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Despite substantial legislation, access to healthcare remains a threatened right. The poorest patients face complex administrative procedures, stigmatization from the administration and caregivers. Social inequalities in health have profound consequences. PASS (Health Care Access Permanence) welcome people without social or partial coverage and/or in precarious situations. Their mission is to promote the return to common law. Many studies show insertion between 60 and 65% in the wake of PASS care. The objective was to evaluate the percentage of patients leaving the Henri MONDOR hospital's dedicated medical PASS, once acquired rights, continuing their follow up with a single-handed general practitioner. Secondarily, we investigate in the various factors that can influence this insertion. The inclusion criteria were the absence of open social security rights at the first consultation, at least one social consultation and one medical consultation. The included patients were contacted by phone at 3 months. The primary outcome was a consultation with a general practitioner within 3 months. 138 patients were included in our study between April 2017 and October 2017: 114 patients were analyzed and 24 lost to follow-up. Among the analyzed patients, 78% had consulted a general practitioner. The mastery of the French language was significantly more represented in this population. Consequently, to this result, we plan to map the general practitioners speaking a language other than French in Ile-de-France and to identify the places to learn French for this population. ; Malgré une législation importante, l'accès aux soins reste un droit menacé. Les patients les plus démunis font face à des démarches administratives complexes, à une stigmatisation de la part de l'administration et de soignants. Les inégalités sociales de santé ont pourtant de lourdes conséquences. Les PASS accueillent des personnes sans couverture sociale ou partielle et/ou en situation de précarité. Elles ont pour mission de favoriser le retour au droit commun. De nombreux travaux montrent une insertion entre 60 à 65% dans les suites d'une prise en charge en PASS. L'objectif était d'évaluer le pourcentage de patients quittant la PASS médicale dédiée de l'hôpital Henri MONDOR, une fois des droits acquis poursuivant leur parcours auprès d'un omnipraticien en ville. Secondairement, nous ont intéressés les différents facteurs pouvant influencer cette insertion. Les critères d'inclusion étaient l'absence de droits à la sécurité sociale ouverts lors de la première consultation, bénéficier d'au moins une consultation sociale et une consultation médicale. Les patients inclus étaient contactés par téléphone à 3 mois. Le critère de jugement principal était la réalisation d'une consultation avec un omnipraticien dans les 3 mois. 138 patients étaient inclus dans notre étude entre avril 2017 et octobre 2017 : 114 patients analysés et 24 perdus de vue. Parmi les patients analysés, 78% avaient consultés un omnipraticien. Le caractère francophone était statistiquement plus représenté dans cette population. Nous envisageons donc de cartographier les médecins généralistes maîtrisant une autre langue que le français en Ile-de-France et de répertorier les lieux permettant d'apprendre le Français.

In the period from 2011 to 2017, there was a fluctuating yet notable increase of unaccompanied minors transiting through Croatia. The 2015 and 2016 events involving the Balkan corridor included a significant number of unaccompanied and separated children, who count as vulnerable groups of refugees and migrants. State policies and measures aimed at providing care and protection to these groups include mechanisms of appointing special guardians, who are tasked with safeguarding their rights and providing general assistance within the system of care during their stay and/or during the status recognition procedure. Using a desk study of relevant accessible documents together with a thematic content analysis of 26 expert interviews that were conducted in three cycles; in 2014, 2016, and 2018 with relevant stakeholders and care providers, the authors discussed the experiences of practitioners in the field and some of the most important challenges they are facing within the special guardianship system. The general role of caregivers in the reception, integration and possible family reunification of unaccompanied children was also examined. The results suggested that due to short period of their stay in Croatia, and due to systemic insufficiencies within the system of care, the state is facing inconsistencies in the implementation of existing European Union standards and of national measures. The special guardianship care system for unaccompanied and separated children, which is moderately influenced by the 2015 and 2016 Balkan corridor experience, has been limited by lack of professional and financial resources, lack of stronger institutional support and somewhat overlapping competences of different parties in the system of care. ; U razdoblju između 2011. i 2017. došlo je do oscilirajućeg, ali vidljivog, porasta broja maloljetnika bez pratnje u tranzitu kroz Hrvatsku. Događaji na balkanskom koridoru tijekom 2015. i 2016. uključivali su i značajan broj djece bez pratnje i djece odvojene od roditelja, koji se smatraju ranjivim skupinama izbjeglica i migranata. Državne politike i mjere usmjerene na skrb za te skupine, odnosno na njihovu zaštitu, uključuju i mehanizme imenovanja posebnih skrbnika koji se bave zaštitom njihovih prava i pružanjem opće potpore u sustavu skrbi tijekom njihova boravka i/ili tijekom postupka priznavanja statusa. Provedenom analizom dostupnih dokumenata nadopunjenom tematskom analizom sadržaja 26 ekspertnih intervjua koji su bili provedeni u tri ciklusa, 2014., 2016. i 2018., među relevantnim dionicima i pružateljima skrbi, u radu se razmatraju neki od najvažnijih izazova u sustavu posebnog skrbništva, ispitujući opću ulogu skrbnika za prihvat, integraciju i moguće spajanje obitelji za djecu bez pratnje. Rezultati upućuju na to da se zbog kratkog razdoblja boravka djece bez pratnje u Hrvatskoj, ali i zbog sustavnih nedostataka u sustavu skrbi, država suočava s nedosljednostima u provedbi postojećih standarda Europske unije kao i nacionalnih mjera. Stoga je sustav posebnog skrbništva za maloljetnike bez pratnje i djecu odvojenu od roditelja, na koji je samo dijelom utjecalo iskustvo s balkanskim koridorom iz 2015. i 2016., ograničen nedostatkom stručnih i financijskih sredstava, izostankom snažnije institucionalne podrške angažmanu posebnih skrbnika te donekle preklapanjem nadležnosti različitih aktera u sustavu skrbi.

International audience ; Pain, one of the most feared symptoms for patients with cancer, remains insufficiently alleviated and impairs quality of life. Therapeutic patient education (TPE) is a relevant approach to this problem while allowing patients to develop skills to better manage their pain. In the "Basse-Normandie" French region, the management of pain relies on two organized networks, thus allowing proximity and accessibility for all concerned. In this context, our team has begun a broad five-step research program that is part of a regional health policy: (1) training in TPE of 10 doctor/nurse pairs; (2) identification of educational expectations of patients and their relatives in the field of cancer pain; (3) design and optimization of a TPE program dedicated to cancer pain; (4) regional pilot study aiming to assess the feasibility, quality and transferability of the program; (5) evaluation of the TPE program by interventional comparative randomization at the national level. This article aims to present the program which originality and strengths are based on collaborative work between health stakeholders. Objectives, methodology and expected results of the research phase (stages 2, 4, 5) are notably developed. The main expected outcomes are to prove the effectiveness of the program in improving the knowledge and skills of patients in the field of pain cancer in order to promote their adherence to treatment and, consequently, to enable them to better manage it. The long-term objective is to disseminate the educational approach by modifying practices that provide a mutual benefit for caregivers and patients. ; La douleur est l'un des symptômes les plus redoutés par les patients atteints de cancer. Elle reste insuffisamment soulagée et retentit sur leur qualité de vie. L'éducation thérapeutique du patient (ETP) constitue une approche pertinente pour répondre à cette problématique en permettant au patient de développer des compétences pour mieux gérer sa douleur. En Basse-Normandie, la prise en charge de la douleur liée au cancer s'appuie notamment sur deux réseaux structurés permettant ainsi la proximité et l'accessibilité pour tous. Dans ce contexte, nous avons construit un large programme de recherche s'inscrivant dans une politique régionale de santé, en cinq étapes : (1) formation à l'ETP de 10 binômes médecins/infirmières ; (2) identification des attentes éducatives des patients et des proches dans le domaine de la douleur ; (3) conception et optimisation d'un programme ETP ; (4) étude pilote régionale permettant d'évaluer la faisabilité, la qualité et la transférabilité du programme ; (5) évaluation du programme d'ETP par randomisation comparative interventionnelle menée à l'échelle nationale. L'objectif de cet article est de présenter la stratégie de notre approche et plus particulièrement les objectifs, la méthodologie et les résultats attendus des phases de recherche (étapes 2, 4, 5). À l'issue des cinq étapes, notre ambition est de démontrer l'efficacité du programme éducatif pour améliorer les compétences des patients leur permettant de mieux gérer leur douleur. La finalité à long terme est de diffuser la démarche éducative avec une modification des pratiques apportant un bénéfice réciproque pour les soignants et les patients.

Relevance / Background Quality and efficiency are used by policymakers as governance criteria in healthcare. This includes the question of the efficiency and quality of care quality in the hospital. The questions about the quality of care, however, can not currently be answered. In addition, qualified specialist staff is missing with increasing care needs. Research question How is the quality of care in the hospital to be assessed and which contribution do the two quality indicators from external inpatient quality assurance make to the quality of care in the hospital? What are supporting criteria for quality in the hospital and how can quality of care be reflected in the hospital at all levels? Methodology Literature review and concept analysis on the theoretical concepts and influencing factors on the quality of care in the hospital. Literature search for quality indicators and findings on decubitus incidence in the hospital. The research took place in the databases PubMed, Embase, Medline, CINAHL and the Cohrane Libery. Exclusion criteria have been defined and specified. A total of 198 studies, 58 reviews and 47 theoretical models and concept papers were included in the review and evaluated. Published data on the Dekubtius incidence of external inpatient quality assurance were used and evaluated. State of research Theoretical models and concept papers are based for the majority of models in the field of quality management and the continuous improvement process and the organization and system theory, less often are concepts of professional attitude and patient centering. Evidence was found from the studies that have a positive effect on the quality of results in the hospital and also on the nurse outcomes. Starting with structures and defined process descriptions on cultural aspects and personality traits of caregivers. Results The questions about the quality of care in the hospital remain open. There is a lack of studies in the German context and a common definition of care quality is lacking in order to be able to evaluate them. The findings on decubitus incidence also difficult to interpret. However, there are indications of criteria that have a positive effect on patient outcomes and nurse outcomes. There are quality indicators and instruments that are used internationally for quality measurement. However, these often only refer to errors and adverse events and only represent part of the quality of care. Discussion The quality control tools used by policy makers have not yet been evaluated for their effectiveness. The political discussion focuses on minimum numbers of employees and thus does not do equitable to the complexity of factors influencing the quality of care. There is a very elaborate quality assurance process with two quality indicators for care and over 400 medical quality indicators. Care quality can not be comprehensively mapped. It requires a definition of care quality, developed from the occupational group with the derivation and definition of quality indicators to comprehensively map and measure quality of care with quantitative and qualitative survey methods. There is a lack of national research on care quality in the hospital to map the complex influencing factors and to meet them.

The deployment of the Dutch Armed Forces in Afghanistan between 2001-2014, had an enormous impact on their organization and personnel. Lessons learned during and after this deployment can help the military medical support organization in improving logistics, administration of, and medical care delivered to service members that sustain injuries during ongoing and future assignments. During the International Security Assistance Force mission between 2006-2010, the Dutch Armed Forces were lead nation in the Uruzgan province, Afghanistan. On their main operating base, the Multinational Base in Tarin Kowt, a Role 2 Enhanced Medical Treatment Facility was operated under Dutch command were a variety of patients and injuries were treated. The deployed surgeon must be aware of and be prepared for being confronted with injuries far beyond the scope of a normal civilian practice. Limited resources, hostile environments, harsh climatological conditions and sometimes long evacuation times, attribute to working conditions that require an unprecedented combination of competences. Future military surgeons will therefore need a wide surgical skillset that is different from, and broader than the skillset that is needed in the highly specialized civilian environment of present day. Damage control surgery plays a prominent role in stabilizing a patient (hemorrhage and contamination control) before being evacuated from zones of combat and subsequently out of theater where more specialist and definitive care can be provided. Although timely evacuation is important, the right care for the right patient on the right time is a justifiable procedure to optimize patient outcome and quality of life. A major challenge for the future military surgeon is to seek ways to maintain essential skills and expertise when exposure to combat situations decreases. The military healthcare organization must be aware of these challenges and provide formalized training and exercise curricula that will benefit military surgeons in maintaining their competencies. This could be achieved by creating an integrated network of civil-military trauma centers that provide definitive care to polytrauma patients and where the military trauma surgeon can preserve and expand his skills in multiple anatomic regions, and in neonatal, obstetrical and aging populations. It is essential that procedures that a military surgeon needs to perform during deployments, are kept up-to-date during civilian practice. To improve trauma care and enhance international collaboration, a shared understanding of distinctive international systems of medical support is needed. Only by reaching consensus can integration of multinational (military) medical care be optimized. One of the foundations of international, joint trauma care should be coalition-wide compatible data collection, with uniform definitions. Such an international coalition-wide registry should co-exist with a detailed national military trauma registry, that preferably has possibilities to be incorporated in a national civilian trauma registry. Integration of civilian and military registries increases the learning potential of the trauma care system. Resiliency of wounded servicemembers often proves remarkable. To preserve and increase quality of life of these service members and their direct circle, it is important that all caregivers involved, join.

International audience ; Background: Public health is a multidisciplinary activity whose fields of action are acquiring an increasingly broad. The Service de santé des armées (SSA) has always had a culture of public health problems thanks to doctors specialized in the treatment of major diseases. Often involved in public health activities, health professionals nevertheless have a fragmented vision. The objective was to describe the social representations of public health of military healthcare workers.Method: The responders were doctors, nurses, veterinarians and pharmacists practicing in different areas of SSA (caregivers, administrators, policy makers) and were interviewed by telephone. A question of spontaneous evocation on the representations of public health in the army was asked. The overall lexical analysis was performed according to the method of rank-frequency. Categorical analysis was conducted to better understand the whole lexical field use.Results: There were 90 responders. The most salient terms were "prevention, epidemiological surveillance and vaccination". The categorical analysis showed that doctors used a lexical field primarily focused on diseases and risk behaviors, nurses on the specifics of military surveillance and policy makers about the cross-discipline.Conclusion: Public health in the army is mainly represented by epidemiological surveillance and prevention. Given the non-mentioned fields, a strengthening of communication on the current challenges of public health would probably improve adherence of healthcare professionals since public health takes on more and more importance in the development of the national health policy and management of health crises. ; Position du problème: La santé publique est une activité multidisciplinaire dont les champs d'action sont de plus en plus nombreux. Le Service de santé des armées (SSA) a toujours eu une culture de la santé publique grâce notamment aux médecins des grandes endémies. Souvent impliqués dans des activités de santé publique les professionnels de santé en ont pourtant une vision parcellaire. L'objectif était de décrire les représentations sociales de la santé publique des professionnels de santé militaires.Méthode: Les répondants étaient des médecins, infirmiers, vétérinaires et pharmaciens exerçant dans les différents domaines du SSA (soignants, administratifs, décideurs) et ont été interrogés par téléphone. Une question d'évocations spontanées portant sur les représentations de la santé publique dans les armées leur a été posée. L'analyse lexicale globale a été effectuée selon la méthode des rang-fréquence. Une analyse catégorielle a été réalisée pour mieux appréhender l'ensemble du champ lexical utilisé.Résultats: Le nombre de répondants a été de 90. Les termes les plus saillants étaient « prévention, surveillance épidémiologique et vaccination ». L'analyse catégorielle a montré que les médecins des forces avaient un champ lexical principalement axé sur les maladies et les conduites à risque, les infirmiers sur les spécificités de la surveillance militaire et les décideurs sur la politique de santé et l'organisation des systèmes.Conclusion: L'image de la santé publique dans les armées est représentée essentiellement par la surveillance et la prévention. Compte tenu des champs d'activités non évoqués, un renforcement de la communication sur les défis actuels et la valorisation des activités de la santé publique permettrait sans doute d'améliorer l'adhésion des acteurs à leur mission de santé publique, au moment où elle revêt une importance majeure dans le développement des politiques de santé et dans la gestion des crises sanitaires.

This thesis examines the practice of haemodialysis and kidney transplantation, the two medical therapies available for persons with kidney failure, from a phenomenological perspective. A basic assumption made in the thesis is that contemporary biomedicine is deeply embedded in the cultural, historical, economic, and political circumstances provided by the particular local, national, and transnational contexts in which it is practiced. The aim of the thesis is twofold. On the one hand, the aim is to examine the forms of person- and patienthood enacted and negotiated in haemodialysis and kidney transplantation care and in the daily lives of persons with kidney failure. On the other hand, the aim is to investigate the ways in which the enacted and negotiated forms of person- and patienthood are culturally embedded and normatively charged. In order to examine and investigate this twofold aim, an empirical material has been gathered that comprises observations and in-depth interviews with patients and caregivers at four haemodialysis units, one in Riga, Latvia, and three in Stockholm, Sweden. The theoretical approach and methodology of the study is cultural and phenomenological in character, drawing on an ethnological and anthropological understanding of culture as processual and relational, and on a phenomenological understanding of personhood as embodied and intertwined with the surrounding world. The thesis shows that patients' encounters and attempts to deal with the diagnoses and treatments associated with kidney failure are complex and often misalign them with the normatively charged orientations enacted and recommended by medicine. The complex situation that emerges when they undergo transplantation, for example, stands in stark contrast to the widespread official view of organ transplantation as a self-evidently health-bringing and normalising therapy. Through their repeated and extensive experiences of undergoing haemodialysis and living with the disease, patients eventually become able to create a synthesis between their lived experiences of their own body and their body as a medical object – what in the thesis is called a 'sick body' – a synthesis that allows them to reorient themselves in life and experience a sense of direction. This process relies, to a large extent, on the temporal structure that haemodialysis affords life; it is by repeatedly undergoing the treatment that patients become able to create a sick body. Even so, many of them find this temporal structure problematic; they experience it as disruptive of their control and future-orientedness and as causing an existentially difficult-to-handle boredom. The thesis also shows that the political developments and the norms prevalent in the two national contexts studied greatly affect the orientations of the treatment practices and the participants' lives. In both Riga and Stockholm, ideals of freedom, activity, control, and self-actualisation influence what forms of patienthood and personhood are enacted. The study indicates that persons who fall ill with a serious and chronic disease only gradually become able to understand and actively cope with their differently embodied circumstances of life. This suggests that medical professionals should not too hastily enlist their patients as experts on their own bodies, but rather provide them with the time and support necessary for making repeated attempts at creating and maintaining a life with a sick body.

Este artigo analisa o modo como as políticas públicas voltadas para a saúde e a assistência social no Brasil se consolidam a partir da centralidade da atuação das mulheres pobres. Por meio de uma pesquisa qualitativa e de análise das trajetórias das usuárias e das agentes de ponta dos ditos "novos" programas sociais brasileiros, pretende-se mostrar que o sucesso que tais programas têm conquistado depende, em grande medida, da atuação dessas mulheres mediadoras dentro da lógica conservadora da divisão sexual do trabalho e da disposição feminina para o cuidado. Em particular, as agentes, em contraponto às usuárias, têm acesso à mobilidade social que as tira do confinamento na esfera privada pela sua presença no mercado de trabalho. No entanto, o maior ganho dessa mobilização feminina a baixo custo e de alta produtividade é direcionado às instituições gestoras dos "novos" programas sociais em questão, desde as organizações filantrópicas até os governos.Palavras-chave : "Novos" programas sociais; Mediação feminina; Família; Trabalho; Divisão sexual do trabalho. Women as the strength behing social programs Yumi Garcia dos Santos This article examines how public policies for health and social care in Brazil are consolidated with the actions of poor women. Through a qualitative research and analysis of the trajectories of these users and top agents of the so called "new" Brazilian social programs, I intend to show that the success such programs have achieved is largely due to the work of these women, who are mediators within the conservative logic of a gender bias division of labor and denomination of women as caregivers. In particular, the agents, as opposed to the users, have access to social mobility that frees them from the confinement of their private sphere by being present in the labor market. However, this female mobilization, with low costs and high productivity, benefits mainly the institutions of the "new" social programs in question, from philanthropic organizations to governmental ones.Keywords:"New" social programs; Feminine mediation; Family; Work; Gender bias labor division. Les femmes comme piliers de la construction des programmes sociaux. Yumi Garcia dos Santos Cet article analyse comment les politiques publiques en matière de santé et d'aide sociale au Brésil se consolident à partir de la centralité d'action des femmes pauvres. Grâce à une recherche qualitative et à une analyse de la trajectoire des utilisatrices et des agents des dits "nouveaux" programmes sociaux brésiliens, notre intention est de montrer que le succès de ces programmes dépend en grande partie de l'action de ces femmes médiatrices au sein d'une logique conservatrice de la division sexuelle du travail et d'un enclin féminin pour les soins. Les agents, en opposition aux usagers, ont tout particulièrement accès à la mobilité sociale qui les sort du confinement de la sphère privée par leur présence sur le marché du travail. Cependant le résultat le plus important, obtenu grâce à cette mobilisation féminine à faible coût mais dont la productivité est élevée, bénéficie les institutions qui gèrent ces "nouveaux" programmes sociaux en question, allant des organisations philanthropiques aux gouvernements.Mots-clés: "Nouveaux" programmes sociaux; Médiation féminine; Famille; Travail; Division sexuelle du travail.Publicação Online do Caderno CRH no Scielo: http://www.scielo.br/ccrh Publicação Online do Caderno CRH: http://www.cadernocrh.ufba.br

Antecedentes: Las enfermedades crónicas no transmisibles, son la principal causa de morbimortalidad a nivel mundial. Comportamiento similar se presenta en Colombia al igual que en Santander. Las patologías cardiovasculares en el 2010 cobraron la vida de 1527 mujeres y 1634 hombres; seguido de las neoplasias, en especial las de localización de tumores malignos que causaron la muerte a 727 mujeres y 755 hombres, estos resultados se ven reflejados en los altos costos requeridos para la atención hospitalaria, ambulatoria y domiciliaria por lo que requiere dedicación, educación y cuidado individualizado. Métodos: Se realizó una búsqueda de artículos teniendo en cuenta tiempo de publicación y las palabras claves; en las bases de datos: MEDLINE, IME, LILACS, Centro Cochrane Iberoamericano, EMBASE, CINAHL, BDIE, en el primer semestre de 2013. Identificando 55 estudios potenciales, de los cuales se seleccionaron seis artículos del comportamiento de los costos de la atención a pacientes con enfermedades crónicas no transmisibles; cabe incluir que se obtuvo información directa por parte de algunas instituciones de Bucaramanga, la cual demuestra el comportamiento de los costos frente al cuidado de enfermería y a nivel interno de cada entidad no solo del sistema de salud sino de los pacientes y cuidadores familiares. Resultados: la enfermedad crónica genera la mayor parte de los costos al Sistema de Salud, situación a tener en cuenta; así como el cuidado efectivo para la atención de pacientes que ya han sido afectados. Conclusiones: el Sistema de Salud debe implementar estrategias preventivas para la aparición de las Enfermedades Crónicas No Trasmisibles (ECNT) y las complicaciones derivadas de ellas, que contemple un cuidado efectivo para la atención de los individuos.Palabras claves: Costos, Cuidado, Enfermedad Crónica no transmisible. Abstract Background: Chronic noncommunicable diseases are the leading cause of morbidity and mortality worldwide. Similar behavior occurs in Colombia as in Santander. Cardiovascular diseases in 2010 claimed the lives of 1527 women and 1634 men ; followed by neoplasms, especially the localization of malignant tumors that killed 727 women and 755 men, these results are reflected in the high cost required for inpatient , outpatient and home care so requires dedication , education and individualized care. Methods: A search of articles were given at time of publication and keyword; in databases: MEDLINE, IME, LILACS, Iberoamerican Cochrane Centre, EMBASE, CINAHL, BDIE in the first half of 2013. By identifying 55 potential studies, of which six articles of behavior of costs of care were selected patients with chronic non- communicable diseases; it should include direct information was obtained by some institutions Bucaramanga, which shows the behavior of costs compared to nursing care and internally each institution not only the health system but patients and family caregivers. Results: Chronic illness generates most of the costs the health system, a situation to consider; and effective care for the care of patients who have already been affected. Conclusions: Health System must implement preventive strategies for the appearance of Chronic Non Communicable (ECNT) and complications arising from them, by providing effective care for the care of individuals.Keywords: Costs, Care, Chronic Non-Communicable Disease.

Background Population ageing is a major public health concern globally as older people with disabilities or suffering from chronic diseases are expected to live longer. The demographic shift in Hong Kong is particularly pronounced and increasing resources on elderly healthcare will add substantially to the government's financial burden. Research has shown the importance of better understanding the healthcare challenges posed by an ageing population in order to promote informed choice, align policy with need, and deliver effective, efficient and sustainable health services. Objectives This dissertation explores the circumstances and factors that influence a household's decision to place an elderly person in a care home. It considers the decision-making process in the contexts of the interactions and negotiations that take place within and between household members; a key objective is to examine the extent to which the elderly are themselves participants in this decision-making process. Description of the sample The researcher interviewed a total of nine Hong Kong Chinese residents from two private nursing homes. They were between 63 and 92 years of age at the time of the interview and had been residing in a care home for an average of 2.5 years. Methods This is a qualitative research study in which primary data were gathered through face-to-face, semi-structured interviews. The research focused on subjects with high-functional status. An inductive approach to thematic analysis was adopted. Results The majority of the subjects had been admitted to hospital as a result of an acute health incident. They were subsequently transferred to the care home directly from the hospital. The subjects drew a direct link between the health incident and their placement in the care home. It became apparent in the course of the interviews, however, that other contextual factors had played an important role in the decision-making process, determining how the subjects themselves retrospectively rationalized their relocations. Over the course of data analysis, family relations, assumed gender roles, perceptions of self-identity, and practical constraints were identified as themes that impacted upon the decision-making process in relation to placement decision within a household setting. The findings suggested the degree to which the broader context of the subjects' past life experiences permeated the decision-making process. It also underscored the importance of the roles and responsibilities assumed by the elderly. Conclusion By examining how the elderly themselves discuss their experiences and justify their choices, the study sheds light on the cultural assumptions, conventions and traditions that shape how subjects perceive norms of behaviour, expectations and responsibilities. Future studies might extend the scope of research further to incorporate the views of household members, who are also potential caregivers. Given that the subjects were admitted to care homes after an acute health episode, which resulted in hospitalization, it would also be worth exploring alternative options in relation to the discharge arrangements for elderly persons. This study would also benefit from further research into the comprehensive long-term care system in Hong Kong, including the provision of services, long-term housing, healthcare choices, and the financing of long-term care. ; published_or_final_version ; Public Health ; Master ; Master of Public Health

Objective: to analyze current Mental Health policies, discriminating health care defined for the post-discharge period of psychiatric hospitalization, with a focus on Nursing care. Method: this is a quantitative, reflective study, based on research in 27 institutional, legislative or officially recognized documents that regulate the area of Mental Health regarding the return of the person to the home after psychiatric discharge. Results: 15 documents were identified that reveal Mental Health care focused on hospital productivity, with difficulty in establishing community structures and interventions. There is a insufficiency and variability in the distribution of human resources and interventions, with lack of uniformity among the various caregivers. In a multidisciplinary logic, nursing intervention is essential to ensure continuity of care. However, it is verified that the intervention of the specialist nurse is insufficiently integrated in the Mental Health policies. Conclusion: Portuguese Mental Health policies are still falling short in the definition and provision of transitional health care specific to the psychiatric post-discharge home. Descriptors: Patient Discharge; Psychiatric Department, Hospital; Health Policy; Psychiatric Nursing; Continuity of Patient Care; Nursing.ResumoObjetivo: analisar as políticas de Saúde Mental atuais, discriminando os cuidados de saúde definidos para o período pós-alta da hospitalização psiquiátrica, com um enfoque sobre os cuidados de Enfermagem. Método: trata-se de um estudo quantitativo, tipo reflexivo, a partir da pesquisa em 27 documentos de caráter institucional, legislativo ou oficialmente reconhecidos que regulam a área de Saúde Mental no que concerne ao regresso da pessoa à casa pós-alta hospitalar psiquiátrica. Resultados: identificaram-se 15 documentos que revelam cuidados de Saúde Mental centrados ainda na produtividade hospitalar, com dificuldade em estabelecer estruturas e intervenções comunitárias. Verificam-se uma insuficiência e a variabilidade na distribuição de recursos humanos e de intervenções, com falta de uniformidade entre os diversos prestadores de cuidados. Constitui-se, em uma lógica multidisciplinar, a intervenção de Enfermagem como essencial para assegurar a continuidade de cuidados. Verifica-se, porém, que a intervenção do enfermeiro especialista está insuficientemente integrada nas políticas de Saúde Mental. Conclusão: mantêm-se as políticas de Saúde Mental portuguesas aquém na definição e prestação de cuidados de saúde transicionais específicos ao pós-alta hospitalar psiquiátrico para a casa. Descritores: Alta do Paciente; Unidade Hospitalar de Psiquiatria; Política de Saúde; Enfermagem Psiquiátrica; Continuidade da Assistência ao Paciente, Enfermagem.ResumenObjetivo: analizar las políticas actuales de Salud Mental, discriminando la atención de salud definida para el período posterior al alta de hospitalización psiquiátrica, con un enfoque en la atención de Enfermería. Método: este es un estudio cuantitativo, reflexivo, basado en la investigación en 27 documentos institucionales, legislativos u oficialmente reconocidos que regulan el área de Salud Mental con respecto al regreso de la persona al hogar después del alta psiquiátrica. Resultados: se identificaron 15 documentos que revelan la atención de Salud Mental centrada en la productividad hospitalaria, con dificultad para establecer estructuras e intervenciones comunitarias. Existe una insuficiencia y variabilidad en la distribución de recursos humanos e intervenciones, con falta de uniformidad entre los distintos cuidadores. En una lógica multidisciplinaria, la intervención de Enfermería es esencial para garantizar la continuidad de la atención. Sin embargo, se verifica que la intervención del enfermero especializado está insuficientemente integrada en las políticas de Salud Mental. Conclusión: las políticas portuguesas de Salud Mental siguen sin cumplir con la definición y la provisión de atención de salud de transición específica para el hogar psiquiátrico posterior al alta. Descriptores: Alta del Paciente; Servicio de Psiquiatría en Hospital; Política de Salud; Enfermería Psiquiátrica; Continuidad de la Atención al Paciente; Enfermería. ; Objetivo: analisar as políticas de Saúde Mental atuais, discriminando os cuidados de saúde definidos para o período pós-alta da hospitalização psiquiátrica, com um enfoque sobre os cuidados de Enfermagem. Método: trata-se de um estudo quantitativo, tipo reflexivo, a partir da pesquisa em 27 documentos de caráter institucional, legislativo ou oficialmente reconhecidos que regulam a área de Saúde Mental no que concerne ao regresso da pessoa à casa pós-alta hospitalar psiquiátrica. Resultados: identificaram-se 15 documentos que revelam cuidados de Saúde Mental centrados ainda na produtividade hospitalar, com dificuldade em estabelecer estruturas e intervenções comunitárias. Verificam-se uma insuficiência e a variabilidade na distribuição de recursos humanos e de intervenções, com falta de uniformidade entre os diversos prestadores de cuidados. Constitui-se, em uma lógica multidisciplinar, a intervenção de Enfermagem como essencial para assegurar a continuidade de cuidados. Verifica-se, porém, que a intervenção do enfermeiro especialista está insuficientemente integrada nas políticas de Saúde Mental. Conclusão: mantêm-se as políticas de Saúde Mental portuguesas aquém na definição e prestação de cuidados de saúde transicionais específicos ao pós-alta hospitalar psiquiátrico para a casa. Descritores: Alta do Paciente; Unidade Hospitalar de Psiquiatria; Política de Saúde; Enfermagem Psiquiátrica; Continuidade da Assistência ao Paciente, Enfermagem.AbstractObjective: to analyze current Mental Health policies, discriminating health care defined for the post-discharge period of psychiatric hospitalization, with a focus on Nursing care. Method: this is a quantitative, reflective study, based on research in 27 institutional, legislative or officially recognized documents that regulate the area of Mental Health regarding the return of the person to the home after psychiatric discharge. Results: 15 documents were identified that reveal Mental Health care focused on hospital productivity, with difficulty in establishing community structures and interventions. There is a insufficiency and variability in the distribution of human resources and interventions, with lack of uniformity among the various caregivers. In a multidisciplinary logic, nursing intervention is essential to ensure continuity of care. However, it is verified that the intervention of the specialist nurse is insufficiently integrated in the Mental Health policies. Conclusion: Portuguese Mental Health policies are still falling short in the definition and provision of transitional health care specific to the psychiatric post-discharge home. Descriptors: Patient Discharge; Psychiatric Department, Hospital; Health Policy; Psychiatric Nursing; Continuity of Patient Care; Nursing.ResumenObjetivo: analizar las políticas actuales de Salud Mental, discriminando la atención de salud definida para el período posterior al alta de hospitalización psiquiátrica, con un enfoque en la atención de Enfermería. Método: este es un estudio cuantitativo, reflexivo, basado en la investigación en 27 documentos institucionales, legislativos u oficialmente reconocidos que regulan el área de Salud Mental con respecto al regreso de la persona al hogar después del alta psiquiátrica. Resultados: se identificaron 15 documentos que revelan la atención de Salud Mental centrada en la productividad hospitalaria, con dificultad para establecer estructuras e intervenciones comunitarias. Existe una insuficiencia y variabilidad en la distribución de recursos humanos e intervenciones, con falta de uniformidad entre los distintos cuidadores. En una lógica multidisciplinaria, la intervención de Enfermería es esencial para garantizar la continuidad de la atención. Sin embargo, se verifica que la intervención del enfermero especializado está insuficientemente integrada en las políticas de Salud Mental. Conclusión: las políticas portuguesas de Salud Mental siguen sin cumplir con la definición y la provisión de atención de salud de transición específica para el hogar psiquiátrico posterior al alta. Descriptores: Alta del Paciente; Servicio de Psiquiatría en Hospital; Política de Salud; Enfermería Psiquiátrica; Continuidad de la Atención al Paciente; Enfermería.

Jennifer Huddleston


As headlines have gotten the attention of parents and policymakers, a new Surgeon General's report has raised concerns about children's and teens' time on social media. Some states, including Utah, Arkansas, and California, have introduced bills that claim to "protect children," but these bills would carry significant consequences for speech and privacy. Many parents and policymakers are wondering what could be done to help keep kids safer online without taking such a restrictive —and likely unconstitutional — approach.
The issue of keeping children and teens safe online is as unique as each individual child and family. The best answers for these concerns are not one‐​size‐​fits‐​all and thus will emerge from a variety of market and civil society forces that can respond to these unique needs. In my latest policy brief, I highlight some ways that policymakers who want to support parents and families navigating these questions could do so without the problems for speech, privacy, and parental choice.
Many great resources exist already, from parental controls to resources for having conversations about technology with children and teens, but parents are often unsure of what parental controls are available, how to have conversations with their children about technology, or where to look for guidance. Policymakers could help empower parents by collating existing resources or engaging in other educational opportunities so families can choose the right solutions for their concerns. These resources need not be developed by the government, as a wide array of both industry and civil society groups have already developed such resources.
Second, further research is needed to understand the underlying concerns around issues like teenage mental health and social media. It should not be presumed that technology is always to blame, and how technology can help with these same issues should also be explored. Not only should further research and conversations include scientific and social science research, but policymakers and trusted adults like parents, caregivers, and teachers should also ask children and teenagers why they prefer to spend time online and discuss the value they find in online communities.
Finally, many states already have a digital or computer literacy component in their curriculums. However, many of these curriculums and standards were developed before social media gained popularity. This year, Florida passed a law to include updated online safety and media literacy around social media in a way that allows schools and parents to be aware of and choose the curriculum. This flexible approach does not dictate to children and teenagers what choices they should make, but instead prepares them to both make responsible choices and understand the risks and benefits of using technology.
In short, it is understandable that many parents are concerned about what they hear about children, teenagers, and social media. It is not uncommon for these concerns to arise with technology or in popular culture. Similar concerns have played out over everything from the novel to video games.
Despite these concerns, many children and teens have found valuable online communities, educational opportunities, or new passions online. Rather than rushing to regulate or take away technology from teenagers, parents, and policymakers should look at the tools available to empower and educate all users on how to have a beneficial online experience.

Service evaluation is a professional requirement for music therapy practitioners and organisations. Yet service evaluation findings are rarely published within the professional literature, and there is limited documentation of the processes and methods of such evaluations, including the rationale, dilemmas, and challenges encountered. This is perhaps due to the perceived status, methodological weaknesses, and context-specificity of service evaluation work. Drawing on our engagement with service evaluation in diverse settings, we have become aware of its potential beyond its typical current uses in the field as well as of the need for open discussion and debate about the service evaluation tools that are available. This is where the aim of this paper lies: to introduce a service evaluation tool, the Impact Areas Questionnaire (IAQ), alongside the studies that led to its construction. Developed originally through a review of 27 individually designed service evaluation projects, this questionnaire contains a number of different impact areas. Adopting an ecological perspective, these areas refer to music therapy's perceived impact not only on service users, but also on families/carers/friends, staff, and the organisational context in its entirety. Following its original development within Nordoff Robbins England and Wales, this questionnaire was tested in the context of Nordoff Robbins Scotland with the aim of exploring its applicability and transferability to other music therapy settings. In addition to presenting the findings of this testing, we discuss the potential use of the IAQ, which is included as an appendix to this article, in other settings and its relevance for knowledge and policy making in the field. ; L'Impact Areas Questionnaire (IAQ): uno strumento di valutazione del servizio di musicoterapia La valutazione del servizio è un requisito professionale per gli esperti e le organizzazioni di musicoterapia. Tuttavia, i risultati della valutazione del servizio sono raramente pubblicati nella letteratura professionale, e la documentazione su processi e metodi di tali valutazioni è limitata, inclusi la logica, i dilemmi e le sfide incontrate. Probabilmente, ciò è dovuto allo stato percepito, alle carenze metodologiche e alla specificità del contesto del lavoro di valutazione del servizio. Attingendo al nostro impegno con la valutazione del servizio in diversi contesti, siamo diventati consapevoli del suo potenziale oltre i suoi tipici usi attuali sul campo, nonché della necessità di una discussione e un dibattito aperto sugli strumenti di valutazione disponibili. È qui che si trova l'obiettivo di questo articolo: introdurre uno strumento di valutazione del servizio, Impact Areas Questionnaire (IAQ), insieme agli studi che hanno portato alla sua costruzione. Sviluppato originariamente attraverso una revisione di 27 progetti, il questionario contiene una serie di diverse aree di impatto. Adottando una prospettiva ecologica, queste aree fanno riferimento all'impatto percepito della musicoterapia non solo sugli utenti dei servizi, ma anche su famiglie, caregivers, amici, personale e contesto organizzativo nella sua interezza. A seguito del suo sviluppo originale all'interno dei centri Nordoff Robbins in Inghilterra e Galles, il questionario è stato testato nel contesto Nordoff Robbins in Scozia con l'obiettivo di esplorarne l'applicabilità e la trasferibilità ad altri contesti di musicoterapia. Oltre a presentare i risultati del test, si discute il potenziale uso dell'IAQ, il quale è incluso come appendice a questo articolo, in altri contesti, e della sua rilevanza per la conoscenza e l'elaborazione di politiche sul campo. Traduzione di Claudio Cominardi

The general purpose of this study is to describe how the Implementation of Multicultural Education Management in Al Muqoddas Islamic Boarding School in Tukmudal Sumber Cirebon. The specific objectives of the study, namely to describe: 1. How is the Planning and Implementation of Multicultural Education in the Islamic Boarding School of Al Muqoddas Tukmudal Sumber Cirebon Regency? 2. How is the final Organizing and Evaluation in the Implementation of Multicultural Education in Al Muqoddas Islamic Boarding School in Tukmudal Sumber Cirebon Regency? 3. What factors are supporting and hindering the implementation of Multicultural Education Management in Al Muqoddas Islamic Boarding School in Tukmudal Sumber Cirebon Regency? This type of research is qualitative. The research approach uses phenomenology. The subjects of the study were Mudir Ma'had, Caregivers, Asatidz councilors and santri parents. Data collection methods using in-depth interviews, observation and documentation. Data analysis techniques using triangulation. The results of the study are 1) Planning for multicultural education in the Islamic Boarding School of Al Muqoddas Tukmudal Sumber Cirebon as an inseparable part of other annual activities carried out by the school in the form of composing and establishing activities to preserve the diversity of national cultural diversity into a unifying Indonesian nation; 2) The implementation of multicultural education at Al Muqoddas Boarding School in Tukmudal Sumber Cirebon, awareness and recognition and acceptance of the attitudes, behaviors, mentality, and morals of the school community carried out in various activities, such as respecting diverse differences, such as ethnicity, descent, skin color, descent religion, work and so on; 3) An assessment of multicultural education at Al Muqoddas Islamic Boarding School in Tukmudal Sumber Cirebon with indicators in the form of changes in attitudes, morals, and mental behaviors and views on social security, economic culture, and politics that unite the nation. Abstrak Tujuan umum penelitian ini adalah untuk mendeskripsikan bagaimana Implementasi Manajemen Pendidikan Multikultural di Pondok Pesantren Al Muqoddas Tukmudal Sumber Cirebon. Tujuan khusus penelitian, yaitu mendeskripsikan tentang: 1.Bagaimana Perencanaan dan Pelaksanaan Pendidikan Multikultural di Pondok Pesantren Al Muqoddas Tukmudal Sumber Kabupaten Cirebon? 2.Bagaimana Pengorganisasian dan Evaluasi akhir dalam Implementasi Pendidikan Multikultural di Pondok Pesantren Al Muqoddas Tukmudal Sumber Kabupaten Cirebon? 3. Faktor-faktor apa yang menjadi pendukung dan penghambat pada implementasi Manajemen Pendidikan Multikultural di Pondok Pesantren Al Muqoddas Tukmudal Sumber Kabupaten Cirebon?. Jenis penelitian adalah kualitatif. Pendekatan penelitian menggunakan fenomenologi. Subjek penelitian adalah Mudir Ma'had, Pengasuh, dewan Asatidz dan Orang tua santri. Metode pengumpulan data menggunakan wawancara mendalam, observasi dan dokumentasi. Teknik analisis data menggunakan trianggulasi. Hasil penelitian yaitu 1) Perencanaan pendidikan multikultural di Pondok Pesantren Al Muqoddas Tukmudal Sumber Cirebon sebagai bagian yang tidak terpisahkan dari kegiatan tahunan lainnya yang dilaksanakan oleh sekolah berupa penyusunan dan penetapan kegiatan melestarikan keragaman budaya bangsa yang majemuk menjadi pemersatu bangsa Indonesia; 2) Pelaksanaan pendidikan multikultural di Pondok Pesantren Al Muqoddas Tukmudal Sumber Cirebon kesadaran dan pengakuan serta penerimaan sikap, perilaku, mental, dan moral warga sekolah yang dilaksanakan dalam berbagai kegiatan, seperti saling menghormati perbedaan yang beragam, seperti suku, keturunan, warna kulit, keturunan, agama, pekerjaan, dan sebagainya; 3) Penilaian pendidikan multikultural di Pondok Pesantren Al Muqoddas Tukmudal Sumber Cirebon dengan indikator berupa perubahan perilaku sikap, moral, dan mental serta pandangannya tentang keregamanan sosial, budaya ekonomi, dan politik yang menjadi pemersatu bangsa

L'accident vasculaire cérébral (AVC) est la cause majeure de la dépendance de l'adulte dans les pays à faible et moyens revenus, y compris la République Démocratique du Congo (DRC). Il y entraine des dépenses majeures pour sa prise en charge en réadaptation alors que les personnes qui en sont victimes manquent souvent des moyens pour supporter les soins de réadaptation. Cette situation peut contribuer à limiter l'accès aux soins de réadaptation à moyen et long termes, avec des répercussions sur la récupération fonctionnelle en termes d'activités de la vie quotidienne (AVQ), de capacité de marcher chez soi ou en communauté, et de participation. De nombreuses études réalisées dans des contextes divers ont fourni des portraits sur les niveaux de réalisation des AVQ et/ou de la marche chez les patients post-AVC. D'autres études se sont focalisées sur la participation de ces patients. Mais à ce jour, à notre connaissance, rien de pareil n'a été conduit dans le contexte de la RDC et de Kinshasa en particulier. C'est ainsi que l'étude que nous avons menée à Kinshasa, capitale de la RDC avait comme buts de (1) décrire les niveaux d'activité et de participation des patients post-AVC vivant à Kinshasa et (2) comparer ces niveaux par rapport aux catégories de vitesse de marche de ces patients. Les résultats ont montré que ces patients, malgré le revenu mensuel insuffisant, voire même inexistant, et le manque d'assurance maladie pour nombreux d'entre eux, avaient généralement un bon niveau d'activité. Cependant, pris individuellement, la plupart de ces patients présentaient encore des limitations à accomplir des activités en communauté. Ils nécessitent donc le soutien de leurs familles respectives et une attention particulière de la part des soignants pour qu'ils progressent, dans la mesure du possible, en termes d'activité et de participation. ; Stroke is the major cause of adult dependence in low-and middle-income countries (LMICs), including the Democratic Republic of Congo (DRC). It leads to enormous expenditure for rehabilitation care, while stroke survivors in this country often experience financial difficulties for supporting rehabilitation care. This situation may contribute to limiting access to mild-and long-term rehabilitation care, with repercussions on functional recovery in terms of activities of daily life (ADLs), walking ability at home or in the community, and participation. Many studies carried out in various contexts have provided portraits on the levels of ADLs and/or walking ability after stroke. Other studies have focused on poststroke participation. Given that, to our knowledge, there is no available study in DRC and Kinshasa particularly, neither on activity and participation nor on walking ability after stroke, our study aimed ) to (1) describe the levels of activity and participation of post-stroke patients living in Kinshasa and (2) compare these levels across subgroup-based walking speed. The results showed that these patients, despite insufficient or non-existent monthly income, and the lack of health insurance for many of them, generally had a good level of activity. However, taken individually, most of these patients still had limitations in performing community activities. They therefore require the support of their respective families and special attention on the part of caregivers to progress, as far as possible, in terms of activity and participation.