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Discussion around the concept of Corporate Social Responsibility (CSR) re-intensified in the 1990s as a response to the increasing power of large corporations, the regulatory vacuum left by neoliberal market deregulation and the changing nature of the state in the context of globalization. This dissertation analyzes the constitution of CSR, grounded in political economy and situated in the context of globalization, and identifies CSR as a constitutive element of global governance. Claims made about the potential business contribution to social and economic development in developing regions are largely unsubstantiated and little is known about the impact of CSR on the people it is supposed to benefit. Mainstream literature strips CSR from its context and assumes that practice can be standardized and the results quantified. The qualitative case study analyzes the contextual practice and impact of CSR activities by EnCana Corporation, Canada’s largest independent oil and gas company, on Indigenous peoples and settler communities in Ecuador, and on the Dene Tha’ First Nation in Canada. Analysis of EnCana’s definition and implementation of CSR reveals a conflicting narrative, attempting to reconcile competitive capitalism with broad moralistic principles and ethics. Corporate culture prioritized the business case and the assumption that triple bottom line goals are compatible and mutually reinforcing. Findings from the case study demonstrate that corporate ideology remained constant across the company’s operations in the two countries, allowing adaptation of its CSR practices only within a certain range of possibilities. The case study provides evidence that EnCana Corporation had to adapt its CSR practice in response to specific articulations of local social-economic and political contexts. Specifically, CSR practices responded first, to national development goals and state capacity; and second, to Indigenous and communal resources and strategies. The findings further suggest that CSR practice creates fragile dependencies, subjecting social, ecological and social justice objectives to economic imperatives. Two important processes contribute to the creation of fragile dependencies. First, at the business-society interface, citizens are conceptualized as stakeholders; second, participation in decision-making becomes institutionalized as a limited form of consultation, often delegated to project proponents, without sufficient involvement of the state.

Einleitung: Im Rahmen eines Projekts wird untersucht, ob sich medizinische Laien mit einem neugestalteten internetbasierten Informationssystem besser informieren können, als dieses mit Suchmaschinen und Gesundheitsportalen möglich ist. Die Evaluation eines Systems zur Informationsversorgung von Kopfschmerzpatienten ist nur dann sinnvoll, wenn tatsächlich viele Menschen im deutschsprachigen Raum unter Kopfschmerzen leiden und mit Ihren Beschwerden eher das Internet als einen Arzt konsultieren. Daher wurde in drei Studien die Prävalenz von Kopfschmerzen und die damit verbundene Arztkonsultationsquote untersucht. Methode: Dazu wurden 2000 Versicherte der BARMER Ersatzkasse, ca. 9000 Studenten der Hochschule Bremen und ca. 1000 Studenten der Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik in Tirol, Österreich (UMIT) angeschrieben und gefragt, ob sie unter Kopfschmerzen leiden und wenn ja, ob sie für ihre Kopfschmerzen bereits eine ärztliche Diagnose haben. Insgesamt nahmen 521 Personen an der Untersuchung teil. Ergebnisse: Davon litten 292 Teilnehmer (56 %) unter Kopfschmerzen. Eine ärztliche Diagnose für diese hatten 52 (18 %). Alles in allem zeigt sich damit eine etwas geringere Kopfschmerzprävalenz als in den vorangegangen Studien. Die in der Literatur genannte Arztkonsultationsquote wird bestätigt. Diskussion: Die Auswertung der drei Studien zeigte, dass die Prävalenz von Kopfschmerzen weiterhin hoch und die damit verbundene Arztkonsultationsquote immer noch gering ist. / Introduction: In a project, it is investigated whether a newly designed web-information system can better inform medical laymen than traditional search engines and health portals. The evaluation of a system for providing information to headache patients is only useful when in fact many people suffer from headaches in the German speaking area and if these people with their complaints rather consult the Internet than a practitioner. Therefore, in three studies the prevalence of headache and the associated physician consultation rate was examined. Method: About 9000 students of the University of Applied Sciences Bremen, 2000 insurants of the BARMER, and about 1000 students of the University of Health Sciences, Medical Informatics and technology Tyrol, Austria (UMIT) were asked if they suffer from headaches and if so whether they already have a medical diagnosis. A total of 521 persons participated in the investigation. Results: From headaches suffered 292 (56%) participants. A medical diagnosis for these had 52 (18%). All in all, it shows slightly lower headache prevalence than found in previous studies. The medical consultation rate cited in the literature is confirmed. Discussion: The evaluation of the three studies showed that the prevalence of headache remains high and the associated physician consultation rate is still low.

Ce travail de recherche en psychologie explore une situation clinique particulière : celle d’un entretien en présence d’un interprète. Il étudie les effets de la présence d’une tierce personne dans un cadre qui est d’ordinaire celui d’un colloque singulier entre un psychologue et un patient. Il s’intéresse également aux effets du côtoiement des langues et du passage par la traduction sur la parole, du côté de son expression et de son interprétation. Une pratique clinique en présence d’un interprète s’est développée, poussée par des mouvements de populations de plus en plus importants, quels qu’en soient les raisons et contextes. Cette pratique récente s’inscrit dans une évolution sociétale contemporaine et se répand notamment dans le milieu associatif. L’entretien en présence d’un interprète puise sa source et son développement dans différents courants de pensée. Le fonctionnalisme, le culturalisme, l’anthropologie psychanalytique, l’ethnopsychanalyse, l’ethnopsychiatrie clinique ainsi que l’expérience clinique interculturelle des Ortigues ont ainsi marqué et influencé la pratique de ce type d’entretien et le domaine d’une clinique dite "interculturelle" dans lequel généralement elle se situe. Actuellement, d’autres dispositifs cliniques avec interprète voient le jour, qu’ils s’inscrivent dans une démarche de groupe ou individuelle. Imposée par la mise en contact de personnes en l’absence de code linguistique commun, cette pratique d’entretien inhabituelle pose de nombreuses questions, aussi bien aux psychologues qu’aux interprètes : Quels sont les caractéristiques et les enjeux d’un entretien en présence d’un interprète ? Quelle clinique peut être envisagée par un psychologue dans cette situation particulière ? Partant de ces interrogations, la situation d’entretien est déclinée suivant trois principaux axes de réflexion, envisagés chacun respectivement du point de vue du psychologue clinicien et de l’interprète, les deux pôles professionnels de la triade concernée par la rencontre :- La spécificité et les particularités de la situation d’un entretien clinique en présence d’un interprète.- La dimension clinique de la parole dans un entretien clinique mené par un psychologue en présence d’un interprète.- Le lien intersubjectif singulier qui se tisse entre les deux professionnels présents : psychologue clinicien et interprète. Les notions de traduction et d’interprétation, centrales dans ce cadre d’entretien, sont présentées dans leur sens commun mais aussi dans leur inscription dans la situation d’entretien étudiée. Est également abordée la question de la traduction des œuvres de Freud [etc...] / This psychology research work explores an especial clinical situation: one including an interpreter. It investigates how the presence of a third person affects a usually private meeting: a consultation between a psychologist and a patient. It also takes an interest in the effects of language co-existence and in the way one’s speech may get lost in translation.The clinical exercise in association with an interpreter has expanded in parallel to the increasing population flows, no matter their reasons and contexts. These particular consultations fit into a contemporary social evolution and they keep spreading, especially in the associations sector. The clinical interview with an interpreter has its roots in several schools of thought. Functionalism, culturalism, psychoanalitic anthropology, ethno-psychoanalysis, clinical ethno-psychiatry as the Ortigues’ clinical experience have influenced this kind of clinical practice and its intercultural professional context. Nowadays new clinical methods are being developed to include an interpreter in group an individual therapies. This particular clinical situation is the consequence of bringing people who do not share the same linguistic code, together. It lad psychologists and interpreters to question themselves: What are the characteristics and the issues of a medical interview with an interpreter? How can a psychologist practice in such a particular circumstance? These questions have been a starting point for both psychologists and interpreters to analyze this clinical exercise. Both professionals have respectively considered the issue according to the three following leads:- The specificity and the particularities of a clinical interview including an interpreter. - The clinical dimension of the speech in a clinical interview including an interpreter and led by a psychologist.- The singular inter-subjective bond that arises between both attending professionals: the clinical psychologist and the interpreter. The notions of translation and interpretation that are central in this type of interviews are not only present in their common meaning but also in a specific context linked to this particular consultation. The matter of translation according to Freud’s work is also approached [etc...]

Background. A demanda por cuidados médicos especializados vem aumentando em todo o mundo. Analisamos uma iniciativa de telemedicina para reduzir o tempo entre encaminhamento e consulta especializada e o número de pacientes na fila de espera. Métodos. Um estudo retrospectivo com controles contemporâneos foi realizado entre junho de 2014 a julho de 2016. As especialidades selecionadas foram incluídas em uma intervenção de telemedicina e comparadas com as especialidades controle reguladas de forma padrão. Os pacientes de intervenção foram combinados com um conjunto aleatório de controles (proporção 1: 1) por semestre e ano de inclusão na lista de espera e pelo índice de demanda e oferta de consultas especializadas (número de pacientes na fila de espera em junho de 2014 dividido pela média de consultas médicas especializadas disponibilizadas durante os 25 meses que compõem o período de análise). A intervenção de telemedicina incluiu o desenvolvimento de protocolos de referência e classificação de risco de pacientes na fila de espera. O tempo de espera para a consulta presencial e a magnitude da diminuição do número de pacientes na fila no final da observação foram os desfechos primários. Resultados. Nefrologia, pneumologia, urologia, neurologia, neurocirurgia e reumatologia foram selecionados para a intervenção, para um total de 50.185 pacientes (idade média: 51,5 anos) versus 50,124 pacientes controles (idade média: 52,2 anos). O tempo médio para o agendamento de consultas foi de 583,5 dias no grupo de intervenção versus 599,8 dias nos controles (p <0,001). O volume da lista de espera diminuiu 61,4% no grupo de intervenção e 53,2% no grupo controle 13 (<0,001). Para pacientes de alto risco (grupo de intervenção apenas), o tempo médio entre encaminhamento e consultas foi de 235,43 dias. Conclusões. A intervenção de telemedicina foi eficaz para diminuir o tempo de espera, especialmente para indivíduos de alto risco, e número de pacientes em espera para consultas médicas especializadas, o que sinaliza um efeito positivo sobre a eficiência do sistema de saúde, com redução de tempo e custos de deslocamentos, além de potencializar a prevenção quaternária ao prevenir consultas desnecessárias com médicos especilaistas, por meio do melhor manejo dos médicos de atenção primária. / Background. The demand for specialist care is increasing worldwide. We tested a telemedicine initiative to reduce the time between referral and specialist appointment and the number of waitlisted patients. Methods. A retrospective trial with contemporaneous controls was conducted between June 2014-July 2016. Selected specialties were included in a telemedicine intervention and compared to control specialties covered by the usual gatekeeping program. Intervention patients were matched to a random set of controls (1:1 ratio) by semester and year of inclusion in the waiting list and by the specialty demand to supply ratio (number of waitlisted patients in June 2014 divided by the mean number of appointment slots during the 25 months comprising the period of analysis). The telemedicine intervention encompassed development of referral protocols and risk classification of waitlisted patients. Waiting time to face-to-face consultation and magnitude of decrease in the number of waitlisted patients at the end of the observation were defined as primary outcomes. Results. Nephrology, pulmonology, urology, neurology, neurosurgery, and rheumatology were selected for the intervention, for a total 50,185 patients (mean age: 51.5 years) vs. 50,124 patients controls (mean age: 52.2 years). Mean referralto- appointment time was 583.5 days in the intervention group vs. 599.8 days in controls (p<0.001). Waitlist volume decreased 61.4% in the intervention group and 53.2% in the control group (<0.001). For high-risk patients (intervention group only), mean time between referral and appointments was 235.43 days. 15 Conclusions. The telemedicine intervention was effective to decrease wait time, especially for high-risk individuals, and number of waitlisted patients, which signal a positive effect of e-consultations on the knowledge of primary care physicians, reducing time and travel costs and enhancing a quaternary prevention and avoiding unnecessary consultations. / Telemedicina

Dans un contexte de raréfaction des terrains constructibles, comment produire de nouveaux logements qui répondent à la fois aux contraintes environnementales (construire dans les enveloppes urbaines déjà bâties) et au désir des habitants de pouvoir acquérir une maison individuelle à un prix abordable ?La démarche « BIMBY », acronyme de Build In My Back Yard (ou « construire dans mon jardin ») prend le contrepied du concept « NIMBY » (Not In My Back Yard, « pas dans mon jardin ») et fait émerger une filière de renouvellement urbain au sein des tissus pavillonnaires existants. L’hypothèse de départ est que la densification de ces quartiers puisse être réalisée à l’initiative de leurs habitants, du moins ceux qui manifestent le besoin de faire évoluer leur logement et/ou leur terrain.Les projets de vie des ménages propriétaires d’une maison individuelle peuvent en effet être à l’origine de la création d’un nouveau logement sur une parcelle déjà bâtie et située au sein d’un tissu déjà urbanisé.Durant ces trois années de thèse, l’équipe d’architectes-urbanistes du laboratoire de recherche In Vivo – dont je fais partie – a reçu plus 1 800 ménages propriétaires d’une maison individuelle lors d’ateliers de concertation BIMBY. Plus de la moitié des participants à ces entretiens ont imaginé et fait dessiner à leur architecte-médiateur un projet de construction d’un nouveau logement dans leur jardin. Dans cette dynamique de concertation, l’habitant peut devenir un acteur déterminant de l’évolution de la ville, en accueillant un nouveau voisin dans son jardin.Cette recherche de thèse opérationnelle est menée en collaboration avec le bureau d’étude Villes Vivantes, et son laboratoire de recherche In Vivo. Elle cherche à appréhender l’impact des projets des habitants des tissus pavillonnaires, lorsque ceux-ci sont intégrés au processus participatif BIMBY. Pour cela, nous avons analysé les 1 800 entretiens qualitatifs effectués avec les propriétaires dans le cadre de démarches BIMBY impulsées par 25 collectivités françaises.Différents scénarios de vie peuvent être à l’origine d’un projet de construction d’un nouveau logement. La destination de celui-ci (pour un tiers, pour un proche ou pour les porteurs de projet eux-mêmes) conditionne l’évolution de la parcelle bâtie ainsi que du quartier et de la commune.C’est pourquoi cette recherche se concentre dans un second temps sur l’influence de la concertation individuelle avec un architecte-médiateur sur la forme des projets imaginés par les habitants. En leur donnant les informations et les outils nécessaires à une bonne compréhension des contraintes techniques, économiques, architecturales et des différentes stratégies patrimoniales possibles, l’architecte contribue à faire évoluer les projets des habitants. L’apport d’une expertise architecturale permet de faire émerger des projets souvent mieux intégrés à leur environnement, contribuant à une densification par micro-projets qui pourrait être mieux acceptée des riverains que les grands projets ou la densification « sauvage ».Pour autant, et ce sera la conclusion de notre étude, la poursuite dans le temps du conseil aux particuliers, et la mise en place d’une politique d’urbanisme intégrant pleinement les projets des habitants sont incontournables pour parvenir à mener un projet d’intensification pavillonnaire vertueux. L’analyse de l’état d’avancement des projets de 180 participants sur huit territoires, et de l’évolution des idées lorsque la concertation se poursuit révèle d’autres perspectives sur les enjeux de l’accompagnement des habitants vers la densification pavillonnaire. / In a context where building land is rare, how cities can produce new housing that answer both the environmental constraints (build in the already built urban envelopes) and the inhabitants desire to buy an affordable house?The "BIMBY" approach, meaning "Build In My Back Yard" and taking the opposing view to the "Not In My Back Yard" concept, creates an urban renewal process within suburban area. The initial hypothesis being that the densification of these districts can be the initiative of the residents needing an evolution of their house or plot.The owners’ projects, focusing on their house and their garden, could create a new home on an already built plot located in an already urbanised neighbourhood. For three years and a half, the Lab InVivo research group (in which I take part) has received more than 1 800 households, owners of a house, during concertation consultation BIMBY. More than half of these owners have drawn a project of a new house in their garden with or without division. In this conciliation dynamic, inhabitants become a decisive actor of the surburbs increasing in “welcoming a new neighbour in theirs garden”.This operational research is carried out in collaboration with the research department Villes Vivantes and the research laboratory In Vivo. It seeks to understand the impact of owners’ projects at large-scale individual housing estates through the participatory BIMBY process.Different stories are the starting point of a building project and their destination (for outsider, for close family, friend or for self-promoters) determines the plot development, district and the town.Therefore the second line of this research seeks to estimate the influence of individual consultation with a mediator architect on the evolution of the type and the architectural form of the projects drawn up by the inhabitants: by giving tools to the inhabitants to develop the best plan of property, the architect contributes to empower owners’ ideas and make them more appropriate. Then, this micro-projects densification could be more accepted by local residents.However, and this is the conclusion of our research, the pursuit of advice associated with an urban planning vision and zoning codes is essential to carry out an intensification project of suburb neighbourhood. The cross-analysis of the progress states 180 participants in eight French suburban areas and the development of the project ideas with the pursuit of the consultation gives us other perspectives on the accompanying stakes of the inhabitants in the direction of the suburbs soft densification.

Made available in DSpace on 2015-05-14T12:42:44Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 424461 bytes, checksum: 9feddfc13a59d913e7778232e859e680 (MD5) Previous issue date: 2009-03-15 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This research considers the investigation of the argumentative strategies used by a nurse to persuade the patient and it s a study of qualitative nature with a descriptive approach, aiming to investigate the semantic-discursive function(s) of the direct and indirect speech acts used by the nurse to persuade the patient to follow the recommended behaviors. To reach this objective, the research had the following stages: description of the direct and indirect acts, according to the Speech Acts Theory, used by the nurse to persuade the patient; survey of the recurrent speech acts and inquiry of the argumentative function(s) of the identified acts. The research was based on the Speech Acts Theory of Austin and Searle, that studies the accomplishment of the speech acts as a way to describe what is explicitly said or not said in the linguistic interaction between nurse-patient, identifying which acts predominate (direct or indirect); and, later, in Perelman s Argument Theory, analyzing as these speech acts are used to persuade the patient, with emphasis in the analysis of the relation between nurse and patient, and of how one convinces the other to do the recommended behaviors. The corpus was composed of nursing consultations, recorded in Units of Family Health in the town of Olinda, and it was exclusively analyzed the speech act of the nurse. In the analysis of the corpus one perceives that, during the consultations, three strong moments in the interaction exist. At the beginning of the nursing consultation, there the nurse investigates the patient s health condition to be able to define the clinical picture, the diagnosis, and later the orientation of the behavior to be adopted to solve the detected health problems. These acts are defined as macro-acts of INVESTIGATING, DIAGNOSING, and GUIDING witch are direct speech acts. It was concluded that the direct macro-act of GUIDING is predominant in the nursing consultation, permeating all of the nurse s talks in the interaction with the patient, and it constitutes one of the main attributes of the nursing profession, and the main purpose of the nursing consultation. Also, it was perceived that these acts occur according to the interlocutor, that is, the nurse adjusts the speech according to the particular audience: the patient, trying to adapt it to his/her values, consistent with the context where it was inserted. Therefore, in the analysis of the corpus, it is noted that the nurse uses sentences in the form of direct speech acts to, through argumentation, reach the goal to direct speech acts and persuade the patient, provoking changes of habits and behaviors. / Esta pesquisa investiga as estratégias argumentativas utilizadas pelo enfermeiro para a persuasão do paciente e se constitui de um estudo de natureza qualitativa de abordagem descritiva com o objetivo de investigar a(s) função(ões) semântico-discursiva(s) dos atos de fala diretos e indiretos utilizados pelo enfermeiro para persuadir o paciente a seguir as condutas recomendadas. Para atingir este objetivo, a pesquisa teve as seguintes etapas: descrição dos atos diretos e indiretos, à luz da Teoria dos Atos da Fala, utilizados pelo enfermeiro para persuadir o paciente; levantamento dos atos de fala recorrentes e investigação da(s) função(ões) argumentativa(s) dos atos identificados. A pesquisa foi embasada na Teoria dos Atos da Fala de Austin e Searle, que se preocupa com a realização dos atos de fala, subsídio para descrever o que é explicitamente dito, ou não dito, na interação linguística entre enfermeiro-paciente, identificando quais os atos que predominam (diretos ou indiretos); e, posteriormente, na Teoria da Argumentação de Perelman, analisando como esses atos da fala são utilizados para persuadir o paciente, com ênfase na análise da relação entre enfermeiro e paciente, e de como aquele convence este para a adesão às condutas recomendadas. O corpus foi composto por consultas de enfermagem, gravadas em Unidades de Saúde da Família do município de Olinda, e foi analisado exclusivamente o ato de fala do enfermeiro.Na analise do corpus, percebeu-se que, durante a consulta, existem três momentos fortes na interação. No início da consulta de enfermagem, em que a enfermeira procura investigar a condição de saúde do paciente para poder definir o quadro clínico, o diagnóstico e, posteriormente, a orientação da conduta a ser a adotada para resolver os problemas de saúde detectados. Esses atos foram definidos como macro-atos de INVESTIGAR, DIAGNOSTICAR e ORIENTAR e são atos diretos de fala. Concluiu-se que o macro-ato direto de ORIENTAR é predominante na consulta de enfermagem, permeando toda a fala do enfermeiro na sua interação com o paciente e que constitui numa das principais atribuições da profissão do enfermeiro e objetivo principal da consulta de enfermagem. Também percebeu-se que esses atos ocorrem em função do interlocutor, ou seja, o locutor adapta seu discurso em função do seu auditório particular: o paciente, procurando adaptar-se aos seus valores, com base no contexto em que ele está inserido. Portanto, na análise do corpus, percebeu-se que o enfermeiro utiliza enunciados na forma de atos de fala diretos para atingir argumentativamente o objetivo de orientar o paciente e conseguir sua persuasão, provocando mudanças de hábitos e comportamentos.

Background. A demanda por cuidados médicos especializados vem aumentando em todo o mundo. Analisamos uma iniciativa de telemedicina para reduzir o tempo entre encaminhamento e consulta especializada e o número de pacientes na fila de espera. Métodos. Um estudo retrospectivo com controles contemporâneos foi realizado entre junho de 2014 a julho de 2016. As especialidades selecionadas foram incluídas em uma intervenção de telemedicina e comparadas com as especialidades controle reguladas de forma padrão. Os pacientes de intervenção foram combinados com um conjunto aleatório de controles (proporção 1: 1) por semestre e ano de inclusão na lista de espera e pelo índice de demanda e oferta de consultas especializadas (número de pacientes na fila de espera em junho de 2014 dividido pela média de consultas médicas especializadas disponibilizadas durante os 25 meses que compõem o período de análise). A intervenção de telemedicina incluiu o desenvolvimento de protocolos de referência e classificação de risco de pacientes na fila de espera. O tempo de espera para a consulta presencial e a magnitude da diminuição do número de pacientes na fila no final da observação foram os desfechos primários. Resultados. Nefrologia, pneumologia, urologia, neurologia, neurocirurgia e reumatologia foram selecionados para a intervenção, para um total de 50.185 pacientes (idade média: 51,5 anos) versus 50,124 pacientes controles (idade média: 52,2 anos). O tempo médio para o agendamento de consultas foi de 583,5 dias no grupo de intervenção versus 599,8 dias nos controles (p <0,001). O volume da lista de espera diminuiu 61,4% no grupo de intervenção e 53,2% no grupo controle 13 (<0,001). Para pacientes de alto risco (grupo de intervenção apenas), o tempo médio entre encaminhamento e consultas foi de 235,43 dias. Conclusões. A intervenção de telemedicina foi eficaz para diminuir o tempo de espera, especialmente para indivíduos de alto risco, e número de pacientes em espera para consultas médicas especializadas, o que sinaliza um efeito positivo sobre a eficiência do sistema de saúde, com redução de tempo e custos de deslocamentos, além de potencializar a prevenção quaternária ao prevenir consultas desnecessárias com médicos especilaistas, por meio do melhor manejo dos médicos de atenção primária. / Background. The demand for specialist care is increasing worldwide. We tested a telemedicine initiative to reduce the time between referral and specialist appointment and the number of waitlisted patients. Methods. A retrospective trial with contemporaneous controls was conducted between June 2014-July 2016. Selected specialties were included in a telemedicine intervention and compared to control specialties covered by the usual gatekeeping program. Intervention patients were matched to a random set of controls (1:1 ratio) by semester and year of inclusion in the waiting list and by the specialty demand to supply ratio (number of waitlisted patients in June 2014 divided by the mean number of appointment slots during the 25 months comprising the period of analysis). The telemedicine intervention encompassed development of referral protocols and risk classification of waitlisted patients. Waiting time to face-to-face consultation and magnitude of decrease in the number of waitlisted patients at the end of the observation were defined as primary outcomes. Results. Nephrology, pulmonology, urology, neurology, neurosurgery, and rheumatology were selected for the intervention, for a total 50,185 patients (mean age: 51.5 years) vs. 50,124 patients controls (mean age: 52.2 years). Mean referralto- appointment time was 583.5 days in the intervention group vs. 599.8 days in controls (p<0.001). Waitlist volume decreased 61.4% in the intervention group and 53.2% in the control group (<0.001). For high-risk patients (intervention group only), mean time between referral and appointments was 235.43 days. 15 Conclusions. The telemedicine intervention was effective to decrease wait time, especially for high-risk individuals, and number of waitlisted patients, which signal a positive effect of e-consultations on the knowledge of primary care physicians, reducing time and travel costs and enhancing a quaternary prevention and avoiding unnecessary consultations. / Telemedicina

Este artículo examina el desarrollo del gas natural y sus implicacionespara las comunidades indígenas guaraníes, en el sudeste deBolivia. Durante la década de 1990, el gobierno boliviano llevó acabo una serie de medidas neoliberales encaminadas a facilitar laexportación de hidrocarburos y a atraer la inversión internacionalpara la explotación del gas y el petróleo. Las protestas sobre elmanejo y la distribución de los beneficios derivados del gas naturalcontribuyeron directamente a la elección de Evo Morales, el primerpresidente indígena de Bolivia. Sin embargo, y a pesar del discursoindigenista de Morales y sus partidarios, la producción del gas haperjudicado a los grupos indígenas de los llanos del este, quienesson impactados directamente por las actividades extractivas. Esteartículo examina el caso de los guaraníes de la Tierra Comunitariade Origen (TCO) Itika Guasu, en el departamento de Tarija,donde se encuentra el ‘megacampo’ de gas Margarita de Repsol.Se propone que la explotación del gas en territorio guaraní ha sidocaracterizado por una carencia de consulta previa y participaciónreal de las poblaciones afectadas. / This article examines the implications of natural gas developmentfor Guaraní indigenous communities in southeastern Bolivia. Duringthe 1990s, the Bolivian government enacted a series of neoliberalreforms designed to attract international investment for natural gasand petroleum exploitation and to facilitate the export of hydrocarbons.Protests over the management and distribution of the benefitsderived from natural gas contributed diretly to the election of EvoMorales, Bolivia´s first indigenous president. Nevertheless, anddespite the pro-indigenous discourse of Morales and his MAS (Movementto Socialism) party, gas production has had negative effectsfor indigenous peoples in Bolivia´s Chaco region, who are directlyimpacted by extractive activities. This article examines the case ofthe Guaraní people of the Tierra Comunitaria de Orígen (OriginaryCommunal Land, TCO) Itika Guasu, in Tarija department, whereRepsol´s Margarita ´mega-field´ is located. It is argued here thatgas exploitation in Guaraní territory has been conducted withoutadequate prior consultation or meaningful participation of thepopulations affected.

La promulgación de la Ley de Consulta Previa a los Pueblos Indígenas u Originarios como mecanismo estatal de participación e inclusión social ha generado debates conceptuales sobre cómo identificar a la población indígena andina. ¿Por qué esta ley tiene dificultades para otorgar a la población andina derechos indígenas a la consulta previa? El presente artículo intenta responder a esta interrogante a partir de un recuento histórico de las formas de identidad andina y de un análisis del debate conceptual internacional sobre la indigeneidad”. Argumentamos que el problema radicaen que la aplicación de la ley estructura un modelo de reconocimiento indígena especialmente restrictivo que no recoge de manera adecuada el dinamismo y complejidad existentes en las formas de adscripción identitaria en los Andes. / The Peruvian government enacted a new law granting consultation rights to indigenous peoples as a mechanism to enhance social inclusion in the country. The law generated debates about the criteria to identify indigenous population in the Andean region. Why does this law have problems granting consultation rights to Andean people? This paper aims to answer the question by reviewing historically the different Andean identities and analyzing the current international debate on indigenity. Our main argument is that the government intrying to apply the law is structuring a restrictive model that is hardlyable to grasp the complexity and dynamism of Andean identities.