No Brasil, pesquisas sobre a situação nutricional apontam para a redução da prevalência de desnutrição no país, mas se observa o aumento da prevalência de sobrepeso e de obesidade. Apesar do diagnóstico nutricional positivo, alguns problemas estruturais permanecem, como a elevada concentração de renda, os altos níveis de analfabetismo funcional, a discriminação social e racial e a prevalência de Insegurança Alimentar e Nutricional (INSAN). Está em curso um processo de legitimação e de exigibilidade do Direito Humano a Alimentação Adequada, no Brasil. A própria constituição federal e a Lei Orgânica de SAN (LOSAN), sancionada em 2006, integram um conjunto de regras de ordenamento jurídico do país que, em tese, garantiria uma alimentação saudável e adequada a todos os brasileiros, em consonância com as Diretrizes Voluntárias da FAO e com os tratados internacionais de direitos humanos, aos quais o Brasil é signatário. O objetivo geral do presente estudo é analisar a Política de Segurança Alimentar e Nutricional (PNSAN) em construção no Brasil, discutindo o seu arranjo institucional e a alocação de recursos. A metodologia da pesquisa foi baseada na análise de dados secundários, de documentos oficiais, e na legislação pertinente envolvendo o período de 2003 ao final do ano de 2008. A análise teve como suporte teórico os ensinamentos da Economia Institucional e de Finanças Públicas. Entre os principais resultados destaca-se a conclusão de que a Política de Segurança Alimentar e Nutricional brasileira está constituída. Com as Leis que a embasam tornou-se uma política de Estado e não mais de um Governo, entretanto, um dos tripés de sua “institucionalidade”, a Câmara Interministerial criada em 2007, peça-chave no processo de articulação da PNSAN, por sua natureza intersetorial, é, sem dúvida, o órgão mais precário do SISAN. Apesar dessa falha institucional, a política tem recebido apoio econômico substantivo, contudo os recursos estão concentrados em um único programa, importante, mas não estruturante. Programas que garantam o emprego e a produção, passando por qualificação, educação e assistência técnica são inequivocamente essenciais para a garantia do Direito Humano a Alimentação Adequada a todos os brasileiros e portanto deveriam receber maiores quantidades de recursos orçamentários. / In Brazil, research on the nutritional situation shows the reduction of the prevalence of malnutrition in the country, but reveals the increased prevalence of overweight and obesity. Although the positive nutritional diagnosis, structural problems remain, such as high income concentration, high levels of functional illiteracy, social and racial discrimination and the prevalence of Food and Nutrition Insecurity. There is an ongoing process of legitimation and enforceability of the Human Right to Adequate Food in Brazil. The federal constitution and the Food and Nutritional Security Law, published in 2006, incorporate a set of rules that, in theory, ensure a healthy and adequate diet to all Brazilians, in line with the FAO Voluntary Guidelines and the international human rights treaties to which Brazil is signatory. The general objective of this study is to analyze the Food and Nutritional Security Policy under construction in Brazil, discussing its institutional arrangement and allocation of resources. The methodology of the research was based on the analysis of secondary data, from official documents, and legislation involving the period of 2003 to 2008. The theoretical analysis was based on the teachings of Institutional Economics and Public Finance. Among the main results there is a conclusion that the Brazilian Food and Nutritional Security Policy is established, with Laws that makes it as a State Policy rather than a government. However, one of the tripods of its \"institutions\", the \"Câmara terministerial\" established in 2007, a key element in the articulation of this Policy, is without doubt the most precarious element of the Food and Nutritional Policy system. Despite this institutional failure, the policy has received substantial economic support, however the resources are concentrated in a single program, an important one, but not structural. Programs made to ensure employment and production, through skills, education and technical assistance are clearly essential to ensure the human right to adequate food to all Brazilians and therefore should receive higher amounts of budgetary resources.

Dentists have traditionally been the sole gatekeepers to the delivery of primary care dental services. Direct Access, a measure that allows Dental Care Professionals to see patients without a referral from a Dentist, is a fundamental change to this long-standing principle. This thesis systematically explores the attitudes of stakeholders across the micro, meso and macro levels of dentistry towards Direct Access in two distinct health care systems, the Netherlands and the UK.Direct Access was introduced in the Netherlands in 2006 and subsequently introduced in the UK in 2013. This study uses a qualitative approach to explore the attitudes towards the introduction of Direct Access in both of these states. It presents the results of semi-structured interviews with 74 participants (individually or as part of a group) including Students, Dental Care Professionals and Dentists at the micro-level, representatives of Professional Associations, Insurers and Dental Schools at the meso-level and Policy Makers at the macro-level. The results of this study show a significant range of attitudes towards Direct Access, but reveal a degree of consensus within individual stakeholder groups towards the reform’s introduction and impact. Dental Care Professionals interpret the introduction of Direct Access as recognition of their capabilities and expect it to primarily benefit patients through access to care and expertise. Dentists were more likely to view the introduction of Direct Access in terms of competition or professional persecution, with the impacts considered from a professional or financial viewpoint. Policy Makers saw potential for Direct Access to realign dental workforces and services to contemporary care needs. Attitudes at the meso level demonstrated the greatest variety and were more influenced by the idiosyncrasies of their respective health care system. In comparing the attitudes towards Direct Access in the Netherlands and the UK there were several differences, such as in the support of the Direct Access by Principal Dentists, however many of these can be explained by differences in healthcare funding and the time difference between the two reforms. Despite these differences stakeholders in both states felt that while Direct Access had the potential to create significant impacts on a range of issues (including professional competition, patient access to care, the reduction of care costs to patients and the state, the redistribution of dental tasks and the remodelling of the dental workforce) it was unlikely to do so in either the Netherlands or the UK. Flaws in the Direct Access regulations, legal obstructions to crucial procedures and imbalances in street-level professional power were perceived to obstruct Direct Access. Rather than revolutionising dental services Direct Access has been implemented selectively in the interest of dental practices.

The diploma thesis Formation of the Health Policy in Vysočina Region is interested in the development of the health policy of the Vysočina Region and the creation and utilization of policy documents aimed at the health care. The constitution of regional public administrations in 2000, the abolition of districts in 2003 and the transfer of hospitals to the region brought new competences to regions. One of them is the health care administration. Originally, in cooperation with the Ministry of Health, and later self Vysočina Region decided to prepare a conceptual document, which would describe the current situation of the regional health service, define objectives and goals for its future direction. Vysočina Region authority started with arrangements of regional health care strategy in 2003 and finished 2007 with Zdravotní plán kraje Vysočina, which was not fully completed. Program Zdraví 21 pro kraj Vysočina and Koncepce eHealth Kraje Vysočina were presented later focused on other areas of health and health care. This thesis is interested by the formation of health care policy in Vysočina Region. The most important questions are how Vysočina Region authority prepared the strategic papers, how are these strategies applied and how is used the feedback in a renewal of the plans. There will be also compared the...

This thesis presents an empirical investigation into substance use, situational characteristics and sexual outcomes in men who have sex with men (MSM) motivated by the high rates of substance use in MSM; the association between substance use and sexual risk behaviours in MSM; the lack of specific theory addressing relationships between substance use, sexual interactions and social interactions between MSM; and the need for clearer understandings of encounter-level associations with sexual risk. Qualitative metasynthesis. This thesis begins with laying the methodological groundwork for a qualitative metasynthesis that theorises the relationship between substance use and social spaces in MSM, with a particular focus on sexual outcomes. The qualitative metasynthesis derives the key organising perspective of ‘littoral spaces’ in which substance use is associated with a pre-planned, though temporary, escape from the boundaries of everyday life to engage in maximal sensory exploration, including through sexual contact. <b>Systematic review of multiple-event analyses. The thesis then turns to a systematic review of previous quantitative multiple-event analyses examining associations between situational characteristics and sexual outcomes, which establishes the need for additional multiple-event analyses addressing specific substance use, location of sex, partner serodiscordance and partner type. Multiple-event analyses. Finally, informed by the qualitative metasynthesis and the systematic review of event-level analyses, this thesis presents multiple-event analyses addressing unprotected anal intercourse (UAI), pleasure and control as sexual outcomes in MSM in England. These analyses found that substance use was associated with greater odds of UAI and pleasure, but not with control, and that non-private locations of sex were associated with decreased odds of UAI and pleasure, but not control. Furthermore, there was sparse evidence of interactions between respondent and partner substance use and between respondent substance use and location of sex in associations with sexual outcomes. These analyses contribute to understandings of associations between substance use, situational characteristics and sexual risk behaviour by presenting the first known analyses on MSM in England and by examining sexual outcomes besides UAI.

Made available in DSpace on 2016-04-27T18:11:50Z (GMT). No. of bitstreams: 1 Natally Ribeiro.pdf: 6316532 bytes, checksum: 409d0123db9fb1cc9e8b3aa3ce1338d1 (MD5) Previous issue date: 2011-02-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: This paper reflects on speech therapy, reading and writing, from relationships between literacy processes, social practices and discursive circulation of children in the process of sociocultural formation. Recent studies have defined literacy as a set of social practices that use writing (as a symbolic and technological system) in given contexts and for specific socio-relational goals. Other studies, in the same direction, see literacy as a set of social practices, culturally constituted and socially situated, highlighting that new literacy studies postulate the written language as a phenomenon that should be observed from a social and ethnographic perspective, since it is from these dimensions that types of literacy can be analyzed. Objective: To characterize and analyze, from the standpoint of speech, literacy, modes of movement and use of adequate writing by 69 students from two third-stage classes of an elementary public school located in the city of São Paulo. Method: We developed and applied a protocol that comprises different writing types in order to verify the recognition skills, familiarity and usage of literacy / language of 69 schoolchildren. The age of students ranged from 5 years and 1 month to 6 years and 1 month (58% male and 42% female). Data analysis was performed by mapping the students' literacy rates based on the levels and types of literacy included in specialized literature. Results and Discussion: Based on the notion of literacy and how it was used in the speech pathologist work undertaken, we see the relevance and usefulness of studies on the use, familiarity and notion of writing styles for school, as they give access to the various logics with which children operate, think and act in practices that involve writing skills. Among the presented writing styles, we find, for this age group, a significant recognition skill: letter; journalistic narratives for children; traffic signs, cartoons; and recipes, which are viewed and / or used by themselves and / or relatives at home, on the way to school and on other social spaces. Conclusion: the presence of literacy practices among those surveyed is remarkable, a fact that suggests the relevance of considering the processes of literacy in both the pedagogical strategies of early childhood education, and in speech therapy with students who have difficulties and / or disturbances in the acquisition of writing. Considering this, speech therapy may benefit (in their clinical work and advice to educational institutions) of reading and writing on the condition indicators of the forms of social interaction, guided by specific social practices, which - apart from learning the conventions - places the ownership and uses of writing in terms of the constitution of subjects and social realities / Introdução: O presente trabalho reflete sobre o trabalho fonoaudiológico com a leitura e a escrita, a partir de relações entre processos de letramento, práticas sociais e circulação discursiva de crianças em processo de constituição sociocultural. Estudos recentes definem o letramento como um conjunto de práticas sociais que usam a escrita (na condição de sistema simbólico e de tecnologia) em contextos e para objetivos sócio-relacionais específicos. Outros estudos, nessa mesma direção, consideram o letramento como um conjunto de práticas sociais culturalmente constituídas e socialmente situadas, destacando que os novos estudos do letramento postulam a linguagem escrita como fenômeno que deve ser observado a partir de uma óptica social e etnográfica, uma vez que é a partir dessas dimensões que se pode pensar nas formas de letramento. Objetivo: Caracterizar e analisar, do ponto de vista fonoaudiológico, o(s) letramento(s), os modos de circulação e uso de gêneros discursivos escritos por 69 escolares de duas classes de terceiro estágio de uma escola municipal de ensino infantil da cidade de São Paulo. Método: Foi construído e aplicado protocolo composto por diversos gêneros discursivos escritos, para se verificar o grau de reconhecimento, de familiaridade e de uso dos mesmos pelos 69 escolares pesquisados. A faixa etária dos escolares é de 5 anos e 1 mês e 6 anos e 1 mês (58% do sexo masculino e 42%, feminino). A análise dos dados se deu a partir do mapeamento dos índices de letramento dos escolares, em função dos níveis e tipos de letramento consignados na literatura especializada sobre o tema. Resultados e Discussão: A partir da noção de letramento e do modo como foi utilizada no trabalho Fonoaudiológico aqui empreendido, constata-se a pertinência e a utilidade de estudos sobre o uso, a familiaridade e os sentidos dos gêneros discursivos escritos para escolares, na medida em que dão acesso à variadas lógicas com as quais as crianças operam, no pensamento e na ação, em práticas que envolvem a presença da escrita. Entre os gêneros discursivos escritos apresentados, encontramos, para essa faixa etária, um reconhecimento significativo para os gêneros: carta; jornalístico; narrativas infantis; placas de trânsito; quadrinhos e receitas, sendo estes visualizados e/ou utilizados por e/ou com familiares em casa, no trajeto à escola e em outros espaços sociais. Conclusão: É notável a presença de práticas letradas entre os pesquisados, o que sugere a relevância em se considerar os processos de letramento, tanto nas estratégias pedagógicas da educação infantil, quanto no trabalho fonoaudiológico com escolares que apresentem dificuldades e/ou distúrbios na aquisição da escrita. Nesse sentido, a Fonoaudiologia pode tirar proveito (em seu trabalho clínico e de assessoria à instituições educacionais) da leitura e da escrita na condição de indicadores das formas de interação social, pautados por práticas sociais específicas, o que para além da aprendizagem das convenções situa a apropriação e os usos da escrita no plano da constituição dos sujeitos e das realidades sociais

Thesis (Ph.D.) -- University of Adelaide, Dept. of History, 2001. / Includes bibliographical references (leaves 280-305).

Thesis (Ph. D.)--RAND Graduate School, 2000. / Includes bibliographical references (p. 123-131). Also available on the Internet.

In recent years, several schools have addressed the No Child Left Behind (NCLB) Act of 2001 by focusing on promoting skill acquisition in reading and math, often overlooking physical education (PE) as a significant part of a child's education. The purpose of this causal-comparative study was to evaluate the effectiveness of an integrated health and physical education (HPE) program on student achievement. This study was grounded in action-based learning theories. The research question examined differences in posttest scores, adjusted for pretest differences, from 204 freshman students enrolled in a Biology-1 class at an urban high school. Students in Group A were enrolled in Biology-1 and an HPE class that incorporates Biology-1 content. Students in Group B were enrolled in Biology-1 but were not in a HPE class; thus, they did not participate in the integrated HPE program. An analysis of covariance (ANCOVA) was used to determine whether the integrated PE program increased student achievement in Biology-1. The findings showed that there was a significant difference between the two groups (p < .05). The Biology-1 students who participated in the integrated HPE program scored significantly higher on the Biology-1 state test than the Biology-1 students who did not participate in the integrated HPE program. These results may influence educational decisions regarding the use of HPE by encouraging serious consideration of an integrated HPE program, which could enhance student achievement, thus promoting positive social change.

Introduction: Cerebrovascular events are a major cause of mortality, disability and healthcare resource use. Despite this, there is a lack of reliable information on their costs and outcomes, particularly related to transient ischaemic attacks (TIA) and minor stroke. Such information is vital to inform decisions about local and national service provision, and to provide reliable estimates for use in cost-effectiveness analyses. Aims This thesis estimates the costs and outcomes of stroke and TIA using data from a population-based study undertaken in a population of over 91,000 individuals in Oxfordshire (the Oxford Vascular Study – OXVASC). In addition, the thesis aims to estimate the short-term cost-effectiveness of two secondary stroke prevention programmes evaluated in a study nested within OXVASC. Methods: Using multiple methods of case ascertainment, 1,282 patients were identified as having suffered a stroke or TIA, of which 1,199 (723 stroke and 476 TIA) patients consented to the study. Follow-up of patients took place at 1, 6, 12 and 24 months, with data collected on patients’ disability, medication usage, living arrangements, and quality of life. Healthcare resource use information was derived from hospital and primary care records, and priced using published unit costs. Findings: Stroke patients had higher case-fatality rates than TIA patients (15% vs. 1%; p<0.001), with 5-year life expectancy being one year longer for TIA patients. For stroke and TIA survivors, the risk of disability remained higher, at around 30% at each of the four follow-ups, than at baseline (17%; p<0.001 for all follow-ups). After standardising for age and gender, average quality of life for stroke and TIA patients combined was significantly lower than English population norms (p<0.001 for all follow-ups). However, when quality of life was compared to population norms by event type, quality of life differences between TIA patients and English population norms no longer remained statistically significant. Important predictors of quality of life included event severity, baseline disability and recurrent vascular events. Total costs were considerably higher 1-year after the initial stroke or TIA than for the year preceding it and, except for day cases, increases were observed for all resource-use categories. Five years after the index event, stroke patients incurred costs of £16,923 (95% CI: 15,149 to 18,858) per patient, significantly higher than those incurred by TIA patients, at £13,904 (95% CI: 11,488 to 16,657; p=0.019). In multivariate analyses, event severity was found to be a significant predictor of inpatient care resource use and costs, as were the presence of recurrent vascular events, especially stroke and coronary events. For non-hospitalised patients, results showed that urgent outpatient specialist assessment and treatment reduced the 90-day risk of fatal or disabling stroke (0.4% vs. 5%, p<0.001) compared with less urgent assessment and treatment. In terms of resource usage, patients who were assessed and treated urgently had lower recurrent stroke hospitalisation (2% vs. 8%; p=0.001), and reduced overall number of days in hospital (average reduction of 4 days; p=0.017). These reductions in hospital resource usage generated savings of £643 per patient assessed and treated urgently in an outpatient clinic (p=0.028). Conclusion: Despite the impact of stroke on death, disability and healthcare resource use, there is a lack of reliable information on costs and outcomes, especially for TIA and minor stroke. Through the use of a population-based study, the gold-standard study design when assessing the incidence and outcomes of TIA and stroke, this thesis provides healthcare decision makers and researchers with a wealth of data on the resource use patterns, costs and outcomes of TIA and stroke patients, and their main predictors.

This thesis is an ethnographic study of a little documented indigenous group, the Warekena people, who live on the Xié River in north-western Amazonia. Examining the mythic histories of the animate riverscape, my work offers an overview of the emergence of riverside dwelling: starting with a macro view of Xié river lifestyles, I explain how seasonal and distinguishing historic-mythic narratives tie in to wider idioms, and to experiences of social reproduction. I focus on reproductive processes and the perinatal period, highlighting methods used by Xié dwellers to nurture healthy, quality-conscious lifestyles, and I examine Xié aetiologies and pathologies. Mindfulness, or awareness, is viewed as a key component of good health. In this context, healthy childbirth is for the birthing mother an art form, a practice for which her total life experience has prepared her. Childbirth is ranked with such other painful experiences as snakebite, and both childbirth and snakebite are opportunities for personal growth. Infant care is seen through the lens of specific, hands-on techniques that promote mindful states in both the carer and the cared for. Mindfulness emerges as a heuristic device that allows us to scrutinize the Amerindian soul and body, also elucidating soul-loss in the ‘animist’ lived world. I argue that mindfulness is a core characteristic of the ‘cool’ hydrocentric and status-conscious lifestyles of Xié river dwellers, and that it defines what it means to be a person, the Xié way.