Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-09T19:00:22Z No. of bitstreams: 1 Simone Pereira Lermontov.pdf: 27639825 bytes, checksum: 8e739b8c382c9f2fc847de9ba00bbec9 (MD5) / Made available in DSpace on 2015-12-09T19:00:22Z (GMT). No. of bitstreams: 1 Simone Pereira Lermontov.pdf: 27639825 bytes, checksum: 8e739b8c382c9f2fc847de9ba00bbec9 (MD5) Previous issue date: 2010 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Este estudo objetivou avaliar os custos e consequências do tratamento da pseudartrose com aplicação de células-tronco. A metodologia correspondeu à avaliação econômica parcial do custo e das consequências desse tratamento. O cenário do estudo foi o Hospital Universitário Antonio Pedro e os sujeitos foram oito pacientes operados entre setembro de 2008 e maio de 2009. A perspectiva do estudo foi a do Sistema Único de Saúde, principal fonte de financiamento da assistência médica no Brasil. Para o tratamento estatístico dos dados foram utilizados o software STATISTICA 6.0 e o teste não paramétrico de Spearman. A análise estatística apresentou resultados satisfatórios dentro de uma margem aceitável. O custo total médio do tratamento foi de R$ 1243.199 e o tempo de consolidação foi em média 14.71429 semanas. Observamos através do teste não paramétrico de Spearman que a correlação entre o custo total e o tempo de consolidação é - 0, 5078, uma indicação fraca de que o custo total é inversamente proporcional ao tempo de consolidação. A partir deste estudo, podemos concluir que o custo com o tratamento não foram exorbitantes. O pequeno tamanho da amostra não afetou os resultados de forma significativa, sendo que os achados em relação à idade são parecidos com os de outros estudos, o que nos leva a concluir que a população acometida pela pseudartrose é a economicamente ativa. A criação de um protocolo foi primordial para o levantamento do custo com o tratamento, possibilitando a consolidação dos dados e nos permitindo visualizar de forma mais abrangente o tratamento. O tempo de consolidação foi igual aos melhores resultados vistos em estudo internacionais e o procedimento se mostrou seguro e eficaz. Constatamos que o questionário SF36 é um instrumento de fácil aplicação e foi de confiabilidade no acompanhamento ambulatorial de pacientes submetidos ao tratamento. / The purpose of this study was to evaluate the costs and consequences of the use of stem cells in the treatment of pseudarthrosis. The methodology involved a partial economic assessment of the cost and consequences of this treatment. The study scenario was the Hospital Universitário Antonio Pedro and the subjects were eight patients operated between September 2008 and May 2009. The study perspective was that of the Sistema Único de Saúde, the main financial resource for medical assistance in Brazil. Statistical treatment of the data was performed using the STATISTICA 6.0 application and the Spearman nonparametric test. The results were statistically significant within an acceptable margin of error. The average treatment cost was R$ 1.247,21 and the average time for consolidation was 12.875 weeks. The Spearman nonparametric test showed that the correlation between the total cost and the time for was -0.25, a weak indication that the total cost is inversely proportional to the time for consolidation. From this study, we can conclude that the treatment costs were not prohibitive. The small size of the sample had no significant influence on the results; the agerelated findings are similar to those of other studies and lead to the conclusion that population affected by pseudarthrosis is economically active. The creation of a protocol was essential for cost evaluation, providing a framework for data consolidation and yielding a more general view of the treatment. The time for consolidation was about the same as for the best results reported in the international literature and the procedure was observed to be safe and effective. We concluded that the SF36 questionnaire is an easily applied tool that can be reliably used in the post-treatment follow-up of the patients.

En définissant les notions de „travail“ et de „ métier“, nous avons observé l’importance du „système d’information“ dans la réinvention du „travail“. Constatant la disparition ainsi que la modification des métiers ; en atteste les licenciements et les réorganisations des entreprises ; le travail ne disparait pas pour autant et s’invite sous de nouvelles formes, comme les statuts auto-entrepreneur et stagiaire, mais aussi en positionnant le consommateur comme travailleur. Du travail visible, sous la forme d’un travail salarié, au travail „caché“, c‘est la société tout entière qui s’en trouve réinventée, et invite à de nouvelles perspectives sociales.Au travers de l’étude de deux SSII (société de services en ingénierie informatique), pendant une durée de 5 ans, nous nous sommes intéressés aux différentes formes de mise au travail de 152 ingénieurs informaticiens. Appréhender le contexte des SSII comme un laboratoire de formes modernes de mise au travail, nous a permis d‘identifier ces mises au travail novatrices et leurs valorisations.Le système d’information se constituant comme l’axe incontestable de cette modification du travail, permet la mise en place d‘un travail normé et standardisé, dessine les nouveaux contours du travail, et ouvre vers de nouvelles perspectives sociales et économiques enrichissantes.Si le système d’information contribue à la mise en œuvre de ces nouvelles formes de travail, les décisions managériales se constituent comme étant à l’origine de cette l’utilisation.Vers quel paradigme nous oriente, cette utilisation du système d‘information ? / Defining the concepts of "work" and "job", we observed the importance of "information system " in the reinvention of "work".Noting the loss and modification of „jobs“ ; evidenced by layoffs and reorganization of enterprises , the work does not disappear , however, and invites new forms , such as statutes of freelance and student , but also by positioning the consumer as a worker.Work visible, in the form of wage labor, to work "hidden" , it is the whole society that is reinvented, and calls for new social perspectives.Through the study of two IT compagnies, for a period of 5 years , we are interested in various forms of work activity concerning 152 computer engineers .Understand the context of IT compagnies as a laboratory for modern forms of development work has enabled us to identify these updates in innovative work and valuations.The information system is forming as the undisputed center of this change of work, allows the establishment of normalized and standardized work , draws the new border of work, and open to new rewarding social and economic opportunities.If the information system contributes to the implementation of these new forms of work , managerial decisions are to be at the origin of this use.To what paradigm directs us, this use of information system?

Abstract Background. It is relatively well established in previous research that unemployment has direct health consequences in terms of mental and physical ill health. Recently, knowledge has emerged indicating that unemployment can lead to economic consequences that remain long after re-establishment in the labour market. However, few empirical studies have been able to apply a life course perspective asking whether there are also long-term health consequences of unemployment, and, when and in which context unemployment may affect the individual health status across the life course. The aim of this thesis was to analyse the relationship between unemployment and illness across the life course, and how it relates to individual and structural factors in the geographical setting of northern Sweden. In particular, three main areas have been explored: youth unemployment and illness in adulthood (Paper I and Paper II), contextual unemployment of national unemployment rate and neighbourhood unemployment (Paper II and Paper III) and lastly, social determinants of health inequality between employment statuses (Paper IV). Methods. This thesis is positioned in Sweden between the early 1980s and the mid-2010s, following two comparable cohorts sampled from northern Sweden (26 and 19 years follow-up time respectively from youth to midlife) and a cross-sectional sample from 2014 of the four northernmost counties in Sweden. The two longitudinal cohorts comprised the Northern Swedish Cohort and the Younger Northern Swedish Cohort, consisting of all pupils in the 9th grade of compulsory school in Luleå municipality in 1981 and 1989. The participants responded to an extensive questionnaire on socioeconomic factors, work and health, in 5 and 2 waves respectively of data collections. Neighbourhood register data from Statistics Sweden was also collected for all participants in the Northern Sweden Cohort. At the latest data collection, 94.3% (n=1010) participated in the Northern Sweden Cohort and 85.6% (n=686) in the Younger Northern Sweden Cohort. The cross-sectional study Health on Equal Terms is a national study, administered by the Public Health Agency together with Statistics Sweden and county councils with the aim of mapping public health and living conditions in the country over time. In this thesis, material from 2014 has been used for northern Sweden with a response rate of around 50% (effective sample n=12769). The statistical analyses used were linear regression, multilevel analysis and difference-in-difference analysis to estimate the concurrent and long-term health consequences of unemployment, and a decomposition analysis to disentangle the inequality in health between different labour market positions. The health outcomes in focus were functional somatic symptoms (the occurrence of relatively common physical illnesses such as head, muscle and stomach ache, insomnia and palpitation) and psychological distress. Results. Among men only, as little as one month of youth unemployment was related to increased levels of functional somatic symptoms in midlife, regardless of previous ill health or unemployment later in life, although only during relatively low national unemployment (pre-recession) when comparing with youth unemployment during high national unemployment (recession). This was explained by the health promoting effect of more time spent in higher education during the recession period. Furthermore, the health impact of neighbourhood unemployment highlights the importance of the contextual setting for individuals’ health both across the life course and at specific periods of life. Lastly, employment-related mental health inequalities exist for both men and women in all life phases (youth, adulthood and midlife). Economic and social deprivation related to unemployment and illness varied across different phases in life and across genders. Conclusion. The key findings of this thesis paint a rather pessimistic vision of the future: one’s own and others’ unemployment may cause not only ill health today but also ill health later in life. Importantly, the responsibility of unemployment and the associated ill health should not be placed on the already marginalised individuals and communities. Instead, the responsibility should be directed towards the structural aspects of society and the political choices that shape these. In other words, health inequality manifested by the position in the labour market is socially produced, unfair and changeable through political decisions. The results of this study therefore cannot contribute to any simple or concrete solutions to the concurrent or long-term health consequences of individual or contextual unemployment, as the solution is beyond the areas of responsibility and abilities of research. However, if there are long-term health consequences of one’s own and other people’s unemployment, labour market and public health policies should be initiated from a young age and continue throughout the life course to reduce individual suffering and future costs of social insurance, sick-leave and unemployment benefits.

Since the beginning of the Syrian crisis five years ago Syria, its neighbouring countries as well as the western world have been affected by the tremendous casualties brought about by the war. The thesis examines various forms and scale of these casualties, namely the economic, social, political and environmental implications. In its first part the thesis identifies true reasons and motives behind the Syrian crisis so that one can understand actions taken by involved actors. Subsequent to it is a detailed presentation of data on economic and social consequences of the Syrian war. Having all the crucial information on table the third chapter attempts to answer a hypothesis that Syria despite the still ongoing bloody conflict holds big potential for dynamic and long-term economic growth. The thesis could be useful for those seeking independent perspective on the crisis as well as for those who are looking for entrepreneurial opportunities in the after-war Syria.

Esta dissertação apresenta uma investigação sobre atores envolvidos na produção de políticas públicas para a primeira infância no Brasil. Nela buscou-se identificar e compreender suas ideias, suas formas de organização, articulação, negociação e tomada de decisão, explicando o predomínio da conciliação e do consenso entre eles. A pesquisa teve também o propósito de testar a viabilidade do uso da Advocacy Coalition Framework (ACF) para o estudo daqueles atores e seu subsistema de políticas, verificando as possibilidades e limitações dessa estrutura teórico-conceitual. Foi feito um estudo de caso sobre a comissão especial da Câmara dos Deputados que aprovou em 2014 o Projeto de Lei nº 6998\\2013, levando à criação do Marco Legal da Primeira Infância (MLPI), a Lei nº 13257 de 8\\3\\2016. Foram analisados os registros em texto e áudio das reuniões e audiências da comissão. A análise de argumentos e posições dos atores foi fundamentada na abordagem conceitual de Michael Freeden e na sua morfologia das famílias ideológicas, em associação com a caracterização das ideologias por Andrew Vincent. Foram identificados conceitos e princípios característicos de diversas famílias ideológicas, revelando-se bases para diferentes coalizões. As constatações da análise foram comparadas com dados fornecidos por atores em entrevistas semiestruturadas. Concluiu-se que houve um empenho comum das coalizões para a construção de um consenso prático que garantisse a aprovação do MLPI, pois esta beneficiaria a todos os atores. O teste de uso da ACF indicou que esta é uma abordagem apropriada para o estudo daquele subsistema de políticas, embora tenha apresentado duas limitações graves: não foi capaz de explicar a ação individual contraditória nem o apoio de todas as coalizões à criação do MLPI. Nesses dois pontos, foi necessário recorrer à abordagem de James March sobre as lógicas da adequação e da consequência. Sendo, tal como a ACF, uma abordagem ideacional, esse sistema de lógicas de ação mostrou-se um complemento viável e eficiente. / This dissertation presents an investigation on individuals and groups devoted to design public policies for early childhood in Brazil. It sought to understand their ideas, the ways they coordinate and compete, their decision-making process, as well as to explain the dominance of consensus among them. This work also aimed to test the feasibility of using Advocacy Coalition Framework (ACF) as theoretical background for the research on those actors and their policy subsystem. A case study was made of the special committee in the Câmara dos Deputados where representatives passed in 2014 the Bill nº 6998\\2013, leading to the creation of a national legal framework for early childhood (MLPI), by Law nº 13257 of 3\\8th\\2016. Records (text and audio) of meetings and hearings held by the commitee were analyzed. The analysis of arguments and positions expressed by actors was based on Michael Freedens conceptual approach of ideologies and his morphology of ideological families, in association with Andrew Vincents characterization of ideologies. Concepts and principles related to various ideologies were identified, pointing out conditions for different coalitions to be formed. The findings of analysis were compared with information provided by actors in semi-structured interviews. It was concluded that there was a common commitment of coalitions to build a practical consensus that would assure the approval of MLPI, as this would benefit all stakeholders. The feasibility test of ACF suggested that this is a suitable approach to the research on that policy subsystem, although it has presented two serious limitations: it was not able to explain the contradictory individual action nor the commitment of all coalitions to the creation of MLPI. To deal with these topics, it was necessary to resort to James Marchs approach on the logics of appopriateness and consequences. Being as much an ideational approach as the ACF, this logic of action system proved to be a viable and efficient complement.

Contexte : La mauvaise qualité et la faible utilisation des services de santé contribuent aux taux élevés de morbidité et de mortalité dans plusieurs pays à faible et à moyen revenu. Face à cette situation, le gouvernement du Burkina Faso a testé une intervention novatrice qui combine le financement basé sur la performance (FBP) à des mesures d'équité en santé. Les formations sanitaires ont reçu des prix unitaires pour des services de santé fournis ainsi que des bonus conditionnels à la qualité des soins. Des comités communautaires ont sélectionné les indigents pour leur octroyer des exemptions de paiements des soins. Malgré le peu d’études sur le sujet, des acteurs en santé mondiale craignent que l’intervention puisse avoir des conséquences non intentionnelles importantes. Objectif : Cette thèse vise à accroître les connaissances scientifiques sur les conséquences non intentionnelles du FBP combiné à des mesures d'équité en santé dans un environnement à faible revenu. Méthodes : Nous avons développé un cadre conceptuel basé sur la théorie de la diffusion des innovations. Une étude de cas multiples a été réalisée avec neuf formations sanitaires au Burkina Faso. Cinq mois sur le terrain ont permis d’effectuer 104 entrevues semi-structurées, 266 séances d'observation et des conversations informelles avec un large éventail d'acteurs incluant les prestataires de soins, les patients et les vérificateurs. Les données qualitatives ont été codées avec QDA miner pour faciliter l’analyse thématique. Nous avons également utilisé des données quantitatives du système de gestion pour décrire l'évolution des services et trianguler les résultats. Résultats : La nature et la mise en œuvre de l'intervention ont interagi avec le système social et les caractéristiques de ses membres pour engendrer des conséquences non intentionnelles importantes, dont la plupart étaient indésirables. Les prestataires de soins ont démontré une fixation sur les mesures de rendement, ont falsifié les registres médicaux et ont enseigné de mauvaises pratiques aux stagiaires pour augmenter leurs subsides et bonus. Comme conséquence non intentionnelle désirable, certaines formations sanitaires ont limité la vente de médicaments sans prescriptions pour encourager les consultations. Les vérifications communautaires, durant lesquelles les patients sont retrouvés pour vérifier les services déclarés, ont entraîné la falsification des données de vérification, la perte de la confidentialité des patients et certaines craintes chez les patients, bien que certains étaient heureux de partager leurs opinions. Enfin, les prestataires de soins ont limité les services offerts gratuitement aux indigents, ce qui a déclenché des conflits. Discussion : Cette thèse contribue au développement des connaissances scientifiques sur la façon dont le FBP, combiné à des mesures d'équité, peut engendrer des conséquences non intentionnelles. Les résultats sont utiles pour affiner ce type d’intervention et éclairer une mise en œuvre efficace dans le secteur du financement de la santé. Plus largement, cette thèse démontre la faisabilité et la valeur ajoutée d'utiliser un cadre conceptuel pour étudier les conséquences non intentionnelles. Elle pourra guider les chercheurs à élargir leur angle d’analyse afin de rendre compte des conséquences intentionnelles et non intentionnelles des interventions complexes en santé. / Background: Poor quality and low utilization of healthcare services contribute to high levels of morbidity and mortality in many low- and middle-income countries (LMICs). In response, the government of Burkina Faso tested an innovative intervention that combines performance-based financing (PBF) with health equity measures. Healthcare facilities received unit fees for targeted services and bonuses conditional upon the quality of care. To reduce inequities in access to care, community-based committees selected indigents, i.e., the poorest segment of the population, to offer them user fee exemptions. Facilities were also paid more for services delivered to indigents. Despite the potential of this type of intervention, many global health actors argue that it could lead to important unintended consequences that influence its overall impact. Yet, little attention has been given to studying the unintended consequences of this complex intervention. Objective: This thesis aims to increase the scientific knowledge on the unintended consequences of PBF combined with health equity measures in a low-income setting. Methods: We developed a conceptual framework based on the diffusion of innovations theory. Using a multiple case study design, we selected nine healthcare facilities in Burkina Faso. Over five months of fieldwork, we collected multiple sources of qualitative data including 104 semi-structured interviews, 266 recorded observation sessions, informal conversations and documentation. Participants included a wide range of stakeholders, such as providers, patients, and PBF verifiers. Data were coded using QDA miner to conduct a thematic analysis. We also used secondary data from the PBF routine management system to describe the evolution of services and triangulate results. Results: Interactions between the nature and implementation of the intervention, the nature of the social system, and its members’ characteristics led to important unintended consequences, most of which were undesirable. Providers were fixated on performance measures rather than on underlying objectives, falsified medical registers, and taught trainees improper practices to increase subsidies and bonuses. As a desirable unintended consequence, we found that some facilities limited the sale of non-prescribed medication to encourage patients to consult. Community verifications, in which patients are traced to verify the authenticity of reported services and patient satisfaction, also led to unintended consequences, such as the falsification of verification data, the loss of patient confidentiality, and fears among patients, although some were pleased to share their views. Lastly, health equity measures also triggered changes that were not intended by program planners. For example, providers limited the free services and medication delivered to indigents, which led to conflicts between parties. Discussion: This thesis contributes to the development of scientific knowledge on how PBF interventions, combined with equity measures, can trigger unintended consequences in a low-income setting. The results are useful to inform effective implementation and refine interventions, particularly in the health financing sector. More broadly, this thesis demonstrates the feasibility and added value of using a conceptual framework to study the unintended consequences of complex health interventions. This thesis can inspire and guide future researchers to broaden their analytical horizons to capture both intended and unintended consequences of health interventions.

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Positing that the characteristics of a state’s military has an effect on civil war outbreak likelihood, this thesis examines a hitherto unexplored relationship —that between military personnel supply method and civil war onset. Based on earlier research on the two phenomena separate from each other, a theory linking conscription to an increased probability of civil war onset compared to voluntary service was developed and an hypothesis derived. A test was then performed by means of several large-n multivariate logistic regression analyses on two sets of country-year level data from 1945 – 1999. Ultimately, the null hypothesis could not be rejected. Results instead indicate that voluntary service might result in a higher probability of civil war onset. This finding is however not statistically significant at the standard level. These findings are of importance for the shaping of military policy, especially in at-risk-of-civil-war countries, and it is strongly suggested that the examined relationship be further investigated in future research.

This investigation on teacher induction documents case studies of three beginning teachers in one target Woreda in Amhara Regional State of Ethiopia. It is organized into six chapters. In Ethiopia, the implementation of the teacher induction programme began in 2005 as part of a larger teacher education reform that is designed to promote the quality and effectiveness of teachers. Five years into the implementation process, it became essential to investigate how well the induction practices are organized and implemented, how beginning teachers were being integrated into the system, and whether the whole process has given beginning teachers better opportunities to learn in practice than by trial and error. The research design for the present investigation was the case study method. As teacher induction is a new venture in the Ethiopian education system, it was important to establish an in-depth understanding of this new phenomenon through case study than making generalizations. My literature readings convinced me about the use of the case study method to do an in-depth study of the situation. Interviews, observations and document analyses were the main tools used to collect the data needed in this research. The data suggests that the three case study teachers, with the support from their respective mentors, completed the formal aspects of the first year induction course as prescribed by the two first-year induction modules. The induction approach followed and applied the course module materials as is. However, in spite of following the prescriptions by the education authorities, variations were noticed in the quantity and quality of professional development activities, action research projects, classroom observations and reflections offered to and completed by the three beginning teachers. Furthermore, the changes observed as a result of the induction programme also varied largely due to personal and situational factors. On the whole, even though the induction guidelines set by the Ethiopian Ministry of Education contain most of the fundamental components of what the literature would consider to be effective for the induction programmes, its implementation in this context was constrained by the lack of some key elements and resources viz. the limited capacity of the mentors, absence of allocated time for induction and mentoring activities in the school programme, lack of subject-specific support in the schools and ineffective monitoring and evaluation of the entire programme, both in school and at the district levels. The present investigation offers policy makers a window into the practices and possible consequences of the induction programme in Ethiopia and presents possibilities for making informed decisions about how to assist practitioners to establish a successful induction programme for beginning teachers. Furthermore, the study offers an empirical test of the theoretical models suggested for setting up effective induction programmes for beginning teachers. The major conclusion that arises is that it is not so much whether the formal aspects of an induction programme are in place or not but more how the on-going support for and interpretations by all the role players that determines the success or otherwise of the programme. It is suggested that more research be done on the conditions that are necessary for the success of beginning teacher induction programme in different contexts in the country. / Curriculum and Instructional Studies / D. Ed. (Curriculum Studies)

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