Becoming deafblind: Negotiating a place in a hostile world

Doctor of PhilosophyThis study addresses the situation of adults who become deafblind. To date, their everday lives have received little attention in the research literature. Of the few studies conducted many involve surveys, the findings of which present the characteristics of people who are deafblind such as their rates of employment, need for support, or use of equipment. There are also a small number of qualitative studies that have explored the effects of having dual sensory impairment, and particularly in relation to communication and psycho-social wellbeing. Important as these research efforts have been, there is little empirical information available about the everyday lives of people who become deafblind and their concerns, nor any systematic attempt to theorise their experiences. There are however many personal anecdotes typically presented at conferences or through community publications and newsletters. This project aimed to redress the gap in the literature by developing a theoretical framework to explain the everyday experiences of adult who become deafblind. In doing so, it built upon the research and anecdotal literature with an overall purpose of presenting, through rigorous research, the experiences of adults who become deafblind and to do so within the broader discourse on disability and disablism. The study was informed by the social relational understanding of disability developed within the Nordic countries. Grounded theory was the method of choice to examine the lives of adults who become deafblind from their own perspective.Participant observation was employed through direct engagement in shared experiences with adults who have become deafblind both at a social group and via an e-mail list group. Mulitple in-depth interviews were undertaken both face to face and by e-mail with a smaller group of eight participants.The core finding from this study is that people who become deafblind are rendered interactionally powerless in a society predicated on seeing and hearing. The powerlessness that they experience comes from having this dual impairment in a world in which being able to see and hear are expected both in the physical and social environment. The inability of people who become deafblind to 'know and be' in the world in the same way as others results in them feeling, and experienceing, interactional powerlessness. In response, people who become deafblind actively engage in trying to minimise or remove their powerlessness. They do so by working to negotiate a place in this hostile world. They adopt four interrelated strategies, namely, doing things differently, managing support relationships, survivings others' perceptions and presenting sides of self.This study, with its central tenet that interactional powerlessness drives ongoing attempts to negotiate a place makes a theoretical contribution to understanding the experience of becoming deafblind. The findings support the concept of disbaility as social relational. Disability is not the same as the sensory impairment, rather it is expressed in the organisation of personal relations in society which render some more powerful than others and in this case, some less powerful due to their inability to use the natural means of communication of hearing and sight. Moreover, the study findings propose that professionals working with people with this dual sensory impairment must endeavour to reduce their part in the hostile world by providing information about options and support available; recognising the complexity of these adults support requirements; and considering the link between psycho-emotional issues and disablism. Further research is needed to understand empirically and theoretically the relative contribution of personal relationships vis a vis organisational or structural relationships in disabling people who become deafblind

Indicadores de gestión para obras sociales provinciales

Las obras sociales provinciales ocupan un lugar preponderante en el sistema de financiación de salud argentino. Dada la complejidad del mercado donde actúan y la segmentación de este colectivo, se visibiliza la necesidad de contar con indicadores que posibiliten el control de gestión de variables clave del sector sanitario. En este trabajo se realiza un análisis de distintos indicadores que contribuyen en la medición de la demanda prestacional, haciendo foco en las consultas y las internaciones, en la consideración de que ambas variables son reconocidas por la doctrina en salud como importantes medidas de la accesibilidad y utilización del sistema. De este modo, la información que se expone en este trabajo resulta de suma relevancia para la planificación y el control sanitario

Health-promoting properties of artichoke in preventing cardiovascular disease by its lipidic and glycemic-reducing action

The artichoke, Cynara scolymus, is one of the most ancient plants grown in the world, and its extracts, obtained from different parts of the plant (leaves, fruits and roots), have been used as medicaments from time immemorial. The pharmacological and therapeutic effects of the artichoke on the liver had already been well known in the 17th century. Modern studies started in the last century confirmed the stimulating properties of artichoke extracts on the liver and gallbladder. The ensuing wave of research was initially focused on the patent liver-stimulating, diuretic and choleretic effects exerted by artichoke preparations on both animals and man, then discovering such other therapeutic properties as the hypolipemizing activity, antioxidant activity and hypoglycemizing activity. This review enumerates the most significant studies that have highlighted these therapeutic properties. Complementary medicine information needs to be incorporated into clinical practice and patient and professional education, in addition to adequate education about proper nutrition. Awareness of the widespread use of complementary and alternative medicine by people with metabolic disorders is crucial for healthcare professionals in order to prevent cardiovascular disease

Indicadores de gestión para obras sociales provinciales

The provincial health insurance are in a preponderant place in the Argentine system of health financing. Given the complexity of the market where they operate and the segmentation of this group, the need to have indicators that make it possible to control the management of key variables in the health sector is necessary. In this paper an analysis of different indicators that contribute to the measurement of the demand for health care is made, focusing on the consultations and hospitalizations, considering that both variables are recognized by the doctrine in health as important measures of accessibility and utilization of the system. Thus, the information presented in this paper is extremely relevant for health planning and control.Las obras sociales provinciales ocupan un lugar preponderante en el sistema de financiación de salud argentino. Dada la complejidad del mercado donde actúan y la segmentación de este colectivo, se visibiliza la necesidad de contar con indicadores que posibiliten el control de gestión de variables clave del sector sanitario. En este trabajo se realiza un análisis de distintos indicadores que contribuyen en la medición de la demanda prestacional, haciendo foco en las consultas y las internaciones, en la consideración de que ambas variables son reconocidas por la doctrina en salud como importantes medidas de la accesibilidad y utilización del sistema. De este modo, la información que se expone en este trabajo resulta de suma relevancia para la planificación y el control sanitario

Health-promoting properties of artichoke in preventing cardiovascular disease by its lipidic and glycemic-reducing action

The artichoke, Cynara scolymus, is one of the most ancient plants grown in the world, and its extracts, obtained from different parts of the plant (leaves, fruits and roots), have been used as medicaments from time immemorial. The pharmacological and therapeutic effects of the artichoke on the liver had already been well known in the 17th century. Modern studies started in the last century confirmed the stimulating properties of artichoke extracts on the liver and gallbladder. The ensuing wave of research was initially focused on the patent liver-stimulating, diuretic and choleretic effects exerted by artichoke preparations on both animals and man, then discovering such other therapeutic properties as the hypolipemizing activity, antioxidant activity and hypoglycemizing activity. This review enumerates the most significant studies that have highlighted these therapeutic properties. Complementary medicine information needs to be incorporated into clinical practice and patient and professional education, in addition to adequate education about proper nutrition. Awareness of the widespread use of complementary and alternative medicine by people with metabolic disorders is crucial for healthcare professionals in order to prevent cardiovascular disease

Beta-glucan- or rice bran-enriched foods : a comparative crossover clinical trial on lipidic pattern in mildly hypercholesterolemic men

Background/ Objectives:There has been growing interest in using dietary intervention to improve the lipid profile. This work aims at analyzing the effects and the comparison of the enrichment of a diet with beta-glucans or rice bran in mildly hypercholesterolemic men.Subjects/Methods:The subjects initially consumed a 3-week Step 1 American Heart Association diet with rice bran-enriched foods. After this adaptation period, volunteers were randomly assigned to follow a crossover, controlled trial that consisted of two treatment with beta-glucan- or rice bran-enriched foods, each of 4 weeks, with a 3-week wash-out, like the adaptation period, between periods. Fasted blood samples were collected on days 0, 21, 49, 70 and 98 in both study arms for measuring low-density lipoprotein (LDL)-cholesterol (primary outcome), total cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, apolipoprotein (apo) A-I, apo B and glucose levels.Results:Twenty-four men (mean age: 50.3\ub15.3, mean body mass index: 24.9\ub11.9) completed the 14-week trial. Subjects in the 3-week adaptation period experienced significant reductions in the mean level of LDL cholesterol, total cholesterol, total cholesterol/HDL cholesterol, LDL cholesterol/HDL cholesterol, apo A-I, apo A-I/apo B and glucose. During the intervention diet periods, a difference was found between treatment groups for the mean change in LDL (0.21 (95% confidence interval (CI): 0.02-0.40), P=0.033) and total cholesterol (0.34 (95% CI: 0.20-0.47), P<0.001). Other parameters evaluated were not significantly affected by the diet consumed.Conclusions:The results of the present crossover clinical trial showed that beta-glucan-enriched foods are more effective in lowering serum LDL levels, compared with rice bran-enriched foods