The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health promotion, early disease detection and the reduction of the burden of chronic disease. However, the implementation of evidence into clinical practice is a highly complex endeavour that has been said to occur in a 'black box‘, defying easily reached explanations of how it happens in practice. The aim of this study is to explore the 'black box‘ of guideline implementation associated with primary health care nurses‘ use of a guideline that targets high health need populations in a region of New Zealand. The potential for improvement of cardiovascular health overall and the reduction of the marked disparities between Mäori (indigenous people of New Zealand) and non-Mäori drives the imperative to enact the recommendations of the Assessment and Management of Cardiovascular Risk guideline. Primary health care nurses are well positioned at the frontline of healthcare to implement the guideline and an investigation of the realities of their practice as they do so will help to illuminate the contents of this particular 'black box‘. The aim is achieved in two components by: 1. Exploring the complexities of primary health care nurses‘ use of the New Zealand Assessment and Management of Cardiovascular Risk guideline. 2. Employing the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify the enablers and barriers to guideline implementation in the primary health care setting. Method Both components of this study involve qualitative methods. The first component involves qualitative description utilising focus groups and interviews to explore the perceptions and experiences of a range of primary health care professionals involved in implementing the AMCVR guideline and thematic analysis of data. The second component utilises template analysis of the data, based on the Promoting Action of Research Implementation in Health Services (PARiHS) framework. There are three elements of the PARiHS framework: Evidence, Context and Facilitation. This second component of the study is a systematic analysis of the enablers and barriers encountered by nurses as they implement the AMCVR guideline. Results The first component of the study generated four themes, which together have provided a rich portrait of the realities for nurses as they implemented the guideline. The four themes are self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. The template analysis revealed that there were several enablers and barriers to guideline implementation in relation to Evidence and Context and that Facilitation was not occurring in a planned way. Conclusion Successful guideline implementation demands multidisciplinary, transformational practice development to create an effective workplace culture. Practice development is a powerful approach well suited to supporting primary health care nurses to maximise their practice-based knowledge and skills, and for them to contribute to the development of systems that will meet the information and communication requirements of successful guideline implementation. The imperative to improve cardiovascular health overall and specifically to address Mäori health inequity mandates sustained effort and mobilisation of resources to ensure successful implementation of the AMCVR guideline.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 7 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Lic.-avh. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 2 uppsatser.

Vid miljöövervakning av konstruktionsprojekt såsom byggnation av väg och järnväg är det vanligt att uppsatta riktvärden för grumlighet överskrids. I en genomgång av årsrapporter från infrastrukturprojektet BanaVäg i Väst visade det sig att riktvärden för grumlighet ofta sätts upp utan noggrann kartläggning av vattendragens naturliga grumlighetsnivåer. Detta arbetssätt beror förmodligen på den oklara lagstiftningen gällande riktvärden på grumlighet och på bristfälliga anvisningar för hur referensprovtagning av grumlighet bör utformas. För att komma åt problematiken med opålitliga riktvärden borde riktvärden därför anpassas till enskilda vattendrag. I detta examensarbete gjordes ett försök att ta fram en metod för att kunna sätta vattendragsanpassade riktvärden. En dynamisk modell utvecklades för att ta fram grumlighet utifrån jordbruksareal, andel lera i avrinningsområdet samt vattenflöde. Modellen gav bäst, men trots allt inte tillfredställande, resultat för vattendrag med avrinningsområden mindre än 100 km2. För vattendrag som hade ett större avrinningsområde blev modellresultaten sämre, förmodligen på grund av en komplex samverkan mellan olika drivvariabler, där vissa inte ens togs hänsyn till i modellen. För att komma vidare med vattendragsanpassade riktvärden i Sverige föreslås fortsättningsvis en omfattande nationell satsning framförallt för större värdefulla vattendrag. Denna satsning bör innefatta anpassning av mer avancerade modeller för grumlighet till svenska förhållanden. Sammanfattningsvis visar studien tydligt att det finns ett stort behov av att förbättra metoderna för att kontrollera grumlighet samt att ta fram riktvärden anpassade utifrån naturliga grumlighetsnivåer i de olika vattendragen. / It has been noticed that construction activities close to watercourses often result in turbidity values that exceed guideline values. A detailed analysis of annual reports from the Swedish infrastructure project “BanaVäg i Väst” has shown that recommended values of turbidity often are determined without consideration of natural variations in turbidity. The performance probably depends on the lack of appropriate legislation on acceptable turbidity values and on how turbidity should be monitored during construction activities. The objective of this thesis was therefore to develop a method to determine background values for turbidity as a basis for setting water system adapted reference values. In the thesis a model for turbidity was developed with agricultural area, clay content within the watershed and discharge as input variables. With the dynamic model variations in turbidity could best be explained in watercourses of watersheds less than 100 km2, but even for these watercourses the model performance remained poor. For watercourses draining larger watersheds the model performance became even poorer, most probably due to complex interactions of a variety of driving variables, of which some were not included as input variables. A recommendation is therefore a national initiative where more advanced models can be used, at least for large watercourses that are highly vulnerable, after adaption to Swedish conditions. This study clearly shows that there is an urgent need in Sweden to improve methods to monitor turbidity as well as to improve guideline values by adjusting them according to background turbidity levels.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2009. / Embargo expiry date: 2010-07-31 plt 2010 / ENGLISH ABSTRACT: The prevalence of chronic diseases of lifestyle such as cardiovascular disease, cancer, type 2 diabetes mellitus and obesity are increasing worldwide due to changes in lifestyle patterns, including changes in the food consumption patterns of consumers. There are numerous players who need to be involved in addressing current lifestyle patterns and in encouraging positive behaviour change. Food companies have a role in evaluating the composition of the products that they offer, as well as in educating consumers with regard to healthy eating practices through both the on-pack information that they supply and in their nutrition strategies and programmes. The main objective of the study was to investigate the nutrition strategies that food companies in South Africa use to communicate with the consumers and to compare it with the knowledge, attitudes and practices of the consumers towards the nutrition information that they receive. The secondary objective was to develop guidelines for food companies in their promotion of the prevention of chronic diseases of lifestyle. Methodology The study population consisted of a sample of 7 food companies operating in South Africa and a sample of 230 South African consumers. Data were collected through test questionnaires aimed at each specific study population. The data were analysed statistically for each study population and the data between the two study populations were compared. Results Most food companies that participated stated that they have a nutrition strategy which outlines their consumer communication policy, but none of these were made available to the researcher. Seventy-one percent of the food companies also indicated that they address chronic diseases of lifestyle in their nutrition strategies, with cardiovascular disease being the main focus. The medium used most frequently by food companies for nutrition education of the consumer is the food label. The majority of food companies agree that they do have a responsibility towards the education of the consumer, but stated that it is not solely their responsibility. Ninety-six percent of consumers read (always or sometimes) the labels of food products when making a purchase. The older the consumer, the more unlikely they are to read the ingredients statement on the label. Consumers are most concerned with cardiovascular disease when purchasing food products. Ninety-five percent of consumers agreed that food companies have a responsibility towards them with regard to nutrition education. The consumers indicated that they prefer food labels and television as the medium for nutrition education, but that they trust doctors and nutritionists the most to relay nutrition messages. Conclusion Consumer education on the prevention of chronic diseases of lifestyle is essential if the behaviour change, necessary to address their rising prevalence, is to become a part of consumers’ lifestyles. Food companies should be actively involved with consumer education pertaining to healthy eating and healthy lifestyle habits. Communication with regard to nutrition education is critical and should be consistent with an integrated approach involving all the role players including the food industry, the Department of Health (DOH) and the Department of Education (DOE). / AFRIKAANSE OPSOMMING: Die prevalensie van kroniese lewensstyl siektes soos hartvatsiektes, kanker, tipe 2 diabetes mellitus en vetsug is wêreldwyd aan die toeneem weens ’n verandering in die lewenstyl van verbruikers wat ’n weer ‘n verandering in eetgewoontes teweeg bring. Daar is verskeie rolspelers betrokke wat ’n bydrae kan lewer om die huidige lewensstyl patrone van verbruikers aan te spreek en om positiewe gedragsveranderinge te bevorder. Voedselmaatskappye speel ‘n tweeledige rol: deur die samestelling van voedselprodukte wat hulle versprei te evalueer, en deur die verbruiker op te voed oor gesonde eetgewoontes. Maatskappye se voedingstrategieë en programme, asook die verpakking van produkte, kan gebruik word om voedingsinligting te verskaf. Die studie se hoof doelwit was om die voedingstrategieё te ondersoek wat deur voedselmaatskappye in Suid Afrika gebruik word en om dit te vergelyk met die kennis, houding en praktyke van die verbruiker teenoor voedingsinligting wat hulle ontvang. Die sekondêre doelwit was om riglyne vir voedselmaatskappye te ontwikkel ter ondersteuning van die maatskappye se inisiatiewe om kroniese lewensstyl siektes te voorkom. Metodologie Die studiepopulasie het bestaan uit ’n steekproef van 7 voedselmaatskappye wat in Suid Afrika werksaam is en ‘n steekproef van 230 Suid Afrikaanse verbruikers. Data is ingesamel deur twee uitgetoetsde vraelyste te gebruik wat spesifiek geteiken was vir elke studie populasie. Die data is statisties geanaliseer vir elke studie populasie en die studie populasies is ook met mekaar vergelyk. Resultate Die meeste voedselmaatskappye wat deelgeneem het aan die studie verklaar dat hulle ‘n voedingstrategie het wat die wyse waarop daar met die verbruiker kommunikeer word uitstippel, nogtans was geeneen van die voedingstrategieë beskikbaar gestel aan die navorser nie. Een en sewentig persent van die voedselmaatskappye het ook aangedui dat kroniese lewensstyl siektes aangespreek word in hul voedingstrategieë en dat daar gefokus word op hartvatsiektes. Voedselmaatskappye gee voorkeur aan die voedseletiket as medium vir voedingvoorligting aan die verbruiker. Die meeste voedselmaatskappye het saamgestem dat hul wel ‘n verantwoordelikheid het teenoor die verbruiker ten opsigte van voedingvoorligting, maar beskou dit nie as uitsluitlik hul verantwoordelikheid nie. Ses en negentig persent van die verbruikers lees voedsel etikette (altyd of soms) wanneer hul aankope doen. Dit blyk dat die ouer verbruiker minder geneig is om die bestanddelelys te lees. Verbruikers is oorwegend bekommerd oor hartvatsiektes wanneer hulle voedselaankope doen. Vyf en negentig persent van die verbruikers stem saam dat voedselmaatskappye ‘n verantwoordelikheid het teenoor verbruikers ten opsigte van voedingvoorligting. Die verbruikers gee voorkeur aan die voedsel etiket en televisie as mediums vir voedingvoorligting, maar hul vertrou meestal op dokters en voedingkundiges om die voedingboodskappe oor te dra. Gevolgtrekking Om gedragsverandering by verbruikers mee te bring met die oog daarop om die toename in kroniese lewensstyl siektes aan te spreek, is dit essensiëel om die verbruiker toe te rus met die nodige kennis oor die voorkoming van kroniese lewenstyl siektes. Voedselmaatskappye behoort aktief betrokke wees by verbruiker opvoeding oor gesonde leef- en eetgewoontes. Kommunikasie ten opsigte van voedingvoorligting moet konsekwent wees en ‘n geїntegreerde benadering moet deur alle rolspelers gevolg word, insluitende voedselmaatskappye, die Departement Gesondheid en die Onderwysdepartement.

Esta tese teve como objetivo identificar como a Educação Física vem constituindo a sua formação a partir da implementação das Diretrizes Curriculares Nacionais e à luz das transformações contemporâneas das formas de ver, vivenciar, compreender e intervir sobre o corpo. A nossa hipótese é de que vem se conformando a existência de duas formações e dois profissionais distintos em Educação Física, mas com concepções semelhantes, influenciadas pelas transformações contemporâneas das formas de conceber e intervir sobre o corpo. Parte-se do pressuposto que tanto o processo de conformação e implementação das Diretrizes quanto as transformações contemporâneas produzem efeitos importantes no processo de formação e nas concepções que os egressos têm do seu trabalho. Inicialmente, então, contextualiza-se as Diretrizes Curriculares Nacionais na trajetória histórica da formação em Educação Física e na conjuntura educacional brasileira, inserindo-a no quadro de reformas da formação profissional de inspiração neoliberal implementadas no final da década de 90 e início dos anos 2000, e analisa-se o processo da sua elaboração e seus desdobramentos. Posteriormente, abordam-se as tramas que hegemonizam determinadas visões e formas de lidar com o corpo na sociedade contemporânea, caracterizando os atuais cultos à saúde perfeita, à boa forma e à performance. A investigação desenvolve-se nos cursos de Educação Física da Universidade do Estado do Rio de Janeiro (UERJ), Universidade Estácio de Sá (UNESA) e Universidade Federal Fluminense (UFF). Para levá-la adiante foram realizadas entrevistas com seis docentes de cada uma das universidades e analisados os projetos pedagógicos, as estruturas curriculares e ementas, além de outros documentos que contivessem informações sobre os cursos. As questões da entrevista foram elaboradas em torno de dois pontos principais: a formação em Educação Física na universidade após a reestruturação curricular provocada pelo novo arcabouço legal e as formas como o curso vem abordando as questões sobre o corpo. A análise dos dados centrou-se nos sentidos e significados instituídos pelos discursos sobre a formação em Educação Física e sobre o corpo circulantes nos documentos e nas falas dos entrevistados. Este percurso permitiu-nos mapear e analisar os sentidos e significados acerca da formação em Educação Física e das formas de tratar o corpo em circulação, os conflitos em torno dos mesmos e a existência, ou não, de hegemonias discursivas

Resumo: A produção da pauta jornalística em TV Digital transita pelo novo espaço que é essa plataforma. A nova maneira de informar no meio televisivo oferece um novo comportamento de emissores e receptores. A análise de telejornais da GloboNews e BandNews na produção de notícias para a televisãom e portais são exemplos de interação entre as mídias. Novas competências e habilidades serão agregadas ao perfil dos profissionais que atuam nesse meio. Os avanços tecnológicos e a produção de conteúdo andam em paralelo e influenciam todo o processo que abordamos. / Abstract: The production of the jounalistic guidelines in the digital TV transit through the new space that is such platform. The new manner of informing in the television media offer a new behaviour from emitters and recipients. The analysis of TV news programs from GloboNews and BandNews in the production of information for television and journalistic websites are examples of interaction between those medias. New competences and habilities are brought together to the profile of professionals that act in this media. The technological advances and the content production walk in parallel and influence the process that we approach. / Orientador: Antonio Carlos de Carlos de Jesus / Coorientador: Francisco Rolfsen Belda / Banca: Maria Cristina Gobbi / Banca: Erika de Moraes / Mestre

This paper critically evaluates Transnational Corporations' (TNCs) claimed adherence to the Global Reporting Initiative (GRI)'s "labour" and "human rights" reporting guidelines and examines how successful the GRI has been in enhancing comparability and transparency. We found limited evidence of TNCs discharging their accountability to their workforce and, rather, we found evidence to suggest that disclosure was motivated more by enhancing their legitimacy. TNCs failed to adhere to the guidelines, which meant that material information items were often missing, rendering comparability of information meaningless. Instead, TNCs reported large volumes of generic/anecdotal information without acknowledging the impediments they faced in practice.