One Foundation's Experience with Primary and Integrated Care Grantmaking: Lessons on Leverage and Policy Change

Significant changes in health care practice usually require changes in compensation practice -- and may also require changes in licensing (of facilities and/or professions), certification and professional training. This is important work that requires a long-term commitment. And it may give rise to push-back from various sources invested in the current state of affairs:* Professionals, not wanting others to be licensed to perform similar services at lower reimbursement rates* Payers, not wanting to open a door to new categories of reimbursable services* Training institutions reluctant to alter curriculum, until it is clear that a new approach has staying powerFoundations are in a powerful position to speak out for change, as we "don't have a dog in the fight." That neutrality can be our strength, particularly as we become known for speaking clearly and from a basis in factual information and evidence-based approaches

Family Planning Experiences and Perceptions of Access: Latina Immigrants in a New Settlement State

Background: Reproductive health is an integral part of women's self-determination and overall health and wellbeing. Public policies can strengthen or undermine reproductive health. As a health behavior, family planning affects many reproductive health outcomes, and is a key gateway health behavior to overall reproductive health and wellbeing. Immigration and welfare policies have significant and often unexplored public health implications. Recent changes in immigration and other public policies affect the health of new Latin American immigrants in myriad ways. In Kentucky, as in other new immigrant settlement states, most adult Latinas are recent immigrants and foreign-born. As such they live in a post-welfare reform environment where immigrants are often barred from accessing public assistance that could mitigate poverty's negative impact on health. Immigrants in these states may also perceive that they are ineligible for services because of the lack of culturally- and linguistically-accessible services and the general attitude towards immigrants. Objective: This study looked at how foreign-born Latina immigrants' perceptions of access to and experiences with family planning in an urban center in Kentucky can inform community-based policy initiatives to improve the reproductive health of Latinas. Methods: Twenty in-depth key informant interviews were conducted from June to August 2011. Nine foreign-born, Latina informal community leaders and 11 social and health service providers, and policy professionals were interviewed in Spanish and English, respectively. Qualitative analysis using an emergent theme approach was conducted using qualitative analysis software. Results: Findings were categorized into 6 areas: social, political, and cultural context of Kentucky; scope and meaning of family planning; instrumental and perceived barriers; instrumental and perceived facilitators; role of policies in access to family planning; and potential impact of the Affordable Care Act on foreign-born Latinas' access to family planning. Both participant populations made the connection between non-health policies (especially immigration, transportation, and language-access) and family planning access. This study's findings suggest that Latina immigrants' perception of access is affected by immigration and transportation policies at the state and federal level, by local attitudes towards immigration, and language access practices at service agencies. Findings also provide insights into culturally- and linguistically-appropriate approaches to increase knowledge and understanding of family planning among foreign-born Latina immigrants. Recommendations: This study indicates the need for changes at the policy, organizational, and programmatic level. Public health leadership is needed to bring about these changes. The need for culturally-and linguistically appropriate community outreach, peer-to-peer education, provider training, strong political messages regarding immigrants, advocacy to reverse policies that damage access to health, and enforcement of existing language access policies are among the recommendations in this study. More research is needed in this area, in particular using participatory methods

Cultura organizacional y su influencia en la calidad de servicio a los usuarios de Provias, Lima, 2019

El objetivo de la tesis ha sido determinar la influencia de la cultura organizacional en la calidad de servicios a los usuarios de Provias, Lima, 2019, con dicho propósito se han tomado en cuenta las teorías de cultura organizacional según Chiavenato (2009). Cultura organizacional es un conjunto de hábitos y creencias que fueron dispuestos a través de valores, normas expectativas y reacciones los cuales son divididos por los miembros de una entidad (p.124). y la teoría de calidad de servicio según Dolors (2004). La calidad de servicio resulta de verificar las expectativas que tiene el usuario y lo que él obtiene o piensa que recibió, es decir la apreciación del resultado de dicho servicio. (p.17). El tipo de investigación ha sido aplicada, enfoque cuantitativo, diseño no experimental de corte transversal, nivel explicativo causal, método hipotético deductivo, la población estuvo conformada por 78 trabajadores de Provias del área de Gestión Administrativa y atención al cliente, la muestra fue censal, el instrumento utilizado ha sido el cuestionario estuvo compuesto por 20 preguntas de tipo Likert; el resultado y la conclusión después de haber analizado y procesado la información es que existe una influencia significativa de la cultura organizacional en la calidad de servicio a los usuarios de Provias

Web 2.0: cita con la conciencia social. Sin casa, no sin voz

Este trabajo pretende conocer cómo se ha gestado la problemática de los desahucios y analizar la importancia de la Participación Ciudadana como medio de cambio. Para ello, por un lado, se ha realizado una contextualización histórica de los acontecimientos políticos y los movimientos sociales surgidos. Por otro lado, se expone cómo las redes sociales funcionan de herramienta para la movilización y se hace un análisis del funcionamiento de la Plataforma de Afectados por la Hipoteca, las campañas realizadas y los logros conseguidos en respuesta a las necesidades de las personas endeudadas. El resultado me lleva a diseñar una propuesta basada en la prevención, desde la que se avance hacia una cultura del alquiler, mediante la concienciación, la promoción desde lo local, la creación de campañas y apoyándonos en la web para conseguir una mayor difusión que alimente la movilización.This work tries to know how the problematics of the evictions has been in preparation and to analyze the importance of the Civil Participation as way of change. For it, on the one hand, there has been realized a historical contextualización of the political events and the social arisen movements. On the other hand, there is exposed how the social networks (nets) work of tool mobilization and there is done an analyisis of the functioning of the Platform of Affected by the Mortgage, the realized there is done an analysis of the functioning of the Platform of Affected by the Mortgage, the realized campaigns and the achievements obtained in response to the needs of the indebted persons. The result leads me to designing an offer based on the prevention, from which the promotion of the partipation is advanced towards a culture of the rent, by means of the raising awareness, from the local thing, the creation of campaigns and us resting on the web to obtain a major diffusion that feeds the mobilization.Grado en Educación Socia

Prenatal Alcohol Exposure as a Case of Involuntary Early Onset of Alcohol Use: Consequences and Proposed Mechanisms From Animal Studies

Prenatal alcohol exposure has been found to be an important factor determining later consumption of this drug. In humans, despite the considerable diversity of variables that might influence alcohol consumption, longitudinal studies show that maternal alcohol intake during gestation is one of the best predictors of later alcohol use from adolescence to young adulthood. Experimental studies with animals also provide abundant evidence of the effects of prenatal alcohol exposure on later alcohol intake. In addition to increased consumption, other effects include enhanced palatability and attractiveness of alcohol flavor as well as sensitization to its sensory and reinforcing effects. Most of these outcomes have been obtained after exposing rats to binge-like administrations of moderate alcohol doses during the last gestational period when the fetus is already capable of detecting flavors in the amniotic fluid and learning associations with aversive or appetitive consequences. On this basis, it has been proposed that one of the mechanisms underlying the increased acceptance of alcohol after its prenatal exposure is the acquisition (by the fetus) of appetitive learning via an association between the sensory properties of alcohol and its reinforcing pharmacological effects. It also appears that this prenatal appetitive learning is mediated by the activation of the opioid system, with fetal brain acetaldehyde playing an important role, possibly as the main chemical responsible for its activation. Here, we review and analyze together the results of all animal studies testing these hypotheses through experimental manipulation of the behavioral and neurochemical elements of the assumed prenatal association. Understanding the mechanisms by which prenatal alcohol exposure favors the early initiation of alcohol consumption, along with its role in the causal pathway to alcohol disorders, may allow us to find strategies to mitigate the behavioral effects of this early experience with the drug. We propose that prenatal alcohol exposure is regarded as a case of involuntary early onset of alcohol use when designing prevention policies. This is particularly important, given the notion that the sooner alcohol intake begins, the greater the possibility of a continued history of alcohol consumption that may lead to the development of alcohol use disorders.The research has been funded by the Basque Government (IT1341-19) to the research group (PI: Gabriel Rodriguez San Juan)

The role of acetaldehyde in the increased acceptance of ethanol after prenatal ethanol exposure

Recent studies show that acetaldehyde, the first metabolite in the oxidation of ethanol, can be responsible for both, the appetitive and the aversive effects produced by ethanol intoxication. More specifically, it has been hypothesized that acetaldehyde produced in the periphery by the liver is responsible for the aversive effects of ethanol, while the appetitive effects relate to the acetaldehyde produced centrally through the catalase system. On the other hand, from studies in our and other laboratories, it is known that ethanol exposure during the last gestational days (GD) consistently enhances the postnatal acceptance of ethanol when measured during early ontogeny in the rat. This increased liking of ethanol is a conditioned appetitive response acquired by the fetus by the association of ethanol’s flavor and an appetitive reinforcer. Although this reinforcer has not yet been fully identified, one possibility points to acetaldehyde produced centrally in the fetus as a likely candidate. This hypothesis is supported by data showing that very early in the rat’s ontogeny brain catalases are functional, while the liver’s enzymatic system is still immature. In this study, rat dams were administered on GD 17–20 with water or ethanol, together with an acetaldehyde-sequestering agent (D-penicillamine). The offspring’s responses to ethanol was then assessed at different postnatal stages with procedures adequate for each developmental stage: on day 1, using the “odor crawling locomotion test” to measure ethanol’s odor attractiveness; on day 5, in an operant conditioning procedure with ethanol as the reinforcer; and on day 14 in an ethanol intake test. Results show that the absence of acetaldehyde during prenatal ethanol exposure impeded the observation of the increased acceptance of ethanol at any age. This seems to confirm the crucial role of acetaldehyde as a reinforcer in the appetitive learning occurring during prenatal ethanol exposure

La comunicación interna y el clima organizacional de los educadores y administrativos de la IE CRFA El Carmelo-Virú,2021

El objetivo principal de esta investigación es determinar la relación entre comunicación interna y el clima organizacional de los docentes y administrativos de la IE Centro Rural de Formación en Alternancia, El Carmelo-Virú, 2021, el enfoque de investigación es cuantitativo y se empleó un nivel de investigación explicativa y correlacional y el diseño es no experimental, la población y censo de estudio está conformada por el personal docente y administrativos lo que nos da un total de 14 colaboradores. Los instrumentos fueron sometidos a confiabilidad mediante el Alfa de Cronbach alcanzado un valor de 0,889 para la variable comunicación interna y 0,913 para la variable clima organizacional. Con los resultados obtenidos se determina que la comunicación interna se relaciona de manera directa y altamente significativa con el clima organizacional de los docentes y administrativos de la IE Centro Rural de Formación en Alternancia, El Carmelo-Virú, 2021 siendo el coeficiente de correlación de pearson es R = 0.790 (existiendo una alta relación positiva) con nivel de significancia menor al 1% (p < 0.01). Se concluyó que la comunicación interna se relaciona de manera positiva en el clima organizacional de los docentes y administrativos de la IE Centro Rural de Formación en Alternancia, El Carmelo-Viru

Programa de integración familiar para el aprendizaje de comunicación en niños de 5 años de la i.e. Josefina Pinillos, Trujillo 2021

El presente trabajo de investigación, es de tipo pre experimental, titulado Programa de integración familiar para el aprendizaje de Comunicación en niños de 5 años de la I.E Josefina Pinillos, Trujillo 2021, se resume en lo siguiente: Se trabajó con una muestra conformada por 49 alumnos de 05 años de edad de dos secciones “A” y “B” de la I.E., a quienes se les aplicó un cuestionario a través de los padres de familia para medir los conocimientos que tienen sus hijos en el área de Comunicación antes de la aplicación del Programa de integración familiar, la cual está orientada a mejorar el aprendizaje de los niños en dicha área, así como también fortalecer el vínculo afectivo entre padres e hijos. En base a lo mencionado anteriormente, las autoras de este estudio de investigación elaboraron un Programa de Integración Familiar, el cual contiene su respectiva fundamentación, estrategias metodológicas, y demás requisitos, el mismo que fue aplicado a los padres de familia y realizado a través de charlas para fortalecer el vínculo afectivo entre padres e hijos, así como también, el manejo de estrategias a practicar en casa para mejorar el aprendizaje de los niños, dichas charlas abordaron temas como la familia, los hábitos y rutinas, donde se realizó debates y exposiciones. Este estudio tiene como objetivo general, demostrar la eficacia del Programa de integración familiar, en el aprendizaje del Área de Comunicación en los niños de 05 años “A” y “B” de la I.E. Josefina Pinillos, Trujillo 2021. La hipótesis formulada para esta investigación es: “El programa de integración familiar influye significativamente en el aprendizaje en el área de Comunicación en los niños de 05 años “A y B”, de la I.E. Josefina Pinillos - Trujillo 2021. El instrumento aplicado fue el cuestionario, el cual se usó en el pre y post test, y fueron elaborados por las autoras de investigación, validado por expertos y sometidos a pruebas de confiabilidad. Cabe señalar, que al tener resultados distintos en el pre test y post test, se agrupó a los padres de familia para orientarlos de manera personalizada, teniendo en cuenta vii las necesidades a reforzar de los niños, el cual sirvió para que puedan mejorar sus aprendizajes en el área de Comunicación. Se ha demostrado que la aplicación del titulado Programa de integración familiar para el aprendizaje de Comunicación en niños de 5 años de la I.E. Josefina Pinillos, Trujillo 2021 es efectiva, puesto que, al aplicar las pruebas estadísticas se encontraron diferencias significativas entre los resultados del pre test y post test.This research work is of a pre-experimental type, entitled Family integration program for learning Communication in 5-year-old children of the I.E. Josefina Pinillos, Trujillo 2021., is summarized in the following: A non-probabilistic convenience sample was used, which is made up of 50 05-year-old students from two sections “A” and “B” of the EI, to whom a questionnaire was applied through their parents. to measure the knowledge that their children have in the area of Communication before the application of the Family Integration Program, which is aimed at improving children's learning in this area, as well as strengthening the affective bond between parents and children. Based on the above, the authors of this research study developed a Family Integration Program, said program contains its respective foundation, methodological strategies, and other requirements, the same that was applied to parents and carried out through talks To strengthen the affective bond between parents and children, as well as the management of strategies to practice at home to improve children's learning, these talks addressed topics such as family, habits and routines, where debates and presentations were held. The general objective of this study is to demonstrate the effectiveness of the Family Integration Program in learning the Communication Area in 05-year-old children "A" and "B" of the I.E. Josefina Pinillos, Trujillo 2021. The hypothesis formulated for this research is: "The family integration program is effective for learning in the Communication Area in 05-year-old children" A "and" B ", from the I.E. Josefina Pinillos - Trujillo, 2021”. The instrument applied was the questionnaire, which was used in the pre and post tests, and were prepared by the research authors, validated by experts and subjected to reliability tests. It should be noted that by having different results in the pre-test and post-test, the parents were grouped together to guide them in a personalized way, taking into account ix the children's needs to be reinforced, which helped them to improve their learning in the communication area. It has been shown that the application of the titled Family Integration Program for learning communication in 5-year-old children of the I.E. Josefina Pinillos, Trujillo 2021 is effective, since, when applying the statistical tests, significant differences were found between the pre-test and post-test results.Tesi

DESEMPENHO DE CULTIVARES DE ALFACE CRESPA PRODUZIDAS EM HIDROPONIA A PARTIR DE MUDAS PRODUZIDAS EM FLOATING E ESPUMA FENÓLICA.

Objetivando-se avaliar o desempenho de cultivares de alface crespa produzidas em hidroponia a partir de mudas produzidas em floating e espuma fenólica, realizou-se um experimento em casa de vegetação, na Fazenda Experimental da Universidade de Marília-SP. O delineamento experimental adotado foi o inteiramente casualizado em esquema fatorial 2 x 2, com cinco repetições, cujos fatores corresponderam respectivamente, a dois sistemas de cultivo para a produção de mudas (floating e espuma fenólica) e duas cultivares de alface crespa (Jullie e TPC). Foram avaliadas as características massa fresca e seca da parte aérea, número de folhas por planta e comprimento do caule. Ocorreram diferenças significativas entre cultivares para todos os caracteres avaliados. Diferença estatística significativa entre sistemas de cultivos foi observada somente para o comprimento de caule. A interação cultivar x sistemas de cultivos não foi significativa para nenhum dos caracteres avaliados. No número de folhas por planta a cultivar TPC foi superior a “Jullie” independente do sistema de cultivo. Já para o comprimento de caule, constatou-se que as duas cultivares apresentaram valores superiores no sistema floating em relação à espuma fenólica e que a cultivar Jullie apresentou comprimento de caule maior que a “TPC” na espuma fenólica. Esses valores mais altos são indesejáveis, uma vez que são responsáveis pelo pendoamento precoce na alface. Para a massa seca da parte aérea verificou-se que a cultivar Jullie foi superior a “TPC” na espuma fenólica, porém não ocorreu diferença entre elas no sistema floating. Conclui-se que nas condições em que foi conduzido o experimento que a cultivar Jullie apresentou maior massa fresca da parte aérea do que a cultivar TPC e que no número de folhas a “TPC” se destacou em relação à “Jullie” e que os sistemas de cultivos não influenciaram no rendimento das cultivares

Endodontic treatment and retreatment: a large systematic review

Introduction: In the context of treatment endodontics, endodontic surgery encompasses various procedures for the treatment of teeth with a history of endodontic treatment failures, such as apical surgery, crown and root resections, surgical repair of perforations, and intentional replantation. Endodontic microsurgery is the evolution of traditional apicectomy techniques and incorporates high magnification, ultrasonic preparation of the root end, and filling of the root end with biocompatible materials. Objective: It was to carry out a vast literature review in a systematic way to show the main considerations of endodontic treatment and retreatment. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from September to November 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 120 articles were found, and 75 articles were evaluated and 35 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 13 studies that did not meet GRADE. Most studies showed homogeneity in their results, with I2 =96.2% &gt;50%. Modern endodontic surgery uses the dental operating microscope and cone beam computed tomography for preoperative diagnosis and treatment planning. In the presence of persistent endodontic lesions or endodontic failure, endodontic treatment or endodontic surgery is required. In the long term, the risk of failure is identical for both groups, with only a slightly higher risk of failure for non-surgical endodontic retreatments when only two years of follow-up are considered