènes les plus marquants que la Chine a connus depuis ses réformes des années 1980. D’une ampleur colossale, elle a constitué un fondement essentiel de sa transition et de son développement économiques. Or, si l’impact social de cette mobilité a été abondamment étudié dans les villes où séjournent les paysans, il demeure peu connu dans leur communauté d’origine, et encore moins en contexte de « nationalité minoritaire ». Reposant sur une enquête de terrain de plus d’une année, cette thèse en géographie sociale examine la (re)construction sociale dans une communauté rurale et minoritaire (c.àd. Hmong ou Miao) de Chine en lien avec le phénomène de la mobilité de travail. D’une intensité croissante, la pratique de la mobilité de travail par les membres de cette communauté est double. Les migrants sont soit des herboristes ambulants dans les villes de l’espace régional, soit des travailleurs salariés dans les villes orientales du pays. L’utilisation d’une approche du changement social intégrant les sphères du réel et de l’imagination et prenant en compte les dimensions territoriale et économique du phénomène migratoire est originale. De même, l’importance égale portée aux discours et aux actions des migrants et des non-migrants dans le processus de transformation sociale se veut novatrice. Dans ses résultats, cette thèse fait état, premièrement, d’une refonte des logiques territoriales et économiques de la communauté étudiée sous l’effet du phénomène migratoire. De toute évidence, les fondements géographiques de son territoire se sont récemment complexifiés et multipliés. Désormais, une variété de lieux, de frontières, de réseaux sociaux et d’échelles se dessine dans les configurations territoriales de ses membres. Les implications économiques sont tout aussi patentes. Outre la forte dominance des transferts d’argent des migrants dans les budgets familiaux, les questions du développement et des inégalités aux différentes échelles de la communauté renvoient aujourd’hui essentiellement au fait migratoire. Deuxièmement, cette thèse montre la forte empreinte laissée par la mobilité dans la sphère sociale. Nécessitant soutien aux extrémités de leur parcours, les migrants sollicitent de plus en plus l’aide de leurs réseaux lignagers, claniques, villageois et matrilinéaires. Et dans ce processus, il n’est pas rare qu’ils enfreignent consciemment les principes hiérarchiques traditionnels de leurs rapports familiaux. Aussi, au travers de la mobilité, des groupes longtemps marginalisés, tels les femmes et les jeunes adultes, ont acquis estime, autonomie et pouvoir décisionnel. Parallèlement, l’ordre social s’est bouleversé. Ce n’est plus le volume de la production agricole, mais le nombre de travailleurs migrants qui détermine aujourd’hui les différentes classes sociales de la communauté. Finalement, dans le contexte plus large des populations rurales et minoritaires de Chine et du Massif sud-est asiatique, cette thèse fait ressortir l’importance d’aborder la question de l’impact social de la mobilité au-delà des paradigmes de la modernisation et de l’intégration. Contrairement à la plupart des écrits touchant à cette question, il ne suffit pas de porter le regard sur l’influence que les urbains et leur mode de vie soi-disant moderne exercent sur les migrants. Il est également nécessaire de reconnaître les capacités d’initiative et d’innovation sociale des membres de ces populations, migrants et non-migrants. Mais aussi, cette recherche démontre que la question identitaire se doit d’être prise en compte. Les sentiments de marginalité et de subordination demeurent vivaces au travers du phénomène migratoire. Et de tels sentiments semblent se traduire, le plus souvent, par un renforcement des liens sociaux et intracommunautaires au sein même de ces populations minoritaires.

Identifying the component structure of job satisfaction by principal components analysis among extension officers in North West Province, South Africa

The component structure of a 34-item scale measuring different aspects of job satisfaction was investigated among extension officers in North West Province, South Africa. A simple random sampling technique was used to select 40 extension officers from which data were collected. A structured questionnaire consisting of 34 job satisfaction and 10 personal characteristic items was administered to the extension officers. Items on job satisfaction were measured at interval level and analyzedwith Principal ComponentAnalysis. Most of the respondents (82.5%) weremales, between 40 to 45 years, 85% were married and 87.5% had a diploma as their educational qualification. Furthermore, 54% of the households size between 4 to 6 persons, whereas 75% were Christians. The majority of the extension officers lived in their job area (82.5), while 80% covered at least 3 communities and 3 farmer groups. In terms of number of farmers covered, only 40% of the extension officers covered more than 500 farmers and 45% travelled more than 40 km to reach their farmers. From the job satisfaction items 9 components were extracted to show areas for job satisfaction among extension officers. These were in-service training, research policies, communicating recommended practices, financial support for self and family, quality of technical help, opportunity to advance education, management and control of operations, rewarding system and sanctions. The results have several implications for motivating extension officers for high job performance especially with large number of clients and small number of extension agents.

Soil fertility and nutrient status of traditional Gayo coffee agroforestry systems in the Takengon region, Aceh Province, Indonesia

Little is known about the traditional coffee cultivation systems in Central Aceh, Indonesia, where coffee production is a major source of income for local Gayo people. Based on field observations and farmer interviews, 14 representative agroforestry coffee plantations of different age classes (60-70 years, 30-40 years, and 20 years) as well as seven adjacent grassland and native forest sites were selected for this study, and soil and coffee leaf samples collected for nutrient analysis. Significant differences in soil and coffee leaf parameters were found between former native forest and Sumatran pine (Pinus merkusii) forest as previous land cover indicating the importance of the land use history for today’s coffee cultivation. Soil pH as well as exchangeable Na and Ca concentrations were significantly lower on coffee plantations compared to grassland and forest sites. Soil C, N, plant available P, exchangeable K, and Mg concentrations showed no consistent differences between land use groups. Nitrogen (N), phosphorus (P), and potassium (K) concentrations of coffee leaves were in the sufficiency range, whereas zinc (Zn) contents were found to be consistently below the sufficiency threshold and significantly lower in coffee plantations of previous pine forest cover compared to those of previous native forest cover. While the results of this study provided insights into the nutrient status of coffee plantations in Central Aceh, the heterogeneity of site conditions, limited sampling size, and scarcity of reliable data about the land use history and initial soil conditions of sampled sites preclude more definitive conclusions about the sustainability of the studied systems.

Swamp buffalo keeping – an out-dated farming activity? A case study in smallholder farming systems in Xishuangbanna, Yunnan Province, PR China

Expansion of rubber tree plantations and agricultural mechanization caused a decline of swamp buffalo numbers in the Naban River National Nature Reserve (NRNNR), Yunnan Province, China. We analysed current use of buffaloes for field work and the recent development of the regional buffalo population, based on interviews with 184 farmers in 2007/2008 and discussions with 62 buffalo keepers in 2009. Three types of NRNNR farms were distinguished, differing mainly in altitude, area under rubber, and involvement in livestock husbandry. While pig based farms (PB; n=37) have abandoned buffalo keeping, 11% of the rubber based farms (RB; n=71) and 100% of the livestock-corn based farms (LB; n=76) kept buffaloes in 2008. Herd size was 2.5 +/-1.80 (n=84) buffaloes in early 2008 and 2.2 +/-1.69 (n=62) in 2009. Field work on own land was the main reason for keeping buffaloes (87.3 %), but lending work buffaloes to neighbours (79.0%) was also important. Other purposes were transport of goods (16.1%), buffalo trade (11.3%) and meat consumption (6.4%). Buffalo care required 6.2 +/-3.00 working hours daily, while annual working time of a buffalo was 294 +/-216.6 hours. The area ploughed with buffaloes remained constant during the past 10 years despite an expansion of land cropped per farm. Although further replacement of buffaloes by tractors occurs rapidly, buffaloes still provide cheap work force and buffer risks on poor NRNNR farms. Appropriate advice is needed for improved breeding management to increase the efficiency of buffalo husbandry and provide better opportunities for buffalo meat sale in the region.

Farmers’ desired traits and selection criteria for maize varieties and their implications for maize breeding: A case study from KwaZulu-Natal Province, South Africa

Adoption of hybrids and improved varieties has remained low in the smallholder farming sector of South Africa, despite maize being the staple food crop for the majority of households. The objective of this study was to establish preferred maize characteristics by farmers which can be used as selection criteria by maize breeders in crop improvement. Data were collected from three villages of a selected smallholder farming area in South Africa using a survey covering 300 households and participatory rural appraisal methodology. Results indicated a limited selection of maize varieties grown by farmers in the area compared to other communities in Africa. More than 97% of the farmers grew a local landrace called Natal-8-row or IsiZulu. Hybrids and improved open pollinated varieties were planted by less than 40% of the farmers. The Natal-8-row landrace had characteristics similar to landraces from eastern and southern Africa and closely resembled Hickory King, a landrace still popular in Southern Africa. The local landrace was preferred for its taste, recycled seed, tolerance to abiotic stresses and yield stability. Preferred characteristics of maize varieties were high yield and prolificacy, disease resistance, early maturity, white grain colour, and drying and shelling qualities. Farmers were willing to grow hybrids if the cost of seed and other inputs were affordable and their preferences were considered. Our results show that breeding opportunities exist for improving the farmers’ local varieties and maize breeders can take advantage of these preferred traits and incorporate them into existing high yielding varieties.

Biochar improves fertility of a clay soil in the Brazilian Savannah: short term effects and impact on rice yield

The objective of this study was to report single season effects of wood biochar (char) application coupled with N fertilization on soil chemical properties, aerobic rice growth and grain yield in a clayey Rhodic Ferralsol in the Brazilian Savannah. Char application effected an increase in soil pH, K, Ca, Mg, CEC, Mn and nitrate while decreasing Al content and potential acidity of soils. No distinct effect of char application on grain yield of aerobic rice was observed. We believe that soil properties impacted by char application were inconsequential for rice yields because neither water, low pH, nor the availability of K or P were limiting factors for rice production. Rate of char above 16 Mg ha^(−1) reduced leaf area index and total shoot dry matter by 72 days after sowing. The number of panicles infected by rice blast decreased with increasing char rate. Increased dry matter beyond the remobilization capacity of the crop, and high number of panicles infected by rice blast were the likely cause of the lower grain yield observed when more than 60 kg N ha^(−1) was applied. The optimal rate of N was 46 kg ha^(−1) and resulted in a rice grain yield above 3 Mg ha^(−1).

Agricultural Production and Yield Estimation: Two distinctive aspects of Brazilian Agriculture and a perspective on world food problems

Brazil has been increasing its importance in agricultural markets. The reasons are well known to be the relative abundance of land, the increasing technology used in crops, and the development of the agribusiness sector which allow for a fast response to price stimuli. The elasticity of acreage response to increases in expected return is estimated for Soybeans in a dynamic (long term) error correction model. Regarding yield patterns, a large variation in the yearly rates of growth in yield is observed, climate being probably the main source of this variation which result in ‘good’ and ‘bad’ years. In South America, special attention should be given to the El Niño and La Niña phenomena, both said to have important effects on rainfalls patterns and consequently in yield. The influence on El Niño and La Niña in historical data is examined and some ways of estimating the impact of climate on yield of Soybean and Corn markets are proposed. Possible implications of climate change may apply.

The Brazilian Zero Hunger social program implications in achieving sustainable development

This article aims to analyse the progress taken by Brazil towards the accomplishment of a sustainable development, mainly highlighting the success of the Zero Hunger social programme in achieving the elimination of starvation. As one of the essential pillars to the sustainable development, the State’s social performance demands actions directed to the elimination of extreme poverty and hunger, establishing a basis for equitable growth. It is necessary to clarify the juridical and constitutional framework of Brazil, aiming to emphasise the Zero Hunger importance in achieving the Brazilian Republic’s goals and reaching an international pattern on sustainable development. Also, it will be stressed that the international order influences Brazilian domestic law and is one of the main aspects for the Zero Hunger program development.

Smallholder farmers’ access to credit in the Amathole District Municipality, Eastern Cape Province, South Africa

Provision of credit has being identified as an important instrument for improving the welfare of smallholder farmers directly and for enhancing productive capacity through financing investment by the farmers in their human and physical capital. This study investigated the individual and household characteristics that influence credit market access in Amathole District Municipality, Eastern Cape Province, South Africa, using a cross sectional data from smallholder farmers’ household survey. The aim is to provide a better understanding of the households’ level socio-economic characteristics, not only because they influence household’s demand for credit but also due to the fact that potential lenders are most likely to base their assessment of borrowers’ creditworthiness on such characteristics. The results of the logistic regression suggest that credit market access was significantly influenced by variables such as gender, education, households’ income, value of assets, savings, dependency ratio, repayment capacity and social capital. Implications for rural credit delivery are discussed.

Factors affecting choice of financial services among rural consumers: Emerging experiences from Gicumbi District, northern Province in Rwanda

Enhancement of financial inclusivity of rural communities is often recognised as a key strategy for achieving economic development in third world countries. The main objective of this study was to examine the factors that influence consumers’ choice of a rural bank in Gicumbi district of Rwanda. Data was collected using structured questionnaires and analysed using a binary probit regression model and non-parametric procedures. Most consumers were aware of Popular Bank of Rwanda (BPR) and Umurenge SACCO through radio advertisements, social networks and community meetings. Accessibility, interest rates and quality of services influenced choice of a given financial intermediary. Moreover, the decision to open a rural bank account was significantly influenced by education and farm size (p<0.1). These results indicate the need for financial managers to consider these findings for successful marketing campaigns.

Familiar characteristics and received familiar support among Brazilian adolescents with and without pregnancy experience

The present paper aimed to investigate how adolescents with pregnancy experience evaluate received support from their families in comparison with an adolescent group without pregnancy experience. 452 low income adolescents, both sex, aged 14 to 19 years old answered to a questionnaire. The results revealed that more girls (64.2 %) than boys (35.8 %) declared pregnancy experience, ?2 (2, n = 2617) = 48.32, p < .001. Moreover, it was observed that the group with pregnancy experience, in comparison with other group, revealed more perception on the family relationships safety, t (408) = -3.0, p < .01; mutual respect among family members in their homes, t (392) = -2.3, p < .05; and received stronger general support from their family, t (397) = -1,3, p < .05. These results are discussed.

Interrater reliability of Alberta Infant Motor Scale in term and preterm born infants between 10 to 16 months age from Talca province - Chile

Purpose: To examine the ‘interrater reliability’ of the Alberta Infant Motor Scale (AIMS) in term and preterm born infants between 10 to 16 months age from Talca province, Maule Region - Chile. Subjects: 115 infants between 10 to 16 months age were incorporated to the study; 95 term born infants were attended in the local Health Centre in Talca City, and 20 preterm infants belonged to the Premature Infants Follow-Up Programme of Talca Regional Hospital. Methods: The motor behaviour of each infant was recorded and later it was assessed by two trained assessors using AIMS. It was obtained the total AIMS’ score and also from prone, supine, seated, and stand subscales. For ‘interrater reliability’ analysis it was used the Intraclass Coefficient of Correlation (ICC), the Standard Error of Measurement (SEM) and 95% limits of agreement. Results: The obtained ICC for the total scores AIMS were major than 0.94 (p<0.0002) for term and preterm born infants. The SEM of total scores was less than 3.1 points, higher than what was found in other similar studies. The 95% limits of agreement were +5.3 to -4.1 points and +7.7 to – 3.9 points in term and preterm born, respectively, revealing ‘interrater agreement’. Conclusion: The AIMS showed adequate ‘interrater reliable’ levels when was applied in Chilean term and preterm born from 10 to 16 month’s age.

Prevalencia de enfermedad celiaca en Latinoamérica: revisión sistemática de la literatura y meta-análisis

Introducción: La enfermedad celiaca (EC) es una enfermedad autoinmune (EA) intestinal desencadenada por la ingesta de gluten. Por la falta de información de la presencia de EC en Latinoamérica (LA), nosotros investigamos la prevalencia de la enfermedad en esta región utilizando una revisión sistemática de la literatura y un meta-análisis. Métodos y resultados: Este trabajo fue realizado en dos fases: La primera, fue un estudio de corte transversal de 300 individuos Colombianos. La segunda, fue una revisión sistemática y una meta-regresión siguiendo las guías PRSIMA. Nuestros resultados ponen de manifiesto una falta de anti-transglutaminasa tisular (tTG) e IgA anti-endomisio (EMA) en la población Colombiana. En la revisión sistemática, 72 artículos cumplían con los criterios de selección, la prevalencia estimada de EC en LA fue de 0,46% a 0,64%, mientras que la prevalencia en familiares de primer grado fue de 5,5 a 5,6%, y en los pacientes con diabetes mellitus tipo 1 fue de 4,6% a 8,7% Conclusión: Nuestro estudio muestra que la prevalencia de EC en pacientes sanos de LA es similar a la notificada en la población europea.

L'educació sanitària en un medi tancat : l'escola. 'La educación sanitaria en un contexto cerrado : la escuela'.

Entender los mecanismos sociales que posibilitan la educación para la salud, conceptualizando la manera de enfermar y de curar, para transformar la realidad. Definir el concepto de salud y de educación sanitaria. Diseñar un programa de educación sanitaria. Analizar el marco institucional dónde se desarrolla el proyecto. 1 grupo-clase de 31 alumnos de segundo grado de EGB (entre 7 y 8 años), seis de ellos integrantes de la clase de Educación Especial. Centro situado en el barrio de Horta, en Barcelona. Realiza un estudio sobre los déficits de cada niño en el area de la educación santitaria y prevención sanitaria. Se propone concienciar también el grupo de maestros en este tema, para que se fomente la estima y el respeto para el propio cuerpo y el de los demás a lo largo de la escolaridad en el centro. Realiza un análisis comparativo entre la teoria médico-pedagógica y la propia praxis en educación. Realiza una encuesta y un análisis de la misma. Emplea un cuento para prevenir la adicción a la nicotina llamado La bruixa Nicotina (La bruja Nicotina). La encuesta consta de 36 preguntas cerradas, con dos ítems posibles. El análisis de las preguntas consta de dos bloques temáticos:a) Las que hacen referencia a la educación sobre las drogas, los hábitos higiénicos, la educación dietética, la educación física, la educación en el tiempo libre, la educación ecológica y la educación sexual. Los resultados de las encuestas demuestra cómo aspectos positivos: que los niños comen solos, les gusta la fruta, tienen el hábito de lavarse los dientes bastante arraigado, se lavan las manos, les gusta leer, etc. Destaca cómo aspectos negativos acostumbran a beber refrescos para cenar, no les gusta la verdura, etc. El alumnado acoge con atención la narración del cuento, demuestra mediante dibujos que se adjunta a la memoria y que ha asimilado e interiorizado los conceptos implícitos y explícitos. Sin pretender hacer un análisis exhaustivo y general de la educación para la salud, el programa de educación para la salud aquí expuesto se adapta adecuadamente a las características de todos los alumnos del centro, debido a la contextualizcaión que se ha realizado previamente. Se propone que la educación para la salud se interiorice en la praxis de los educadores ofreciendo pautas, hábitos y puntos de referencia claros y coherentes para el alumnado.