La pertinence et les enjeux éthiques d'interventions de santé publique envers l'infertilité et l'âge maternel avancé

Des études récentes ont démontré une augmentation de la prévalence de l’infertilité au Canada ainsi qu’une augmentation fulgurante de l’utilisation de la procréation assistée. Le Québec s’est doté en 2010 d’un programme de financement de la procréation assistée visant un accès universel ainsi que la protection de la santé des mères et des enfants. Les diverses parties prenantes attribuent un certain nombre de lacunes à ce programme, incluant l’absence de mesures de prévention et de promotion de la santé visant à réduire la prévalence de l’infertilité. En effet, une proportion significative de cas d’infertilité découle de facteurs modifiables et relatifs aux modes de vie tels que le tabagisme, les infections transmises sexuellement et par le sang, les problèmes de poids, les toxines environnementales et l’âge. De plus, l’âge maternel avancé ainsi que l’usage de la procréation assistée comportent des risques pour la santé des mères et des enfants au sujet desquels la population ne possède pas une connaissance suffisante. Des approches en amont ont été proposées par diverses organisations et dans divers pays, toutefois, peu ont été adoptées. Force est de constater que ces initiatives représentent de grands défis au point de vue de l’acceptabilité sociale, en raison de la nature sensible du sujet et d’une grande valorisation sociale de l’autonomie reproductive. L’éthique des communications en santé permet d’identifier ces défis qui touchent l’usage de tactiques persuasives, le risque de stigmatisation et l’attribution indue d’une responsabilité. Si leur élaboration tient compte de ces enjeux, les campagnes de communications en santé ont le potentiel d’informer adéquatement la population afin de favoriser l’autonomie et la santé reproductive des individus, sans causer de dommage iatrogénique. L’éthique de l’ « empowerment », qui requiert l’attribution d’une responsabilité individuelle de nature prospective, l’apport de ressources concrètes et l’implication des communautés, permet d’identifier les besoins en termes de solutions législatives favorisant des contextes socioéconomiques qui soutiennent la santé reproductive et l’autonomie reproductive.

Empowerment: model i instrument de mesura basat en les variables primàries o efectives PIEQ (Primary Items Empowerment Questionnaire)

In this thesis a review of the state of the art on empowerment is found. A proposal is put forward for a model of the effective variables of empowerment, a new theoretical model that provides a distinct classification of individual variables. The model consists of four metavariables called reciprocal, unidirectional, shared and reflexive. Finally, a measurement tool for measuring and representing these variables graphically is described, including its process of elaboration through a preliminary pilot study that served to refine and improve the questionnaire. Both the model and the instrument proposed aim to determine the state of the primary variables involved in determining the predisposition and potential of a working group towards empowerment. With the measurement tool both organisational, departmental, working group and/or individual data can be obtained. This instrument can help companies and organisations to discover the limitations existing within a working group and act in consequence.

A case study and interview with Jill McDonald CEO and President of McDonald's Northern Europe Division

Purpose – The purpose of this paper is to demonstrate how strategy is developed and implemented within a subsidiary of a global organization, the relationship between subsidiary and headquarters and the need for continuous change and adaption to remain relevant. Furthermore, this case study describes a successful process of invention and adoption. Design/methodology/approach – The paper draws on documentary evidence and a semistructured interview with Jill McDonald CEO and President of McDonald’s Northern Europe Division with responsibility for the UK, Sweden, Finland, Denmark, Norway and the Republic of Ireland. Management research rarely captures the views of the top executive, yet the top executives have a broad picture and are key strategic decision makers. Findings – The case study and interview offers a unique insight into factors contributing to McDonald’s unprecedented success (it has paid an increased dividend for the past 37 years). It also sheds light on its successful internationalization strategy. Originality/value – The case study draws on published material and augments this with an in-depth interview with the Chief Executive. Very few case studies offer insight into the thinking of a Chief Executive managing a subsidiary of a global organization. Its value lies in the lessons that managers and students of management can draw on the approach adopted by a highly successful global organization.

Application of the concepts of agro-tourism, agricultural diversification and food and nutrition for the development of Caribbean communities with reference to standards and priority setting

Introduction There is a renewed call for a new approach to development with emphasis on community empowerment or participation, with the belief that more sustainable activities will be undertaken in those communities. Much of that call, however, is coming not from within the communities, but primarily from advocates of change who may have little to do with those communities. What then will the new approach bring apart from a change in who are the decision-makers? And how do we ensure that the change that is called for will, in fact, bring added benefits to the communities themselves? To be sure, there are some successful stories of a community approach to problem solving. However, there are also many more stories of project failures. Serious analytical work, therefore, needs to be done to determine the factors that promote a successful community-based approach; when this approach should be used; and the methodology that should be employed. In an attempt to determine these factors, a brief analysis will be made of some of the governing structures in the subregion and their possible impact on the proposed new approach. Some of the earlier efforts at stakeholder and community approach to projects will also be examined as well as the new development strategy that is prompting the call for this new paradigm. The new paradigm focuses to a large extent on decision-making and community empowerment. With few exceptions, it is short on the promotion of tangible activities that are based on the resource inventory of the communities. This is not surprising, since, as noted before, the advocates of community empowerment may have very little connection with the communities and, in most cases, are unfamiliar with the resource base. Hence, a theoretical case is made, suggesting more style than substance. Another obvious shortcoming of this new paradigm is its continued over- dependence on assistance from the outside to build communities. Externally funded projects, seminars and meetings outside of the communities and foreign technical assistance continue to dominate these projects. While, of course, all communities have basic common needs such as water, health, education and electricity, there is sufficient diversity within communities to allow for tailoring of activities and programmes such that their differences become assets. It is in that context, that agro-tourism activities, standards, agricultural diversification, food and nutrition and priority setting have been chosen as aspects and activities for promoting community development, drawing on the various strengths of communities, rural or urban.

Exploring the relationship between women’s empowerment and the internet in China: potentials and constraints

This thesis reports on an exploratory study of the relationship between the Internet and women’s empowerment in China. The theoretical framework of the study combines feminist theorisations of power – the core concept of empowerment – with insights from sociological perspectives on power and gender, as well as collective action theory. This allows for the conceptualisation of women’s empowerment as a dynamic process that is shaped by a set of communicative practices. Focusing on female Chinese bloggers and women’s groups of different organisational types, this study aims to explore the respective ways in which these two types of women actors use the Internet with a view to examining whether, and the extent to which it enables them to generate a sense of empowerment. The empirical data mainly derives from interviews with female bloggers and with staff members from different women’s groups, as well as from a features analysis and social network analysis of the sampled blogs and official websites of studied groups. Overall, the findings suggest that the opportunities offered by the Internet for women’s empowerment through awareness-raising, social interactions, and the organising of collective action, are limited. For female bloggers, their activities do not translate the new communicative practices afforded by the Internet into concrete action to bring about changes in their everyday life. On the contrary, blogs become an alternative platform to discipline their behaviours and to reinforce patriarchal gendered norms. Moreover, the research finds that the promise of empowerment is further undermined by the pervasive commercialisation of the Internet and state control. For women’s groups, contextual factors prevent them from fully realising the potential of the Internet for increasing their organisational visibility, promoting public awareness about gender issues, building a sense of the collective, campaigning, or networking. The major barriers in these processes are state control, a lack of resources, online censorship, and at times, competition from commercial sites. In this respect, the Internet does not play a significant role in forming a collective to challenge existing unjust power relations.

El rol de la Unión Africana (UA) en el Cuerno de África a partir del caso de Somalia - AMISOM (2007-2013)

El propósito de esta monografía es comprender cuál ha sido el rol de la Unión Africana (UA), dentro de la misión de paz AMISOM en el periodo de 2007- 2013. Por ello, el trabajo abarca aspectos geopolíticos e históricos, que han influido en la configuración del conflicto armado de Somalía y que han llevado progresivamente a la creación, evolución e implementación de mecanismos como las misiones de paz. Además, se abarcan los planteamientos del neo-funcionalismo y el neo-regionalismo para comprender las estructuras y las dinámicas propias de la UA y así, comprender la naturaleza tanto de sus acciones, como de sus propósitos; propósitos que aclaman el fomento del panafricanismo. Desde aquí se puede entender como su rol ha contribuido con el crecimiento del mercado de la industria militar en la región, a costa de la responsabilidad de proteger. Por último, se concluye que dichas dinámicas han llevado a la creación de comunidades de inseguridad.

Child Care (Pre School Services) Regulations 1996 and Child Care (Pre School Services) (Amendment) Regulations 1997

The purpose of this Guide is to offer guidance on the Child Care (Pre- School Services) Regulations, 1996. It is written for persons charged with responsibility for implementing the legislation and for anyone affected by its provisions, in particular persons who are carrying on or proposing to carry on a pre-school service. The Regulations and the Explanatory Guide expand on the provisions of Part VII of the Child Care Act, 1991 Download the Report here

National Standards for Residential Care Settings for Older People

National Standards for Residential Care Settings for Older People The Health Information and Quality Authority (the Authority) is the statutory agency with responsibility for developing standards for health and social care services, with the exception of mental health services, and then ensuring that the standards are being met. It is the function of the Authority to set the standards for residential care settings for older people including nursing homes, inspect that they are being met and register providers that meet them. This will be undertaken by the Social Services Inspectorate within the Authority. Click here to download PDF 458kb

Framework Agreement between the Minister for Health and the Irish Medical Organisation in respect of a process for engagement concerning the GMS/GP Contract

Minister of State with responsibility for Primary Care, Alex White TD, today (4 June 2014) concluded a series of meetings with the Irish Medical Organisation (IMO) with the signing of the Framework Agreement between the Minister of Health, the HSE and the Irish Medical Organisation (IMO) setting out a process for engagement concerning the GMS/GP contract and other publicly funded contracts involving General Practitioners (GPs). Download document here

Simple steps to a healthy heart

The number of deaths from coronary heart disease in Northern Ireland has dropped significantly, according to recent figures. However, the Public Health Agency is urging everyone to take steps to protect their heart and reduce their chances of developing the disease during National Heart Month (February).Despite the number of deaths dropping significantly in recent years, coronary heart disease is still the number one killer across the country. Over 2,200 people died in Northern Ireland from coronary heart disease in 2010 compared to just over 2,300 people in 2009 - an overall reduction of 100 province-wide. The latest figure reveals the positive downward trend is continuing - in 2008, there were 2,410 deaths, 2,493 in 2007 and 2,554 in 2006, while in 1979 there were nearly 5,000 deaths. Throughout National Heart Month in February, the PHA is calling for people to follow a number of steps in a bid to reduce their chances of developing the disease.Smoking is a major risk factor and, the more cigarettes you smoke, the higher the risk, according to Dr Christine McMaster, Consultant in Public Health Medicine, with responsibility for cardiovascular disease in the PHA."The reduction in smoking over the past number of years through public education, stop smoking programmes and smoke free legislation has had a major impact on reducing deaths from heart disease. However, 24% of the population in Northern Ireland still smoke, putting them at risk of developing the disease."People who suffer from high blood pressure also run an increased risk of developing coronary heart disease. High blood pressure is a silent, but treatable condition. In order to minimise the risk, I would urge everyone over the age of 45 to have their blood pressure measured every five years by their GP," said Dr McMaster.Simple lifestyle changes will also reduce the risk of heart disease, including eating at least five servings of fruit and vegetables a day, avoiding saturated fats, limiting alcohol intake and taking at least 30 minutes of exercise a day, five days a week.Dr McMaster described the reduction in deaths from coronary heart disease over the past few years as "a big success story". "It shows that people can take very positive steps to reduce their risk of heart disease by getting their blood pressure checked and adopting a healthier lifestyle; in particular by not smoking," he added. "The message is clear during National Heart Month - you only have one heart and you can take steps to keep it healthy."

1.5 m for Finglas Addiction Support Team (FAST)

Noel Ahern T.D., Minister of State at the Department of Community, Rural and Gaeltacht Affairs with responsibility for the National Drugs Strategy, has announced funding of €1.5m under the Premises Initiative Fund to Finglas Addiction Support Team (FAST). FAST is a community-based initiative funded by the Department of Community, Rural & Gaeltacht Affairs under the National Drugs Strategy through Finglas/Cabra Local Drugs Task Force.This resource was contributed by The National Documentation Centre on Drug Use.

HIV & AIDS education and prevention plan 2008-2012. Mid-term review.

In 2008 a 4-year plan for HIV and AIDS Education and Prevention in Ireland was published. The plan aimed to contribute to a reduction in new infections of HIV and AIDS through education and prevention measures. It also aimed to guide and inform the development of policy and services in the statutory and non-statutory sectors with responsibility in this regard. This report is produced as a response to a letter from the Secretariat of the National AIDS Strategy Committee (NASC). The letter requested “feedback from the Education and Prevention Sub-Committee on prevention activities currently in place and on progress to date on the Education and Prevention Action Plan (2008-2012).” In addition, action 2 under Action Area 5: Monitoring and evaluation states that “a mid-term review of the implementation of this action plan should be published”. We note from the HPSC data that there has been a slight decrease in the overall number of new HIV infections however; there has been a huge concern over the large increase in new diagnoses in men who have sex with men (MSM). Although we cannot provide the evidence for the reason for this increase, it is stipulated that there has been a huge increase in the education and prevention programmes targeted at MSM and the report will show the evidence of that increase (Action Area 3: Preventing new infections: population group MSM). There is a presumption that because of increased awareness, access and confidence of MSM and improved treatment that there are more MSM being tested and more diagnoses. This report presents an update on the progress of the implementation of the actions in the HIV and AIDS Education and Prevention Plan 2008-2012.This resource was contributed by The National Documentation Centre on Drug Use.

Leda förändring genom relationer, processer och kultur

Forskningens syfte var att bidra med en ny kunskapssyntes om vad det innebär att leda förändring ur ett vårdvetenskapligt perspektiv. Vårdledaren har, speciellt vid större förändringar inom organisationen, en stor betydelse för hur vårdandet förvaltas genom att hålla den vårdande traditionen levande och genom formningen av den vårdande kulturen och vårdgemenskapen. Den övergripande hermeneutiska forskningsansatsen med tillämpning av metodologisk triangulering har influerats av Gadamers, Ricoeurs och Ödmans syn på hermeneutik med förståelse och förklaring som kompletterar varandra. Forskningens övergripande frågeställning ”Vad innebär det att leda förändring ur ett vårdvetenskapligt perspektiv?” förankrades i de fyra underliggande frågeställningarna. Den första frågeställningen berörde meningsinnehållet i begreppet förändring samt dess gestaltning. Metoden var en hermeneutisk begreppsbestämning på en ontologisk och kontextuell nivå enligt Koorts metod för begreppsbestämning. Genom en personalenkät undersöktes personalens åsikter (totalt 597 personer) om den kommande fusionen och förändringen samt deras förväntningar på ledarna under förändringsprocessen för att få svar på vad förutsättningarna var för en förändring eller förändringsprocess med avsedda mål och effekter. Svaret på hur vårdledaren och dennes uppgifter gestaltades vid en förändring samt hur vårdledarna uppfattade förändring och den kommande förändringsprocessen erhölls genom djupintervjuer med vårdledare (17). Av resultatet framgår att vårdledaren leder förändring genom att leda relationer, processer och kultur och genom ett stödjande, reflekterande och kulturbärande ledarskap med syftet att åstadkomma en verklig och hållbar förändring. För att åstadkomma en verklig och hållbar förändring, dvs. en inre omgestaltning och omdaning som vardande, förutsätts dock att både tankemönster och handlanden förändras. Riktningen och insatserna för förändringen skall ha sin grund i en tydlig och meningsfull målsättning och vision utgående från en gemensam värdegrund. En arena för dialog borde utvecklas så att förändringens liksom även vårdandets vision och mission förankras och utvecklas till handling och förändring. Vårdledarens primära uppgift eller mission var att tillhandahålla varje individuell patient en god vård. Den primära missionen var med andra ord att med ansvarsfullhet tjäna vårdandet sak utgående från ett etiskt förhållningssätt. I tjänande av vårdandets sak fanns dock en tillit till att förändringen gagnar patienten och hans eller hennes vård, men vårdledarnas anpassning till förändringen var utan djupare engagemang. Vårdledarna kände även en oro för sitt uppdrag som vårdledare, vårdarbetets ställning och mandatet som patientens advokat. Vårdledaren är också en kulturbärare, vilket innebär att även kulturen har betydelse under en förändringsprocess. Genom att leda kulturen skapar vårdledaren en öppen, bekräftande och evidensbaserad atmosfär med centrala värderingar som ger uttryck för den rådande andan och kulturen.