Provider diversity in the English NHS: a study of recent developments in four local health economies

Objectives: The overall objective of the research was to assess the impact of provider diversity on quality and innovation in the English NHS. The aims were to map the extent of diverse provider activity, identify the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organisations within the NHS, and the factors that affect the entry and growth of new private and TSOs. Methods: Case studies of four Local Health Economies (LHEs). Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and Third Sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Results: Involvement of diverse providers in the NHS is limited. Commissioners’ local strategies influence degrees of diversity. Barriers to the entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS Trusts to respond by making improvements. Information sharing diminishes as competition intensifies. Conclusions: There is scope to increase the participation of diverse providers in the NHS, but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.

National climate policies across Europe and their impacts on cities strategies

Globally, efforts are underway to reduce anthropogenic greenhouse gas emissions and to adapt to climate change impacts at the local level. However, there is a poor understanding of the relationship between city strategies on climate change mitigation and adaptation and the relevant policies at national and European level. This paper describes a comparative study and evaluation of cross-national policy. It reports the findings of studying the climate change strategies or plans from 200 European cities from Austria, Belgium, Estonia, Finland, France, Germany, Ireland, Italy, Netherlands, Spain and the United Kingdom. The study highlights the shared responsibility of global, European, national, regional and city policies. An interpretation and illustration of the influences from international and national networks and policy makers in stimulating the development of local strategies and actions is proposed. It was found that there is no archetypical way of planning for climate change, and multiple interests and motivations are inevitable. Our research warrants the need for a multi-scale approach to climate policy in the future, mainly ensuring sufficient capacity and resource to enable local authorities to plan and respond to their specific climate change agenda for maximising the management potentials for translating environmental challenges into opportunities.

Reclamações dos utentes : estudo dos resultados e medidas correctivas no contexto dos Agrupamentos de Centros de Saúde de Lisboa e Vale do Tejo

RESUMO - A qualidade dos cuidados de saúde, evolui ao longo dos tempos e é agora considerada um direito e um pilar fundamental nos serviços de saúde. As reclamações dos utentes podem revelar informação acerca das experiências entre os utentes e as organizações de saúde. Desta forma as reclamações podem ser consideradas como indicadores de qualidade que permitem identificar áreas e/ou oportunidades de melhoria, e de grande representatividade no processo da melhoria contínua da qualidade na saúde. Sendo fundamental dar voz aos utentes do SNS e possibilitar a sua participação activa no processo de melhoria da prestação dos cuidados de saúde, com este trabalho pretendeu-se estudar a forma como as reclamações dos utentes nos ACES na Região de Saúde de Lisboa e Vale do Tejo, contribuem para a melhoria da qualidade nos referidos serviços de saúde. Foram reconhecidas e analisadas as principais causas de reclamação, as correspondentes medidas correctivas e as necessidades e/ou dificuldades no seu processo de implementação, bem como a respectiva avaliação dos resultados obtidos e identificação das recomendações dos Coordenadores dos Gabinetes do Utente no âmbito dos ACES da Região de Saúde de LVT. Efectuou-se a análise de revisão bibliográfica e a consulta dos dados, desagregados, das causas mais mencionadas nas reclamações no âmbito do estudo e foram realizados contactos informais com a estrutura regional e nacional do Sistema SIM-Cidadão. Foram aplicados 15 questionários aos Coordenadores Locais dos Gabinetes do Cidadão dos ACES da ARSLVT, apresentando a investigação um carácter exploratório e qualitativo. Os questionários, foram enviados e recebidos anonimamente através da plataforma para estudos estatísticos Survey Monkey. A sua análise e interpretação, foi efectuada de forma a organizar os seus dados de uma forma sistematizada e permitir categorizar a informação para permitir a sua análise. Os resultados evidenciaram que as reclamações dos utentes apresentadas nos Gabinetes do Cidadão, de certa forma, foram um contributo para o processo da melhoria da qualidade nos ACES da Região de Saúde de Lisboa e Vale do Tejo através do adopção de medidas e acções correctivas, ultrapassando algumas limitações devida à criação de estratégias locais. No entanto foi evidente que algumas limitações não foram passiveis de ser ultrapassadas, pois envolvem decisões do âmbito externo aos ACES. Os resultados alcançados e as recomendações dos Coordenadores, podem evidenciar algumas mudanças organizacionais, mas transparecem a ideia de que existe ainda um longo caminho a percorrer.

Anopheles species composition explains differences in Plasmodium transmission in La Guajira, northern Colombia

Malaria in La Guajira, the most northern state of Colombia, shows two different epidemiological patterns. Malaria is endemic in the municipality of Dibulla whereas in Riohacha it is characterised by sporadic outbreaks. This study aimed to establish whether differences in transmission patterns could be attributed to different vector species. The most abundant adult female species were Anopheles aquasalis, exclusive to Riohacha, and Anopheles darlingi, restricted to Dibulla. Anopheles mosquitoes were identified using morphology and the molecular markers internal transcribed spacer 2 and cytochrome c oxidase I. All specimens (n = 1,393) were tested by ELISA to determine natural infection rates with Plasmodium falciparum and Plasmodium vivax. An. darlingi was positive for P. vivax 210, with an infection rate of 0.355% and an entomological inoculation rate of 15.87 infective bites/person/year. Anopheles albimanus larvae were the most common species in Riohacha, found in temporary swamps; in contrast, in Dibulla An. darlingi were detected mainly in permanent streams. Distinctive species composition and larval habitats in each municipality may explain the differences in Plasmodium transmission and suggest different local strategies should be used for vector control.

La Costa Brava ante los nuevos retos del turismo

The first section of this paper summarises the most relevant charateristics of the contemporary tourist model, also called postfordist or postmodernist. In the second part the traditional tourist model developed in the Costa Brava in the past decades, is reviewed. Emphasising the saturation of tourist facilities on the coast line, expansive urban growth, thanks to a tolerant administration, poor complementary supply and concentrated demand in few markets and the proximity of Barcelona conurbation, stressed by second homes. In the third section, some strategies developed in recent years to readapt the Costa Brava to the new tendencies in tourism, are presented. Incorporation of the inland to the tourist product, new planning policics, lessening urban densities and height, and a change in mind in favour of protected natural areas, diversification of demand with new markets, specially form Eastern Europe (although this might be considered as a continuation ofthe traditional tourist model) and the emergence of local strategies oriented towards the creation of new tourist products based upon natural and cultural resources

Rotation mentale et différences sexuelles: influence des axes directionnels extraits de l'environnement

Les tâches nécessitant des manipulations et des transformations de figures géométriques et de formes, comme les tâches de rotation mentale, donnent lieu à des différences de performance entre hommes et femmes qui restent intrigantes. Plusieurs hypothèses ont été proposées pour expliquer ces différences. La plus récurrente porte sur les différences de stratégie globale vs locale utilisées pour traiter l'information. Bien que cette conjecture soit intéressante, elle reste difficile à opérationnaliser car elle englobe tous les mécanismes cognitifs (acquisition, conservation et récupération de l'information). Ce travail prend la forme d'un retour aux sources dans la mesure où il se base sur des recherches anciennes qui ont montré que les hommes perçoivent significativement mieux que les femmes la verticale et l'horizontale. Il teste l'hypothèse selon laquelle les hommes, comparativement aux femmes, présentent une plus forte indépendance au champ perceptif visuel et sont donc plus susceptibles d'utiliser la verticalité et l'horizontalité pour résoudre une tâche de rotation mentale. Une première série d'expériences s'est penchée sur la perception spatiale pour évaluer son impact sur la résolution d'une tâche impliquant la rotation mentale. Les résultats ont montré que seuls les hommes se référaient à la verticalité et à l'horizontalité pour résoudre la tâche. Une seconde série d'expériences ont investigué l'effet de la présence, ou absence, d'axes directionnels directement liés à une tâche de rotation mentale. Elles ont été menées également en environnement réel afin d'évaluer comment le déplacement actif ou passif, correspondant à un changement de perspective en lieu et place d'une rotation mentale, module la performance des hommes et des femmes. Les résultats n'ont pas mis en évidence de différence sexuelle. Notre hypothèse est vérifiée puisque c'est uniquement lorsque la tâche ne présente pas d'axes orthogonaux évidents mais implicites que seuls les hommes, plus indépendants au champ perceptif visuel que les femmes, utilisent la perception de la verticalité et de l'horizontalité pour améliorer leur compétence en rotation mentale. -- Tasks that require manipulation and transformation of geometric shapes and forms, like tasks of mental rotation and give rise to differences in performance between men and women, remain intriguing. Several hypotheses have been proposed to explain these differences. The most recurring hypothesis addresses differences in global versus local strategies for processing information. While this conjecture is interesting, it remains difficult to study because it encompasses all the cognitive mechanisms (acquisition, retention and output). This work returns to the sources, which are based on earlier research that shows that men are significantly better than women at perceiving verticality and horizontality. It tests the hypothesis according to which men, as compared to women, exhibit a greater independence on the perceptive visual field, and therefore are more susceptible to utilizing the verticality and the horizontality to solve a mental rotation task. A first set of experiments examined spatial perception in order to assess its impact on the resolution of a task involving mental rotation. The results showed that only men referred to the verticality and the horizontality to solve the task. A second series of experiments investigated the effect of a presence, or absence of directional axes directed tied to the task of mental rotation. They were also conducted in a real world environment to evaluate how the active or passive displacement, corresponding to a change in perspective instead of a mental rotation, modulates the performance of men and women. The results did not show sex differences. Our hypothesis is verified: it is only when the task presents no obvious, but implicit orthogonal axes that men, who exhibit a greater independence on the perceptive visual field than women, use the perception of verticality and horizontality to improve their competence in mental rotation.

Évaluation du processus : analyse de l’évaluabilité et de la mise en œuvre d’une stratégie d’amélioration de la couverture vaccinale au Burkina Faso.

La vaccination qui est le sujet sur lequel porte cette recherche est une des questions de santé publique les plus importantes; elle fait néanmoins l’objet de nombreuses controverses. Dans le contexte de cette thèse, c’est plutôt l’accès à la vaccination qui est mis en question. La présente recherche vise à analyser une stratégie d’amélioration de la couverture vaccinale à l’aide d’une évaluation de processus extensive en trois étapes faisant suite à une documentation approfondie du contexte. En effet, la recherche analyse les perceptions et les facteurs d’influence de la couverture vaccinale avant l’intervention, les assises conceptuelles et théoriques de cette intervention, l’implantation et la réception de l’intervention et enfin les résultats et les mécanismes mis en œuvre pour les atteindre. Les résultats indiquent que la vaccination s’insère dans l’ensemble des stratégies locales de protection fondées sur des notions endogènes du risque. Ces éléments culturels associés à des facteurs socioéconomiques et aux rapports entre parents et services de santé concourent à expliquer un niveau relativement bas de couverture vaccinale complète de 50% avant l’intervention. L’analyse exploratoire de l’intervention indique que celle-ci intègre une théorie initiale implicite et une philosophie. L’intervention finale était évaluable; cependant, la validation de sa théorie a été compromise par des écarts dans l’implantation. L’approche descriptive montre des taux de réalisation d’activités assez élevés, une atteinte de plus de 95% des cibles et un niveau de réception acceptable, ce qui indique que l’intervention est une stratégie réalisable mais à améliorer. La couverture vaccinale après l’intervention est de 87%; elle est influencée positivement par les niveaux de connaissance élevés des parents et le fait pour les enfants d’être nés dans un centre de santé, et négativement par l’éloignement par rapport au site de vaccination. L’atteinte des résultats suit la procédure principale d’amélioration du niveau de connaissance des parents. Celle-ci est basée sur un mécanisme latent qui est la perception des « opportunités » que fournit la vaccination pour prévenir divers risques sanitaires, sociaux et économiques. Cependant, des approches complémentaires tentent de maximiser les effets de l’intervention en utilisant les pouvoirs conférés aux relais communautaires féminins et la coercition sociale. Cette recherche contribue à éclairer la relation entre l’évaluation du processus et l’analyse de l’évaluabilité, à conceptualiser et opérationnaliser autrement les notions de doses d’intervention administrées et de doses reçues. Sur le plan de la pratique, la recherche contribue à proposer l’amélioration des profils de personnel pour les activités de vaccination et la vulgarisation de la stratégie. Des propositions sont faites pour l’amélioration de l’intervention et l’information des institutions de financement des interventions.

La Costa Brava ante los nuevos retos del turismo

The first section of this paper summarises the most relevant charateristics of the contemporary tourist model, also called postfordist or postmodernist. In the second part the traditional tourist model developed in the Costa Brava in the past decades, is reviewed. Emphasising the saturation of tourist facilities on the coast line, expansive urban growth, thanks to a tolerant administration, poor complementary supply and concentrated demand in few markets and the proximity of Barcelona conurbation, stressed by second homes. In the third section, some strategies developed in recent years to readapt the Costa Brava to the new tendencies in tourism, are presented. Incorporation of the inland to the tourist product, new planning policics, lessening urban densities and height, and a change in mind in favour of protected natural areas, diversification of demand with new markets, specially form Eastern Europe (although this might be considered as a continuation of the traditional tourist model) and the emergence of local strategies oriented towards the creation of new tourist products based upon natural and cultural resources

Governos locais e políticas de promoção econômica: uma análise da promoção econômica nos municípios brasileiros com população acima de 50 mil habitantes

This work aims to analyze the policy of economic promotion in the Brazilian cities of medium and great size (with population above of 50.000 hab.). The objective of the research is to launch light in the debate on the regional and municipal development, presenting the recent hypotheses supplied by literature. Of complementary form, had for specific objective presents the results of the Research of Basic Information of Cities - PIM, of Brazilian Institute of Geography and Statistics (IBGE), in two surveys carried through together to the Brazilian local governments (1999 and 2009). It analyzes the instruments of economic promotion used by local governments and the influence of the development variables, as the Local Human Index of Development (HID-L) and the Local Gross Domestic Product (GDP-L). The research sample that factors as HID-L and GDP-L has significant influence in economic promotion of cities and must be taken in account in the definition of the local strategies of development

Tecendo saberes: fenomenologia do tratamento da dependência química

Esta pesquisa buscou conhecer o trabalho desenvolvido no Centro de Cuidados a Dependentes Químicos - CCDQ, localizado no município de Belém, estado do Pará, único serviço público no Brasil dentro do Sistema Único de Saúde destinado a oferecer tratamento específico para dependência química de álcool e outras drogas em regime de internação em longa duração, seguida de acompanhamento ambulatorial. A escassez de pesquisas nesta área no contexto local, fomenta a importância da discussão sobre o uso de drogas e as formas de tratamento existentes. Essa nova possibilidade de tratamento surgida das demandas sociais do município, através de dados compilados por diversas pesquisas, que levaram o governo estadual a planejar e implementar o centro, tinha por objetivo respeitar a voluntariedade do sujeito, incentivar a construção de um ambiente humanizado, pautada na lógica da reforma psiquiátrica, no que concerne à participação da família e práticas ressocializantes. Examinamos algumas contribuições da gestalt-terapia, Psicologia de base fenomenológica – existencial, que orienta minha linha de pesquisa e da Terapia Ocupacional, minha área de atuação, correlacionando-as como ciências e intervenções que dialogam no campo da interdisciplinaridade, tendo em vista o tratamento da drogadicção. A coleta de dados se deu através de questionários com questões abertas, respondidos por representantes da coordenação do centro, da equipe psicossocial e usuários do serviço. A perspectiva fenomenológica-existencial gestáltica configurou a fundamentação teórica na condução desse estudo, em que procuramos colaborar com este campo de investigação, desvelando alguns sentidos contidos nos diferentes discursos dos atores que trabalham ou se tratam no CCDQ e que colaboraram para configurar este relatório. Observamos a partir desses discursos, transformados em unidades de significação, que tanto o trabalho voltado às famílias, quanto as atividades ressocializantes estão deficitárias, sendo apontada também a necessidade de capacitação da equipe e a ausência de suporte da rede de serviços de saúde dentre outras questões. Pela especificidade dos resultados, pretendemos contribuir com a fundamentação de estratégias locais de ações preventivas e terapêuticas em drogadicção, além de possibilitar o conhecimento do que já vem sendo construído neste campo de atuação, tendo em vista ainda que novas ações terapêuticas podem ser construídas a partir da avaliação dos serviços já existentes prestados à população, bem como suscitar reflexões sobre as políticas, as ações e os seres humanos.

Antropología de la Conservación en España. Balance y perspectivas

En este artículo presentamos un balance de la Antropología de la Conservación en el Estado español. Durante las últimas décadas, la protección de los espacios naturales ha aumentado de una manera exponencial en todo el mundo. A la vez que se extendía esta patrimonialización de la naturaleza, los trabajos etnográficos sobre las áreas protegidas han ido ganando terreno dentro de la disciplina y, en particular, en el campo de la Antropología Ambiental. La mencionada bibliografía ha puesto de relieve los múltiples aspectos derivados de las nuevas políticas territoriales de regulación, apropiación y mercantilización de la ‘naturaleza’. En este trabajo realizamos una revisión exhaustiva de la producción generada a raíz de este interés por las áreas protegidas en nuestro país subrayando sus principales aportaciones, características y debilidades. De este modo pretendemos reflexionar acerca de su continuidad, con el fin de evitar la mera reiteración y favorecer el avance en sus resultados.

Le Petit Prince et ses deux traductions en suédois

L’objectif de ce mémoire est une analyse et une évaluation de la retraduction en suédois de « Le Petit Prince » d’Antoine de Saint-Exupéry (T2), parue chez Modernista, en 2015, en relation avec le texte source en français et en relation avec la traduction classique, parue chez Rabén&Sjögren, en 1952 (T1 ; la version révisée de 2015, actuelle au moment de la retraduction). L’analyse se base sur quelques concepts de Lita Lundquist, notamment la distinction entre stratégie de traduction « imitative » et « fonctionnelle », et la cohérence entre la stratégie « globale » et les stratégies « locales ». De plus, notre analyse nous mène à la distinction entre « traduction » et « révision », comme présentée par Philippe Bouquet (2012), et à la distinction entre une définition linguistique de traduction – approche principale de ce travail – et une définition socio-culturelle selon Toury (1995). Les résultats principaux sont 1) la découverte d’un manque de stratégie globale cohérente dans la T2 – à la différence de la T1– et 2) une dépendance forte de la T1 dans la T2. Aussi, dans la retraduction, nous avons remarqué une stratégie locale remarquable de suppression totale du pronom personnel suédois de man. Ces résultats sont brièvement discutés sous la lumière des aspects socio-culturels et dans une section sur l’applicabilité de l’hypothèse de la retraduction (Tegelberg 2014).

Achieving forms of sustainable and competitive tourism in coastal areas: the case of Baixo Vouga

Tourism has become the world’s largest industry, and has overcome economic sectors such as oil production and car manufacturing. It is foreseen that tourism will continue to expand in the future and will spread all around the world. In Europe, the tourism sector is made of 440 million international arrivals that are responsible for accounting about 10% of European GDP and generating 20 million jobs. Coastal destinations are major tourist destinations. This is due to their physical attractiveness, beautiful landscapes, and fine open space for leisure activities. Nevertheless, sun-sea-sand tourism depends very much on the environment. In this way, coastal destination ought to be properly planned so they do not exceed the limits of acceptable change (LAC) of the ecosystems, and keep their attractiveness. Being an economic activity, it is essential that coastal tourism is competitive, and show capacity to attracting new and enlarged markets. Coastal destinations should diversify its products and services, smooth seasonality and become more competitive. Diversification should create more growth and employment, and also reduce environmental, economic and social impact caused by the concentration of tourism activity in a few months of the year and the use of only the beach resource. This paper aims at analyzing the application of the competitiveness concept to tourism in coastal areas (Ria de Aveiro region, Central Portugal), and draws attention to the principle of environmental, economical and social sustainability.

Avaliação da potencial migração de Helicoverpa armigera (Lepidoptera: Noctuidae) por massas de ar para áreas produtoras de cultivos hospedeiros do Estado de São Paulo.

Resumo Helicoverpa armigera (Hübner, 1808) (Lepidoptera: Noctuidae) é um inseto exótico, altamente polífago, que foi detectado no Brasil em 2013 causando sérios danos em cultivos de soja, milho e algodão, localizados em áreas estaduais específicas das regiões Nordeste e Centro-Oeste com a presença do bioma Cerrado. Após o período de um ano o inseto foi identificado em várias regiões do País. A literatura indica que o inseto adulto apresenta características físicas que favorecem sua grande capacidade de voo, tanto em distância (100-1000 km) quanto a elevadas altitudes (maiores que 1,5 km acima do nível do solo), aumentando o seu potencial para dispersão de longo alcance, principalmente por voos migratórios das áreas já atacadas. Por essa razão, as massas de ar brasileiras podem atuar como potenciais facilitadoras à atividade migratória do inseto a longas distâncias para as áreas de maior concentração de seus cultivos hospedeiros preferenciais, resultante da atração natural do inseto aos fatores químicos delas decorrentes. Desse modo, devem ser consideradas em avaliações de áreas mais propícias à presença de H. armigera para orientar monitoramentos e estratégias de manejo locais. Este trabalho avaliou a potencial migração de H. armigera por massas de ar para áreas produtoras de cultivos hospedeiros do estado de São Paulo, considerando seus municípios produtores de algodão, soja, milho, tomate, feijão, café e laranja; as principais massas de ar brasileiras; a presença de grandes áreas com cultivos de eucalipto e pinus (outras potenciais barreiras físicas ao inseto); e a localização do bioma Cerrado paulista. Informações das áreas produtoras e das áreas plantadas por município de 2008, 2012 e 2014, disponibilizadas pelo IBGE, foram utilizadas em planos de informação georreferenciados, elaborados em ArcGis 10.3, para identificar a localização de suas respectivas grandes áreas em cada ano. O cruzamento georreferenciado também resultou mapas das áreas plantadas em 2014 com todos os cultivos citados, indicando as de maior potencial de infestação/reinfestações de H. armigera no estado de São Paulo, para orientar monitoramentos e estratégias de Manejo Integrado de Pragas - MIP locais. Abstract Helicoverpa armigera (Hübner, 1808) (Lepidoptera: Noctuidae) is an exotic insect highly polyphagous, which was detected in Brazil in 2013 causing serious damage to soybean, corn and cotton crops located in specific state areas in the northeast and center-west regions with the presence of Cerrado Biome (similar to the Savannah). After a oneyear period, the insect was detected in several regions of the country. Foreign literature indicates that the adult phase of the insect shows certain physical characteristics which favor its great flight capacity, even related to reach long distances (100-1000 Km) as many as to reach high altitudes (overtaken 1.5 Km above the ground level), increasing its potential of farthest dispersion, mainly by migratory flights from the areas already attacked. Therefore, the Brazilian air masses may act as potentially enhance the insect's farthest migratory activity to areas of greater concentration of its preferential host crops due to the insect's natural attraction to their chemical factors. Thus, migration potential of H. armigera by air masses toward preferential host crop areas must be considered in evaluations of most favorable areas to the presence of the insect to guide monitoring and local management strategies. The present work evaluated the H. armigera migration potential by air masses toward producing areas of host crops in São Paulo state, Brazil, considering its municipalities producing cotton, soybean, corn, tomato, bean, coffee, orange, eucalyptus and pine trees, as well as the main Brazilian air masses and the presence of Cerrado Biome in the state. Information of producing and of planting areas with the annual crops by municipalities in 2008, 2012 and 2014, provided by IBGE, were used in cross-maps made using ArcGis 10.3, in order to identify the location of their respective greater areas in each year. Cross-maps also provided results indicating the planting areas in 2014 with all crops already mentioned, as well as the potential areas to infestation/reinfestations of H. armigera in São Paulo State, in order to guide monitoring and local strategies of IPM.