In response to recent decentralization in Ethiopia, we investigated the status of and pressure exerted on Awash National Park (ANP), vis-a- vis Park resources, observed land use and land cover changes, causes of park-related conflicts, use and management role of stakeholders at federal, regional and local level and the impact of policy on sustainable resources conservation through a comparative framework of before (pre-1995) and after decentralization (post-1995). We used a combination of two black and white aerial photographs of 1975 and 1986, a satellite image of 2006, field observation, information from local communities and Geographic Information System (GIS) to generate the land use and land cover profile. We selected a total of 210 respondents by stratified random sampling, and group discussion participants and key informants using the purposive sampling technique. Direct observed participation of stakeholders, household questionnaire, and interview with key informants and focus group discussions were used to collect data. Our results showed a declining scattered bushland by a rate of 20.61km2 per year between 1972 and 1986. On the other hand, Shrub encroachment increased by 32.2 % between 1972 and 1986 and by 10.3 % (77.4 km2) during the entire study period. Grassland was the largest cover type in the area between 1986 and 2006 and expanded by 14.2 % (106.4 km2) between 1972 and 1986. The majority of respondents highlighted that the most important drivers of the observed LULC changes pre-1995 were the combined effects of the land reform policy and changes in Park boundary (size of the Park). Population growth was reported to be the main driving factor for LULC change pre-and post-1995. The continuing existence of the area as a national Park receives unreserved support from most pastoral and agro-pastoral communities. From the data we conclude that overall, decentralization in Ethiopia was not effective in terms of improving the status of Awash National Park. We recommend action should be taken in terms of reducing human and livestock pressure and to prevent and solve interest-based conflicts between stakeholder / Environmental Sciences / Ph. D. (Environmental Sciences)

The evaluation of government programs can provide a better use of the resources invested, as well as providing social policy makers and program managers with insights into the design of more consistent policies and more effective public management. The objective of this study is to elaborate an evaluation of the Thousand Women Program in Alagoas, specifically to examine the effectiveness of the program by verifying compliance with the objectives proposed by the program, identifying the impact on the lives of participating women, analyzing the cost-effectiveness of the Program together with the efficiency of its processes and finally to elaborate a proposal for improvement. The research, in the form of na exploratory study, of a qualitative nature, was carried out through a case study, using documentary research techniques, the survey method and the participant research. After establishing the parameters for measuring the efficiency, effectiveness and effectiveness of the Program, these were applied in practice, using as basis the courses carried out in the city of Campo Alegre, Alagoas. It was verified that the Program can be effective in meeting the objectives, effective as the transformation of the local reality with some reservations and inefficient. / A avaliação de programas governamentais pode proporcionar uma melhor utilização dos recursos aplicados, além de fornecer aos formadores de políticas sociais e aos gestores de programas dados importantes para o desenho de políticas mais consistentes e para a gestão pública mais eficaz. O objetivo deste estudo consiste em elaborar uma avaliação do Programa Mulheres Mil em Alagoas, mais especificamente pretende examinar a eficácia por meio da verificação do atendimento aos objetivos propostos pelo programa, identificar o impacto causado na vida das mulheres participantes, analisar a relação custo-efetividade do Programa juntamente com a eficiência de seus processos e por fim elaborar uma proposta de melhoria. A pesquisa, na forma de estudo exploratório, de natureza qualitativa, foi realizada por meio de estudo de caso, utilizando como técnicas a pesquisa documental, o método survey e a pesquisa participante. Após o estabelecimento dos parâmetros para aferição da eficiência, eficácia e efetividade do Programa, estes foram aplicados na prática, utilizando como base os cursos realizados no município de Campo Alegre, Alagoas. Verificou-se que o Programa consegue ser eficaz quanto ao atendimento dos objetivos, efetivo quanto a transformação da realidade local com algumas ressalvas e pouco eficiente.

I Sverige finns det idag cirka 86 000 inventerade områden som är eller misstänks vara förorenade. Ett förorenat område kan ha en skadlig effekt på människor, djur och miljö vid exponering av föroreningarna. Områden som är förorenade kan därför behöva behandlas för att lokalt förbättra markkvalitén och för att minska risker. Ett problem som börjat uppmärksammas i branschen är att saneringar av mark också kan leda till betydande negativa konsekvenser som till exempel utsläpp av växthusgaser och nyttjande av fossila resurser. Bland annat riskeras det svenska miljömålet ”Begränsad klimatpåverkan” att inte uppnås om ingenting förändras. Den vanligaste metoden för att efterbehandla ett förorenat område i Sverige är genom schaktsanering. Studiens syfte var att undersöka klimatpåverkan och resurshanteringen från schaktsanering genom att göra en livscykelanalys på metoden. Metodens klimatpåverkan jämfördes också med andra saneringsmetoder. Resultaten visade att för schaktsanering bidrog transport och deponiarbetet till den största klimatpåverkan och resursanvändningen. Genom minskade transportavstånd, användning av fordon med lägre energiåtgång per transportarbete eller utbyte mot mer förnyelsebara drivmedel sågs miljöpåverkan minska. Deponering av massor sågs dessutom vara energikrävande, varpå incitament för att återvinna och återanvända massor i högre utsträckning än vad det görs idag efterfrågas. I jämförelse med andra saneringsmetoder sågs biokol vara den metod som gav upphov till en relativt liten klimatpåverkan. Dessutom medförde biokol en mer resurseffektiv avfallshantering i och med minskad deponering av jord, organiskt avfall och uttag av jungfruliga råvaror för återfyllnad. / In Sweden, there are currently approximately 86,000 inventoried sites that are identified as being contaminated. A contaminated site can have a harmful effect on humans, animals and the environment when exposed to the contaminants. Contaminated areas may therefore need to be remediated to locally improve soil quality and to reduce risks. A problem that has been noticed in the industry is that remediation of land can also lead to significant negative environmental consequences, such as the release of greenhouse gases and the use of fossil resources. For example, the Swedish environmental quality objective "Reduced climate impact" might not be achieved unless there are improvements. The most common method to remediate a contaminated site in Sweden is through “dig and dump”. The purpose of this study was to investigate the climate impact and resource usage from “dig and dump” by performing a life cycle assessment of this most common remediation method. The climate impact of the method was also compared with other remediation methods. The results showed that for “dig and dump”, transports and landfill of the soil contributed to the greatest climate impact and resource use. Through reduced transport distances, use of vehicles with lower energy consumption or exchange for more renewable fuels, the environmental impact was reduced. Landfilling of excavated soil was also energy demanding, and incentives to recycle and reuse soil to a greater extent than is done today are preferred. In comparison with other remediation methods, biochar was a method that caused a relatively small climate impact. In addition, biochar led to a more resource-efficient waste management through reduced disposal of soil, organic waste, and extraction of virgin raw materials for refilling.

Introduction. L’ostéoarthrose trapézo-métacarpienne (OTM) est l’une des ostéoarthroses (OA) de la main la plus prévalente, la plus douloureuse et la plus handicapante. Bien qu’une approche biopsychosociale soit préconisée dans la gestion de douleur chronique, la majorité des études sur l’OTM ne documentent que ses composantes physiques. La gestion de cette pathologie est souvent jugée sous-optimale, probablement due à une méconnaissance de la maladie et à l’absence de guide de pratique clinique. Ce travail doctoral a visé à (1) documenter l’efficacité des interventions non-chirurgicales et chirurgicales et (2) investiguer les impacts de l’OTM dans diverses sphères de la vie, (3) examiner les facteurs biopsychosociaux qui influencent la sévérité de la douleur et des incapacités fonctionnelles, et (4) documenter l’utilisation des ressources en santé que font les personnes atteintes d’OTM. Méthodologie. Le premier objectif a eu recours à deux revues systématiques en suivant la méthodologie de la Cochrane Collaboration. Pour les deuxième, troisième et quatrième objectifs, une étude descriptive a été menée auprès de 228 participants atteints d’OTM. Ils ont répondu à un questionnaire comprenant diverses échelles dûment validées. Des régressions linéaires multiples ont été utilisées afin d’identifier les facteurs de la sévérité de la douleur et des incapacités fonctionnelles. Résultats. Les résultats des revues systématiques ont montré des preuves scientifiques de qualité faible à modérée qui appuient l’efficacité des interventions suivantes en termes de douleur, d’incapacités fonctionnelles, de satisfaction et/ou d’événements indésirables: (1) injections de solution saline (intra-/extra-articulaire); (2) orthèse thermoplastique du pouce; (3) mobilisation nerveuse; (4) combinaison des exercices/mobilisation nerveuse et articulaire; (5) trapézectomie par voie antérieure ou postérieure; (6) trapézectomie et reconstruction ligamentaire avec ½ flexor carpi radialis (FCR) et tunnel métacarpien; (7) trapézectomie et reconstruction ligamentaire et interposition tendineuse en utilisant ½FCR et tunnel métacarpien; et (8) arthroplastie par distraction d’hématome. Pour ce qui est des résultats de l’étude descriptive, les participants étaient âgés de 63 ans en moyenne et plus de 80% d’entre eux rapportaient de la douleur d’intensité modérée à sévère (≥ 4/10). Leur score moyen au QuickDASH (incapacités fonctionnelles) était modéré (46,1/100). Leur score moyen de qualité de vie physique (SF-12v2) était inférieur à la moyenne de la population générale (41,0 vs 50,0). Près de 30% des participants présentaient des signes cliniquement significatifs d’anxiété et/ou de dépression. La fréquence de la douleur et le niveau d’incapacités fonctionnelles expliquaient 59,0 % de la variance dans la sévérité de la douleur tandis que le sexe, l'intensité de la douleur, la dépression et l'éducation expliquaient 60,1 % de la variance dans les scores d’incapacités fonctionnelles. Acétaminophène, anti-inflammatoires non stéroïdiens oraux, injections intra-articulaires de cortisone, orthèses, massage/exercices et application de chaleur/froid étaient fréquemment employées, tandis que les principes ergonomiques, des aides techniques, de la mobilisation nerveuse et des interventions psychosociales l’étaient beaucoup moins. Conclusions. L’OTM peut engendrer une douleur sévère, affectant divers aspects de la vie quotidienne. Les connaissances générées par cette thèse permettront de bonifier les recommandations des guides de pratique pour l’OTM, ainsi que de faciliter la gestion personnalisée de cette pathologie dans une perspective biopsychosociale. / Introduction. Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent, painful, and handicapping hand osteoarthritis (OA). Although a biopsychosocial approach is advocated in the management of chronic pain, the majority of studies on TMO document only its physical components. The non-surgical management of this pathology is often considered suboptimal, probably due to the poor understanding of the TMO and the absence of a clinical practice guide. This doctoral work thus aimed to (1) document the efficacy of non-surgical and surgical interventions and (2) investigate the impacts of TMO in various spheres of daily life, (3) examine the biopsychosocial factors that influence the severity of pain and functional disability, and (4) document the healthcare resources used by TMO patients. Methods. To answer the first objective, two systematic reviews were conducted using the methodology of the Cochrane Collaboration. For the second, third and forth objectives, a descriptive study was carried out among 228 participants with TMO. They answered a questionnaire comprising various scales duly validated. Multiple linear regression analyses were used to identify factors of pain severity and functional disability. Results. The results of the systematic reviews showed low to moderate quality evidence supporting the efficacy of the following interventions in terms of pain, physical function, satisfaction and/or adverse events: (1) saline injections (intra-/extra-articular); (2) custom-made thermoplastic thumb orthosis; (3) nerve mobilization; (4) combination of exercises/nerve and joint mobilization; (5) trapeziectomy by anterior or posterior approach; (6) trapeziectomy and ligament reconstruction with ½ flexor carpi radialis (FCR) and metacarpal tunnel; (7) trapeziectomy and ligament reconstruction and tendon interposition using ½FCR and metacarpal tunnel; and (8) distraction hematoma arthroplasty. The descriptive study revealed that the participants were on average 63 years old and over 80% of them reported moderate to severe pain (≥ 4/10). Their mean QuickDASH score was moderate (46.1/100) for functional disability. Their mean physical quality of life score (SF-12v2) was lower than the average in the general population (41.0 vs 50.0). Nearly 30% of the participants had clinically significant signs of anxiety and/or depression. Pain frequency and magnitude of disability explained 59.0% of the variance in pain severity while sex, pain intensity, depression and education explained 60.1% of the variance in functional disability scores. Acetaminophen, oral nonsteroidal anti-inflammatory drugs, cortisone injections, orthotics, hand exercise, hand massage and heat/cold application were frequently employed, while ergonomic principles, assistive devices, nerve mobilization and psychosocial intervention were much less used. Conclusions. TMO can cause severe pain and affect various aspects of daily life. The new knowledge generated by this thesis will allow to improve the recommendations for TMO, thus facilitating a tailored management of this pathology from a biopsychosocial perspective.

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