Det övergripande syftet med denna C-uppsats är att få en generell förståelse för hur religion kan influera på folkhälsofrågor. Vi spenderade två och en halv månad i Honduras med syftet att få en förståelse för hur religion kan påverka folkhälsofrågor och folkhälsoarbete. I det specifika fallet Honduras är syftet att diskutera hur katolska kyrkan influerar på den reproduktiva hälsan i Honduras. Studien är kvalitativ till sin karaktär och resultatet baseras på information från personliga intervjuer. För att ta reda på hur katolska kyrkan influerar den reproduktiva hälsan i landet intervjuade vi personal som arbetar på de största aktörerna involverade i arbetet med reproduktiv hälsa. Vi intervjuade även två katolska organisationer. Det finns en konflikt mellan katolska kyrkan och de icke-katolska organisationerna som arbetar med reproduktiv hälsa. En majoritet av de icke-katolska organisationerna ser katolska kyrkan, i synnerhet de två katolska organisationerna Pro Vida och Opus Dei, som ett hinder i arbetet med att förbättra den reproduktiva hälsan hos befolkningen. Sett från ett maktperspektiv blir slutsatsen att det existerar en synlig konflikt mellan katolska kyrkans intressen och den honduranska befolkningens intressen och att katolska kyrkan utövar makt över den honduranska befolkningen i den bemärkelsen att de inkräktar på deras reproduktiva rättigheter. Hur katolska kyrkan influerar på den reproduktiva hälsan behöver dock mer omfattande undersökas. / The overall objective of this essay is to provide a general understanding of how religion can influence on public health issues. We spent two and a half month in Honduras with the goal to achieve an understanding of the influence of religion on public health issues and public health work. In the particular case of Honduras the purpose is to discuss how the Catholic Church influences reproductive health in Honduras. It is a qualitative study and the result is based on information gathered in one-on-one interviews. As a way to find out how the Catholic Church influences reproductive health in the country we interviewed the staff of the main actors involved in the work with reproductive health, as well as two Catholic organizations. There is a conflict between the Catholic Church and the Non-Catholic organizations working with reproductive health. Almost all of the Non-Catholic organizations view the Catholic Church, with focus on the two Catholic organizations, Pro Vida and Opus Dei, as an obstacle in the work with improving the reproductive health in the population. From a power theory perspective we reach the conclusion that there is a visible conflict between the interests of the Catholic Church and the interests of the Honduran population and that the Catholic Church exercises power over the population by intruding on their reproductive rights. However, how the Catholic Church influences reproductive health matters needs to be further investigated.

Predictive models based in symptomatology of suspected dengue patients seeking medical care in Honduras. The models based on logistic regression models predicted the outcomes of dengue fever/ severe dengue. Sensitivity and specificity are discussed. It also describe the level of agreement between Honduran classification of severe dengue and the ones based on World Health Organization guidelines of 1997 and 2009. / Introduction: Dengue is a major public health problem in tropical and subtropical countries but its clinical presentation may be similar to many febrile illnesses. Since in endemic countries laboratory confirmation is frequently delayed, the majority of dengue cases are diagnosed based on patient’s symptomatology. This can often lead to misdiagnosis and potential serious health complications. The objective of this study was to identify clinical, hematological and demographical parameters that could be used as predictors of dengue fever among patients with febrile illness. Methods: We conducted a retrospective cohort study of 548 patients presenting with febrile syndrome to the largest public hospitals in Honduras. Patients’ clinical, laboratory, and demographical data as well as dengue laboratory confirmation by either serology or viral isolation were used to build a predictive statistical model to identify dengue cases. Results: Of 548 patients, 390 were confirmed with dengue infection while 158 had negative results. Univariable analysis revealed seven variables associated with dengue: male sex, petechiae, skin rash, myalgia, retro-ocular pain, positive tourniquet test, and bleeding gums. In multivariable logistic regression analysis, retro-ocular pain petechiae and bleeding gums were associated with increased risk, while epistaxis and paleness of skin were associated with reduced risk of dengue. Using a value of 0.6 (i.e., 60% probability for a case to be positive based on the equation values), our model had a sensitivity of 86.2%, a specificity of 27.2%, and an overall accuracy of 69.2%; allowing for the diagnosis of dengue to be ruled out and for other febrile conditions to be investigated. Conclusions: The application of predictive models can be valuable when laboratory confirmation is delayed. Among Honduran patients presenting with febrile illness, our data reveal key symptoms associated with dengue fever, however the overall accuracy of our model is still low and specificity remains a concern. Our model requires validation in other populations with similar pattern of dengue transmission. Key Words: Dengue, fever, Predictive model, symptoms, Honduras / Thesis / Doctor of Philosophy (PhD) / Predictive models based in symptomatology of suspected dengue patients seeking medical care in Honduras. The models based on logistic regression models predicted the outcomes of dengue fever/ severe dengue. Sensitivity and specificity are discussed. It also describe the level of agreement between Honduran classification of severe dengue and the ones based on World Health Organization guidelines of 1997 and 2009.

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Since the 1800's, technological advances have extended the foundation on which telemedicine could build. With its evolution, telemedicine has proven to be a means of offering effective health care interventions, from a multitude of disciplines. Teledermatology, a specialty application of telemedicine, offers great potential in improving the standard of dermatologic care by bridging the gap between the expert opinion of dermatologists and those without access to basic dermatologic care, particularly in developing nations, where skin disease continues to be a major public health problem. In Honduras, the setting for this study, and other developing nations, technology to support telemedicine is available. Dermatologic disease is among the most common disease presentations in the developing world, which left untreated due to a lack of access to adequate medical care, can progress causing increased morbidity or even death. A potential but untested solution is teledermatology. Teledermatology offers great potential in improving the standard of dermatologic care by bridging the gap between the expert opinion of dermatologists and those without access to basic dermatologic care. The purpose of this study was to evaluate the prevalence and types of dermatologic conditions and the feasibility of a store-and-forward teledermatology system in an underserved area of Honduras, so as to potentially provide more timely diagnosis and treatment, implementation of preventative measures, and offer long term solutions.so as The justification and significance of this study was the potential of store-and-forward teledermatology to improve the standard of dermatologic care by improving access of populations in underserved areas to dermatology specialists through affordable technology. The methodology of this study was primarily case study descriptive. This study was conducted at a public primary care clinic (JMA Clinic) and satellite sites in underserved areas of Francisco Morazán, Honduras. During a four week period in Spring 2011, patients with dermatologic conditions were examined and photos taken of condition. The patient information was sent to 3 U.S. board certified dermatologists, who provided diagnosis and treatment within 24 hours, which allowed the clinic physician sufficient time to review recommendations before patient follow-up. Patients would receive follow-up within 48 hours of initial visit. Diagnostic agreement, image quality, and user satisfaction were evaluated. IRB forms were submitted and clearance given. The data was analyzed with SPSS using descriptive statistics. The primary findings were the types of dermatologic conditions, interobserver agreement, image quality, and patient and physician satisfaction. The findings of this study substantiate the need for dermatologic care, as approximately 1 out of every 5 patients of the JMA Clinic presented with a dermatologic condition. The majority of these patients were children or women in their late 20s and early 30s; many of whom had their condition for more than a year and most had not received prior therapy. The types of dermatologic conditions observed were typical of that seen at a dermatology clinic in the U.S., yet inclusive of tropical and regional differences. Dermatitis, infectious and pigmentary conditions were the most common presentations. The interobserver diagnostic agreement achieved was 78%, and improved when considering differential diagnoses. Image quality received high ratings. Patients and physicians recorded a high level of overall satisfaction. Physicians indicated improved knowledge of teledermatology. Because of the unique environment and circumstances, the results are limited to the setting in which the study occurs. This project was a pilot study limited to 4 weeks of data collection and will be limited in significance by its duration and small sample size with respect to the conclusions that can be drawn about the prevalence and types of dermatologic conditions. This study illustrates that teledermatology is a viable means of providing dermatologic care to those in an underserved area of Honduras, where a lack of or limited access to general healthcare or specialty dermatologic care exists. The data offers insights to draw conclusions and recommendations on the potential for similar models to be implemented in underserved areas throughout Honduras and other similar regions. / Ph. D.

There is a need to counteract economic injustice in the world. As an architect, as a creator, it is my responsibility to make the world a better place. I want to help people to help themselves by concentrating their efforts in a constructive way. I desire to create a prototypical solution for a village in an area with high unemployment and desperate poverty as a means to give work to people and to serve as an example for other groups of people wanting to do the same. The site I've chosen to illustrate this concept of self-help housing is a 300 x 500 meter plateau in Tegucigalpa, Honduras. / Master of Architecture

La cooperación internacional para el desarrollo (CID) se ha convertido en un ámbito importante de la política internacional. Los cambios acontecidos en el orden internacional se han reflejado en la arquitectura de la CID. Durante los últimos años, nuevos actores y dinámicas han caracterizado dicha arquitectura. La predominancia que tenían la Cooperación Norte-Sur (CNS), los países desarrollados y sus instituciones ha sido puesta en cuestión por actores del Sur que han empezado a posicionarse como oferentes de CID mediante la modalidad de cooperación Sur-Sur (CSS). Este cambio ha abierto el espacio para que países latinoamericanos como el Perú empiecen a desempeñar un rol como oferentes de CID. Pese a la relevancia del tema, en la academia y en la práctica, los estudios de casos como el Perú son escasos. La presente investigación se enmarca en la corriente de literatura que busca indagar cuáles son las motivaciones que tienen los Estados para proveer CID a determinados países. Específicamente, se analizará la oferta de CID peruana para Honduras. Esto debido a que el Perú desempeña exclusivamente el rol de oferente y que, en términos cuantitativos, es uno de los países con los que más proyectos se han desarrollado. Con el objetivo de determinar dichas motivaciones se empleará un marco teórico constructivista y una metodología cualitativa, basada principalmente en entrevistas y otras fuentes primarias. La hipótesis principal plantea que las ideas de los principales tomadores de decisiones acerca del rol que el Perú debería ocupar en la arena internacional son la motivación principal. Una hipótesis alternativa enfatiza motivaciones de carácter económico y comercial. Se concluye que las motivaciones de los Estados son de carácter muy diverso, que las concepciones de los tomadores de decisiones tienen un rol central y que es necesario desarrollar más investigación empírica para el caso peruano.

No / Family entrepreneurial teams are groups of related individuals who engage in entrepreneurship. Entrepreneurial teams studies emphasize the resources that members bring to the team. Family business studies suggest that relationships and social theories are important. Social capital explains the formation and composition of family entrepreneurial teams (FETs). Analysis is of case studies of FETs based in Honduras. A shared commitment to entrepreneurial stewardship of the family's assets underpins formation of FETs. Trust and shared values were important for membership. This study highlights that families are not internally consistent, and family ties are not equally strong.

Ce mémoire de maîtrise traite d’un phénomène qui a gagné en importance dans les études sur l’Amérique latine : l’exploitation des ressources naturelles par des compagnies étrangères et l’augmentation des mouvements de résistance des populations locales contre l’implantation de ces compagnies. Délaissant l’accent généralement placé sur la naissance de ces mouvements, les impacts du temps sur les transformations du phénomène de résistance sont mesurés et analysés. Le cas de la compagnie minière canadienne Goldcorp Inc., exploitant de l’or dans la vallée de Siria, au Honduras, illustre à merveille les diverses techniques utilisées lors d’une lutte de longue haleine par une population rurale désirant résister à une compagnie transnationale au capital économique, politique et scientifique plus important. Ainsi, les dynamiques du mouvement de résistance soulignent des changements dans sa forme première à la suite de l’intrusion de nouveaux acteurs locaux et internationaux. Des identités, construites avec l’arrivée de la mine, sont aussi en jeu chez les groupes qui s’affrontent dans la région. L’étude d’un mouvement vers la fin de sa vie indique, de plus, le besoin de redéfinir la résistance et de sortir d’un schème purement actif vers un qui inclut aussi l’aspect discursif et moral dans sa définition. / This research deals with a phenomenon growing in interest in Latin American studies: natural resources exploitation from foreign companies and the growth of local resistance movements against the implementation of these companies. Going away from the general emphasis put on the birth of these movements, transformations due to the impact of time are instead measured and analyzed. The specific case of Goldcorp Inc. a Canadian mining company exploiting gold in the Siria Valley, Honduras, illustrates perfectly many tactics used by a rural population in an extensive battle and who wishes to resist to a multinational company that have more social, economic and politic power. Therefore, the resistance movement’s dynamics illustrate the changes in its primary form after the arrival of new local and international actors. Identities, build with the beginning of the mining exploitation, are also in play within the groups that are clashing in the region. Moreover, the study of a movement close to the end of its life demonstrate the need to redefine the notion of resistance in order to move away from the purely active form of it and include as well the discursive and moral aspects in its definition.

La thèse analyse, dans une perspective historique et comparative, le parcours suivi vers la citoyenneté sociale par les populations afro-descendantes d’Amérique centrale entre 1948 et 1966. Avec le système esclavagiste puis son abolition comme points de départ de la réflexion, les Africains et les Afro-descendants du monde entier ont commencé à systématiser leurs réflexions, leurs luttes et leur organisation, notamment au travers de personnalités comme Marcus Garvey ou d’organisations comme le Mouvement panafricaniste, afin de rejeter la stigmatisation apportée par l’invention coloniale de la « race noire ». Ce processus s’est initié entre la Première Guerre mondiale et l’émergence du système des Nations unies, qui a fourni la base d’un nouvel ordre international, se traduisant notamment par la Déclaration universelle des droits de l’homme et le début de la décolonisation en Afrique. Après les indépendances centraméricaines au début du XIXe siècle et au cours des processus de construction républicaine à l’oeuvre dans chacun des pays de la région, le développement national au Guatemala, au Honduras, au Nicaragua, au Costa Rica et au Panama a toutefois été marqué par l’empreinte identitaire laissée par la Couronne espagnole dans la région ainsi que par des politiques de métissage et/ou de blanchiment de la population. À partir de la deuxième partie du XIXe siècle, la vague d’immigration d’origine africaine en provenance des Caraïbes a remis en question cet imaginaire collectif et l’idée de citoyenneté portée par les élites de chaque pays. Si la question normative de la citoyenneté afro-descendante en Amérique centrale s’est donc longtemps inscrite dans un contexte international d’exclusion raciale, qui renvoie notamment au système de ségrégation aux États-Unis, le développement progressif de dispositifs légaux dans chaque pays a ouvert une nouvelle ère d’intégration citoyenne après la Seconde Guerre mondiale, faisant écho aux nouveaux instruments juridiques internationaux et à la Charte internationale des droits de l’homme. / The thesis analyzes, through comparative and historical perspectives, the path followed by theAfrodescendant populations in Central America, between 1948 and 1966, towards social citizenship. Having theslavery system and its latter abolition as a starting point, the African and Afrodescendant populations around theworld systematized their thoughts, battles and organization, especially through personalities such as Marcus Garveyand the Pan Africanist Movement; as means to counteract the burden created by the colonial invention of the “blackrace”. This process had place when the World War I and the United Nations System provided the base for a newinternational order; which after World War II, turned into creating the Organization of United Nations, the UniversalDeclaration of Human Rights and the beginning of decolonization in Africa. In addition, after the Central AmericanIndependence and in the middle of their republican construction, the differentiated national development followed byGuatemala, Honduras, Nicaragua, Costa Rica and Panama, took over the identity footprint institutionalized by theSpanish crown in the region; which afterwards turned into the miscegenation and/or population whitening. However,the wave of Caribbean Afrodescendant immigration from the second half of the nineteenth century, confronted thecollective imaginary as well as the citizen profile chosen by each of these country elites. Therefore, the singularnormative and social citizenship progress of the Afrodescendant populations in Central America, fell within theinternational racial exclusion context, such as United States’ racial segregation; as well as the paradoxicalrefinement of civil matters legal provisions in each country, and the strengthening of national measures restrictingimmigration; all of the above as part of a new human rights era, with its international legal instruments and theInternational Bill of Human Rights.

Models are important tools for understanding the hydrological processes that govern water transport in the landscape and for prediction at times and places where no observations are available. The degree of trust placed on models, however, should not exceed the quality of the data they are fed with. The overall aim of this thesis was to tune the modeling process to account for the uncertainty in the data, by identifying robust parameter values using methods from computational geometry. The methods were developed and tested on data from the Choluteca River basin in Honduras. Quality control of precipitation and discharge data resulted in a rejection of 22% percent of daily raingage data and the complete removal of one out of the seven discharge stations analyzed. The raingage network was not found sufficient to capture the spatial and temporal variability of precipitation in the Choluteca River basin. The temporal variability of discharge was evaluated through a Monte Carlo assessment of the rating-equation parameter values over a moving time window of stage-discharge measurements. Al hydrometric stations showed considerable temporal variability in the stage-discharge relationship, which was largest for low flows, albeit with no common trend. The problem with limited data quality was addressed by identifying robust model parameter values within the set of well-performing (behavioral) parameter-value vectors with computational-geometry methods. The hypothesis that geometrically deep parameter-value vectors within the behavioral set were hydrologically robust was tested, and verified, using two depth functions. Deep parameter-value vectors tended to perform better than shallow ones, were less sensitive to small changes in their values, and were better suited to temporal transfer. Depth functions rank multidimensional data. Methods to visualize the multivariate distribution of behavioral parameters based on the ranked values were developed. It was shown that, by projecting along a common dimension, the multivariate distribution of behavioral parameters for models of varying complexity could be compared using the proposed visualization tools. This has a potential to aid in the selection of an adequate model structure considering the uncertainty in the data. These methods allowed to quantify observational uncertainties. Geometric methods have only recently begun to be used in hydrology. It was shown that they can be used to identify robust parameter values, and some of their potential uses were highlighted. / Modeller är viktiga verktyg för att förstå de hydrologiska processer som bestämmer vattnets transport i landskapet och för prognoser för tider och platser där det saknas mätdata. Graden av tillit till modeller bör emellertid inte överstiga kvaliteten på de data som de matas med. Det övergripande syftet med denna avhandling var att anpassa modelleringsprocessen så att den tar hänsyn till osäkerheten i data och identifierar robusta parametervärden med hjälp av metoder från beräkningsgeometrin. Metoderna var utvecklade och testades på data från Cholutecaflodens avrinningsområde i Honduras. Kvalitetskontrollen i nederbörds- och vattenföringsdata resulterade i att 22 % av de dagliga nederbördsobservationerna måste kasseras liksom alla data från en av sju analyserade vattenföringsstationer. Observationsnätet för nederbörd befanns otillräckligt för att fånga upp den rumsliga och tidsmässiga variabiliteten i den övre delen av Cholutecaflodens avrinningsområde. Vattenföringens tidsvariation utvärderades med en Monte Carlo-skattning av värdet på parametrarna i avbördningskurvan i ett rörligt tidsfönster av vattenföringsmätningar. Alla vattenföringsstationer uppvisade stor tidsvariation i avbördningskurvan som var störst för låga flöden, dock inte med någon gemensam trend. Problemet med den måttliga datakvaliteten bedömdes med hjälp av robusta modellparametervärden som identifierades med hjälp av beräkningsgeometriska metoder. Hypotesen att djupa parametervärdesuppsättningar var robusta testades och verifierades genom två djupfunktioner. Geometriskt djupa parametervärdesuppsättningar verkade ge bättre hydrologiska resultat än ytliga, var mindre känsliga för små ändringar i parametervärden och var bättre lämpade för förflyttning i tiden. Metoder utvecklades för att visualisera multivariata fördelningar av välpresterande parametrar baserade på de rangordnade värdena. Genom att projicera längs en gemensam dimension, kunde multivariata fördelningar av välpresterande parametrar hos modeller med varierande komplexitet jämföras med hjälp av det föreslagna visualiseringsverktyget. Det har alltså potentialen att bistå vid valet av en adekvat modellstruktur som tar hänsyn till osäkerheten i data. Dessa metoder möjliggjorde kvantifiering av observationsosäkerheter. Geometriska metoder har helt nyligen börjat användas inom hydrologin. I studien demonstrerades att de kan användas för att identifiera robusta parametervärdesuppsättningar och några av metodernas potentiella användningsområden belystes.