Windhoek has several inherited structural challenges that include a trend of decreasing densities of urban settlements, along with social inequalities and highly skewed levels of access and mobility. The most vulnerable members of the society in Windhoek currently carry the majority of the transportation costs and inconveniences. Non-Motorised Transport (NMT) in Eveline Street forms a significant part of the daily activity of people as they commute to and from public transport stops and stations, places of work, places of education and walking to water collection points and means of creating a living. The implementation of Non-Motorised Transport (NMT) facilities as a manner of supporting NMT trips has been largely neglected in Eveline Street thus, exposing NMT users to road accidents. Non-Motorised Transport (NMT) is a core aspect in the development of a sustainable transport system for the City of Windhoek. Its importance derives from the high percentage of persons in Windhoek who depends on NMT, as well as its economic and ecological efficiency compared to Motorised Transport (MT) on distances up to approximately 5 km. Approximately 20% of Windhoek's households can afford to own a car, therefore roads alone are not enough to secure social sustainability and only worsens already existing income inequality (Araes, 2007). Non-Motorised Transport (NMT) supplements public transport, contributes to lively urban quarters and is an integral part of the transport system of Windhoek. Low income households in Windhoek spend up to one quarter (25%) of their income on transport (Zwicky et al., 2013). Non-Motorised Transport (NMT) users are the most vulnerable traffic-group, often involved in severe accidents and there is a need for special attention and provision to enable, strengthen and develop NMT as a proper and feasible mode of transport in Windhoek. Non-Motorised Transport (NMT) has an important role to play in greening the economy in the context of providing and promoting more sustainable transport options, forming part of more cost-effective solutions in establishing a sustainable transport system to improve economic progression for the residents of Windhoek. The main motivating reason for this research was to investigate the current opportunities and challenges being experienced that affects the promotion of the Non-Motorised Transport (NMT) in providing a sustainable urban mobility within Eveline Street in the Windhoek Municipal area, Namibia. This study further seeks to examine the potential and sustainability for effective transportation planning for Non-Motorised Transport (NMT) and its effects in the reduction of Motorised Transport (MT) congestion in the area. In Windhoek, the main types of Non-Motorised Transport (NMT) users are pedestrians (majority type) and cyclists (minority type). The research paper aims to come up with the conclusive proposals and possible intervention measures that will help in the provision and management of Non-Motorised Transport (NMT) infrastructure to ensure a sustainable urban transport system. Thus, helping Windhoek municipality, Namibian government, stakeholders and practitioners to make better informed decisions when addressing the transport challenges of NMT users in urban areas. The scope of the research was limited to Non-Motorised Transport (NMT), more specifically, walking and cycling as a mode of transport in the infamous Eveline Street in the high density suburb of Greenwell Matongo in the area of Katutura in the greater Windhoek municipality. Eveline Street being used as a case study to understand what potential value NMT trips could be for Windhoek. There are various benefits to Non-Motorised Transport (NMT) as a mode of transport. Safety benefits of successful NMT facilities include lower risk of road collisions, injuries and fatalities, while there are also several health benefits of NMT trips, which include lowered levels of stress, obesity and other Non-Communicable Diseases (NCDs). NonMotorised Transport (NMT), as a mode of transport, is one of the most sustainable modes of transport, as it does not rely on fuel and, is one of the cleanest modes of transportation. Furthermore, Non-Motorised Transport (NMT) trips have various socio-economic benefits that help to address equality concerns, which are highly relevant for pedestrians in Windhoek. An example, of how improved NMT trips could address equality issues, would be increasing the mobility and accessibility of vulnerable members of society. This can be for socio-economic reasons or physical and mental abilities that influence the individual's ability to commute. The research methodology involved the review of literature, primary and secondary data collection, validation and analysis, interpretation and subsequent recommendations to address urban mobility challenges and policy recommendations to promote NMT for Windhoek Municipality. The methodology comprises surveys, traffic counts; direct observation and behavioral studies. The tools used included questionnaires, tally sheets, walkability audit tool, maps and photographs. The secondary data was obtained mainly through the literature review of the existing work by academic and researchers on NMT, land use and transport planning, institutional setup and policy administration. Other sources of secondary data included universities, libraries, internet, GIZ Studies, MVA Namibia, SUTMP, Local authorities records, Namibia Statistics Agency, and Government documents on transport and environment. The data was collected by administering roadside questionnaire, direct observations of behavior and the walkability of the area, interviewing key informants, photographs and Global Positioning Systems (GPS) locations.
Hintergrund: Mit Einführung der fallpauschalierenden Diagnosis Related Groups (DRG) im Jahr 2003 wurde die bis dahin bestehende Kostenorientierung des deutschen Vergütungssystems von einer Leistungsorientierung abgelöst. Das DRG-System zielt mit seinen Anreizwirkungen auf eine effizientere Erbringung der Leistungen und ermöglicht gleichzeitig Leistungsverlagerungen zwischen den Kliniken. Neben solchen beabsichtigten Mengenveränderungen werden jedoch auch Tendenzen zur Über- und Fehlversorgung bzw. Indikationsausweitung vermutet, welche dem Grundsatz der Bedarfsgerechtigkeit (§ 70 SGB V) im gesetzlichen Gesundheitssystem widersprechen. Mit dem Krankenhausstrukturgesetz 2016 wurden nun gezielt Instrumente zur Mengensteuerung einzelner stationärer Leistungen etabliert, die über Bewertungsabsenkungen am fallpauschalierenden Finanzierungssystem der DRGs ansetzen. Hierüber soll nicht indizierten Leistungsausweitungen begegnet werden. Eine objektive Versorgungslast ist medizinisch in vielen Bereichen kaum zu ermitteln. Über Analysen der Versorgungssituation anhand vorhandener Krankenhausabrechnungsdaten lässt sich aber die Leistungsentwicklung verfolgen und es lassen sich demografische von anderen Einflüssen trennen. Damit können Anhaltspunkte für möglicherweise bestehende Über-, Unter- und Fehlversorgungen gewonnen werden. Die Krankenhausabrechnungsdaten (DRG-Statistik) ermöglichen für den stationären Bereich solche Analysen, die dazu beitragen können, Trends mengenanfälliger und nicht mengenanfälliger Leistungen im Sinne der Bedarfsgerechtigkeit zu identifizieren. Methodik: Die vorliegende kumulative Dissertation nutzt die DRG-Statistik auf Fallebene (Mikrodaten) in drei Projekten, um Mengenentwicklungen und regionale Unterschiede einzelner stationärer Behandlungs- und/oder Eingriffsarten detailliert zu analysieren. Als Beispiel potentiell von einer Fallzahlsteigerung betroffenen Leistung wurden stationäre Behandlungs- und/oder Eingriffsarten im Wirbelsäulenbereich gewählt. Als Beispiel für Leistungen ohne die Vermutung einer Leistungsausweitung wurden Amputationen der unteren Extremität herangezogen. Abschließend wird anhand der im Jahr 2016 zum ersten Mal getroffenen politischen Entscheidungen zur Definition mengenanfälliger (§ 9 Abs. 1c KHEntgG) und nicht mengenanfälliger Leistungen (§ 9 Abs. 1 Nummer 6 KHEntgG) diskutiert, inwieweit sich Analysen auf Basis der Mikrodaten eignen, um solche Definitionen empirisch zu unterlegen. Ergebnisse: Die vorgestellten Manuskripte konnten zeigen, dass sich die Mikrodaten der DRG-Statistik eignen, um retrospektiv bis zum Jahr 2005 Fallzahlentwicklungen einzelner Behandlungen deskriptiv zu beschreiben. Über eine geschlechts- und altersspezifische Standardisierung kann der Anteil der demografisch bedingten Veränderung und somit näherungsweise die dadurch bedingte Bedarfsentwicklung geschätzt werden. Inwieweit der nicht-demografisch bedingte Anstieg wirtschaftlichen Anreizen folgt oder aber durch Entwicklungen der medizinischen Behandlungsverfahren bedingt ist, kann anhand der DRG-Statistik nicht abschließend beurteilt werden. Die Analysen der nicht-demografisch bedingten Entwicklungen können aber detaillierte Informationen über die Indikationen und Verfahren liefern, bei denen sich Veränderungen ergeben haben. Schlussfolgerung: Analysen der DRG-Statistik können Trends für mengenanfällige und nicht mengenanfällige Leistungen identifizieren. Kleinräumige Analysen helfen ferner, anhand regionaler Versorgungsunterschiede Hinweise auf Über- und Unterversorgungsprobleme zu finden. Dies ermöglicht es den Fachvertretern, unter Berücksichtigung bekannter Veränderungen der Behandlungskonzepte und ggf. der Leitlinien, die medizinische Sinnhaftigkeit von Veränderungen zu beurteilen. Zur Interpretation der nicht-demografisch bedingten Fallzahlentwicklung sind dabei neben wirtschaftlichen Anreizen insbesondere Prävalenzentwicklungen der zugrundeliegenden Erkrankungen, neue Behandlungstechniken, medizinisch begründete Indikationsausweitungen und Veränderungen in der Erwartungshaltung der Patienten zu diskutieren. ; Background: With the introduction of the Diagnosis Related Groups (DRGs) in 2003, the existing cost orientation of the German hospital payment system was replaced by a performance oriented system. With its incentive effects, the DRG-System aims at an efficient provision of services and at the same time makes it possible to shift services between hospitals. In addition to intended changes in case volumes, however, tendencies towards overuse and misuse or expansion of indications are also suspected, which undermine the principle of need-based supply (§ 70 SGB V) in the statutory health system. The Hospital Structure Act of 2016 (Krankenhausstrukturgesetz) established targeted instruments for controlling the volume of individual inpatient services. Those instruments lower the relative weight of certain DRGs. This is intended to compensate for non-indicated case increases. An objective need of supply can hardly be determined medically in many areas. By analysing the care situation on the basis of existing hospital discharge data, however, it is possible to monitor the development of services and separate demographic from other influences. This can provide clues for possible overuse, underuse and misuse. The hospital discharge data (DRG-Statistics) enable inpatient analyses that can help identify trends in "volume sensitive" and "non volume sensitive" services in terms of need-based supply. Methodology: This cumulative dissertation uses the DRG-Statistics at case level (microdata) in three projects to analyse in detail volume developments and regional differences of individual inpatient treatment and/or intervention types. As an example of potentially volume sensitive services inpatient teatments for spinal disease were chosen. As an example for services without the assumption of volume sensitivity amputations of the lower limb were analysed. Finally, this dissertation will use the unprecedented political decisions from 2016 on the definition of volume sensitive (§ 9 para. 1c KHEntgG) and non volume sensitive services (§ 9 para. 1 no. 6 KHEntgG) to discuss whether analysis on the basis of the DRG-Statistics could be used to rationalise such definitions. Results: The manuscripts presented show that the microdata of the DRG-Statistics are suitable for describing case number developments of individual treatments retrospectively up to the year 2005. By means of gender and age specific standardisation, the proportion of demographically induced changes and thus the approximate development of the need of supply can be estimated. The extent to which the non-demographic increase follows economic incentives or is due to developments in medical teatment procedures cannot be conclusively assessed on the basis of the DRG-Statistics. However, the analyses of non-demographic developments can provide detailed information on the indications and procedures that have changed. Conclusion: Analyses of the DRG-Statistics can identify trends for volume sensitive and non volume sensitive services. Small-scale analyses also help to find indications of over- and undersupply poblems on the basis of regional supply differences. This enables the experts to assess the medical significance of changes, taking into account known changes in treatment concepts and guidelines. In order to Interpret the non-demographic development of the number of cases, special prevalence trends of the uderlying diseases, new treatment techniques, medically justified extensions of indications and changes in patient expectations must be discussed in addition to economic incentives.
Мета роботи - дослідити та узагальнити досвід роботи професорсько-викладацького складу кафедри ГЗ та МК за 50 років (1967-2017 рр.). Дослідити динаміку змін навчально-педагогічної і наукової роботи, дати оцінку напрацювань, зробити висновки для подальшого вдосконалення навчального процесу, підготовки медичних кадрів і наукової діяльності. Матеріал і методи. Досліджено архівні та поточні матеріали організації та діяльності ГУ "Запорізька медична академія післядипломної освіти МОЗ України" і кафедри ГЗ та МК за 1926-2017 рр. Проаналізовано та узагальнено матеріали навчально-методичної, педагогічної та наукової діяльності професорсько-викладацького складу кафедри. Результати. Проведене дослідження і оцінка матеріалів багаторічної роботи професорсько-викладацького складу кафедри цивільної оборони та медицини катастроф, а також аналіз динаміки змін навчально-педагогічногопроцесу, навчально-методичної роботи та наукових досягнень дозволили зробити висновки для подальшого вдосконалення навчального процесу і наукової діяльності. Висновки. Минуле медицини, розглянуте в компараціі з її сучасним станом, дозволило простежити і оцінити в історичній послідовності зміни в медичній освіті, навчальному процесі, змісті медичних знань, підготовці медичних кадрів, проблематики науки, панівних теоріях і парадигмах, організаційних формах надання екстреної медичної допомоги при надзвичайних ситуаціях техногенного, природного, соціального і військового характеру, а також намітити шляхи їх подальшого вдосконалення. ; Цель работы – исследовать и обобщить опыт работы профессорско-преподавательского состава кафедры ГЗ и МК за 50 лет (1967‐2017 гг.). Исследовать динамику изменений учебно-педагогической и научной работы, дать оценку наработок, сделать выводы для дальнейшего совершенствования учебного процесса, подготовки медицинских кадров и научной деятельности. Материал и методы. Исследованы архивные и текущие материалы организации и деятельности ГУ "Запорожская медицинская академия последипломного образования МЗ Украины" и кафедры ГЗ и МК за 1926-2017 гг. Проанализированы и обобщены материалы учебно-методической, педагогической и научной деятельности профессорско-преподавательского состава кафедры. Результаты. Проведенное исследование и оценка материалов многолетней работы профессорскопреподавательского состава кафедры гражданской обороны и медицины катастроф, а также анализ динамики изменений учебно-педагогического процесса, учебно-методической работы и научных достижений позволили сделать выводы для дальнейшего совершенствования учебного процесса и научной деятельности. Выводы. Прошлое медицины, рассмотренное в компарации с ее современным состоянием, позволило проследить и оценить в исторической последовательности изменения в медицинском образовании, учебном процессе, содержании медицинских знаний, подготовке медицинских кадров, проблематике науки, господствующих теориях и парадигмах, организационных формах оказания экстренной медицинской помощи при чрезвычайных ситуациях техногенного, природного, социального и военного характера, а также наметить пути их дальнейшего совершенствования. ; Objective. To study and generalize experience of theteaching staff of the Civil Protection and Disaster Medicine Department for a period from 1967 to 2017. To investigate the dynamics of changes in educational, pedagogical and scientific work, to evaluate the achieve-ments and to draw conclusions regarding further improvement of educational process and training of medical personnel and scientific activities. Material and methods. Archival and current materials of organization and activities of the State Institution "Zaporizhzhya Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine" and Civil Protection and Disaster Medicine Department for 1926–2017 are studied. Educational, pedagogical and scientific materials of the teaching staff of the Department are analyzed and summarized. Results. Studied materials and generalized experience, analysis of dynamics of changes in the educational and pedagogical process, educational and methodo-logical work and scientific achievements and their evaluation made it possible to draw conclusions regarding further improvement of the educational process and scientific activities. Conclusions. The past of medicine, considering its present state, made it possible to trace and evaluate, in the historical sequence, changes in medical education, educational process, content of medical knowledge, training of medical personnel, problems of science, mainstream theories and paradigms, organizational forms of emergency medical care in emergency situations of anthropogenic, natural, social and military nature and to outline ways of their further improvement. ; Le but de ce travail est de rechercher et de résumer l'expérience de la faculté du département de CP et MK pendant 50 ans (1967-2017). Explorer la dynamique des changements éducatifs - travaux pédagogiques et scientifiques pour évaluer les développements, dégager des conclusions permettant d'améliorer encore le processus d'éducation, la formation du personnel médical et les activités scientifiques. Matériel et méthodes. Les documents d'archives et actuels de l'organisation et des activités de l'institution d'État «Académie de médecine de Zaporizhia pour l'enseignement postdoctoral du ministère de la Santé de l'Ukraine» et des départements du CP et de MK pour la période 1926-2017 font l'objet d'une enquête. Le matériel pédagogique et les activités méthodiques, pédagogiques et scientifiques de la faculté du département sont analysés et résumés. Les résultats Recherche et évaluation du matériel de nombreuses années de travail du corps professoral du département de défense civile et de médecine des catastrophes, ainsi qu'analyse de la dynamique des changements dans l'enseignement et la pédagogie processus, travaux éducatifs et méthodiques et réalisations scientifiques ont permis de tirer des conclusions pour améliorer encore le processus éducatif et les activités scientifiques. Conclusions. Le passé de la médecine, considéré par rapport à son état actuel, a permis de suivre et d'évaluer les changements survenus dans l'éducation médicale, le processus éducatif, le contenu des connaissances médicales, la formation du personnel médical, les problèmes de la science, les théories et les paradigmes dominants et les formes organisationnelles de soins médicaux d'urgence les situations de nature humaine, naturelle, sociale et militaire, ainsi que les moyens de les améliorer.
Objective. To study and generalize experience of theteaching staff of the Civil Protection and Disaster Medicine Department for a period from 1967 to 2017. To investigate the dynamics of changes in educational, pedagogical and scientific work, to evaluate the achieve-ments and to draw conclusions regarding further improvement of educational process and training of medical personnel and scientific activities. Material and methods. Archival and current materials of organization and activities of the State Institution "Zaporizhzhya Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine" and Civil Protection and Disaster Medicine Department for 1926–2017 are studied. Educational, pedagogical and scientific materials of the teaching staff of the Department are analyzed and summarized. Results. Studied materials and generalized experience, analysis of dynamics of changes in the educational and pedagogical process, educational and methodo-logical work and scientific achievements and their evaluation made it possible to draw conclusions regarding further improvement of the educational process and scientific activities. Conclusions. The past of medicine, considering its present state, made it possible to trace and evaluate, in the historical sequence, changes in medical education, educational process, content of medical knowledge, training of medical personnel, problems of science, mainstream theories and paradigms, organizational forms of emergency medical care in emergency situations of anthropogenic, natural, social and military nature and to outline ways of their further improvement. ; Le but de ce travail est de rechercher et de résumer l'expérience de la faculté du département de CP et MK pendant 50 ans (1967-2017). Explorer la dynamique des changements éducatifs - travaux pédagogiques et scientifiques pour évaluer les développements, dégager des conclusions permettant d'améliorer encore le processus d'éducation, la formation du personnel médical et les activités scientifiques. Matériel et méthodes. Les documents d'archives et actuels de l'organisation et des activités de l'institution d'État «Académie de médecine de Zaporizhia pour l'enseignement postdoctoral du ministère de la Santé de l'Ukraine» et des départements du CP et de MK pour la période 1926-2017 font l'objet d'une enquête. Le matériel pédagogique et les activités méthodiques, pédagogiques et scientifiques de la faculté du département sont analysés et résumés. Les résultats Recherche et évaluation du matériel de nombreuses années de travail du corps professoral du département de défense civile et de médecine des catastrophes, ainsi qu'analyse de la dynamique des changements dans l'enseignement et la pédagogie processus, travaux éducatifs et méthodiques et réalisations scientifiques ont permis de tirer des conclusions pour améliorer encore le processus éducatif et les activités scientifiques. Conclusions. Le passé de la médecine, considéré par rapport à son état actuel, a permis de suivre et d'évaluer les changements survenus dans l'éducation médicale, le processus éducatif, le contenu des connaissances médicales, la formation du personnel médical, les problèmes de la science, les théories et les paradigmes dominants et les formes organisationnelles de soins médicaux d'urgence les situations de nature humaine, naturelle, sociale et militaire, ainsi que les moyens de les améliorer. ; Цель работы – исследовать и обобщить опыт работы профессорско-преподавательского состава кафедры ГЗ и МК за 50 лет (1967‐2017 гг.). Исследовать динамику изменений учебно-педагогической и научной работы, дать оценку наработок, сделать выводы для дальнейшего совершенствования учебного процесса, подготовки медицинских кадров и научной деятельности. Материал и методы. Исследованы архивные и текущие материалы организации и деятельности ГУ "Запорожская медицинская академия последипломного образования МЗ Украины" и кафедры ГЗ и МК за 1926-2017 гг. Проанализированы и обобщены материалы учебно-методической, педагогической и научной деятельности профессорско-преподавательского состава кафедры. Результаты. Проведенное исследование и оценка материалов многолетней работы профессорскопреподавательского состава кафедры гражданской обороны и медицины катастроф, а также анализ динамики изменений учебно-педагогического процесса, учебно-методической работы и научных достижений позволили сделать выводы для дальнейшего совершенствования учебного процесса и научной деятельности. Выводы. Прошлое медицины, рассмотренное в компарации с ее современным состоянием, позволило проследить и оценить в исторической последовательности изменения в медицинском образовании, учебном процессе, содержании медицинских знаний, подготовке медицинских кадров, проблематике науки, господствующих теориях и парадигмах, организационных формах оказания экстренной медицинской помощи при чрезвычайных ситуациях техногенного, природного, социального и военного характера, а также наметить пути их дальнейшего совершенствования. ; Мета роботи - дослідити та узагальнити досвід роботи професорсько-викладацького складу кафедри ГЗ та МК за 50 років (1967-2017 рр.). Дослідити динаміку змін навчально-педагогічної і наукової роботи, дати оцінку напрацювань, зробити висновки для подальшого вдосконалення навчального процесу, підготовки медичних кадрів і наукової діяльності. Матеріал і методи. Досліджено архівні та поточні матеріали організації та діяльності ГУ "Запорізька медична академія післядипломної освіти МОЗ України" і кафедри ГЗ та МК за 1926-2017 рр. Проаналізовано та узагальнено матеріали навчально-методичної, педагогічної та наукової діяльності професорсько-викладацького складу кафедри. Результати. Проведене дослідження і оцінка матеріалів багаторічної роботи професорсько-викладацького складу кафедри цивільної оборони та медицини катастроф, а також аналіз динаміки змін навчально-педагогічногопроцесу, навчально-методичної роботи та наукових досягнень дозволили зробити висновки для подальшого вдосконалення навчального процесу і наукової діяльності. Висновки. Минуле медицини, розглянуте в компараціі з її сучасним станом, дозволило простежити і оцінити в історичній послідовності зміни в медичній освіті, навчальному процесі, змісті медичних знань, підготовці медичних кадрів, проблематики науки, панівних теоріях і парадигмах, організаційних формах надання екстреної медичної допомоги при надзвичайних ситуаціях техногенного, природного, соціального і військового характеру, а також намітити шляхи їх подальшого вдосконалення.
Objective. To study and generalize experience of theteaching staff of the Civil Protection and Disaster Medicine Department for a period from 1967 to 2017. To investigate the dynamics of changes in educational, pedagogical and scientific work, to evaluate the achieve-ments and to draw conclusions regarding further improvement of educational process and training of medical personnel and scientific activities. Material and methods. Archival and current materials of organization and activities of the State Institution "Zaporizhzhya Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine" and Civil Protection and Disaster Medicine Department for 1926–2017 are studied. Educational, pedagogical and scientific materials of the teaching staff of the Department are analyzed and summarized. Results. Studied materials and generalized experience, analysis of dynamics of changes in the educational and pedagogical process, educational and methodo-logical work and scientific achievements and their evaluation made it possible to draw conclusions regarding further improvement of the educational process and scientific activities. Conclusions. The past of medicine, considering its present state, made it possible to trace and evaluate, in the historical sequence, changes in medical education, educational process, content of medical knowledge, training of medical personnel, problems of science, mainstream theories and paradigms, organizational forms of emergency medical care in emergency situations of anthropogenic, natural, social and military nature and to outline ways of their further improvement. ; Le but de ce travail est de rechercher et de résumer l'expérience de la faculté du département de CP et MK pendant 50 ans (1967-2017). Explorer la dynamique des changements éducatifs - travaux pédagogiques et scientifiques pour évaluer les développements, dégager des conclusions permettant d'améliorer encore le processus d'éducation, la formation du personnel médical et les activités scientifiques. Matériel et méthodes. Les documents d'archives et actuels de l'organisation et des activités de l'institution d'État «Académie de médecine de Zaporizhia pour l'enseignement postdoctoral du ministère de la Santé de l'Ukraine» et des départements du CP et de MK pour la période 1926-2017 font l'objet d'une enquête. Le matériel pédagogique et les activités méthodiques, pédagogiques et scientifiques de la faculté du département sont analysés et résumés. Les résultats Recherche et évaluation du matériel de nombreuses années de travail du corps professoral du département de défense civile et de médecine des catastrophes, ainsi qu'analyse de la dynamique des changements dans l'enseignement et la pédagogie processus, travaux éducatifs et méthodiques et réalisations scientifiques ont permis de tirer des conclusions pour améliorer encore le processus éducatif et les activités scientifiques. Conclusions. Le passé de la médecine, considéré par rapport à son état actuel, a permis de suivre et d'évaluer les changements survenus dans l'éducation médicale, le processus éducatif, le contenu des connaissances médicales, la formation du personnel médical, les problèmes de la science, les théories et les paradigmes dominants et les formes organisationnelles de soins médicaux d'urgence les situations de nature humaine, naturelle, sociale et militaire, ainsi que les moyens de les améliorer. ; Цель работы – исследовать и обобщить опыт работы профессорско-преподавательского состава кафедры ГЗ и МК за 50 лет (1967‐2017 гг.). Исследовать динамику изменений учебно-педагогической и научной работы, дать оценку наработок, сделать выводы для дальнейшего совершенствования учебного процесса, подготовки медицинских кадров и научной деятельности. Материал и методы. Исследованы архивные и текущие материалы организации и деятельности ГУ "Запорожская медицинская академия последипломного образования МЗ Украины" и кафедры ГЗ и МК за 1926-2017 гг. Проанализированы и обобщены материалы учебно-методической, педагогической и научной деятельности профессорско-преподавательского состава кафедры. Результаты. Проведенное исследование и оценка материалов многолетней работы профессорскопреподавательского состава кафедры гражданской обороны и медицины катастроф, а также анализ динамики изменений учебно-педагогического процесса, учебно-методической работы и научных достижений позволили сделать выводы для дальнейшего совершенствования учебного процесса и научной деятельности. Выводы. Прошлое медицины, рассмотренное в компарации с ее современным состоянием, позволило проследить и оценить в исторической последовательности изменения в медицинском образовании, учебном процессе, содержании медицинских знаний, подготовке медицинских кадров, проблематике науки, господствующих теориях и парадигмах, организационных формах оказания экстренной медицинской помощи при чрезвычайных ситуациях техногенного, природного, социального и военного характера, а также наметить пути их дальнейшего совершенствования. ; Мета роботи - дослідити та узагальнити досвід роботи професорсько-викладацького складу кафедри ГЗ та МК за 50 років (1967-2017 рр.). Дослідити динаміку змін навчально-педагогічної і наукової роботи, дати оцінку напрацювань, зробити висновки для подальшого вдосконалення навчального процесу, підготовки медичних кадрів і наукової діяльності. Матеріал і методи. Досліджено архівні та поточні матеріали організації та діяльності ГУ "Запорізька медична академія післядипломної освіти МОЗ України" і кафедри ГЗ та МК за 1926-2017 рр. Проаналізовано та узагальнено матеріали навчально-методичної, педагогічної та наукової діяльності професорсько-викладацького складу кафедри. Результати. Проведене дослідження і оцінка матеріалів багаторічної роботи професорсько-викладацького складу кафедри цивільної оборони та медицини катастроф, а також аналіз динаміки змін навчально-педагогічногопроцесу, навчально-методичної роботи та наукових досягнень дозволили зробити висновки для подальшого вдосконалення навчального процесу і наукової діяльності. Висновки. Минуле медицини, розглянуте в компараціі з її сучасним станом, дозволило простежити і оцінити в історичній послідовності зміни в медичній освіті, навчальному процесі, змісті медичних знань, підготовці медичних кадрів, проблематики науки, панівних теоріях і парадигмах, організаційних формах надання екстреної медичної допомоги при надзвичайних ситуаціях техногенного, природного, соціального і військового характеру, а також намітити шляхи їх подальшого вдосконалення.
Гіповолемія різної етіології залишається однією з провідних проблем в практиці інтенсивіста, з вирішенням якої лікар стикається в щоденній практиці. Лікування гіповолемії полягає в лікуванні причини втрати рідини та рідинній ресусцитації. З цієї причини кількісний та якісний склад волемічної терапії залишається незмінно актуальним та дискутабельним питанням. Лікування гіповолемії проводять шляхом застосуванням розчинів кристалоїдів та колоїдів. В силу низки причин кристалоїди не можуть повністю задовольнити потреби клініцистів. Основним недоліком цієї групи розчинів є їхня обмежена здатність підтримувати рівень артеріального тиску (АТ) та інших показників гемодинаміки через нетривалість часу знаходження у кров'яному руслі та низький волемічний ефект. Це є поштовхом до постійних досліджень ефективності та безпеки колоїдних розчинів, які не не проникають через ендотеліальний бар'єр та мають виражений плазморозширювальний ефект. Однак, ця група лікарських засобів має ряд протипоказів та обмежень у використанні, і чи ненайоднозначішими в ракурсі «ефективність-безпека» являються препарати на основі гідроксиетиетилкрохмалів (ГЕК).В статті наведено дані останніх досліджень ефективності та безпеки використання різних інфузійних препаратів. Основну увагу приділено ГЕК-вмісним лікарським засобам. Зокрема дослідження доцільності використання препаратів на основі ГЕК Координаційною групою по процедурі взаємного визнання і децентралізованої процедури з лікарських препаратів для медичного застосування (Coordination group for Mutual recognition and Decentralised procedures – human, CMDh), яка є регулюючим органом обігу лікарських засобів для медичного застосування на території держав-членів Європейського союзу (ЄС) та Комітету оцінки ризиків у сфері фармаконагляду (Pharmacovigilance Risk Assessment Committee, PRAC) в хронолічній послідовності з наведенням останнього рішення вище зазначених організацій з даного питання. Також в статті висвітлено дії та рішення аналогічної вітчизняної організації – Науково-експертної ради ДП «Державний експертний центр МОЗ України» (ДЕЦ МОЗ України). Проаналізовано використання препаратів на основі молекул ГЕК в Україні, виявлено, що в 46% дана група лікарських засобів використовувалась не за показами ; Hypovolemia of various etiologies remains one of the leading problems in the practice of intensive care, the physician challenges in daily practice. Treatment of hypovolemia is elimination of the causes of fluid loss and fluid resuscitation. For this reason, the quantity and quality of infusion therapy remains actuality and discuss. Treatment of hypovolemia includes crystalloids and colloids. In cause of many reasons, crystalloids cannot fully satisfy the needs of clinicians. The main disadvantage of this group of solutions is their limited ability to maintain blood pressure (BP) and other hemodynamic parameters due to a shorter time in the bloodstream and low volemic effect.This prompts ongoing research into the efficacy and safety of colloid solutions that do not penetrate the endothelial barrier and have expressed plasma-expansion effect. However, these drugs have a number of contraindications and limitations in use. The hydroxyethyl starch drugs are most unclear in the "effectiveness-safety" meaning. The artical includes data from recent studies on the effectiveness and safety of the use of various infusion drugs. The main focus is on HES-containing drugs.In particular, investigation on the expediency of using drugs based on the HES of Coordination group for Mutual recognition and Decentralised procedures – human, (CMDh), which is a medicines regulatory body representing the European Union (EU) Member States, Iceland, Liechtenstein and Norway and Pharmacovigilance Risk Assessment Committee (PRAC) in chronological order with the final decision of CMDh on the issue. The article also represents the actions and decisions of a similar ukrainian organization – State Enterprise "State Expert Center of the Ministry of Health of Ukraine". The use of drugs based on HES molecules in Ukraine was analyzed, and it was found that in 46% this group of drugs was not used accordingly indications. ; Гиповолемия различной этиологии остается одной из ведущих проблем в практике интенсивиста, с решением которой врач сталкивается в ежедневной практике. Лечение гиповолемии заключается в лечении причины потери жидкости и жидкостной ресусцитации. По этой причине количественный и качественный состав волемический терапии остается неизменно актуальным и дискутабельным вопросом. Лечение гиповолемии проводят путем применения растворов кристаллоидов и коллоидов. В силу ряда причин кристаллоиды не могут полностью удовлетворить потребности клиницистов. Основным недостатком этой группы растворов является их ограниченная способность поддерживать уровень артериального давления (АД) и других показателей гемодинамики из-за непродолжительного времени нахождения в кровяном русле и низкий волемических эффект. Это дает толчок к постоянным исследованиям эффективности и безопасности коллоидных растворов, которые не проникают через эндотелиальный барьер и имеют выраженный плазморозширяющий эффект. Однако, эта группа лекарственных средств имеет ряд противопоказаний и ограничений к использованию, и самыми неоднозначными в ракурсе «эффективность-безопасность» являются препараты на основе гидроксиэтилкрахмалов (ГЭК). В статье приведены данные последних исследований эффективности и безопасности использованияразличных инфузионных препаратов. Основное внимание уделено ГЭК-содержащим лекарственным средствам. В частности, исследования целесообразности использования препаратов на основе ГЭК Координационной группой по процедуре взаимного признания и децентрализованной процедуры по лекарственным препаратам для медицинского применения (Coordination group for Mutual recognition and Decentralised procedures – human, CMDh), которая является регулирующим органом оборота лекарственных средств для медицинского применения на территории государств-членов Европейского союза (ЕС) и Комитета оценки рисков в сфере фармаконадзора (Pharmacovigilance Risk Assessment Committee, PRAC) в хронологичной последовательности с указанием последнего решения вышеуказанных организаций по данному вопросу. Также в статье освещены действия и решения аналогичной отечественной организации – ГП «Государственный экспертный центр МЗ Украины». Проанализировано использование препаратов на основе молекул ГЭК в Украине, выявлено, что в 46% случаев данная группа лекарственных средств использовалась не по показаниям.
Гіповолемія різної етіології залишається однією з провідних проблем в практиці інтенсивіста, з вирішенням якої лікар стикається в щоденній практиці. Лікування гіповолемії полягає в лікуванні причини втрати рідини та рідинній ресусцитації. З цієї причини кількісний та якісний склад волемічної терапії залишається незмінно актуальним та дискутабельним питанням. Лікування гіповолемії проводять шляхом застосуванням розчинів кристалоїдів та колоїдів. В силу низки причин кристалоїди не можуть повністю задовольнити потреби клініцистів. Основним недоліком цієї групи розчинів є їхня обмежена здатність підтримувати рівень артеріального тиску (АТ) та інших показників гемодинаміки через нетривалість часу знаходження у кров'яному руслі та низький волемічний ефект. Це є поштовхом до постійних досліджень ефективності та безпеки колоїдних розчинів, які не не проникають через ендотеліальний бар'єр та мають виражений плазморозширювальний ефект. Однак, ця група лікарських засобів має ряд протипоказів та обмежень у використанні, і чи ненайоднозначішими в ракурсі «ефективність-безпека» являються препарати на основі гідроксиетиетилкрохмалів (ГЕК).В статті наведено дані останніх досліджень ефективності та безпеки використання різних інфузійних препаратів. Основну увагу приділено ГЕК-вмісним лікарським засобам. Зокрема дослідження доцільності використання препаратів на основі ГЕК Координаційною групою по процедурі взаємного визнання і децентралізованої процедури з лікарських препаратів для медичного застосування (Coordination group for Mutual recognition and Decentralised procedures – human, CMDh), яка є регулюючим органом обігу лікарських засобів для медичного застосування на території держав-членів Європейського союзу (ЄС) та Комітету оцінки ризиків у сфері фармаконагляду (Pharmacovigilance Risk Assessment Committee, PRAC) в хронолічній послідовності з наведенням останнього рішення вище зазначених організацій з даного питання. Також в статті висвітлено дії та рішення аналогічної вітчизняної організації – Науково-експертної ради ДП «Державний експертний центр МОЗ України» (ДЕЦ МОЗ України). Проаналізовано використання препаратів на основі молекул ГЕК в Україні, виявлено, що в 46% дана група лікарських засобів використовувалась не за показами ; Hypovolemia of various etiologies remains one of the leading problems in the practice of intensive care, the physician challenges in daily practice. Treatment of hypovolemia is elimination of the causes of fluid loss and fluid resuscitation. For this reason, the quantity and quality of infusion therapy remains actuality and discuss. Treatment of hypovolemia includes crystalloids and colloids. In cause of many reasons, crystalloids cannot fully satisfy the needs of clinicians. The main disadvantage of this group of solutions is their limited ability to maintain blood pressure (BP) and other hemodynamic parameters due to a shorter time in the bloodstream and low volemic effect.This prompts ongoing research into the efficacy and safety of colloid solutions that do not penetrate the endothelial barrier and have expressed plasma-expansion effect. However, these drugs have a number of contraindications and limitations in use. The hydroxyethyl starch drugs are most unclear in the "effectiveness-safety" meaning. The artical includes data from recent studies on the effectiveness and safety of the use of various infusion drugs. The main focus is on HES-containing drugs.In particular, investigation on the expediency of using drugs based on the HES of Coordination group for Mutual recognition and Decentralised procedures – human, (CMDh), which is a medicines regulatory body representing the European Union (EU) Member States, Iceland, Liechtenstein and Norway and Pharmacovigilance Risk Assessment Committee (PRAC) in chronological order with the final decision of CMDh on the issue. The article also represents the actions and decisions of a similar ukrainian organization – State Enterprise "State Expert Center of the Ministry of Health of Ukraine". The use of drugs based on HES molecules in Ukraine was analyzed, and it was found that in 46% this group of drugs was not used accordingly indications. ; Гиповолемия различной этиологии остается одной из ведущих проблем в практике интенсивиста, с решением которой врач сталкивается в ежедневной практике. Лечение гиповолемии заключается в лечении причины потери жидкости и жидкостной ресусцитации. По этой причине количественный и качественный состав волемический терапии остается неизменно актуальным и дискутабельным вопросом. Лечение гиповолемии проводят путем применения растворов кристаллоидов и коллоидов. В силу ряда причин кристаллоиды не могут полностью удовлетворить потребности клиницистов. Основным недостатком этой группы растворов является их ограниченная способность поддерживать уровень артериального давления (АД) и других показателей гемодинамики из-за непродолжительного времени нахождения в кровяном русле и низкий волемических эффект. Это дает толчок к постоянным исследованиям эффективности и безопасности коллоидных растворов, которые не проникают через эндотелиальный барьер и имеют выраженный плазморозширяющий эффект. Однако, эта группа лекарственных средств имеет ряд противопоказаний и ограничений к использованию, и самыми неоднозначными в ракурсе «эффективность-безопасность» являются препараты на основе гидроксиэтилкрахмалов (ГЭК). В статье приведены данные последних исследований эффективности и безопасности использованияразличных инфузионных препаратов. Основное внимание уделено ГЭК-содержащим лекарственным средствам. В частности, исследования целесообразности использования препаратов на основе ГЭК Координационной группой по процедуре взаимного признания и децентрализованной процедуры по лекарственным препаратам для медицинского применения (Coordination group for Mutual recognition and Decentralised procedures – human, CMDh), которая является регулирующим органом оборота лекарственных средств для медицинского применения на территории государств-членов Европейского союза (ЕС) и Комитета оценки рисков в сфере фармаконадзора (Pharmacovigilance Risk Assessment Committee, PRAC) в хронологичной последовательности с указанием последнего решения вышеуказанных организаций по данному вопросу. Также в статье освещены действия и решения аналогичной отечественной организации – ГП «Государственный экспертный центр МЗ Украины». Проанализировано использование препаратов на основе молекул ГЭК в Украине, выявлено, что в 46% случаев данная группа лекарственных средств использовалась не по показаниям.
My research analyzes how the remaking anew of tradition—the return to"traditional" birthing arts (home birth, midwife-assisted birth, water birth, "natural" birth)—has resulted in the commodification of indigenous culture and the re-inscription of racial inequalities on the one hand, and, despite feminist rhetoric about women's liberation from (masculine) biomedical hegemony, the reconfiguring of parent-child bonds in ways that again place the burden of correctly producing future bioconsumers on women's shoulders. I focus on the extremes of contemporary Mexican society—disenfranchised indigenous families and members of the global meritocracy—and in doing so, I demonstrate how citizenship retains value for some while being rendered an inadequate analytical frame for others. More specifically, I argue that the privileged do not position themselves as citizens through claims to public resources; instead, they accumulate cultural capital through privatized services. Through an examination of processes of racialization and patterns of bioconsumption, I critique the broad application of the concept of citizenship, and make a case for the consideration of the bioconsumer (individuals for whom market-based consumption of medical services plays a formative role in how their identities are syncretically portrayed and perceived). The main stakes of bioconsumption are the presentation of self and accrual of cultural capital. Furthermore, I demonstrate how what is under negotiation in the alternative birth movement is the social-moral body onto which identities get mapped. Close ethnographic study reveals how the so-called "humanization" of birth and the reduction of maternal and infant mortality are distant projects that are collapsed onto one another and produce an emerging ideology of "good parenthood." In this ideology, children represent parents' stake in the contemporary global meritocracy. This work therefore uncovers how traditional ways of birthing are being destroyed and reinvented through racialized class privilege, which is based on a model of neoliberal consumption that simultaneously promotes "humanity" and reinforces inequality by infusing transnational movements with reified class logics and racialization. I thus consider Mexican traditional midwivery as a unique lens for examining how indigeneity becomes an object of consumption via ethnomedical piracy within a transnational racialized economy. Through 28 months of in-depth, multi-sited research across Mexico, from October 2010 to November 2013, this dissertation analyzes the physical and social mobility of some individuals, and the relative immobility of others, through the lens of humanized birth. In writing this dissertation, I aim to make the following interventions:First, I disrupt notions of citizenship-making by placing under the same lens those for whom citizenship is always just out of reach and those for whom citizenship is not a concern as their privileged access to privatized markets allows for a supra-state existence. I offer the concept of "supranationalism" as a contribution to emerging literature that rethinks states as the consolidation of territory and government, thus opening up other ways of conceptualizing polity and geography. I use the topic of birth to provide ethnographic evidence of how biopower is not only imposed by states upon citizen-subjects; but by powerful, extra-governmental, social and economic forces operating in the context of neoliberalism, thus resulting in real material consequences and shaping health outcomes. Second, I deploy the concepts of racialization and power when I critique the ways in which the global alternative birth movement inadvertently appropriates and commodifies indigenous culture. When "indigeneity" is invoked in the realm of so-called "humanized" birth, the object is fetishized, separated entirely from its cultural, socioeconomic, and geographical context, and repackaged for popular consumption—leading me to rethink the relationship between neoliberal citizenship and consumerism. I use the example of midwifery in Mexico to examine racialized identities-turned-merchandise, with real effects for the bodies of women. Building upon studies that explore the political economy of the body under contemporary global capitalism, I use a transnational context to analyze the political economy of identities vis-à-vis the body.In this dissertation, I examine the disparate and unequal distribution of "traditional," and ethnomedical forms of "natural" birth among social collectivities. The dissertation examines the mobility of humanized birth practitioners and participants who travel across borders to contribute to ideology and practices being produced transnationally, while comparatively immobile women are socially situated in ways that preclude their participation in medical migrations. Thus, while my ethnographic research provides detailed examples of how humanized birth is reshaped and reconstituted in sites that bear stark contrast to the social and geographic locations where the humanized birth model was originally produced, I am more concerned with how politic economic terrains are not only traversed, but are themselves transformed by medical migration. Finally, I complexify notions of feminist liberation by asking how humanized birth may be the first step within a new regime of pressures and "requirements" presented by modern-day "good parenting." I resist viewing children only as commodities; however, I do argue that children represent parents' stake in our contemporary meritocracy—a system that naturalizes extreme inequality by allowing us to believe in democratic structures and the idea that education and proper preparation will open doors for children to a brilliant future. Furthermore, I suggest that meritocratic structures exert pressure in the womb. The difference between a privatized and public childhood begins in vitro with prenatal care.
Staff and patients of hospital psychiatry services are commonly confronted by the aggressive behaviour of patients. Such behaviour can result in numerous, and varied, adverse outcomes that ultimately reduce the quality of care that can be offered. Psychiatric services and mental health legislation place great emphasis on providing services within the least-restrictive environment; this means that prompt identification and treatment of patients at risk of aggression and violence is critical. Thus, elucidation of the personal features of patients that influence aggression is an important focus for empirical research. Moreover, it is essential that in explicating such features, the contextual nature of aggression occurring in hospital psychiatry services be considered. In this thesis, a number of personal features relevant to aggression in hospital psychiatry services are discussed. The main focus is on understanding interpersonal hostile-dominance (HD) and its relationship with aggression in hospital psychiatry services through the integration of two complementary theoretical models: the General Aggression Model (GAM) and Interpersonal Theory. The GAM is a comprehensive aggression theory, while Interpersonal Theory highlights the importance of relational functioning in understanding personality and interpersonal behaviour. Underpinning this dissertation are four distinct, yet related research aims: (1) To assess the influence of interpersonal and personality factors, GAM-specified cognitions and related affective states, and clinical factors on psychiatric inpatient aggression; (2) To delineate interpersonal HD in psychiatric inpatients; (3) To examine the stability of HD and its relationship with psychiatric symptoms and aggression over time; and (4) To explore whether HD mediates the relationship between childhood abuse and neglect and aggressive behaviour in psychiatric inpatients. For the empirical component of this research, 200 adult psychiatry inpatients were assessed using the Positive and Negative Syndrome Scale (PANSS), the State-Trait Anger Expression Inventory-2: Trait Anger scale (STAXI-2:TA), the Measures of Criminal Attitudes and Associates: Attitudes Towards Violence scale (MCAA:ATV), the Schedule of Imagined Violence (SIV), the Childhood Trauma Questionnaire (CTQ), the Psychopathy Check List: Screening Version (PCL:SV), the Impact Message Inventory-Circumplex (IMI-C), and the Overt Aggression Scale (OAS). Assessments took place within five days of their admission to the low-dependence environment. Forty-one participants were available at six months post-hospital discharge for follow-up assessment using the PANSS, IMI-C, and the Life History of Aggression Questionnaire: Aggression subscale (LHA:A). In relation to the first aim, results showed that HD, psychopathy, the tendency to rehearse aggressive scripts, positive attitudes towards violence, trait anger, and disorganised and excited symptoms predicted psychiatric inpatient aggression. However, only HD remained as a significant unique predictor in the hierarchical regression analysis, confirming the importance of HD in the prediction of psychiatric inpatient aggressive behaviour. In relation to the second aim, interpersonal, affective, and behavioural features of psychopathy, the tendency to rehearse aggressive scripts, and positive, negative, disorganised, and excited psychiatric symptoms remained as significant unique predictors of HD in a hierarchical regression model. This suggests that HD reflects a characteristic tendency towards interpersonal, affective, and behavioural problems marked by hostility and dominance, combined with a tendency toward frequent aggressive script rehearsal, and more severe psychopathology. In relation to the third aim, results showed that HD was stable over time, despite an overall reduction in psychiatric symptoms, and that HD was associated with greater symptom severity over time. Furthermore, it was found that elevated HD and greater severity of excited psychiatric symptoms in the community, along with more severe positive psychiatric symptoms in the hospital and in the community, were associated with aggressive behaviour occurring post-discharge. These findings implicate HD as a risk factor for more severe psychopathology, and highlight HD as a risk factor for post-discharge aggression. In relation to the final aim, childhood abuse and neglect experiences were commonly reported, with between 41% and 50.5% of participants reporting having experienced at least moderate severity of the different forms of childhood maltreatment. More severe emotional, physical, and sexual abuse, and physical neglect in childhood were associated with higher HD in adulthood. Higher levels of HD and all forms of childhood abuse and neglect were associated with aggression; HD mediated the relationship between childhood abuse and neglect, and aggression. These results indicate that childhood maltreatment contributes to interpersonal HD, which then influences aggressive behaviour. Together, these findings highlight the importance of HD and Interpersonal Theory to the problem of aggression in hospital psychiatric services. These results are also important to the GAM and suggest interpersonal style and Interpersonal Theory should have an important role in models that seek to account for interpersonal aggression and violence. Additionally, this body of research enhances conceptualisations of HD and reinforces the importance of understanding the developmental impact of childhood abuse and neglect experiences from an interpersonal perspective. By assessing interpersonal style on admission, patients with elevated levels of HD can be identified. HD can then be considered in subsequent treatment plans and aggression prevention strategies. Post-discharge assessments of HD would also be useful. Reductions in HD, and therefore aggression, might be achieved through a broad intervention that covers interpersonal and affective characteristics, emotional and behavioural regulation, cognitions and psychiatric symptoms, in an interpersonally informed framework.
My dissertation, "Essays in Public Economics," is comprised of three chapters. The first one, titled "Altruism, Reciprocity, and Equity: A Unified Motive for Intergenerational Transfers" is to address the following question: Why do parents divide bequests equally while transferring inter vivos gifts unequally? Across times and places, why have there mainly been only two extreme choices of distribution of bequests: either to give them to just one child (unigeniture) or to divide them equally (equigeniture)? How can a motive for intergenerational transfers explain both "equal division puzzle" (the former) and polarized inheritance patterns (the latter)? This chapter presents a behavioral model that coherently rationalizes these empirical realities. Namely, as head of a family, a parent altruistically cares about children but also wants them to spend effort for family. However, effort is costly and individual level of each child is unverifiable to a third party adjudicator. Given this incomplete information, there rise only two stable equilibria: either equigeniture or unigeniture. When the productivity of effort rises, the evolution of inheritance pattern from unigeniture to equigeniture occurs. So equigeniture is eventually adopted due to a rise in the productivity throughout industrialization. Furthermore, if the parent wants to counterbalance inequality among children who exert equal effort, the greater amount of inter vivos gift is transferred to a child with lower relative income compared to his siblings, while bequests remain equally divided. This model is consistent with the aforementioned empirical realities but also lends itself to further empirical tests. First of all, with a data set of pre-industrial agrarian societies, we find that a rise in the productivity of effort causes equigeniture to be chosen over unigeniture, which is consistent with the model. Second of all, through an empirical analysis on a micro-level data on inter vivos transfers in contemporary families, we find supporting evidence as follows: (i) income inequality among children increases the probability that their parent gives any inter vivos gift; and (ii) the amount of the gift is negatively associated with relative income of each child compared to his siblings.The second chapter "Retirement and Exposure of Pension to Financial Market Fluctuations" studies how exposure of pension wealth to stock market fluctuations affects retirement behavior both theoretically and empirically. Characteristics of optimal plan for retirement are elaborated with reflecting that liquidizing pension wealth is more tied to retirement decisions than non-pension wealth as well as embodying time-sensitive restrictions on availability of pension benefits. Theoretical analysis finds that exposure of pension to financial market fluctuations does not always entail perfectly symmetric response of retirement. Exposure of pension to a positive shock actually brings responses of retirement only if the magnitude of the positive shock is large enough to compensate for foregone labor earnings and demand for resources necessary for post-retirement consumptions. In particular, whereas exposure of pension to a small negative shock leads to a decrease in retirement, exposure of pension to a positive shock with the same magnitude might not yield an increase in retirement. Next, empirical analysis is conducted with Health and Retirement Study, micro-level biennial panel data of senior workers in U.S., to examine actual retirement responses over the recent business cycle. Little evidence is found on a discernible increase in retirement rate owing to exposure of pension to the 2004 and 2006 positive shocks. However, the 2002 and 2008 negative shocks prove to lead to a decrease in retirement rate. In the view of theoretical findings, this is not self-contradictory but still can be consistent with a positive wealth effect on retirement; rather, it points to a case where these positive shocks are not sharp and large enough to bring substantive earlier retirement.The third chapter, titled "Optimal Income Taxation and Optimal Revenue Mobilization," analyzes characteristics of nonlinear optimal income taxation and optimal revenue mobilization when the tax enforcement of a government is not costless (and thus not presumed to be perfect). The government cannot observe and verify an individual's innate ability although that ability turns out to cause inequality amongst them. This prevents the government from avoiding efficiency loss in the taxation, since each taxpayer can take advantage of private information over their own ability by reducing working hours to pretend to be less able than he truly is. Optimal income tax schedule is designed to minimize the efficiency loss from deterring such behavior to maximize social welfare. Moreover, the desired expenditure of the government is set for enhancing minimum living standard of society. In executing the tax schedule to finance this, however, tax evasion occurs due to imperfect enforcement. Although the government can verify the true amount of taxpayer's earnings, unlike their ability, it is costly to increase the enforcement rate. The optimal rate equalizes a gain of net increase in the tax revenue with a loss of decreased utility of risk-averse taxpayers from an increment in the rate. Notably, this chapter shows that aggregate loss of tax revenue can theoretically justify non-zero tax rate on top earners.
Resumen: Esta tesis estudia la obesidad desde una mirada de la Sociología, donde se percibe que es una enfermedad multifactorial y bastante compleja, que está inserta en un contexto socioeconómico, político, demográfico y epidemiológico. Desde en el campo sociológico, se aprecia que origina un estigma social. Como estigmatizadora la obesidad produce discriminación, prejuicio y exclusión social. El objetivo es describir y analizar cómo las personas obesas responden y enfrentan las cuestiones sociales ante el tratamiento bariátrico. La investigación en cuestión tiene un abordaje cualitativo basado en las entrevistas en profundidad a 17 personas obesas que hicieron el tratamiento bariátrico en Argentina y en Brasil y relatan sus experiencias. Buscando otros aportes metodológicos que pudiesen ayudar en la comprensión de la obesidad como un fenómeno sociológico, las entrevistas e indagaciones se dirigen a familiares, profesionales del área de la salud, así como a informaciones periodísticas, programas de televisión y acompañamiento en las redes sociales. Por medio del análisis de las entrevistas y la recolección de los datos, los resultados encontrados mostraron que, las personas obesas además de tener que luchar constantemente con el exceso de peso, sufren prejuicios en distintos ambientes, como en la familiar, en el trabajo, en la escuela, etc. Todo eso porque prevalece en la sociedad una creencia y una visión estética del cuerpo escultural, donde la obesidad no es mirada como una enfermedad y sí como una preferencia en opción estrictamente individual. La investigación alcanzó las siguientes consideraciones: la obesidad no tiene cura – es una enfermedad crónica y multifactorial, y el tratamiento bariátrico permite "administrar" mejor el control de peso; de por vida la persona obesa (sobre todo por genética) va a tener que cuidar de su alimentación; las personas obesas que hicieron el tratamiento bariátrico perciben una presión social que no sólo discrimina, sino que también impide al individuo controlar su aumento de peso; la persona obesa vive en un estado constante de invisibilidad/visibilidad y enfrentamiento delante de su enfermedad, que genera discriminaciones, falta de participación social y aislamiento; la cirugía es el cambio, "la metamorfosis" que ayuda a salir definitivamente del escondite en el que uno se encuentra a causa de la obesidad; las personas obesas consideran que la cirugía les proporciona medios para alcanzar un "peso posible" no siempre el "peso ideal" encumbrado socialmente. El Barómetro Social de la Obesidad puede ser una herramienta que posibilita medir la presión social a las personas obesa en el contexto que vive. Palabras-clave: Barómetro Social de la Obesidad; Discapacidad; Estigma; Normalidad, Obesidad; Personas Obesas; Peso Ideal; Sociología del Cuerpo; Tratamiento Bariátrico. ; Abstract: This thesis considers obesity from a sociological point of view. According to this, obesity can be perceived as a multifactorial and quite complex disease, which is embedded in a socio-economic, political, demographical and epidemiological context. From a sociological point of view, obesity creates a social stigma that produces discrimination, prejudice and social exclusion. The aim of this thesis is to describe and analyze how obese people respond and face social issues during the bariatric treatment. This research is a qualitative approach based on in depth interviews with 17 obese people who did bariatric treatment in Argentina and Brazil and shows their experiences. Seeking other methodological approaches that could help in the understanding of obesity as a sociological phenomenon, interviews and inquiries are directed to families, professionals in health, as well as news reports, television programs and support in social networks. After analyzing the interviews and collecting data it was demonstrated that, as well as having to constantly battle with being overweight, obese people suffer prejudice in different environments for instance in their families, at work, at school, etc. All that prevails in our society because there is an aesthetic vision where people believe that it is necessary to have a sculpted body and, as a result, obesity is not considered to be a disease but rather a strictly individual choice. The investigation achieved the following considerations: There is no cure for obesity, it is a chronic and multifactorial disease, and bariatric treatment can help people managing better their weight control; but an obese person (especially if genetic influenced ) will have to take care of his diet during his lifetime. The obese person that has received bariatric treatment suffers from social pressure, not only discrimination, but also some facts that may not allow him to control his weight gain. Overweight people live in a constant state of visibility /invisibility and they are always fighting his illness, which generates discrimination, lack of social participation and isolation. For them this surgery is the change; the "metamorphosis" that helps them being permanently removed from the hiding places they were in because of that illness. Obese people are aware that surgery provides means to achieve a "possible weight" that is not always the socially exalted "ideal weight". The Social Barometer of Obesity is a tool that enables measurement of social pressure in the living contexts of obese people.
2012 Summer. ; Includes bibliographical references. ; Wild waterfowl and aquatic birds serve as the natural reservoir host for influenza A viruses. As the reservoir, wild waterfowl play an important role in the persistence and transmission of influenza viruses among bird populations and to other mammalian species. In many Asian countries, domestic ducks are raised for meat and egg production. Some of these domestic ducks are ranged on rice paddies or post-harvest rice fields. The ducks provide service to the rice fields by fertilizing the field with feces and aerating the field by swimming and walking through the ground cover. Additionally, the ducks serve as a form of insect control through their natural grazing behaviors. The role that domestic ducks play in the ecology of influenza viruses is poorly understood. Highly pathogenic avian influenza H5N1 virus (HPAI H5N1) originated in Guangdong Province, China in 1996, which was followed by global dissemination of the virus that began in 2003. This virus is unprecedented in geographical spread, economic consequences and public health significance. At the present time, HPAI H5N1 virus is endemic six countries, including Indonesia. Indonesia has experienced the highest incidence of human infections with HPAI H5N1 virus and one of the highest case fatality rates. Control of the virus in Indonesia has proven extremely challenging, due to its diverse and complex poultry and domestic duck production systems. HPAI H5N1 virus is highly virulent in chickens and turkeys and causes severe systemic disease. Outbreaks of HPAI H5N1 in poultry populations are accompanied by high mortality. In contrast, HPAI H5N1 virus is typically nonpathogenic or mildly pathogenic in ducks and mortality in duck flocks during outbreaks of the virus is absent or limited. This allows ducks to serve as silent carriers of the virus, as they may shed large quantities of virus without displaying clinical signs of illness allowing infected ducks to evade detection by flock owners or government livestock officials. Domestic duck production is common in Southeast Asia. Indonesia has a large domestic duck population, estimated at more than 34 million ducks. Because HPAI H5N1 induces only mild disease in domestic ducks, outbreaks of the virus are difficult to detect and are rarely reported by domestic duck flock owners. Thus, domestic duck flocks have been left out of many government HPAI H5N1 surveillance and control programs. While a number of studies have demonstrated that the presence of domestic ducks in a country or at a specific location may be a risk factor for the presence of HPAI H5N1 virus, few studies have been conducted evaluating the role that domestic ducks play in the ecology of HPAI H5N1 virus. The objectives of the studies described in this dissertation were to elucidate the role of domestic ducks in the maintenance and spread of avian influenza viruses, particularly HPAI H5N1 virus, by evaluating domestic duck flock characteristics and behaviors, estimating the prevalence and incidence of avian influenza viruses in these flocks and characterizing HPAI H5N1 viruses detected in the field. To meet the objectives, two studies were conducted in West Java, Indonesia. The first study was a cross-sectional study aimed at characterizing domestic duck flocks and estimating the point prevalence and seroprevalence of avian influenza viruses, particularly HPAI H5N1 virus. This study was followed by a 7 month longitudinal study, aimed at estimating the incidence of avian influenza viruses, particularly HPAI H5N1 virus, in domestic duck flocks and evaluating flock illness and mortality during avian influenza virus outbreaks. A subset of samples from each of the studies was transported to the United States for virus characterization. The findings of the studies conducted demonstrate that domestic duck flocks are raised in complex production systems, are highly mobile, have significant contact with wild and domestic birds and mammals, are frequently ill and are provided with little formal veterinary care. The prevalence and incidence of avian influenza virus, including HPAI H5N1 virus, are high in domestic duck flocks in Indonesia. Clinical signs of illness and increased mortality did not correlate with the presence of avian influenza virus in the flock. Interestingly, there was also no correlation between increased flock mortality and the presence of HPAI H5N1 virus in the flock, demonstrating that domestic duck flocks can be asymptomatically infected with HPAI H5N1 virus while shedding high quantities of virus. Characterization of some of the viruses isolated from domestic duck flocks demonstrated that the flocks can be infected with more than one avian influenza virus at one time, as demonstrated by one flock that was positive for HPAI H5N1, as well as H3 and H7 avian influenza viruses. These situations are concerning, as domestic duck flocks may serve as mixing vessels for avian influenza viruses and co-infections in these flocks may result in the emergence of novel influenza viruses that may have capabilities for human-to-human transmission. It is likely that domestic ducks play an important role in the maintenance and spread of avian influenza viruses, including HPAI H5N1 virus. A number of domestic duck flock practices, including extensive flock movement, frequent introduction and sale of ducks, free-ranging of ducks in areas where they have contact with wild birds and animals and continual contact of duck flocks with other duck and poultry flocks, increasingly adds to the difficulty of control of HPAI H5N1 virus within this production system and makes eradication of the virus within a country extremely challenging.
Telegrams exchanged between Gen, Plutarco Elías Calles and the following people: private citizens, governors, the Manager of the Banco de México, Agustín Rodríguez, the Head of the National Lottery, Manuel E. Otálora, Garrison Commanders, the Secretary of Agriculture and Development, Francisco S. Elías, The secretary of War and Navy, Pablo Quiroga, Customs Managers, the Secretary General of the Veracruzan Labor Party, Amador Zárate, the Secretary General of the Executive Committee for the League of Agrarian Communities from Toluca, Felipe Estrada, the President of El Salvador, Maximiliano Hernández Martínez, the Municipal Committees of the National Revolutionary Party, the Cruz Azul Workers Forum Party, a Commercial Company of Chemical Products, the Assistance Manager of the Mercantile and Agricultural Bank, Ltd., Frank D. Wilkey, Consuls, the President of the republic Abelardo Rodríguez, and his personal secretary Soledad González. The aforementioned telegrams concern information about not having been able to take care of a matter due to sickness, appreciation for get-well greetings, appreciation for funding allocation for the School of Medicine, reply of acknowledgement about somebody's passing, report on the cyclone victims in San Luis Potosí, a request for assisting with the transportation of items purchased by Gen. Plutarco Elías Calles, a memo stating that notes were taken on previous messages, a request for information on private citizens' health status, information about the realization of a Convention to establish the Radical Guanajuatense Party, information of a packet to a consul, requesting trail passes, report on the vote result to renew the City Council in Veracruz, requests for assisting the Victims in San Luis and Oaxaca, report on the social peace in Chiapas, a request for financial aid to the School of Medicine, information about the possible shipping of a steam shovel, scheduling appointments, requesting assistance for banana exports, appreciation for funds allocation to repair the national dry-dock in Guaymas, Sonora, a request to use Cruz Azul cement to build the Monument to the Revolution, information about B.A. Gustavo Ariza's assuming office as Interim governor of Puebla, a request for funds allocation to the Commercial Company of Chemical Products, a request to help someone not to be discharged from the army, confirming the departure of Senator Cruz, confirmation of Gen. Plutarco Elías Calles' departure to Tehuacán to negotiate a matter with the president, a request for information about a bank account, appreciation for the shipping of diathermy endplates, requesting to assist Juan Platt, requesting the ban of circulation of an American newspaper in Ciudad Juárez due to a smear campaign against Manuel Llantada, an invitation to an Air force exhibition in Jalapa, confirmation of mailing a memorandum. / Telegramas entre el Gral. PEC, particulares, Gobernadores, Director del Banco de México Agustín Rodríguez, Director de la Lotería Nacional Manuel E. Otálora, Comandantes de Guarnición, Secretario de Agricultura y Fomento Francisco S. Elías, Secretario de Guerra y Marina Pablo Quiroga, Jefes de Aduanas, Secretario General del Partido Veracruzano del Trabajo Amador Zárate, Secretario General del Comité Ejecutivo de la Liga de Comunidades Agrarias de Toluca Felipe Estrada, Presidente de El Salvador Maximiliano Hernández Martínez, Comités Municipales del Partido Nacional Revolucionario, El Forum Club Obreros Cruz Azul, Compañía Comercial de Productos Químicos, Subgerente del Banco Mercantil y Agrícola, S.A. Frank D. Wilkey, Cónsules, Presidente de la República Abelardo L. Rodríguez y la Secretaria Particular del Gral. PEC, Soledad González, acerca de: informe sobre no haber atendido asunto por motivos de salud, agradecimientos por sus buenos deseos, agradecimientos por envíos de fondos para la Escuela de Medicina, respuesta de enterado sobre fallecimiento, informe sobre damnificados por ciclón en San Luis Potosí, solicitud de otorgamiento de facilidades para transportación de objetos comprados por el Gral. PEC, comunicación de haber tomado nota de mensajes anteriores, solicitud de estado de salud de particulares, notificación sobre celebración de Convención para constitución del Partido Radical Guanajuatense, informe de envío de paquete a Cónsul, solicitud de pases de ferrocarril, informe sobre resultado votación para renovación de Ayuntamiento de Veracruz, solicitudes de ayuda a damnificados de San Luis y Oaxaca, informes sobre paz social en Chiapas, solicitud de ayuda económica para la Escuela de Medicina, informe sobre posible envío de pala de vapor, concesión de audiencias, solicitud de ayuda para exportar plátano, agradecimiento por envío de fondos para la reparación del varadero nacional de Guaymas, Son.; solicitud para que se emplee cemento Cruz Azul en la construcción del Monumento a la Revolución, informe sobre toma de posesión como Gobernador interino de Puebla del Lic. Gustavo Ariza, solicitud de envío de fondos a la Compañía Comercial de Productos Químicos, solicitud de ayuda para que no se dé de baja en el ejército, notificación de salida del Senador Cruz, notificación de salida del Gral. PEC para Tehuacán a tratar asunto con Presidente, solicitud de informes sobre cuenta bancaria, agradecimiento por envío de placas terminales diatermia, solicitud de atenciones a Juan Platt, solicitud de prohibición de circulación del periódico americano a Ciudad Juárez por injusta campaña de descrédito que inició contra Manuel Llantada, invitación a festival aéreo en Jalapa, le notifica del envío de memorándum.
Telegrams exchanged between Gen. Plutarco Elías Calles and the following people: private citizens, governors, military people, the Association of students of the Chemistry Department from the Federal District, Congressmen, a former president, the Organizing Commission of the Peninsular Expo in Campeche, the President of the National Chamber of Irapuato, Mayors, the League of Agrarian Communities from Ciudad Victoria, Tamaulipas, the Acción Poblana Great Revolutionary Party and the Peasant and Workers party, the Revolutionary Parties from Sinaloa, the National Confederation of Electricians and the Regional Confederation of Cooperatives of the Federal District. The aforementioned telegrams concern replies of acknowledgement, instructions to rush the plowing work in el Mante, report on the advance of works of the International Road in Tapachula, Chiapas, a notice indicating that they have not shipped horses to Tlaxcala, thanking for the appointment of Roberto Medellín as president of the University, notice on the smear campaign against the governor of Durango, a request for supporting Tomás Garido Canabal's attendance to the Peninsular Expo, requests for appointments, reports on the peaceful situation in the various states, confirming the inauguration of Arturo M. Elías as Governor of Baja California, confirming B.A. López Lira's appointment, congratulations to Gen. Agustín Olachea on his appointment in Baja California, a request to support the import of American wheat in Irapuato, scheduling appointments, a request for returning documents that were seized from the Agrarian Committee of Arcelia, Guerrero, Congratulatory greetings and endorsement of Gen. Plutarco Elías Calles on the designation of Abelardo Rodríguez as President of the Republic, report on the guarantees granted to Chauffeurs and car owners from Tampico, a request for shipping fertilizer to Villa Juárez, Tamaulipas, the Governor of Sonora Rodolfo Elías Calles informs of the revenues gained in a year of his administration, a request to support the prosecution of civilian murderers in Acapulco, Guerrero, a report by the Governor of Guanajuato José, J. Reinoso on respecting the individual rights in his state, a request for intervention in the election process in favor of Col. Miguel Armienta in Culiacán, Sinaloa, a report on the granting of guarantees to chauffeurs from Tampico, an invitation to the inauguration of the pavement works of the Tijuana-Ensenada road, reports on proselytism campaigns in favor of Gen. Mijares Palencia in Puebla, a report of the cultivated area on the Mayo and Yaqui Rivers, a request to not rescind the contract signed with the Former Racetrack Cooperative of Peralvillo, shipping of furniture, confirmation of the appointment of Dr. Castillo Nájera as Minister in Sweden, declining an invitation due to health issues. / Telegramas entre el Gral. PEC, particulares, Gobernadores, Militares, Sociedad de Alumnos de la Facultad de Ciencias Químicas del Distrito Federal, Diputados, Ex-Presidente, Comisión Organizadora de la Exposición Peninsular en Campeche, Presidente de la Cámara Nacional de Comercio de Irapuato, Presidentes Municipales, Liga de Comunidades Agrarias de Ciudad Victoria, Tamps.; Gran Partido Revolucionario Acción Poblana y Partido Campesino y Obrero, Partidos Revolucionarios de Sinaloa, Confederación Nacional de Electricistas, Federación Regional de Cooperativas del Distrito Federal, acerca de: respuestas de enterado, instrucciones para que se agilicen los trabajos de barbecho en El Mante, informe sobre avance en la Carretera Internacional en Tapachula, Chis., notificación de que no se ha enviado caballada a Tlaxcala, agradecimiento por designación de Roberto Medellín como Rector de la Universidad, notificación de campaña de descrédito contra Gobernador de Durango, solicitud de intervención para que Tomás Garrido Canabal asista a Exposición Peninsular, solicitudes de audiencia, partes sobre tranquilidad en los estados, notificación sobre toma de posesión como Gobernador de Baja California de Arturo M. Elías, notificación de ratificación del nombramiento del Lic. López Lira, felicitaciones al Gral. Agustín Olachea por designación de cargo en Baja California, solicitud de intervención para que no se importe trigo americano en Irapuato, concesión de audiencias, solicitud de que se devuelva documentación arrebatada al Comité Agrario de Arcelia, Gro.; felicitaciones y adhesiones al Gral. PEC con motivo de la designación de Abelardo Rodríguez como Presidente de la República, informe de garantías otorgadas a la Liga de Choferes y Propietarios de Automóviles de Tampico, solicitud de envío de abono a Villa Juárez, Tamps.; informe del Gobernador de Sonora, Rodolfo Elías Calles, sobre los ingresos obtenidos en un año de gestión, solicitud de ayuda para que se enjuicie a asesinos civiles en Acapulco, Gro.; informe del Gobernador de Guanajuato José J. Reynoso sobre el respeto a las garantías individuales en su estado, solicitud de intervención en proceso electoral a favor del Corl. Miguel Armienta en Culiacán, Sin., informe de impartición de garantías a choferes de Tampico, invitación a inauguración de trabajos de pavimentación en el camino Tijuana-Ensenada, informes sobre campaña de proselitismo a favor del Gral. Mijares Palencia en Puebla, informe de superficie sembrada en ríos Mayo y Yaqui, solicitud de intervención para que no se rescinda el contrato a la Cooperativa Ex-Hipódromo de Peralvillo, envío de muebles, notificación de nombramiento de Ministro en Suecia a favor del Dr. Castillo Nájera, declinación de invitación por cuestiones de salud.
[eng] This doctoral thesis focuses on active Spanish scholarly journals which follow internationally‐recognized quality standards, in order to analyze their main features, study the adoption of Open Access, observe the relationship between their price and bibliometric impact, and examine its internationality characteristics. Web of Science (WoS) and Scopus have been selected as the sources for identifying the journals. After depurating mistakes, a final list of 445 journals has resulted. A set of indicators has been defined and all data has been collected from the journals' primary source (website or hard copy). Correlations and association tests have been carried out to explore relationships among variables. The population of Spanish journals indexed in WoS and Scopus grew steadily over the last years: there were 300 titles by 2012, 406 by 2013 and 445 by 2015. A 69.7% of these were launched after 1980 and their average age is 30 years. This selection of This selection of 445 journals stands for a 25% of journals published in Spain, but the subject areas are not equally distributed - Science, Technology and Medicine fields (STM) are overrepresented, while Social Sciences and Humanities (SSH) appear less frequently. Indeed, 84% of all journals concentrate in only three of the seven subject areas considered for this study – 35% on Social S., 32% on Health S. and 18% on Arts & Humanities. Universities and research centers (mostly the Spanish National Research Council, CSIC) publish 43% of the journals. To run their publishing services, most of them use OJS platforms (34% of the total population). They publish mostly on Arts & Humanities (in Spanish language) and Social Sciences. Online‐only format and free access are their favorite output. Commercial publishers are the second in importance, accounting for the 32% of the journals. They focus on Health Sciences and run most of the few free‐access journals with APCs. They also account for most of the few hybrid journals, which are usually published in English. Elsevier is the largest commercial publisher, publishing about 17% of all the journals in this study. Scientific societies, professional associations and other not‐for‐profit private institutions publish 21% of the journals. They own or participate in another 24% of the journals, which are published by companies like Elsevier. Indeed, their scientific participation is crucial, reaching almost half of the population studied (45%). Government agencies publish only a 4% of all the journals. As to languages, almost half of the journals (47%) are published only in Spanish. Nonetheless, 26% are published both in Spanish and English, and 18% only in English. Remaining languages are residual. Free access is the most common type of publication (64.5%), followed by restricted (16.6%), embargo (14.4%) and hybrid (4.5%). Free‐access is associated with academic publishers and Social Sciences, while restricted‐access and hybrid journals are more common among companies and usually refer to STM fields. Open Access, as measured by free access with self‐archiving permissions, results in 56.9% of the total of journals. This indicates a sustained increase according to previous studies. Article Processing Charges (APCs) are beginning to be introduced in Spain, but only in 7% of these journals. Both free‐access and hybrid journals charging APCs are associated with commercial publishers, English language and high bibliometric impact rates. Annual subscription prices are much higher for STM, commercial companies and English language content, but the difference is lower when using price per article, because expensive journals usually provide more scientific content. APC prices are on average ten times higher in hybrid titles than in free‐access ones. Impact Factor (IF, which is only available for 27% of the studied journals), Scimago Journal Rank (SJR) and Source‐Normalized Impact per Paper (SNIP) have in general higher impact values for STM fields, journals with APCs and journals published in English. While the highest IFs usually appear in journals issued by commercial publishers, highest SNIPs are related to journals published by associations and societies. Subscription prices, both at volume and article level, have no relationship with any impact indicator. On the contrary, APC prices correlate moderately with impact indicators, but only with SJR and SNIP, not with IF. English language, foreign‐authored articles, international collaborations and foreign members at scientific teams have been identified and measured as elements that indicate internationality. Except for international collaborations, with very few appearances (especially in Arts & Humanities), all elements have global averages of around 33%, although they vary depending on subject areas and access types. The English language is most common in STM fields, journals published by companies and journals charging APCs. Foreign authors are more present in Health Sciences and Mathematics & Physics, and journals with APCs. The proportion of foreign experts is similar to that of foreign authors', but with smoother differences among categories – also, they are lower in Health Sciences and higher in Engineering. Academic publishers usually include more members from foreign institutions than the rest. Internationality elements present a similar pattern, especially as far as the participation of foreign authors and foreign experts is concerned. Limitations of the study, future research lines and final considerations are provided. ; [cat] Aquesta tesi doctoral estudia les revistes científiques espanyoles actives i amb un nivell de qualitat reconegut internacionalment, per tal d'analitzar les seves característiques principals, el grau d'adopció d'Accés Obert, la relació entre el preu i l'impacte bibliomètric, i els seus elements d'internacionalitat. Web of Science (WoS) y Scopus van ser seleccionades com a les fonts adequades per identificar la població objecte d'estudi. Després de depurar els errors detectats a les llistes de revistes extretes, es va obtenir una llista definitiva de 445 revistes. Es va definir un conjunt d'indicadors i es van recollir totes les dades de la font d'informació principal (el lloc web o la versió impresa de cada revista). Finalment, es van realitzar proves de correlació i associació per explorar relacions entre variables. S'ha posat de manifest que la població de revistes espanyoles indexades a WoS y Scopus ha crescut de manera sostinguda durant els darrers anys: hi havia 300 títols al 2012, 406 al 2013, i 445 al 2015. El 69,7% dels darrers van ser creats després de 1980 i la seva edat mitjana és de 30 anys. Aquesta selecció de 445 revistes suposa el 25% dels títols publicats a Espanya, tot i que les àrees temàtiques no hi estan reflectides de manera proporcional: la ciència, tecnologia i medicina i estan sobre-representades, mentre es recull un baix percentatge sobre ciències socials i humanes. Tot i així, el 84% de les revistes es concentren en només tres dels set camps considerats en aquest estudi: 35% en ciències socials, 32% en ciències de la salut, i 18% en arts i humanitats. Les universitats i els centres d'investigació publiquen el 43% de les revistes estudiades, amb especial menció del CSIC (Centre Superior d'Investigacions Científiques). La majoria d'aquestes revistes usen Open Journal Systems (OJS), plataforma on es recolza el 34% del total. Les institucions acadèmiques també publiquen principalment revistes sobre arts i humanitats (en castellà) i sobre ciències socials. Aquests títols solen estar disponibles en línia, sense versió impresa, i en Accés Obert. Les editorials comercials són les segones en importància, ocupant-se del 32% de les revistes, la majoria de les quals tracten sobre ciències de la salut. Aquestes entitats són responsables de moltes de les escasses revistes que inclouen càrrecs per publicació ("Article Processing Charges", APC), tant en Accés Obert com híbrides (aquestes últimes, principalment en anglès). Elsevier és l'editorial amb més títols, publicant el 17% de les revistes d'aquest estudi. Les societats científiques, associacions professionals i altres institucions privades sense ànim de lucre publiquen el 21% de les revistes, i a més a més col·laboren en un altre 24%, del qual s'ocupa principalment Elsevier. La participació d'aquest tipus d'institucions és crucial, ja que en total arriba al 45% de totes les revistes de la població analitzada. Finalment, els ens governamentals responen només del 4% dels títols Quant als idiomes, quasi la meitat de les revistes (47%) estan publicades només en castellà. No obstant, el 26% està publicat en castellà i anglès, i el 18% exclusivament en anglès. La presència de la resta d'idiomes és residual. L'accés lliure és el tipus d'accés més comú (64,5%), seguit pel restringit (16,6%), embargat (14,4%) i híbrid (4,5%). És freqüent a les editorials acadèmiques i a les ciències socials, mentre que l'accés restringit i híbrid és més comú entre les comercials i normalment es troba als àmbits de la ciència, tecnologia i medicina. Les revistes en Accés Obert, considerades com aquelles disponibles en accés lliure i amb permisos d'auto-arxiu, suposen el 56,9% d'aquesta població. Segons estudis anteriors, aquesta dada indica un augment sostenible del grau d'adopció de l'Accés Obert. Els càrrecs per publicació s'estan començant a introduir a Espanya, però de moment només estan presents al 7% d'aquests títols. Tant les revistes en accés lliure amb APC com les híbrides es publiquen per editorials comercials, en anglès i amb alts indicadors d'impacte bibliomètric. Els preus de subscripció anual són molt més alts a revistes sobre ciència, tecnologia i medicina. També ho són als títols publicats per editorials comercials i a revistes en anglès. No obstant, la diferència de preu disminueix si es considera el preu per article, perquè les revistes més cares solen aportar més contingut científic. Els preus dels APC són, de mitjana, deu vegades més cars a les revistes híbrides que a les d'accés lliure. El Factor d'Impacte (IF, que només està disponible per al 27% de les revistes estudiades), el Scimago Journal Rank (SJR) i el Source-Normalized Impact per Paper (SNIP), tenen en general valors més alts per a les revistes sobre ciència, tecnologia i medicina, amb APC i en anglès. Mentre que els valors més elevats d'IF apareixen a les revistes publicades per editorials comercials, els SNIP més alts estan relacionats amb associacions i societats. Els preus de subscripció no guarden relació amb cap indicador d'impacte, ni a nivell de volum anual ni a nivell d'article. Pel contrari, els preus dels APC correlacionen moderadament amb indicadors d'impacte, però només amb SJR i SNIP, no pas amb IF. L'anglès, els articles escrits per autors estrangers, les col·laboracions internacionals i els experts estrangers dels equips editorials han estat considerats com a elements d'internacionalitat mesurables. Excepte les col·laboracions internacionals, amb molt poca incidència (especialment baixa en arts i humanitats), tots els elements tenen una mitjana general aproximada del 33%, tot i que depenen molt de l'àrea temàtica i del tipus d'accés. La llengua anglesa és la més comú en ciència, tecnologia i medicina, així com a les revistes publicades per editorials comercials i també en publicacions amb APC. Els autors d'altres països tenen major presència a ciències de la salut, matemàtiques i física, i també a revistes amb APC. La proporció d'estrangeria és similar entre autors i equip editorial, però amb diferències menys notables entre categories. La proporció d'experts forans és també inferior a ciències de la salut, i superior a enginyeries. Les revistes publicades per institucions acadèmiques solen incloure més investigadors amb filiació estrangera als seus equips editorials que la resta de revistes. En general, els elements d'internacionalitat presenten patrons de distribució similars, especialment quant a autors i experts estrangers. Finalment, es descriuen les limitacions d'aquest estudi, possibles línies futures d'investigació, i conclusions globals.
