L'utilizzo dei casi di studio per favorire l'apprendimento di metodologie e strumenti per lo sviluppo organizzativo o di percorsi di cura nelle aziende sanitarie

La formazione, in ambito sanitario, è considerata una grande leva di orientamento dei comportamenti, ma la metodologia tradizionale di formazione frontale non è la più efficace, in particolare nella formazione continua o “long-life education”. L’obiettivo primario della tesi è verificare se l’utilizzo della metodologia dello “studio di caso”, di norma utilizzata nella ricerca empirica, può favorire, nel personale sanitario, l’apprendimento di metodi e strumenti di tipo organizzativo-gestionale, partendo dalla descrizione di processi, decisioni, risultati conseguiti in contesti reali. Sono stati progettati e realizzati 4 studi di caso con metodologia descrittiva, tre nell’Azienda USL di Piacenza e uno nell’Azienda USL di Bologna, con oggetti di studio differenti: la continuità di cura in una coorte di pazienti con stroke e l’utilizzo di strumenti di monitoraggio delle condizioni di autonomia; l’adozione di un approccio “patient-centred” nella presa in carico domiciliare di una persona con BPCO e il suo caregiver; la percezione che caregiver e Medici di Medicina Generale o altri professionisti hanno della rete aziendale Demenze e Alzheimer; la ricaduta della formazione di Pediatri di Libera Scelta sull’attività clinica. I casi di studio sono stati corredati da note di indirizzo per i docenti e sono stati sottoposti a quattro referee per la valutazione dei contenuti e della metodologia. Il secondo caso è stato somministrato a 130 professionisti sanitari all’interno di percorso di valutazione delle competenze e dei potenziali realizzato nell’AUSL di Bologna. I referee hanno commentato i casi e gli strumenti di lettura organizzativa, sottolineando la fruibilità, approvando la metodologia utilizzata, la coniugazione tra ambiti clinico-assistenziali e organizzativi, e le teaching note. Alla fine di ogni caso è presente la valutazione di ogni referee.

The Charity and the Poverty

At the end of the middle Ages, financial savings institutions developed, largely in response to the increasingly usurious money-lending practices of the Jews and to the adaptation of church authorities to the by then well developed commercial and financial operations. It was the Franciscan Order that took the initiative to develop such institutions, first in Italy and later in other western European Mediterranean towns. These were the so-called Monte di Pieta, which lent money at low rates of interest taking objects in pawn as security. However, as they had to operate with circulating capital and on the principles of savings banks, they may be considered to be the predecessors of modern banks. Although charity was declared in the very names of these institutions, this was no longer in the sense of the medieval mercy towards the virtuous poor, but more a support for impoverished members of higher social strata, as loan applicants had to place valuable movable property in pawn, meaning that they first had to possess such property. In spite of this, the institutions had the character of the primeval accumulation of capital, although not so much for individuals as for a community or, in the latter's name, for a commune, i.e. the local authority, which at least in the cases of Koper and Piran was also the founder. However, the stagnation of trade with the hinterland and the decline in the economic power of the Venetian Republic, particularly in the late 17th and early 18th centuries, pushed pawnshops into a more miserable existence, with ups and downs linked with the irregularities of profit-making on behalf of the institution, particularly by its clerks.

Parental Responsibility

Parental responsibility can be broadly defined as a legal term that specifies rights and responsibilities of parents towards their children. It is usually given initially to the birth mother and the married father, though unmarried fathers can obtain it either with the agreement of the mother or through a court order. In accordance with the provisions in law the court can also transfer parental responsibility to other persons (e.g. adoptive parents) or in cases of child abuse or neglect to the state, represented by local authority social services. While the concept of parental responsibility can be found in most countries, the exact terminology varies from one country to another, as well as over time.

NakInfo online: Developer's manual

The Local Urban Observatory in Nakuru (LUO, Kenya 2003) has developed a progressive and to date unique electronic information service called NakInfo. The objective of LUO is to make residents aware of public services delivery by their Local Authority, in this case the Municipal Council of Nakuru, and give them a voice in achieving improved quality of life. NakInfo facilitates community participation in local government business and demonstrates how to implement such participation in a developing country. The LUO project was formally initiated by the Municipal Council of Nakuru in January 2003, in collaboration with the Centre for Development and Environment (CDE) of the University of Berne (Switzerland) with funding from the Swiss Agency for Development and Cooperation (SDC).

Prácticas defensivas, conflictos y autoridades en la frontera bonaerense.Los pagos de Magdalena y Pergamino (1752-1780)

Este trabajo ahonda en el funcionamiento de la frontera bonaerense a partir del análisis de distintas Comandancias de Fronteras, principalmente las ubicadas en los pagos de Pergamino al norte y Magdalena al sur de la jurisdicción, haciendo hincapié en la articulación generada entre las fuerzas militares regulares y los cuerpos milicianos para llevar a cabo la práctica defensiva. El recorte temporal (1752-1780) contempla desde la puesta en funcionamiento de las Comandancias hasta las reformas defensivas efectuadas por el Virrey Vértiz, que trastocaron algunos rasgos básicos de nuestro objeto de estudio. Nos interesa conocer la formación de tal frontera, las prácticas concretas que le daban vida, los sujetos sociales que emergieron en este proceso y los conflictos que protagonizaron. Seguimos las trayectorias de los Sargentos Mayores de Milicias -en especial, Diego Trillo en Pergamino y Clemente López Osornio en Magdalena- como ejemplos de una forma de autoridad local resultante de la legitimidad que proveía el ejercicio de la "defensa".

Prácticas defensivas, conflictos y autoridades en la frontera bonaerense.Los pagos de Magdalena y Pergamino (1752-1780)

Este trabajo ahonda en el funcionamiento de la frontera bonaerense a partir del análisis de distintas Comandancias de Fronteras, principalmente las ubicadas en los pagos de Pergamino al norte y Magdalena al sur de la jurisdicción, haciendo hincapié en la articulación generada entre las fuerzas militares regulares y los cuerpos milicianos para llevar a cabo la práctica defensiva. El recorte temporal (1752-1780) contempla desde la puesta en funcionamiento de las Comandancias hasta las reformas defensivas efectuadas por el Virrey Vértiz, que trastocaron algunos rasgos básicos de nuestro objeto de estudio. Nos interesa conocer la formación de tal frontera, las prácticas concretas que le daban vida, los sujetos sociales que emergieron en este proceso y los conflictos que protagonizaron. Seguimos las trayectorias de los Sargentos Mayores de Milicias -en especial, Diego Trillo en Pergamino y Clemente López Osornio en Magdalena- como ejemplos de una forma de autoridad local resultante de la legitimidad que proveía el ejercicio de la "defensa".

Prácticas defensivas, conflictos y autoridades en la frontera bonaerense.Los pagos de Magdalena y Pergamino (1752-1780)

Este trabajo ahonda en el funcionamiento de la frontera bonaerense a partir del análisis de distintas Comandancias de Fronteras, principalmente las ubicadas en los pagos de Pergamino al norte y Magdalena al sur de la jurisdicción, haciendo hincapié en la articulación generada entre las fuerzas militares regulares y los cuerpos milicianos para llevar a cabo la práctica defensiva. El recorte temporal (1752-1780) contempla desde la puesta en funcionamiento de las Comandancias hasta las reformas defensivas efectuadas por el Virrey Vértiz, que trastocaron algunos rasgos básicos de nuestro objeto de estudio. Nos interesa conocer la formación de tal frontera, las prácticas concretas que le daban vida, los sujetos sociales que emergieron en este proceso y los conflictos que protagonizaron. Seguimos las trayectorias de los Sargentos Mayores de Milicias -en especial, Diego Trillo en Pergamino y Clemente López Osornio en Magdalena- como ejemplos de una forma de autoridad local resultante de la legitimidad que proveía el ejercicio de la "defensa".

A paralysis in public health policy: water fluoridation in Queensland (1996-2006)

By focusing on developments between 1996 and 2006, this paper explains the reasons for one of Australia’s public health inconsistencies, the comparatively low adoption of adjusted water fluoridation in Queensland. As such, this work involved literature review and traditional historical method. In Queensland, parliamentary support for water fluoridation is conditional on community approval. Political ambivalence and the constraints of the “Fluoridation of Public Water Supplies Act (1963)” Qld have hindered the advocacy of water fluoridation. The political circumstance surrounding the “Lord Mayor’s Taskforce on Fluoridation Report” (1997) influenced its findings and confirms that Australia’s biggest local authority, the Brisbane City Council, failed to authoritatively analyse water fluoridation. In 2004, a private member’s bill to mandate fluoridation failed in a spectacular fashion. In 2005, an official systems review of Queensland Health recommended public debate about water fluoridation. Our principal conclusion is that without mandatory legislation, widespread implementationof water fluoridation in Queensland is most unlikely.

Odour pollution problems within the district of the Wrekin council

This thesis is concerned with various aspects of Air Pollution due to smell, the impact it has on communities exposed to it, the means by which it may be controlled and the manner in which a local authority may investigate the problems it causes. The approach is a practical one drawing on examples occurring within a Local Authority's experience and for that reason the research is anecdotal and is not a comprehensive treatise on the full range of options available. Odour Pollution is not yet a well organised discipline and might be considered esoteric as it is necessary to incorporate elements of science and the humanities. It has been necessary to range widely across a number of aspects of the subject so that discussion is often restricted but many references have been included to enable a reader to pursue a particular point in greater depth. In a `fuzzy' subject there is often a yawning gap separating theory and practice, thus case studies have been used to illustrate the interplay of various disciplines in resolution of a problem. The essence of any science is observation and measurement. Observation has been made of the spread of odour pollution through a community and also of relevant meterological data so that a mathematical model could be constructed and its predictions checked. It has been used to explore the results of some options for odour control. Measurements of odour perception and human behaviour seldom have the precision and accuracy of the physical sciences. However methods of social research enabled individual perception of odour pollution to be quantified and an insight gained into reaction of a community exposed to it. Odours have four attributes that can be measured and together provide a complete description of its perception. No objective techniques of measurement have yet been developed but in this thesis simple, structured procedures of subjective assessment have been improvised and their use enabled the functioning of the components of an odour control system to be assessed. Such data enabled the action of the system to be communicated using terms that are understood by a non specialist audience.

The development of a regional energy assessment model

Shropshire Energy Team initiated this study to examine consumption and associated emissions in the predominantly rural county of Shropshire. Current use of energy is not sustainable in the long term and there are various approaches to dealing with the environmental problems it creates. Energy planning by a local authority for a sustainable future requires detailed energy consumption and environmental information. This information would enable target setting and the implementation of policies designed to encourage energy efficiency improvements and exploitation of renewable energy resources. This could aid regeneration strategies by providing new employment opportunities. Associated reductions in carbon dioxide and other emissions would help to meet national and international environmental targets. In the absence of this detailed information, the objective was to develop a methodology to assess energy consumption and emissions on a regional basis from 1990 onwards for all local planning authorities. This would enable a more accurate assessment of the relevant issues, such that plans are more appropriate and longer lasting. A first comprehensive set of data has been gathered from a wide range of sources and a strong correlation was found between population and energy consumption for a variety of regions across the UK. In this case the methodology was applied to the county of Shropshire to give, for the first time, estimates of primary fuel consumption, electricity consumption and associated emissions in Shropshire for 1990 to 2025. The estimates provide a suitable baseline for assessing the potential contribution renewable energy could play in meeting electricity demand in the country and in reducing emissions. The assessment indicated that in 1990 total primary fuel consumption was 63,518,018 GJ/y increasing to 119,956,465 GJ/y by 2025. This is associated with emissions of 1,129,626 t/y of carbon in 1990 rising to 1,303,282 t/y by 2025. In 1990, 22,565,713 GJ/y of the primary fuel consumption was used for generating electricity rising to 23,478,050 GJ/y in 2025. If targets to reduce primary fuel consumption are reached, then emissions of carbon would fall to 1,042,626 by 2025, if renewable energy targets were also reached then emissions of carbon would fall to 988,638 t/y by 2025.

A systems approach to public sector budgeting: the case of the planning, programming, budgeting system for the health and personal social services

The aim of this thesis is to examine the specific contextual factors affecting the applicability and development of the planning, programming, budgeting system (P.P.B.S.) as a systems approach to public sector budgeting. The concept of P.P.B.S. as a systems approach to public sector budgeting will first be developed and the preliminary hypothesis that general contextual factors may be classified under political, structural and cognitive headings will be put forward. This preliminary hypothesis will be developed and refined using American and early British experience. The refined hypothesis will then be tested in detail in the case of the English health and personal social services (H.P.S.S.), The reasons for this focus are that it is the most recent, the sole remaining, and the most significant example in British central government outside of defence, and is fairly representative of non-defence government programme areas. The method of data collection relies on the examination of unpublished and difficult to obtain central government, health and local authority documents, and interviews with senior civil servants and public officials. The conclusion will be that the political constraints on, or factors affecting P.P.B.S., vary with product characteristics and cultural imperatives on pluralistic decision-making; that structural constraints vary with the degree of coincidence of programme and organisation structure and with the degree of controllability of the organisation; and finally, that cognitive constraints vary according to product characteristics, organisational responsibilities, and analytical effort.

Environmental quality in residential areas : a social survey approach to improvement priorities

The research is concerned with the measurement of residents' evaluations of the environmental quality of residential areas. The research reflects the increased attention being given to residents' values in planning decisions affecting the residential environment. The work was undertaken in co-operation with a local authority which was in the process of revising its housing strategy, and in particular the priorities for improvement action. The study critically examines the existing evidence on environmental values and their relationship to the environment and points to a number of methodological and conceptual deficiencies. The research strategy developed on the basis of the research review was constrained by the need to keep any survey methods simple so that they could easily be repeated, when necessary, by the sponsoring authority. A basic perception model was assumed, and a social survey carried out to measure residents' responses to different environmental conditions. The data was only assumed to have ordinal properties, necessitating the extensive use of non-parametric statistics. Residents' expressions of satisfaction with the component elements of the environment (ranging from convenience to upkeep and privacy) were successfully related to 'objective' measures of the environment. However the survey evidence did not justify the use of the 'objective' variables as environmental standards. A method of using the social survey data directly as an aid to decision-making is discussed. Alternative models of the derivation of overall satisfaction with the environment are tested, and the values implied by the additive model compared with residents' preferences as measured directly in the survey. Residents' overall satisfactions with the residential environment were most closely related to their satisfactions with the "Appearance" and the "Reputation" of their areas. By contrast the most important directly measured preference was "Friendliness of area". The differences point to the need to define concepts used in social research clearly in operational terms, and to take care in the use of values 'measured' by different methods.

Structural limits and teachers' perspectives

This thesis is about the relationship between schooling and the economic and political structures which constrain its institutional framework. It focusses on teachers, as mediators of structural constraints, and on middle schools, as institutions which occupy a functionally transitional place between the primary and secondary traditions. In approaching the problem of linking the different perspectives of macro and micro sociologies, I argue the view that the individual mediates the contradictions between the socially cooperative processes of production and the competitive individualism which legitimates the private appropriation of wealth and income. The link is observable in the schooling process as a pattern of contradictions and tensions mediated by the rhetoric of equality of opportunity. In order to elucidate the link, the processes within the boundaried institutions must be viewed in the context of those changing tensions within the state administrative systems, which reverberate into schools as economic and political constraints. Framed within the ideology of the Flowden Report (1967), middle schooling was set within a discourse which stressed cooperative relationships rather than competitive standards. Since the mid-1970s, administrative policies have heightened the competitive battle for declining resources and attacked the Plowden ideology. Focussing the fieldwork on six middle schools in one local authority, T use an eclectic methodology to relate economic and political policies, generated in the state administrative system, to the situation in the schools between 1979 and 1981. The methodology incorporates a time dimension in order to highlight the tensions as they play upon teachers' changing definitions of the changing situation. I conclude that the intersubjective socio-cultural relations of schooling cannot be properly explained without making explicit the changing tensions in the rule/resource relationships which teachers mediate through their particular institutions.

Community involvement in urban nature conservation : case studies of the Urban Wildlife Group 1980-85

The effectiveness of the strategies employed by the Urban Wildlife Group (a voluntary conservation organisation) to provide and manage three urban nature parks has been evaluated, using a multiple methods methodology. Where the level of community interest and commitment to a project is high, the utilisation of the community nature park strategy (to maximise benefits to UWG and the community) is warranted. Where the level of interest and commitment of the local community is low, a strategy designed to encourage limited involvement of the community is most effective and efficient. The campaign strategy, whereby the community and UWG take direct action to oppose a threat of undesirable development on a nature park, is assessed to be a sub-strategy, rather than a strategy in its own right. Questionnaire surveys and observations studies have revealed that urban people appreciate and indeed demand access to nature parks in urban areas, which have similar amenity value to that provided by countryside recreation sites. Urban nature parks are valued for their natural character, natural features (trees, wild flowers) peace and quiet, wildlife and openness. People use these sites for a mixture of informal and mainly passive activities, such as walking and dog walking. They appear to be of particular value to children for physical and imaginative play. The exact input of time and resources that UWG has committed to the projects has depended on the level of input of the local authority. The evidence indicates that the necessary technical expertise needed to produce and manage urban nature parks, using a user-oriented approach is not adequately provided by local authorities. The methods used in this research are presented as an `evaluation kit' that may be used by practitioners and researchers to evaluate the effectiveness of a wide range of different open spaces and the strategies employed to provide and manage them.

Planning for cycling in the West Midlands

The issues involved in planning for pedal cyclists are examined with reference to the West Midlands County. Working with a local cycling campaign group, the researcher uses action research methods to investigate and influence the campaign. Development of cycle planning is traced through the literature, focusing on bicycle ownership, bicycle use and cycling policy. UK practice is contrasted with the integrated approach of other countries. An extensive bibliography is provided. Local authority cycle planning through the TPP process is systematically assessed over three years. This provides a context for the information regarding cycling in the West Midlands. Existing data is presented from the 1981 Census and local police road accident and bicycle theft records. The developing relationship between the local authority and the cycle campaign group is narrated in detail, explaining the problems that can beset efforts to improve conditions for cyclists. The researcher was closely involved in this interaction, particularly with policy and a major public inquiry. A survey of the Cycle Campaign Network indicates that the local group was not atypical. To provide information relevant to the local campaign and for effective local planning, a survey of 3,500 West Midlands residents was conducted using a novel combination of questionnaires and interviews. It shows that 1) Bicycle ownership and use is considerably higher than indicated by the 1978/9 National Travel Survey 2) Cycling is most import to certain disadvantaged sections of the community, particularly the young, those without access to a car and in the lower SEGs. The broader issues of transport policy are discussed, concluding that cycling is regarded as a marginal activity and that changes in general transport policy, land use planning and fiscal arrangements are necessary conditions for cycle planning to succeed. An integrated package of cycling measures involving engineering, education, enforcement and encouragement is also required. Recommendations are made concerning central government, local authorities and cycle campaign groups. Subjects for further research are identified.