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1.
J Emerg Manag ; 19(5): 469-478, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34812482

RESUMO

BACKGROUND: The emergency departments of the hospitals and emergency medical services (EMSs) centers have a critical role for providing urgent medical care for patients. The statistical data of the present study were provided by the EMS headquarters of the city of Isfahan, from August to November 2017. RESULTS: The findings showed that on average, 210 missions were accomplished each day by the emergency call center, with an average duration of about 53 minutes, for each mission. In addition, the average time for response time (the time between a call and dispatch of the ambulance) was less than 3 minutes, and the average time for arrival time (the time between request of ambulance and the arrival to the scene) was 8.1 minutes. Adequacy of current number of ambulances and staff is evaluated. CONCLUSION: Considering an average of 8.1 minutes for arrival time, we conclude that the EMS of Isfahan is within an acceptable range, compared to the international standards. In fact, it is shown that the infrastructures of EMS system including ambulance fleets, staff, and equipment are sufficient, and as an effective step for reducing the total time of the mission, the EMS has to operate seamlessly with the patient's admission process in hospitals. Information such as workload hours, availability of resources and staff, etc. ought to be shared between the EMS and the hospital.


Assuntos
Desastres , Serviços Médicos de Emergência , Ambulâncias , Hospitais , Humanos , Teoria de Sistemas
2.
Artigo em Inglês | MEDLINE | ID: mdl-34574692

RESUMO

The declining discovery rate of world-class ore deposits represents a significant obstacle to future global metal supply. To counter this trend, there is a requirement for mineral exploration to be conducted in increasingly challenging, uncertain, and remote environments. Faced with such increases in task and environmental complexity, an important concern in exploratory activities are the behavioural challenges of information perception, interpretation and decision-making by geoscientists tasked with discovering the next generation of deposits. Here, we outline the Dynamics model, as a diagnostic tool for situational analysis and a guiding framework for designing working and training environments to maximise exploration performance. The Dynamics model is based on an Ecological Dynamics framework, combining Newell's Constraints model, Self Determination Theory, and including feedback loops to define an autopoietic system. By implication of the Dynamics model, several areas are highlighted as being important for improving the quality of exploration. These include: (a) provision of needs-supportive working environments that promote appropriate degrees of effort, autonomy, creativity and technical risk-taking; (b) an understanding of the wider motivational context, particularly the influence of tradition, culture and other 'forms of life' that constrain behaviour; (c) relevant goal-setting in the design of corporate strategies to direct exploration activities; and (d) development of practical, representative scenario-based training interventions, providing effective learning environments, with digital media and technologies presenting decision-outcome feedback, to assist in the development of expertise in mineral exploration targeting.


Assuntos
Internet , Aprendizagem , Minerais , Teoria de Sistemas
4.
PLoS Comput Biol ; 17(8): e1009263, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34460810

RESUMO

The identification of subnetworks of interest-or active modules-by integrating biological networks with molecular profiles is a key resource to inform on the processes perturbed in different cellular conditions. We here propose MOGAMUN, a Multi-Objective Genetic Algorithm to identify active modules in MUltiplex biological Networks. MOGAMUN optimizes both the density of interactions and the scores of the nodes (e.g., their differential expression). We compare MOGAMUN with state-of-the-art methods, representative of different algorithms dedicated to the identification of active modules in single networks. MOGAMUN identifies dense and high-scoring modules that are also easier to interpret. In addition, to our knowledge, MOGAMUN is the first method able to use multiplex networks. Multiplex networks are composed of different layers of physical and functional relationships between genes and proteins. Each layer is associated to its own meaning, topology, and biases; the multiplex framework allows exploiting this diversity of biological networks. We applied MOGAMUN to identify cellular processes perturbed in Facio-Scapulo-Humeral muscular Dystrophy, by integrating RNA-seq expression data with a multiplex biological network. We identified different active modules of interest, thereby providing new angles for investigating the pathomechanisms of this disease. Availability: MOGAMUN is available at https://github.com/elvanov/MOGAMUN and as a Bioconductor package at https://bioconductor.org/packages/release/bioc/html/MOGAMUN.html. Contact: anais.baudot@univ-amu.fr.


Assuntos
Algoritmos , Modelos Biológicos , Biologia Computacional , Simulação por Computador , Bases de Dados de Ácidos Nucleicos , Redes Reguladoras de Genes , Humanos , Modelos Genéticos , Distrofia Muscular Facioescapuloumeral/genética , Distrofia Muscular Facioescapuloumeral/metabolismo , RNA-Seq , Software , Biologia de Sistemas , Integração de Sistemas , Teoria de Sistemas , Transcriptoma
5.
F1000Res ; 10: 193, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34249336

RESUMO

Current approaches to listening are built on standard cognitive science, which considers the brain as the locus of all cognitive activity. This work aims to investigate listening as phenomena occurring within a brain, a body (embodiment), and an environment (situatedness). Drawing on insights from physiology, acoustics, and audiology, this essay presents listening as an interdependent brain-body-environment construct grounded in dynamic systems theory. Coupling, self-organization, and attractors are the central characteristics of dynamic systems. This article reviews the first of these aspects in order to develop a fuller understanding of how embodied auditory perception occurs. It introduces the mind-body problem before reviewing dynamic systems theory and exploring the notion of coupling in human hearing by way of current and original analogies drawn from engineering. It posits that the current use of the Watt governor device as an analogy for coupling is too simplistic to account for the coupling phenomena in the human ear. In light of this review of the physiological characteristics of the peripheral auditory system, coupling in hearing appears more variegated than originally thought and accounts for the diversity of perception among individuals, a cause for individual variance in how the mind emerges, which in turn affects academic performance. Understanding the constraints and affordances of the physical ear with regard to incoming sound supports the embodied listening paradigm.


Assuntos
Metáfora , Teoria de Sistemas , Acústica , Percepção Auditiva , Humanos , Som
6.
J Appl Behav Anal ; 54(4): 1293-1296, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34449097
7.
PLoS Comput Biol ; 17(7): e1009234, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34297714

RESUMO

Metabolic adaptations to complex perturbations, like the response to pharmacological treatments in multifactorial diseases such as cancer, can be described through measurements of part of the fluxes and concentrations at the systemic level and individual transporter and enzyme activities at the molecular level. In the framework of Metabolic Control Analysis (MCA), ensembles of linear constraints can be built integrating these measurements at both systemic and molecular levels, which are expressed as relative differences or changes produced in the metabolic adaptation. Here, combining MCA with Linear Programming, an efficient computational strategy is developed to infer additional non-measured changes at the molecular level that are required to satisfy these constraints. An application of this strategy is illustrated by using a set of fluxes, concentrations, and differentially expressed genes that characterize the response to cyclin-dependent kinases 4 and 6 inhibition in colon cancer cells. Decreases and increases in transporter and enzyme individual activities required to reprogram the measured changes in fluxes and concentrations are compared with down-regulated and up-regulated metabolic genes to unveil those that are key molecular drivers of the metabolic response.


Assuntos
Redes e Vias Metabólicas , Modelos Biológicos , Fenômenos Bioquímicos , Neoplasias do Colo/genética , Neoplasias do Colo/metabolismo , Biologia Computacional , Simulação por Computador , Quinase 4 Dependente de Ciclina/antagonistas & inibidores , Quinase 6 Dependente de Ciclina/antagonistas & inibidores , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Glicólise , Células HCT116 , Humanos , Cinética , Modelos Lineares , Análise do Fluxo Metabólico/estatística & dados numéricos , Metabolômica/estatística & dados numéricos , Estudo de Prova de Conceito , Inibidores de Proteínas Quinases/farmacologia , Teoria de Sistemas
8.
Sensors (Basel) ; 21(13)2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34283152

RESUMO

In order to explore the changes that autonomous vehicles on the road would bring to the current traffic and make full use of the intelligent features of autonomous vehicles, the article defines a self-balancing system of autonomous vehicles. Based on queuing theory and stochastic process, the self-balancing system model with self-balancing characteristics is established to balance the utilization rate of autonomous vehicles under the conditions of ensuring demand and avoiding an uneven distribution of vehicle resources in the road network. The performance indicators of the system are calculated by the MVA (Mean Value Analysis) method. The analysis results show that the self-balancing process could reduce the average waiting time of customers significantly in the system, alleviate the service pressure while ensuring travel demand, fundamentally solve the phenomenon of concentrated idleness after the use of vehicles in the current traffic, maximize the use of the mobile vehicles in the system, and realize the self-balancing of the traffic network while reducing environmental pollution and saving energy.


Assuntos
Poluição Ambiental , Teoria de Sistemas , Processos Estocásticos
9.
Health Res Policy Syst ; 19(1): 95, 2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34147105

RESUMO

Given their inherent complexity, we need a better understanding of what is happening inside the "black box" of population health interventions. The theory-driven intervention/evaluation paradigm is one approach to addressing this question. However, barriers related to semantic or practical issues stand in the way of its complete integration into evaluation designs. In this paper, we attempt to clarify how various theories, models and frameworks can contribute to developing a context-dependent theory, helping us to understand the black box of population health interventions and to acknowledge their complexity. To achieve this goal, we clarify what could be referred to as "theory" in the theory-driven evaluation of the interventional system, distinguishing it from other models, frameworks and classical theories. In order to evaluate the interventional system with a theory-driven paradigm, we put forward the concept of interventional system theory (ISyT), which combines a causal theory and an action model. We suggest that an ISyT could guide evaluation processes, whatever evaluation design is applied, and illustrate this alternative method through different examples of studies. We believe that such a clarification can help to promote the use of theories in complex intervention evaluations, and to identify ways of considering the transferability and scalability of interventions.


Assuntos
Saúde da População , Humanos , Projetos de Pesquisa , Teoria de Sistemas
10.
Elife ; 102021 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-33899737

RESUMO

Renshaw cells (V1R) are excitable as soon as they reach their final location next to the spinal motoneurons and are functionally heterogeneous. Using multiple experimental approaches, in combination with biophysical modeling and dynamical systems theory, we analyzed, for the first time, the mechanisms underlying the electrophysiological properties of V1R during early embryonic development of the mouse spinal cord locomotor networks (E11.5-E16.5). We found that these interneurons are subdivided into several functional clusters from E11.5 and then display an unexpected transitory involution process during which they lose their ability to sustain tonic firing. We demonstrated that the essential factor controlling the diversity of the discharge pattern of embryonic V1R is the ratio of a persistent sodium conductance to a delayed rectifier potassium conductance. Taken together, our results reveal how a simple mechanism, based on the synergy of two voltage-dependent conductances that are ubiquitous in neurons, can produce functional diversity in embryonic V1R and control their early developmental trajectory.


Assuntos
Potenciais de Ação , Canais de Potássio de Retificação Tardia/metabolismo , Potássio/metabolismo , Células de Renshaw/metabolismo , Canais de Sódio/metabolismo , Sódio/metabolismo , Medula Espinal/metabolismo , Animais , Feminino , Glutamato Descarboxilase/genética , Proteínas de Fluorescência Verde/genética , Masculino , Camundongos Transgênicos , Modelos Neurológicos , Morfogênese , Fenótipo , Medula Espinal/embriologia , Teoria de Sistemas , Fatores de Tempo
11.
J Youth Adolesc ; 50(7): 1293-1307, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33856624

RESUMO

Dual systems theories of adolescent risk-taking propose that the socioemotional and self-regulation systems develop at different rates, resulting in a peak in sensation-seeking in adolescence at a time when self-regulation abilities are not yet fully mature. This "developmental imbalance" between bottom-up drives for reward and top-down control is proposed to create a period of vulnerability for high-risk behaviors such as delinquency, substance use, unprotected sex, and reckless driving. In this study, data from the Swiss longitudinal normative z-proso study (n = 1522, n = 784 male; aged 11, 13, 15, 17, and 20) were used to test whether the presence of a developmental imbalance between sensation-seeking and self-regulation is associated with trajectories of engagement in delinquency across early adolescence to adulthood. Using a latent class growth analysis of sensation-seeking, self-regulation, and delinquency, it was found that a model with 3 classes was optimal in the whole sample and male sub-sample, including one class characterized by a developmental imbalance and corresponding adolescent peak in delinquency. In females, there was no evidence for a class that could be described according to the trajectories hypothesized in dual systems theory. This study's results support the claim that a developmental imbalance may drive an adolescent increase in delinquency. However, this applies only to a small subgroup of individuals, particularly males.


Assuntos
Comportamento do Adolescente , Delinquência Juvenil , Adolescente , Adulto , Feminino , Humanos , Comportamento Impulsivo , Estudos Longitudinais , Masculino , Assunção de Riscos , Teoria de Sistemas
12.
Pharm Res ; 38(4): 625-635, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33751326

RESUMO

The connection between pharmacokinetic models and system theory has been established for a long time. In this approach, the drug concentration is seen as the output of a system whose input is the drug administered at different times. In this article we further explore this connection. We show that system theory can be used to easily accommodate any therapeutic regime, no matter its complexity, allowing the identification of the pharmacokinetic parameters by means of a non-linear regression analysis. We illustrate how to exploit the properties of linear systems to identify non-linearities in the pharmacokinetic data. We also explore the use of bootstrapping as a way to compare populations of pharmacokinetic parameters and how to handle the common situation of using multiple hypothesis tests as a way to distinguish two different populations. Finally, we demonstrate how the bootstrap values can be used to estimate the distribution of derived parameters, as can be the allometric scale factors.


Assuntos
Benzamidas/farmacocinética , Análise de Dados , Modelos Biológicos , Propanolaminas/farmacocinética , Administração Intravenosa , Animais , Área Sob a Curva , Benzamidas/administração & dosagem , Simulação por Computador , Cães , Feminino , Masculino , Modelos Animais , Propanolaminas/administração & dosagem , Ratos , Análise de Regressão , Teoria de Sistemas
13.
Biosystems ; 205: 104404, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33785383

RESUMO

The purpose of this article is to establish a link between number theory and morphology and to justify the possibility of using p-adic arithmetic to model biological forms. The work consists of two parts. In the first part we develop some mathematical technique which is based on the theory of locally compact abelian groups and on the concept of p-adic spectrum of series, sequences and infinite products. In the second part, this technique is applied to some classical series and infinite products in order to reveal their new properties and to construct some biomorphic structures, which arise as continuous images of systems of 2-adic balls (or spheres) when they are mapped into the complex plane. The article also introduces the concept of Ω-classes of natural numbers, which are the 2-adic analogue of the residual classes in modular arithmetic. Their connection with the process of discrete 2-adic diffusion is shown. It is shown that Ω-classes produce biomorphic forms with bilateral symmetry and also induce on the set of natural numbers a countable set of multidimensional symmetries. The paper also introduces the concept of the cellular structure of the set of natural numbers and describes a method for constructing from these cells 2-adic organisms based on the metaphor of biological morphogenesis.


Assuntos
Matemática , Modelos Biológicos , Morfogênese , Biologia de Sistemas , Algoritmos , Animais , Fenômenos Fisiológicos Celulares , Humanos , Teoria de Sistemas
14.
Ital J Pediatr ; 47(1): 76, 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33766070

RESUMO

National service systems in child healthcare are characterized by diversity and complexity. Primary, secondary, tertiary and quaternary healthcare services create complex networks covering pediatric subspecialties, psychology, sociology, economics and politics. Can pediatrics exist without philosophy? Does the absence of integrating philosophical perspectives during conceptualization of pediatric care contribute to deficiencies in the service systems structuring child healthcare? Philosophy offers new ways of complex systems thinking in scientific and clinical pediatrics. Philosophy could improve coping strategies on different levels when dealing with ethics of research projects, individual child healthcare and crises of healthcare service systems. Boundary and ultimate situations experienced by severely sick children require help, hope and resilience. Patients and families as well as pediatricians and other caregivers must act in concert. All of them may benefit from consulting with philosophers. The aim of this article is to point out the risks of a strict separation of scientific insight and sensory experience affecting child healthcare in our modern society, which is dominated by technology, competition and lack of equity and time.


Assuntos
Pediatria , Filosofia Médica , Teoria de Sistemas , Criança , Serviços de Saúde da Criança , Saúde Holística , Humanos
15.
Pediatrics ; 147(2)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33495367

RESUMO

Advances in science are fundamentally changing the way we understand how inextricable interactions among genetic predispositions, physical and social environments, and developmental timing influence early childhood development and the foundations of health and how significant early adversity can lead to a lifetime of chronic health impairments. This article and companion article illustrate the extent to which differential outcomes are shaped by ongoing interactive adaptations to context that begin at or even before conception and continue throughout life, with increasing evidence pointing to the importance of the prenatal period and early infancy for the developing brain, the immune system, and metabolic regulation. Although new discoveries in the basic sciences are transforming tertiary medical care and producing breakthrough outcomes in treating disease, this knowledge is not being leveraged effectively to inform new approaches to promoting whole-child development and preventing illness. The opportunity for pediatrics to serve as the leading edge of science-based innovation across the early childhood ecosystem has never been more compelling. In this article, we present a framework for leveraging the frontiers of scientific discovery to inform new strategies in pediatric practice and advocacy to protect all developing biological systems from the disruptive effects of excessive early adversity beyond providing information on child development for parents and enriched learning experiences for young children.


Assuntos
Experiências Adversas da Infância , Desenvolvimento Infantil , Saúde da Criança , Proteção da Criança , Pediatria/métodos , Resiliência Psicológica , Biologia de Sistemas , Experiências Adversas da Infância/prevenção & controle , Experiências Adversas da Infância/psicologia , Criança , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Ecossistema , Meio Ambiente , Relações Familiares , Humanos , Lactente , Recém-Nascido , Apego ao Objeto , Atenção Primária à Saúde/métodos , Determinantes Sociais da Saúde , Meio Social , Transtornos de Estresse Traumático/etiologia , Transtornos de Estresse Traumático/fisiopatologia , Transtornos de Estresse Traumático/psicologia , Transtornos de Estresse Traumático/terapia , Estresse Fisiológico/fisiologia , Estresse Psicológico/etiologia , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologia , Estresse Psicológico/terapia , Teoria de Sistemas
16.
CPT Pharmacometrics Syst Pharmacol ; 10(1): 18-29, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33217169

RESUMO

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic requires the rapid development of efficacious treatments for patients with life-threatening coronavirus disease 2019 (COVID-19). Quantitative systems pharmacology (QSP) models are mathematical representations of pathophysiology for simulating and predicting the effects of existing or putative therapies. The application of model-based approaches, including QSP, have accelerated the development of some novel therapeutics. Nevertheless, the development of disease-scale mechanistic models can be a slow process, often taking years to be validated and considered mature. Furthermore, emerging data may make any QSP model quickly obsolete. We present a prototype QSP model to facilitate further development by the scientific community. The model accounts for the interactions between viral dynamics, the major host immune response mediators and tissue damage and regeneration. The immune response is determined by viral activation of innate and adaptive immune processes that regulate viral clearance and cell damage. The prototype model captures two physiologically relevant outcomes following infection: a "healthy" immune response that appropriately defends against the virus, and an uncontrolled alveolar inflammatory response that is characteristic of acute respiratory distress syndrome. We aim to significantly shorten the typical QSP model development and validation timeline by encouraging community use, testing, and refinement of this prototype model. It is our expectation that the model will be further advanced in an open science approach (i.e., by multiple contributions toward a validated quantitative platform in an open forum), with the ultimate goal of informing and accelerating the development of safe and effective treatment options for patients.


Assuntos
COVID-19/imunologia , Desenvolvimento de Medicamentos/métodos , Imunidade Celular/imunologia , Modelos Biológicos , SARS-CoV-2/imunologia , Teoria de Sistemas , Animais , Antivirais/imunologia , Antivirais/farmacologia , Antivirais/uso terapêutico , Antígenos CD8/antagonistas & inibidores , Antígenos CD8/imunologia , COVID-19/terapia , Citocinas/antagonistas & inibidores , Citocinas/imunologia , Desenvolvimento de Medicamentos/tendências , Humanos , Imunidade Celular/efeitos dos fármacos , SARS-CoV-2/efeitos dos fármacos
17.
Soc Work Public Health ; 36(2): 98-117, 2021 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-33380283

RESUMO

Utilizing the biopsychosocial model and the ecological systems theory, this disquisition explores on the risk factors associated with the COVID-19 pandemic. The discourse shows the interconnectedness of biological, psychological, and social domains in expatiating on the COVID-19 pandemic. It calls for the need to strengthen the resilience of the global community in the face of health outbreaks such as COVID-19. It emphasizes on the perspectives that pandemics are managed before they emerge through building systems that are resilient. Thus, it appreciates the need for a therapeutic milieu as a building block to resilience. The article calls for the adoption of a developmental stance to analyzing health outbreaks and clinical issues. The adumbration shows the reciprocity effects of the health outbreak [macrocosms] and individual factors [microcosms]. To its end, the paper implies that COVID-19 is a call for integration toward effective health planning between social policy formulators, urban and rural planners, epidemiologists, development practitioners, clinicians, researchers to mention but a few. Ultimately, the paper calls for social workers to consider a developmental-clinical social work approach which helps foster "health in all policies" so as to build resilience against the morbus and limit the proliferation of diseases.


Assuntos
COVID-19/psicologia , Modelos Biopsicossociais , Serviço Social , Teoria de Sistemas , Ansiedade , Comorbidade , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Transtornos Nutricionais , Pandemias , Fatores de Risco , SARS-CoV-2 , Fatores Sexuais , Classe Social , Ideação Suicida
18.
Nurs Philos ; 22(2): e12320, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32835447

RESUMO

Intensive care nursing is prone to episodic anxiety linked to patients' immediate needs for treatment. Balancing biomedical interventions with compassionate patient-centred nursing can be particularly anxiety provoking. These patterns of anxiety may impact compassion and patient-centred nursing. The aim of this paper is to discuss the application of Bowen Family Systems Theory to intensive care nursing, mapping a framework to support critical care nurses' well-being and, consequently, the quality of care they provide. This article is founded on research, theoretical papers and texts focused on Bowen Family Systems Theory (BFST), and findings from a constructivist study on patient-centred nursing and compassion in the intensive care unit. The goal of Bowen Family Systems Theory is to empower individuals, decreasing blame and reactivity. Bowen Family Systems Theory can be applied to the sometimes intimate relationships that develop in this environment, aiding understanding of nurses' experience of compassion satisfaction and fatigue. Where organizational factors and management styles fall short in supporting critical care nurses to meet expectations, BFST can offer a perspective on the processes that occur within the intensive care unit, impacting nurse well-being and quality of care. This paper makes plain the importance of understanding the anxiety that occurs within the intensive care unit as a system, so that individuals, such as critical care nurses, can be supported appropriately to ensure nurse well-being and quality care.


Assuntos
Enfermagem de Cuidados Críticos/métodos , Qualidade da Assistência à Saúde/normas , Teoria de Sistemas , Atitude do Pessoal de Saúde , Enfermagem de Cuidados Críticos/normas , Humanos , Satisfação no Emprego , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos
19.
Child Psychiatry Hum Dev ; 52(3): 376-388, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32656659

RESUMO

Background research on children associated with armed forces and armed groups (CAAFAG) and the analysis of how to facilitate their social reintegration and human development reveals a variety of complex individual and collective challenges with which they are confronted; however, their social and cultural environment, and the risks that may impede their future development and well-being, remain understudied. This empirical research reports the results of descriptive and correlational analyses of data emanating from author-administered interviews, and focus group discussions with 128 CAAFAG and two psychologists working with them in rehabilitation centers in the eastern Democratic Republic of Congo. The entire sample involved relatively young participants (N = 130, M = 17.11, SD = 4.28), with the youngest child aged 11. The outcomes sustain that the psychosocial rehabilitation programme framed within Urie Bronfenbrenner's bioecological systems theory shows promising effects in enhancing CAAFAG's well-being, human growth; and in reducing potential violent behavior.


Assuntos
Militares/psicologia , Reabilitação Psiquiátrica/psicologia , Transtornos de Estresse Pós-Traumáticos/reabilitação , Violência/psicologia , Adolescente , Desenvolvimento do Adolescente , Agressão , Criança , Desenvolvimento Infantil , Saúde da Criança , República Democrática do Congo , Humanos , Masculino , Pesquisa Qualitativa , Teoria de Sistemas , Adulto Jovem
20.
Sex Reprod Health Matters ; 28(1): e1854153, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308051

RESUMO

Evidence of the health system challenges to promoting respectful maternity care (RMC) is limited in Ethiopia and globally. This study investigated the health system constraints to RMC in three Southern Ethiopian hospitals. We conducted a qualitative study (7 focus group discussions (FGDs) with providers of RMC and 12 in-depth interviews with focal persons and managers) before and after the implementation of an RMC intervention. We positioned childbirth services within the health system and applied complex adaptive system theory to analyse the opportunities and constraints to the promotion of RMC. Both system "hardware" and "software" factors influencing the promotion of RMC were identified, and their interaction was complex. The "hardware" factors included bed availability, infrastructure and supplies, financing, and health workforce. "Software" factors encompassed service providers' mindset, staff motivation, and awareness of RMC. Interactions between these factors included privacy breaches for women when birth companions were admitted in labour rooms. Delayed reimbursement following the introduction of fee-exemption for maternity services resulted in depleted revenues, supply shortages, and ultimately disrespectful behaviour among providers. Other financial constraints, including the insufficient and delayed release of funds, also led to complex interactions with the motivation of staff and the availability of workforce and supplies, resulting in poor adherence to RMC guidance. Interventions aimed at improving only behavioural components fall short of mitigating the mistreatment of women. System-wide interventions are required to address the complex interactions that constraint RMC.


Assuntos
Atitude do Pessoal de Saúde , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/normas , Qualidade da Assistência à Saúde , Atenção à Saúde/economia , Etiópia , Feminino , Humanos , Masculino , Serviços de Saúde Materna/economia , Motivação , Pesquisa Qualitativa , Respeito , Análise de Sistemas , Teoria de Sistemas
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