The phenomenon of orphans and vulnerable children (OVC) in Zambia is a consequence of the HIV and AIDS epidemic. Many of these children are orphaned at a critical developmental stage of their lives when parental care and nurture is most needed. In the African world view, children’s opinions in matters concerning them including care are rarely sort or heard. The main aim of this research was to gain a holistic understanding of the silent voices of children affected and/or infected by the HIV and AIDS, and specifically about their experiences of care and/or lack of it. The other aims were: 1) to research alternative means of getting the silent stories of the marginalized children heard by the Zambian society; and 2) to disseminate the research findings to policy makers. Ten children orphaned by AIDS and vulnerable children, who are the core-searchers, drawn from three Lusaka urban based NGOs participated in the study. The research process and experience was reflected upon by the researcher, co-researchers and the care givers. The research was carried out from a Practical Theology perspective and the narrative approach within the postmodern social-constructionist paradigm. The ABDCE model for fiction writing as a metaphor for doing narrative research was used. This approach enabled the researcher to carry out the research in a systematic manner. It also allowed the researcher and the co-researchers to begin and work together throughout the research process, as the researcher listened to the co-researchers’ stories and experiences of care and/or lack of it and was drawn into them. / Thesis (PhD)--University of Pretoria, 2012. / Practical Theology / unrestricted

The transition from primary to secondary school is considered to be a challenging process for all pupils, but particularly difficult for those with social and emotional difficulties. Nurture groups aim to develop social and emotional skills and are seen to correspond closely with the recommendations made in transition literature. It is therefore proposed that nurture provision could be an effective means of supporting socially and emotionally vulnerable pupils in the transition. Previous literature adds support to this view, but no study as yet has focused specifically upon this topic. A small-scale case study design was used to explore the ways in which one secondary school applied nurture principles to support vulnerable pupils through the transition process. The research followed an embedded, single case design incorporating contextual and interview data regarding the school's nurture provision. Contextual information was gathered through the research diary and analysed in relation to the identified propositions. In addition, four illustrative case examples surveyed the views of the nurture facilitator and three pupils who received different levels of nurture support: these interviews were analysed using thematic analysis. An integrated case description combines the findings from all data sources and offers a coherent account of the provision.The findings support the proposition that nurture provision can be an effective means of supporting socially and emotionally vulnerable pupils in the transition to secondary school. In line with nurture literature, the findings suggest that secondary schools need to adapt the primary nurture model to ensure provision meets the needs of their setting and cohort. While this promotes flexibility, secondary schools still need to adhere to a number of core principles to ensure they are delivering a true nurturing approach. A tentative model is presented, which proposes that secondary school nurture provision should aim to support social and emotional development through a range of provision that is firmly grounded in psychological theory. Provision should adhere closely to the six nurture principles, with effective identification of needs informing a personalised approach that is tailored to each individual pupil. The importance of relationships for learning and development is emphasised. The thesis concludes by suggesting that nurture provision can be an effective means of supporting socially and emotionally vulnerable pupils in the transition to secondary school, providing a number of core elements are in place.

Federally qualified health centers (FQHCs) that harness the reinforcing nature of collaborative efforts with aging services can better prepare for the future of older adult populations. The purpose of this research was to identify collaborative efforts between FQHCs and aging services and distinguish perceptions and knowledge regarding older adult populations. Executive directors, medical directors and social service directors (N=44) at 31 FQHCs across the state of Texas completed surveys measuring structural, procedural and environmental components of the health center setting. The 2007 Uniform Data System and 2000 US Census provided additional data on health centers use and services. Descriptive statistics analyzed independent variables of health center characteristics. Bivariate analysis determined significance of association between independent variables and levels of collaboration with aging services. Results found that all health centers collaborated with at least one aging service, with more informal than formal partnerships. Respondents indicated major barriers to providing services to older adults, including inadequate transportation, inadequate insurance, and limited funding. Respondents also indicated overloaded staff as a major barrier to collaborating with aging services. Aging topics for staff development and perceptions about older adults were also identified. Health center tenure (p=0.005, lambda=1.000), professional tenure (p=0.011, lambda=1.000), leadership in aging services (p=0.002, lambda=1.000), recent gerontological training (p=0.002, lambda=0.500), formal gerontological training p=0.002, lambda=1.000), strategic planning (p=0.002, lambda=1.000), and having older adults on governing boards (p=0.002, lambda= 1.000) were significantly associated with informal collaboration with aging services. Health center tenure (p=0.006, lambda=0.500), leadership in aging services (p=0.004, lambda=0.500), recent training (p=0.010, lambda=0.500), formal training (p=0.005, lambda=0.500), the designation of health center staff older adult services (p=0.025, lambda=0.250), strategic planning (p=0.011, Iambda=0.500), and older adults on governing board (p=0.009, lambda=0.500) were significantly associated with formal collaboration with aging services. In conclusion, FQHCs' efforts at partnering with aging services should include an investment in key staff and board development, the designation of staff to older adult programs, and strategic planning.

Information about what it is that prevents young men from vulnerable areas from getting into a criminal way of life shines with their absence. This becomes a problem as these individuals’ risk being stigmatized and stamped. The main purpose of this essay is to find out why young adult men from the Järva area do not end up in a criminal way of life. By highlighting causes that exist, we have also chosen a sub-purpose, as we want to find out what the place Järva has meant to the young and adult men's lifes and upbringing. To achieve the study's purpose and answer to the questions, we have used a qualitative study where we interviewed five young adult men aged 22-26 and a youth leader with 10 years of experience working with youth in Järva. In the result, the young-adult men highlight how factors such as family, area, friends and long-term sustainability have had an impact on not committing criminal acts. This study aims to prove the opposite, when it comes to the negative stigma that occurs with coming from Järva. The study reveals a clear answer as to why young adults from Järva were prevented from getting into a criminal lifestyle and how the place Järva influenced their choices in life. / Information kring vad det är som gör att unga män från utsatta områden inte hamnar in i en kriminell livsstil lyser med sin frånvaro. Detta blir ett problem då dessa individer riskerar att stigmatiseras och stämplas. Huvudsyftet med denna uppsats är ta reda på vad som gör att ungavuxna män från Järvaområdet inte hamnar i en kriminell livsstil. Genom att lyfta fram orsaker som existerar har vi även valt ett delsyfte, då vi vill ta reda på vad platsen Järva har haft för betydelse för de unga-vuxna männens liv och uppväxt. För att uppnå studiens syfte och svar på frågeställningarna har vi använt oss av en kvalitativ studie där vi intervjuade fem unga-vuxna män i åldrarna mellan 22–26 år och en ungdomsledare med 10 års erfarenhet av arbete med ungdomar i Järva. I resultatet belyser de unga-vuxna männen hur faktorer som familj, område, vänner och långsiktig hållbarhet har haft en påverkan till att inte utföra kriminella handlingar. Den negativa stigmatiseringen som uppstår med att komma från Järva, hoppas vi med denna studie bevisa motsatsen. I studien framkommer det tydliga svar om vad som gör att unga-vuxna män från Järva hindrats hamna i en kriminell livsstil samt hur platsen Järva påverkat deras val i livet.

Un corpus de recherches en sciences sociales et en santé publique menées principalement en Amérique du Nord depuis les années 1980 montre que l'absence de logement personnel a un effet délétère sur l'état de santé, physique et psychique des familles sans logement. En France, les études quantitatives sur la santé des femmes sans-domicile restaient exceptionnelles avant la réalisation de l'enquête ENFAMS conduite en Ile-de-France en 2013. A partir des données de cette enquête, nous avons montré que, bien qu’elles soient plus jeunes que les femmes en population générale, la santé des femmes sans logement est plus mauvaise, en particulier en ce qui concerne leur santé mentale et leur santé nutritionnelle. Malgré un état de santé plus mauvais, les femmes sans logement ont moins recours aux soins que les femmes en population générale. Cette thèse a permis de souligner l’importance du suivi gynécologique dans l’accès au dépistage des cancers féminins puisque la proportion de femmes dépistées du cancer du col de l’utérus est deux fois plus élevée chez les femmes avec un suivi que chez celles sans suivi. Nous avons aussi montré que dans le contexte français d’une couverture maladie universelle et de l’existence de filets de protection sociale, nous ne retrouvons pas les associations classiquement observées entre renoncement aux soins et ressources financières ou assurance maladie. Les professionnels en soins primaires doivent s’appuyer sur les fenêtres d’opportunité de dépistage qu’offre chacun de leur contact avec les services de soins. Les stratégies d’amélioration à l’accès aux soins de ces femmes ne doivent pas seulement viser à lever les obstacles financiers. / Social sciences and public health research conducted mainly in North America, since the 1980s, have shown that homelessness has a significant impact on health, physical conditions and psychological health of families without housing. In France, quantitative studies on homeless women were scarce until the realization of the ENFAMS survey in Paris region in 2013.Based on data from this survey, we showed that, although younger than women in the general population, the health of homeless women is worse, especially with regards to their mental health and nutritional status. Despite their poor health, homeless women have less access to health care than women in the general population. Our research has highlighted the importance of gynecological follow-up in accessing women's cancer screening since the proportion of women who were screened for cervical cancer was twice as high among women with follow-up than among women without follow-up. We have also shown that in the French context of universal health coverage and numerous social safety nets, we do not find the classic associations between unmet health care needs and financial resources or health insurance status.Primary care professionals need to rely on windows of opportunity provided by each of their contact with health care services to make them benefit from cancer screening. Strategies to improve the access to health care of these women must not only aim to remove financial barriers.

Face au phénomène complexe de la vulnérabilité, le législateur a compris que la réponse ne pouvait pas être unique. Le nombre de mesures proposées en droit des majeurs protégés est ainsi suffisamment conséquent pour qu’une grande diversité de situations apparaisse. Que ce soit sur le plan de l’âge, de la situation familiale, sociale ou professionnelle ou au regard du handicap ou de l’état de santé (physique ou mental), la « population » des majeurs protégés présente une forte hétérogénéité. La loi offre à l’organe de protection, titulaire d’un pouvoir pour exercer sa mission, de multiples outils pour sauvegarder l’intérêt du majeur protégé. Variables, ces instruments laisseraient à penser qu’il n’est pas concevable de construire une théorie générale du pouvoir cohérente en droit des majeurs protégés. Toutefois, en ce domaine, au cœur de la notion de pouvoir, se trouve le critère de la prise en charge de l’intérêt exclusif du majeur protégé. C’est là en effet le critère auquel il est systématiquement fait référence. L’objectif de notre thèse était dès lors de parvenir à démontrer que s’il existe en droit des majeurs protégés des variables attachées au pouvoir, ces dernières ne sauraient masquer l’unité de son régime. La découverte de constantes, lesquelles sont consubstantielles au pouvoir en ce domaine, permet d’en extraire une théorie générale. À partir de cet instant, le pouvoir en droit des majeurs protégés prend une coloration nouvelle. En adaptant la définition proposée par la doctrine à la spécificité du droit des majeurs protégés, nous proposons de définir le pouvoir comme la prérogative juridique et/ou matérielle confiée à un organe de protection et le plus souvent sous le contrôle d’un juge, qui ne remédie pas forcément à une incapacité d’exercice mais qui est toujours répartie entre différents organes. Le pouvoir est finalisé par l’intérêt exclusif, mais non égoïste, d’une personne majeure vulnérable, du fait de l’altération de ses facultés personnelles. Tant le principe de responsabilité que celui de l’interdiction d’agir sous l’empire d’un conflit d’intérêts constituent des procédés efficients pour lutter contre le mauvais exercice du pouvoir. Une conception renouvelée du pouvoir a ainsi pu être proposée à partir de l’étude de ses variables et de ses constantes en droit des majeurs protégés. Ayant abouti à une théorie générale du pouvoir, l’étude ici menée peut donc servir de base à une analyse critique du droit positif et aboutir à son amélioration. / Confronted to the complex phenomenon that vulnerable adults represent, the legislative body has realized that the answer to this situation had to be multi-faceted. The number of measures taken in the field of the vulnerable adult's legal status is substantial enough to lead to a great variety of situations. Vulnerable adults represent a widely heterogeneous group whether we look at age, family, social and work situations, or physical or psychological conditions. The protective body that holds the power to carry out its mission has various legal tools at its disposal to protect the vulnerable adult's interests. These instruments are variable, and could first lead us to think that it would be impossible to build a consistent general theory of legal power in the field of the vulnerable adults’ protection. Here, however, at the heart of the notion of power, stands the idea of how to fully care to the vulnerable adult's sole interest. It is the one guideline that is systematically referred to. Thus, our goal was to show that even though there are many power-related variable features in the legal field of vulnerable adults protection and safeguarding, they cannot dissimulate the unity of the field. As we unveiled the permanent features, inherent to the power in this matter, it allowed us to draw a general theory. From then on, the concept of power in the vulnerable adults protection takes a different tone. By adjusting the classic definition of power to the specificity of the vulnerable adult protection and its legal field, we propose to define the power as the legal and/or material prerogative entrusted to a protective body and mostly under the control of a judge. This prerogative does not necessarily remedy the incapacity to act in law but is always divided between several actors. The purpose of the power is the sole but non-egotistic interest of the vulnerable adult because of his or her cognitive impairment. The principle of responsibility and the principle of a ban on acting under the influence of a conflict of interests are both efficient ways to prevent an improper use of power. The analysis of variables and permanent features in the vulnerable adult protection legal field thus allowed us to propose a refreshed idea of power. Since the study undertaken here has resulted in a general theory of legal power, it can then be used as a critical analysis of positive/substantive law and lead to its improvement.

En France, sous l'impulsion de la loi du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé, des modifications profondes de la relation de soin en faveur d'une participation plus active des patients ont été engagées imposant un repositionnement de chaque acteur de cette relation. La loi précise que l'implication des patients dans les processus de prise de décision doit être recherchée y compris lorsque les patients présentent des limitations de leurs capacités de décision. L'affirmation de ces droits va de pair avec la reconnaissance de capacités de décision aux patients et le développement d'une décision médicale partagée. Elle entraîne néanmoins, lorsque ces capacités sont atteintes, des difficultés concrètes dans le recueil du consentement du patient et/ou de ses représentants légaux et aidants. Il est aujourd'hui reconnu que les besoins en santé orale des patients présentant des limitations durables de leurs capacités de décision sont non satisfaits et augmentés par rapport à la population générale. Ces inégalités de santé résultent de nombreux obstacles dans l'accès aux soins et à la prévention, mais aussi dans la prise en charge, et alors que le principe d'égal accès au soin de tous les citoyens est reconnu comme un fondement juridique national. Cette situation constitue une perte de chance pour ces personnes d'autant plus qu'une santé bucco-dentaire dégradée peut avoir, au-delà des conséquences locales, des répercussions sur la santé générale et plus particulièrement sur la qualité de vie et l'intégration sociale. Ces difficultés cumulées quotidiennement conduiraient donc à privilégier des thérapeutiques symptomatiques sans réflexion de l'ensemble des acteurs autour d'une réhabilitation fonctionnelle globale. Pourtant, il est reconnu que la lutte contre les inégalités de santé passe par le développement d'une prise en charge globale de la santé. S'appuyant sur une participation des différents acteurs et notamment des patients aux prises de décision, celle-ci prévoit un décloisonnement entre les domaines relevant du sanitaire, du social et de l'éducatif pour un continuum par priorité. Ce travail, par une recherche qualitative et participative, a pour objectif d'explorer les raisons des limitations de réponse thérapeutique auprès de chaque acteur de la relation de soin - les patients, les aidants et les chirurgiens-dentistes. Une fois celles-ci mieux comprises, les différentes représentations sont confrontées et les tensions éthiques qui s'y dégagent discutées. Puis, des pistes d'évolution de la prise en charge de la santé orale, et au-delà, des évolutions sociétales sont proposées pour espérer à terme réduire les inégalités de santé. / In France, under the impulse of the Law of 4 March 2002 on patients' rights and the quality of the health system, deep changes have been undertaken in the care relationship for a more active participation of patients. This imposes a repositioning of each individual involved in the relationship. The law specifies that the involvement of patients in decision-making should be sought even when they present limitations of their decision-making abilities. The affirmation of these rights is consistent with the recognition of patients' decision-making abilities and the development of a shared decision. Nevertheless, when the limits of these abilities are reached, it leads to practical difficulties in the consent of patients and/or legal guardians and caregivers. It is now recognized that the oral health needs of patients with enduring limitations of their decision-making abilities are not satisfied, and are increased compared to those of the general population. These health inequities result from many barriers in access to care and prevention, but also during care, and yet the principle of equal access to care for all citizens is recognized as a national legal principle. This situation constitutes a loss of opportunity for these people - especially as, beyond its local impacts, impaired oral health may have impacts on their overall health and particularly on their quality of life and social integration. These limitations, which accumulate day after day, may lead to symptomatic therapies being favoured without concerted thinking on a global functional rehabilitation. Yet it is recognized that the fight against health inequalities requires the development of comprehensive overall health care. This means that, relying on the participation of the different stakeholders including patients in decision-making, the barriers separating areas concerning health, social and educational care have to be abolished for a continuum by priority. The aim of this work is to explore, by qualitative and participatory research, the reasons for the limitations of the therapeutic response from each member of the care relationship - patients, caregivers and dentists. Once these reasons have been better understood, the different representations are considered face to face and the ethical tensions that emerge are discussed. Then, ways in which the management of oral health can be improved and, beyond this evolution, ways in which society could change are proposed with the ultimate hope of reducing health inequalities.

Two studies were conducted to present two new theoretical constructs based on narcissistic personality and Daoist water-like personality research. Narcissistic group orientation (NGO) was developed to incorporate both the grandiose and vulnerable expressions of narcissism into a group-oriented social variable. NGO is pathological group orientation with two distinct expressions that share a common etiology in social identity monopolization. The conditions that promote social identity monopolization and ultimately increase the salience of the particular self-category, differ amongst the grandiose and vulnerable expressions of NGO. The grandiose expression increases salience of a particular self-category to facilitate opportunistic use for self-enhancement, while the vulnerable expression increases salience of a particular self-category to facilitate threat detection and avoidance. Water-like group orientation (WGO) was developed to provide a measure of secure in-group positivity which is in contrast to defensive in-group positivity. WGO is a prosocial group orientation that is based on the Daoist principle of wuwei (non-action) or underacting which is conceived here as a lack of desire for control. Study 1 aimed to provide support for the factor structure of the newly developed scales and provide evidence of validity. The results of confirmatory factor analyses in Study 1 and Study 2 supported a two-factor NGO model and a two-factor WGO model. The two-factor NGO model is made up of a grandiose narcissistic group orientation (GNGO) factor and a vulnerable narcissistic group orientation (VNGO) factor. WGO Factor 1 (WGOF1) is an in-group confidence and satisfaction factor, and WGO Factor 2 (WGOF2) is an out-group respect and altruism factor. Study 1 also gathered evidence of convergent validity for both the NGO and WGO constructs. Both GNGO and VNGO exhibited positive correlations with social dominance orientation and blind patriotism, and negligible correlations with constructive patriotism. WGOF1 exhibited positive correlations with social dominance orientation and blind patriotism, and a negligible correlation with constructive patriotism. WGOF2 exhibited negative correlations with social dominance orientation and blind patriotism, and a positive correlation with constructive patriotism. Study 2 sought to gather support for the factor structure of NGO and WGO once again and to examine the relationship between GNGO, VNGO, WGOF1, and WGOF2 with a multicomponent measure of in-group identification that includes solidarity, satisfaction, centrality, self-stereotyping, and in-group homogeneity. GNGO, VNGO, and WGOF1 were positively related to all five in-group identification components, while WGOF2 was unrelated to all five in-group identification components. The NGO and WGO scales may be used to study groups who are experiencing acute or ongoing intergroup conflict, intense scrutiny, or aggressive groups. These scales may be used to develop a greater understanding of group and environmental characteristics that lead to defensive in-group positivity.

Ante la baja concientización sobre el cuidado del medio ambiente, así como de prácticas relacionadas a la protección del ambiente en las entidades públicas, pese a contar con un marco normativo sobre la materia y entes reguladores, se tuvo a bien desarrollar en el Ministerio de la Mujer y Poblaciones Vulnerables (MIMP) sede central y sede Miraflores, la Campaña ECOMIMP 2019 dirigida a todos los/as trabajadores/as de las distintas modalidades contractuales de la institución. La citada Campaña desarrollada en los meses de noviembre y diciembre del año 2019, tuvo por finalidad sensibilizar y concientizar a los/as trabajadores/as del MIMP, sobre el cuidado y protección del medio ambiente, a través de actividades competitivas de segregación de residuos sólidos y ahorro de recursos entre oficinas, siendo las oficinas con mayores cantidades de residuos sólidos segregados en la competencia que obtuvieron (primer, segundo y tercer puesto). Los ganadores tuvieron como premio visitar una de las plantas recicladoras de Lima, con el fin de conocer y fomentar prácticas sobre el manejo adecuado de los residuos. Finalmente, y a efectos de medir el impacto de la campaña ECOMIMP 2019 en los trabajadores/as del MIMP, se elaboró un cuestionario de 29 preguntas (entre abiertas y cerradas), las mismas que fueron validadas por profesionales de distintas entidades públicas, y que tuvieron por objeto obtener información sobre sus experiencias durante el desarrollo de la campaña, así como la repercusión de la misma en su vida diaria (distintos ámbitos). La investigación se enmarca en un diseño no experimental, transversal y de enfoque cuantitativo, en el que se obtuvo una muestra de 121 encuestados con un margen de error de 5%. / Given the low awareness of caring of the environment, as well as practices related to the protection of the environment in the public entities, despite having a regulatory framework on the subject and regulatory entities, it developed in the Ministry of the Women and Vulnerable Populations (MIMP) headquarters and Miraflores headquarters, the ECOMIMP 2019 Campaign aimed at workers of the different contractual modalities of the institution. The aforementioned Campaign developed in the months of November and December in 2019, had the purpose of sensitizing and raising awareness to the workers of the MIMP, on the care and protection of the environment, through competitive activities of segregation of solid waste and saving of resources between offices, being the offices with the highest amounts of segregated solid waste in the competition they obtained (first, second and third place). The winners had the prize of visiting one of the recycling plants in Lima, in order to learn about and promote practices on the proper management of the waste. Finally, and in order to measure the impact of the ECOMIMP 2019 campaign on the MIMP workers, a questionnaire of 29 questions (between open and closed) was prepared, the same ones that were validated by professionals from different public entities, and which had the objective to obtain information about their experiences during the development of the campaign, as well as its repercussion in their daily life (different scopes). The research is framed in a non-experimental design, transversal and quantitative approach, in which a sample of 121 respondents was obtained with a margin of error of 5%. / Trabajo de investigación

Objective: To describe the design of the Feel4Diabetes-intervention and the baseline characteristics of the study sample. Design: School- and community-based intervention with cluster-randomized design, aiming to promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes among families from vulnerable population groups. The intervention was implemented in 2016–2018 and included: (i) the ‘all-families’ component, provided to all children and their families via a school- and community-based intervention; and (ii) an additional component, the ‘high-risk families’ component, provided to high-risk families for diabetes as identified with a discrete manner by the FINDRISC questionnaire, which comprised seven counselling sessions (2016–2017) and a text-messaging intervention (2017–2018) delivered by trained health professionals in out-of-school settings. Although the intervention was adjusted to local needs and contextual circumstances, standardized protocols and procedures were used across all countries for the process, impact, outcome and cost-effectiveness evaluation of the intervention. Setting: Primary schools and municipalities in six European countries. Subjects: Families (primary-school children, their parents and grandparents) were recruited from the overall population in low/middle-income countries (Bulgaria, Hungary), from low socio-economic areas in high-income countries (Belgium, Finland) and from countries under austerity measures (Greece, Spain). Results: The Feel4Diabetes-intervention reached 30 309 families from 236 primary schools. In total, 20 442 families were screened and 12 193 ‘all families’ and 2230 ‘high-risk families’ were measured at baseline. Conclusions: The Feel4Diabetes-intervention is expected to provide evidencebased results and key learnings that could guide the design and scaling-up of affordable and potentially cost-effective population-based interventions for the prevention of type 2 diabetes.