Funding and remuneration of interdisciplinary primary care teams in Canada: a conceptual framework and application

Abstract Background Reliance on interdisciplinary teams in the delivery of primary care is on the rise. Funding bodies strive to design financial environments that support collaboration between providers. At present, the design of financial arrangements has been fragmented and not based on evidence. The root of the problem is a lack of systematic evidence demonstrating the superiority of any particular financial arrangement, or a solid understanding of options. In this study we develop a framework for the conceptualization and analysis of financial arrangements in interdisciplinary primary care teams. Methods We use qualitative data from three sources: (i) interviews with 19 primary care decision makers representing 215 clinics in three Canadian provinces, (ii) a research roundtable with 14 primary care decision makers and/or researchers, and (iii) policy documents. Transcripts from interviews and the roundtable were coded thematically and a framework synthesis approach was applied. Results Our conceptual framework differentiates between team level funding and provider level remuneration, and characterizes the interplay and consonance between them. Particularly the notions of hierarchy, segregation, and dependence of provider incomes, and the link between funding and team activities are introduced as new clarifying concepts, and their implications explored. The framework is applied to the analysis of collaboration incentives, which appear strongest when provider incomes are interdependent, funding is linked to the team as a whole, and accountability does not have multiple lines. Emergent implementation issues discussed by respondents include: (i) centrality of budget negotiations; (ii) approaches to patient rostering; (iii) unclear funding sources for space and equipment; and (iv) challenges with community engagement. The creation of patient rosters is perceived as a surprisingly contentious issue, and the challenges of funding for space and equipment remain unresolved. Conclusions The development and application of a conceptual framework is an important step to the systematic study of the best performing financial models in the context of interdisciplinary primary care. The identification of optimal financial arrangements must be contextualized in terms of feasibility and the implementation environment. In general, financial hierarchy, both overt and covert, is considered a barrier to collaboration

Algumas concepções de alunos do ensino médio a respeito das proteínas

O conceito de proteína e sua síntese são importantes para a compreensão de processos em biotecnologia, por exemplo, a produção de novos fármacos, área em avanço nas últimas décadas. Assim, o objetivo desse trabalho foi verificar, dentre alunos do Ensino Médio, quais tipos de concepções eles têm ou trazem sobre proteína e síntese proteica, e que tipo de influência pode ter contribuído para a formulação de tais concepções, através de um questionário diagnóstico, composto por questões abertas, aplicado a 133 alunos de uma escola pública e de uma particular. Os resultados analisados basearam-se em categorização de respostas. Concluímos que, mesmo os alunos já tendo estudado assuntos relativos a proteínas, ainda carregavam traços de concepções alternativas, o que forneceu informações valiosas sobre possíveis falhas no processo de aprendizagem. Assim, para que haja uma "ressignificação" desses conceitos, é necessário que as discussões desse tema sejam ampliadas, vinculando-os aos conteúdos correlatos previamente trabalhados

A autoavaliação da aprendizagem de inglês como língua estrangeira em um ambiente tandem a distância Self-assessment of English as a foreign language learning in a distance tandem setting

Este trabalho visa discutir as características do processo de autoavaliação da aprendizagem de inglês como língua estrangeira em um contexto tandem a distancia. Trata-se, mais especificamente, da apresentação de uma pesquisa na qual se analisam os dados coletados no ambiente teletandem (TELLES, 2005) por uma brasileira (aprendiz de inglês), durante suas interações via chat com dois parceiros norteamericanos (aprendizes de português). A análise enfoca as metas e estratégias de aprendizagem em relação aos parâmetros e critérios adotados pela brasileira em seu processo de autoavaliação.<br>This work aims at discussing the characteristics of self-assessment process in a tandem language learning setting. It is the presentation of a study in which the data were collected by a Brazilian participant (learner of English as a foreign language) during her interactions via chat with two North American teletandem (TELLES, 2005) partners (learners of Portuguese as a foreign language). The analysis focused on the learning goals and strategies in relation to the parameters and criteria defined by the Brazilian learner in her self-assessment process

Low back and neck and shoulder pain in members and non-members of adolescents' sports clubs : the Finnish Health Promoting Sports Club (FHPSC) study

Background: The objective of this study was to investigate the prevalence of self-reported low back pain (LBP) and neck and shoulder pain (NSP), and the related factors in members and non-members of adolescents’ sports clubs. Methods: This cross-sectional study was based on surveys of 14–16-year-olds as a part of the Finnish Health Promoting Sports Club (FHPSC) Study. The surveys on self-reported health behaviours, injuries, and musculoskeletal health were conducted among sports club members (n = 962) and non-members (n = 675). Binary logistic regression analysis was applied to study the associations between dependent variables of LBP and NSP, and the independent factors. Results: The prevalence of LBP during the preceding 3 months was 35.0 % in girls and 24.5 % in boys (p < 0.05 for sex difference). The prevalence of NSP was 55.9 % in girls and 27.3 % in boys (p < 0.001 for sex difference). Being a sports club member increased the odds for LBP in boys (odds ratio [OR] 2.35, 95 % CI 1.48–3.72). On the other hand, sports club participation was associated with lower odds of frequent NSP in girls (OR 0.52, 95 % CI 0.33–0.82). No associations were found between other leisure-time physical activity and LBP or NSP. Higher screen time (computer games, TV/DVD, phone, Internet) during leisure-time increased the odds of NSP in boys and LBP in boys and girls. Conclusions: In this study, self-reported LBP and NSP were already relatively common among adolescents. Girls have a higher risk for reporting LBP and NSP. Measures that are more effective in the prevention of LBP in male sports club members are needed. Excessive screen time is weakly associated with LBP and NSP, which should be taken into account in health promotion among adolescents.peerReviewe