Heterogeneidades das políticas estaduais de distanciamento social diante da COVID-19: aspectos políticos e técnico-administrativos / Heterogeneidades de las políticas estatales de distanciamiento social frente a la COVID-19: aspectos políticos y técnico-administrativos / Asymmetries of state government social distancing policies in the face of COVID-19: political and technical-administrative aspects

Resumo Este artigo tem o objetivo de analisar a liderança dos governos estaduais brasileiros na implementação de políticas de distanciamento social para o enfrentamento da disseminação da COVID-19. Pressupõe-se que as políticas de distanciamento social são heterogêneas, apesar da liderança dos governos, ou seja, apresentam certo grau de assimetria nas restrições do funcionamento do comércio e de atividades com potencial de aglomeração de pessoas. Diante disso, foram combinados os debates sobre processo de produção de políticas públicas e sobre autonomia e federalismo, para investigar a influência dos fatores políticos ou técnico-administrativos nas políticas estaduais. Os seguintes procedimentos metodológicos foram utilizados: análise de conteúdo de 134 normativas estaduais; mapeamento do alinhamento político-partidário dos governadores estaduais ao presidente da República; análise dos recursos médico-hospitalares de cada unidade da federação baseada no Cadastro Nacional de Estabelecimentos de Saúde (CNES). O contexto emergencial revelou baixa coordenação interfederativa pelo governo federal, provocando uma competição entre entes federativos e forte liderança estadual na gestão da crise no âmbito local. A pesquisa mostra, por um lado, que as decisões sobre as políticas de distanciamento social não podem ser explicadas por fatores políticos; e por outro, a correspondência entre a capacidade do sistema de saúde local e o nível de rigor das políticas de distanciamento social. Conclui-se que, na atual situação de transtorno social intenso, preferiu-se a racionalidade técnica a barganhas políticas.

Resumen Este artículo tiene como objetivo analizar el liderazgo de los gobiernos de los estados brasileños en la implementación de políticas de distanciamiento social para enfrentar la propagación de la COVID-19. Se parte del supuesto de que, a pesar de la existencia de este liderazgo, las políticas de aislamiento social son heterogéneas, con cierto grado de asimetría en las restricciones al funcionamiento del comercio y de actividades con potencial de aglomeración de personas. Se combinaron debates sobre el proceso de producción de políticas públicas, autonomía y federalismo para investigar si los factores políticos o técnico-administrativos influyen en la naturaleza de estas políticas a nivel estatal. Se utilizaron los siguientes procedimientos metodológicos: análisis de contenido de 134 regulaciones de estados; mapeo del alineamiento político-partidario de los gobernadores estatales con el presidente de la República; y análisis de los recursos médicos y hospitalarios de cada unidad de la federación con base en el Registro Nacional de Establecimientos de Salud. El contexto de emergencia reveló una baja coordinación interfederativa del gobierno federal, lo que provocó la competencia entre entidades federales y el fuerte liderazgo estatal en la gestión de la crisis en ámbito local. Por un lado, el artículo presenta evidencia de que las decisiones sobre políticas de distanciamiento social no pueden explicarse por factores políticos; y, por otro, existe una correspondencia entre la capacidad del sistema de salud local y el nivel de rigor de las políticas de distanciamiento social. Se concluye que, en la actual situación de intenso desorden social, se prefirió la racionalidad técnica a las negociaciones políticas.

Abstract This article aims to analyze the leadership of Brazilian state governments on lockdown and social distancing policies to keep COVID-19 from spreading. It is assumed that the states' policies on this matter are heterogeneous, and their implementation regarding how commercial activities - and others that potentially involve a large concentration of people - is asymmetric. Therefore, the study observed the debates on policy-making processes and on autonomy and federalism to investigate the influence of political or technical-administrative factors on policies adopted at the state level in Brazil. The methodology used content analysis of 134 state norms, mapping the political-party alignment of state governors to the president, analysis of medical and hospital resources of each federation unit based on the National Register of Health Establishments. The emergency context revealed low inter-federative coordination by the federal government, competition among states, and states leadership in crisis management at the local level. The article presents evidence that state governments' leadership cannot be justified by political party alignment with the president. However, there is a correspondence between both the local health system capacity and the rigor of lockdown and social distancing policies, which indicates that, in an intense social disorder situation, technical rationality was preferable to political bargaining.

Formulação da lei do sistema único de assistência social e a legitimação da política de assistência social / The formulation of social assistance law and the legitimation of the social assistance public policy

Resumo O trabalho analisa o processo decisório que envolveu a formulação, pelo Ministério do Desenvolvimento Social e Combate à Fome, do Projeto de Lei 3077/2008 e sua posterior aprovação como Lei 12.435/2011, que institucionalizou na ordem jurídica brasileira o Sistema Único de Assistência Social. A metodologia se baseou em pesquisa bibliográfica, análise das atas do Conselho Nacional de Assistência Social de 2008 a 2011 e documentos públicos do Ministério e entrevistas com atores-chave que atuaram no Ministério entre 2008 e 2011. A análise demonstrou que a Lei tinha como principais objetivos legitimar as práticas já em curso na Assistência Social e estabelecer segurança jurídica para os gestores federais. A decisão de elaborar a Lei aponta para a importância dos "policy makers" no processo de inclusão de temas na agenda pública.

Abstract This paper analyzes the decision-making process involving the formulation of Bill 3077/20081 by the Ministry of Social Development and Fight against Hunger, and its subsequent approval as Law 12.435/2011, which institutionalized the Unified Social Assistance System (SUAS). The methodology was based on bibliographic research, analysis of the minutes of the National Social Assistance Council from 2008 to 2011, and public documents from the Ministry and interviews with key stakeholders who worked at the Ministry between 2008 and 2011. The results showed that the Law aimed mainly to legitimize management practices already underway in Social Assistance and to establish legal certainty for federal managers. The decision to propose the Law highlights the relevance of "policymakers" in including issues on the public agenda.

Radiation Safety in Emergency Medicine: Balancing the Benefits and Risks

The use of computed tomography (CT) in emergency departments has increased over several decades, as physicians increasingly depend on imaging for diagnoses. Patients and medical personnel are put at risk due to frequent exposure to and higher levels of radiation, with very little evidence of improvements in outcomes. Here, we explore why CT imaging has a tendency to be overused in emergency departments and the obstacles that medical personnel face in ensuring patient safety. The solution requires cooperation from all emergency care stakeholders as well as the continuous education of doctors on how CT scans help in particular cases.

Processo decisório em sistemas de saúde: uma revisão da literatura / Decision making process in health systems: a literature review

Resumo Sistemas de saúde podem ser compreendidos como sistemas sociais que apresentam uma combinação de recursos, organização, financiamento e gerência que visam oferecer serviços de saúde para uma população. Para Tanios et al., a tomada de decisão em sistemas de saúde envolve a definição de critérios e valores, além do uso de evidências e do julgamento de alternativas na formulação de políticas públicas em saúde. O objeto deste artigo é a realização de uma revisão bibliográfica sobre o processo decisório em sistemas de saúde, como forma de auxiliar e orientar futuras pesquisas sobre o tema. Para isso, foi realizada a busca bibliográfica nas bases ISI Web of Knowledge e Scopus, sem restrição quanto ao período de publicação. A partir disso, foi feita a redação sintóptica dos conteúdos extraídos das publicações levantadas nessa busca. Os resultados dessa revisão foram agrupados em quatro temas: definições e contexto do processo decisório em sistemas de saúde; critérios e desafios do processo; modelos de tomada de decisão; e informações e sistemas de informação de suporte ao processo decisório.

Abstract Health systems are social systems that combine different types of resources, organization structures, funding models and management mechanisms to provide health services to a defined population. Tanios et al. say that the decision-making process in a health system deals with the definition of criteria and values, use of evidences and evaluation of health policies. In this context, this research aims to conduct a literature review about the decision-making process in health systems, to assist and guide future studies. In this regard, a bibliographic search was made in two different databases: ISI Web of Knowledge and SCOPUS. Publications found in this search were summarized through a superficial reading and the results were grouped into four themes: definitions and context in the decision-making process in health systems; criteria and challenges in this process; decision-making models; and information and information systems to support decision makers.

How does the patient react after reading the informed consent form of a gynecological surgery? A qualitative study / Como o paciente reage depois de ler o termo de consentimento livre e esclarecido de uma cirurgia ginecológica? Um estudo qualitativo

Abstract Objective To analyze the reaction of women after reading the Informed Consent Form (ICF) before undergoing elective gynecological/urogynecological surgeries. Methods A qualitative study with 53 women was conducted between September 2014 and May 2015. The analysis of the content was conducted after a scripted interview was made in a reserved room and transcribed verbatim.We read the ICF once more in front of the patient, and then she was interviewed according to a script of questions about emotions and reactions that occurred about the procedure and her expectations about the intra- and postoperative period. Results The women had a mean age of 52 years, they were multiparous, and most had only a few years of schooling (54.7%). The majority (60.4%) of them had undergone urogynecological surgeries. Hysterectomy and colpoperineoplasty were themost frequent procedures. Ten women had not undergone any previous abdominal surgery. Fear (34.6%) was the feeling that emerged most frequently from the interviews after reading the ICF, followed by indifference (30.8%) and resignation (13.5%). Nine women considered their reaction unexpected after reading the ICF. Three patients did not consider the information contained in the ICF to be sufficient, and 3 had questions about the surgery after reading the document. Conclusion Reading the ICF generates fear in most women; however, they believe this feeling did not interfere in their decision-making process.

Resumo Objetivo Analisar a reação das mulheres após lerem o Termo de Consentimento Livre e Esclarecido (TCLE) antes de se submeterem a cirurgias ginecológicas/uroginecológicas eletivas. Métodos Um estudo qualitativo com 53 mulheres foi realizado entre setembro de 2014 e maio de 2015. A análise do conteúdo foi feita depois de uma entrevista que seguia um roteiro, que foi realizada em uma sala reservada e transcrita de forma fidedigna. Nós lemos de novo oTCLE na frente da paciente, e depois ela era entrevistada de acordo comumroteiro de questões sobre emoções e reações que ocorreram sobre o procedimento e suas expectativas sobre o período intra e pós-operatório. Resultados As mulheres tinham uma média de 52 anos, eram multíparas, e com poucos anos de educação (54,7%). A maioria (60,4%) já havia realizado cirurgias uroginecológicas. A histerectomia e a colpoperineoplastia foram as cirurgias mais frequentes. Dez mulheres não tinham sido submetidas a nenhum procedimento. O medo (34,6%) foi o sentimento que mais emergiu das entrevistas depois da leitura do TCLE, seguido da indiferença (30,8%) e da resignação (13,5%). Nove mulheres consideraram suas reações inesperadas depois da leitura do TCLE. Três pacientes não consideraram a informação do TCLE suficiente, e outras 3 tiveram dúvidas sobre a cirurgia depois de lerem o documento. Conclusão A leitura do TCLE desperta o medo namaioria dasmulheres; contudo, elas acreditam que este sentimento não interferiu na tomada de decisão relativa ao tratamento.

Potencial de vazão ambiental: método participativo para estimar vazão ambiental em rios na Amazônia / Potential of environmental flow: participatory method for determining environmental flow in hydropower's reservoirs in Amazon rivers

RESUMO O potencial de vazão ambiental (PVA) é um método alternativo de estimativa de vazão por considerar principalmente as características ecológicas, econômicas e culturais das bacias hidrográficas, reduzindo erros de estimativa na avaliação de impactos ambientais para implantação ou operação de usinas hidrelétricas (UHEs). O objetivo desta pesquisa foi adaptar a metodologia do PVA para grandes bacias da Amazônia usando abordagem holística. A metodologia de estimativa do PVA foi adaptada às bacias hidrográficas dos rios Tocantins, no Pará, Jari, no Amapá e Pará, e Araguari, no Amapá, em fase de operação e/ou instalação de UHEs. Os resultados sugerem que, nos rios Tocantins e Araguari, ambos sob influência de barramentos em operação, o parâmetro mais relevante do PVA foi o estresse hídrico. Diante dos impactos diretos dessas UHEs, a vazão é elevada e suficiente para manter o ecossistema ou a diversidade aquática durante o ano. Contudo, a resposta do método na bacia hidrográfica do rio Jari indicou o parâmetro dependência econômica como o mais crítico, já que o rio é intensamente utilizado para a locomoção pelos moradores do Pará e Amapá e, dessa forma, o cálculo da vazão por método não adequado comprometeria essa tão importante função do rio. Concluiu-se que o método PVA é uma ferramenta alternativa interessante à gestão de grandes bacias por ser flexível, adaptável e principalmente por permitir a participação dos agentes envolvidos nos processos decisórios.

ABSTRACT The potential of environmental flow (PVA) is an alternative method to estimate the flow as it mainly considers the ecological, economic and cultural characteristics of the basins, reducing estimation errors in the assessment of environmental impacts for deployment or operation of hydroelectric power plants (HPPs). The aim of this research was to adapt the PVA methodology for Amazon's large basins using holistic approach. The methodology for estimating the PVA was adapted to the watersheds of the rivers Tocantins, in Pará, Jari, in Amapá and Pará, and Araguari, in Amapá, under operation and/or final installation of HPPs. The results suggest that, in the Tocantins and Araguari rivers, both under the influence of dams in operation, the most relevant parameter of PVA was water stress. Taking into account the direct impact of these HPPs, the flow rate is high enough to keep the ecosystem or aquatic diversity during the whole year. However, the response of the PVA in the Jari river basin, in the ultimate construction phase, the most relevant parameter was the economic dependence, because the priority is the fluvial transport, and, in this way, estimating the flow by a non-adequate method would jeopardize this very important function. We concluded that the PVA method is an interesting tool for managing large basins, because it is flexible, adaptable and especially allowing the participation of the agents involved in the decision making processes.

Introduction Process of the Tobacco Graphic Health Warning Law in Korea: Analysis on the National Assembly Minutes / 보건행정학회지

Graphic health warning on the tobacco product package is a cost-effective tobacco control policy to convey information on harmful effect of tobacco use to health, and it is known not only to motivate smokers to quit but also to deter adolescents from start smoking. In case of Korea, amendments to National Health Promotion Act requiring implementation of graphic health warning had been submitted 13 times, from 2002 to May 2015. In May 2015, the amendment had been approved by the National Assembly and it enters into force on December 23, 2016. This research analyzed the discussions from Health and Welfare Committee of the National Assembly during the implementation of the graphic health warning in order to study decision making process of legislators. Study found that there was a shift from a general opposition on implementing graphic health warning at first to a harsh conflict over relaxation of the regulation once discussing the implementation in earnest. Particularly, while the group supporting the implementation of the graphic health warning or opposing relaxation advocated the amendment with scientific and knowledge-based evidences including the World Health Organization Framework Convention on Tobacco Control, the group opposing the adoption of the amendment itself or suggesting relaxation tended to defend their position with empathy on smokers or tobacco industries.

A influência das características pessoais do empreendedor nas escolhas estratégicas e no processo de tomada de decisão / The influence of personal characteristics of the entrepreneur on the strategic choices and the decision making process

Os pesquisadores há muito têm procurado compreender os conceitos de escolha e decisão estratégicas. Uma maneira de examinar essa questão é o recurso à abordagem das características pessoais do empreendedor. De acordo com a teoria dos modelos mentais, não há similaridade na maneira como diferentes empreendedores percebem o ambiente de negócios e no modo como fazem escolhas e tomam decisões. O elo que se estabelece entre os modelos mentais e as escolhas e decisões estratégicas pode ser um dos fatores predominantes a induzir diferentes empreendedores a ter percepções variadas diante de um mesmo ambiente de negócios. Este ensaio tem por objetivo discutir essa ligação por meio da abordagem teórica dos modelos mentais e sob a ótica dos temperamentos. Como resultado da análise, concluiu-se que o modelo mental do empreendedor - operacional ou estratégico - pode explicar suas escolhas e decisões estratégicas. Conhecer seu modelo mental pode ajudar o empreendedor a evitar, ou reduzir, obliquidades geradas na análise estratégica do ambiente de negócios e a favorecer a superveniência de escolhas e decisões estratégicas mais efetivas.

Researchers have long attempted to understand the concepts of strategic choices and decisions. One way to analyze this issue is to approach it through the personal characteristics of the entrepreneur. According to the theories of mental models, there are differences in the way entrepreneurs perceive the business environment and make choices and decisions. The connection between mental models and strategic choices and decisions may be one of the main factors leading different entrepreneurs to different perceptions when facing the same business environment. This study aims to discuss this connection through a theoretical approach to the mental models, from the perspective of the temperaments model. The authors conclude that the mental model of the entrepreneur - operational or strategic - may explain their strategic choices and decisions. An understanding of the entrepreneur's mental model can reduce or prevent biases in the strategic analysis of the business environment and promote a more effective process of strategic choices and decisions.

Assessment of village water and sanitation committee in a district of Tamil Nadu, India.

A descriptive study was conducted among 75 members of five Village Water and Sanitation Committees (VWSCs) and 15 local residents in Tamil Nadu, India to assess committee's formation and decision making process. There were 64% females and rest were males, all aged between 20 years and 45 years. A total of 50.7% of them passed 12 th standard and 29.3% belonged to self-help groups. Although, all of them were aware about presence of guidelines, none of them knew its contents. About 20% opined that meetings were not being conducted regularly. All members said that they had problems in attending meeting regularly, take decisions if at least 10 (67%) members are present and fund was not adequate for 1 year period. One-third of local residents did not know the committee formation process and none of them aware about guidelines. Formation and decision making process of VWSC should be improved to tackle the sanitation problem.

O processo de tomada de decisão na prática clínica: a medicina como estado da arte / The decision making process in clinical practice: medicine as a state of the art practice

JUSTIFICATIVA E OBJETIVOS: Tomar uma decisão constitui um processo pelo qual se escolhe uma ou algumas ações dentre várias possíveis. A escolha é baseada em um conjunto de informações que levam ao intelecto a processar probabilidades de desfecho optando pela mais aprazível ou de maior chance de sucesso. A propedêutica médica está reforçada no século XXI pelos instrumentos de apoio às decisões informatizadas que visam reduzir a incerteza diagnóstica e terapêutica. Apesar dos esforços, ainda não foi totalmente decifrado a forma como o médico exerce suas decisões. CONTEÚDO: Serão discutidos os aspectos da prática da medicina com abordagem sobre como as decisões são tomadas no ambiente médico. A discussão será baseada no conceito das heurísticas, sistemas epidemiológicos, sistemas informatizados de apoio às decisões, Medicina Baseada em Evidências, Medicina Baseada em Experiência e Medicina Baseada em Preferências. CONCLUSÃO: O processo de tomada de decisão na pratica clínica e o pensamento médico vem sendo pouco discutidos e valorizados. A visualização da tomada de decisão como meramente intuitiva desvaloriza um processo tão nobre e apaixonante. É de extrema importância para a classe médica adquirir uma autoconsciência de sua prática a fim de detectar os erros que a leva ser alvo de processos pelos pacientes e para que haja redução das incertezas.

BACKGROUND AND OBJECTIVES: Making a decision is a process by which one chooses one or a few of several possible actions. The choice is based on a set of information that leads the individual to process outcome probabilities, opting for the more pleasant or that with greater chance of success. In the twenty-first century, medical propedeutics, consisting of medical history, physical examination and laboratory tests, is supported by computed decision instruments aimed at reducing uncertainty about the diagnosis and treatment. Despite of our best efforts, we cannot fully decipher how a doctor takes his decisions. CONTENTS: We will discuss aspects of the practice of medicine approaching how decisions are made in the medical environment. The discussion will be based on the concept of heuristics, epidemiological systems, and computed-supported decision making, Evidence-Based Medicine, Experience-Based Medicine and Preference-Based Medicine. CONCLUSION: Decision making process in clinical practice, and medical thinking, have been little discussed and valued. The view of decision making as merely intuitive devalues such a noble and passionate process. It is extremely important for physicians to have self-awareness of their practice in order to detect errors that lead the patients to sue them, and to reduce the degree of uncertainty.

Competências relevantes para a efetividade do processo decisório em defesa aérea / Relevant competences for an effective decision-making process in air defense

Este artigo investiga o impacto das competências consideradas essenciais para o desempenho das atividades de defesa aérea sobre a efetividade do processo decisório. Como principais referenciais teóricos, foram utilizados os estudos de Simon (1970; 1987) sobre o processo decisório e o modelo de competências por setor de Gramigna (2002). Na pesquisa de campo, utilizou-se a triangulação de dados: entrevistas, análise documental, observações e questionário, por meio do qual levantou-se a percepção dos profissionais que desempenham as funções em estudo. Os dados foram analisados através de análise fatorial exploratória e análise de regressão linear múltipla. Os resultados da pesquisa realizada para este artigo contribuem para o estabelecimento de programas voltados ao desenvolvimento de competências individuais específicas, com impacto direto nas competências essenciais da organização. Os achados deste artigo servem também aos gestores militares como subsídio para decisões relativas à alocação de pessoal e formação de equipes, visando distribuir de forma mais racional os indivíduos, aliando suas competências aos interesses organizacionais, tal seja, alinhando as práticas de gestão de pessoas à estratégia organizacional.

This article discusses the impact of the air defense core competences on the effectiveness of the decision-making process. Its theoretical framework includes Simon's studies on the decision-making process (1970; 1987), Gramigna's model of competences by industry (2002), and an empirical study based on interviews, document analysis, observations, and a questionnaire distributed to 21 officers from the Integrated Air Defense and Traffic Control Center (Cindacta). The data collected was analyzed through factorial analysis and multiple linear regression. The findings contribute to the organization of training programs that focus on the development of specific individual skills that influence the organization's core competences. They can also be used by military staff to support decisions on personnel allocation and team building, in order to link human resources practices to organizational strategy.

Construção democrática e modelos de Constituição / Democracy-building and constitutional models / Construction démocratique et modèles de constitution

This article makes a theoretical contribution to the comparative analysis of constitutional choices in new democracies, particularly those related to the profile of constitutions, reform and amendment political processes, and legal review and legal interpretation. The constitution itself is viewed as an object of research and analysis. Special attention is dedicated to the case of policy-oriented constitutions and their impact on the submission of government and public policy agendas. The constitutionalization of public policies is viewed as an additional veto point in the political system. Since different constitutional patterns engender distinct decision-making processes, the study examines how the related costs affect government efficiency and jeopardize democratic representation.

Dans cet article, on propose un apport théorique à l'analyse comparative de choix constitutionnels pour les nouvelles démocraties, surtout ceux qui concernent les constitutions, les processus politiques de réforme et d'amendement ainsi que les processus de révision et d'interprétation juridiques. La constitution y est considérée comme un objet en soi d'investigation et d'analyse. On examine surtout le cas de constitutions de politiques dirigées et leur impact sur la préparation de programmes gouvernementaux et sur les politiques publiques. La constitutionnalisation de politiques publiques est envisagée comme un nouveau point d'opposition du système politique. Sachant que différents modèles constitutionnels engendrent des processus de décision divers, on examine ici comment leurs coûts affectent l'efficacité gouvernementale et gênent la représentation démocratique.

Continuidades e descontinuidades da Federação Brasileira: de como 1988 facilitou 1995 / Continuités et discontinuités de la Fédération Brésilienne: comment 1988 a rendu 1995 plus facile / Continuities and discontinuities in the Brazilian Federation: how 1988 made 1995 possible

The article shows that the drafters of the 1988 Brazilian Constitution approved political institutions that combine broad jurisdictional authority to the Federal government along with limited institutional veto powers to subnational governments. The study has examined 59 initiatives of legislation addressing federal matters voted by the Chamber of Deputies from 1989 to 2006. The article explores how political institutions affect the decision-making process of federal issues, by distinguishing main actors´ preferences from federal institutions, controlled by presidential terms.

Dans cet article, on cherche à montrer que les responsables de la Constitution brésilienne de 1988 ont créé un modèle d'État federal qui associe une large autorité juridictionnelle à l'État central avec des possibilités institutionnelles assez limitées de veto aux gouvernements subnationaux. L'etude tien pour base l'examen des 59 initiatives en matière d'intérêt federal soumises au Congrès national de 1989 à 2006. On y examine les déterminants fédératifs du processus décisionnel, tout en faisant la distinction entre les préférences explicites des principaux acteurs et l'effet des institutions fédératives, contrôlées par mandat présidentiaux.

Privatização e processo decisório / Privatisation et processus de décision / Privatization and the decision-making process

This article examines the political determinants of privatization of the fixed telephony sector in four countries, based on a neo-institutionalist approach. These countries faced similar pressures by telephone companies in favor of privatization, suggesting an apparent convergence in the sector's reorganization. However, although all four adopted some degree of privatization, the process followed different paths and designs in each country. This variation can be explained by the different institutional contexts in which the reforms were carried out. Where there was concentration of power in the Executive, privatization was launched "earlier" and approved more quickly than in countries in which such concentration waslessintense. Meanwhile, the existence of multiple veto points and stakeholders with veto power did not impede the reform, but increased the cost of its unilateral adoption by the Executive, forcing the latter to negotiate and form a minimum consensus within the governing coalition.

Dans cet article, on examine les déterminants politiques de la privatisation dans le secteur de la téléphonie fixe dans quatre pays à partir d'une approche néo-institutionnelle. Ces pays ont subi des pressions assez semblables en faveur de la privatisation des entreprises de téléphonie qui convergeaient apparemment vers la réorganisation du secteur. Malgré leur adhésion à la privatisation, chaque pays a suivi des voies et des modèles divers. Cette variation peut s'expliquer à partir des différences de contexte institutionnel où les réformes ont eu lieu. La concentration du pouvoir exécutif a contribué à un début "précoce" de la privatisation approuvée dans un délai plus court que celui des pays où cette concentration était plus faible. La présence de plusieurs points de veto et de partenaires ayant pouvoir de veto, n'a pas empêché la réforme mais a accru le coût de son adoption unilatérale par le pouvoir exécutif, imposant la négociation et la formation d'un consensus mínimum au sein de l'alliance gouvernementale.

Korean Families' Eating-out Behavior in Relation to Family Life Cycle / 대한지역사회영양학회지

This study was conducted to compare families eating-out behavior in relation to family life cycle in order to provide basic information on nutritional education about eating-out. The data were collected by the survey method from 440 families who lived in apartment complexes in Kyong-ju and Seoul. The structured questionnaire included items about the frequency of eating out, the choice of eating-out menus, the decision maker of the eating-out process, the attitudes toward eating out and the general characteristics of the families. The major results are as follow: 1) In the cafe of telephone delivery service, and eat-in restaurants, the subjects showed statistical significance (p<0.01). With respect to telephone delivery service, families in Step II used it most frequently, but families in Step I rarely used it. With respect to eat-in restaurants, families in Step II used them most frequently but families in Step IV rarely used them. 2) In all the family life cycle steps, the most favorable menu was fried chicken for take-out type, Chajang noodles, fried chicken and pizza fur telephone delivery, pizza for internet delivery, raw fish and beef for eat-in restaurant, Docbokki, laver rolled rice and ramyun for convenience flood stores. 3) The wife was most influential in making decisions about the take-out type (p<0.001). In the case of telephone deliveries (p<0.001), the wife was the most influential in the families of Steps I and II, but the children were the most influential in the families of Steps III and IV. In the case of eat-in restaurants (p<0.001), the husband had the most effect on the decision-making process. In the case of convenience flood stores (p<0.001), the children were the most influential in the families in Steps III and IV. In most family life cycle steps, each of them chose their own meal. 4) from a factor analysis perspective, attitudes toward eating out have been grouped according to two factors, namely 'Advantage' and 'Nutrition'. No factor showed a significant difference among the family life cycle steps.

Decision making process about the diagnostic workup for patients with abdominal pain / 中国实用内科杂志

Abdominal pain is an alarming signal indicating that either tissue or organ in the abdominal cavity is in trouble.The etiology of abdominal pain is often obscure.The underlying diseases are multidisciplinary,and the disease process varies with time.Often,an acute abdominal pain (including acute abdomen) requires urgent diagnosis and treatment.Chronic abdominal pain involves many difficult cases.Having fifty years of clinical experiences,the author concludes that a scientific decision making process is essential in the diagnosis of all types of abdominal pain.It involves the following:(1)Data collection through history taking,physical examamination,and laboratory diagnosis.(2)Analysis and synthesis of data are important to gain insight into the disease process for the establishment of a logical diagnosis.(3)Close observation is required for acute abdominal pain of unknown origin.Even after a diagnosis is made,the patient should still be followed up to check if the diagnosis and treatment are correct.

Experience on Decision Making to Donate a Living-Related Kidney / 성인간호학회지

The purpose of this study was to understand how living-related kidney donors experience to donate a kidney using the Grounded Theory method. Total of 11 kidney donors were participated in the study. Semi-structured individual interviews were utilized to gather data. All interviews were audiotaped and transcribed verbatim. Constant comparative analysis was employed using the NUDIST4.0 software program. As a result of analysis "process of decision making" was identified as a core category and the process consists of three stages; the initial, the intermediary, and the last stages. Ten subcategories emerged as important in this process; 1) preceding factors, 2) direct factors, 3) indirect factors, 4) donor characteristics I, 5) wish to give (a kidney), 6) motives and momentums to donate, 7) interfering factors, 8) facilitating factors, 9) donor characteristics II and the 10) final decision to donate. During the initial stage, the donors recognize their wish to give a kidney to the recipient, and the first five subcategories were related to this stage. The intermediary stage is an action stage which involves taking the tests of tissue compatibility with the recipient. The next four categories were related to the intermediary stage. The last stage starts when the donors finally decide to donate a kidney and ends with the operation. The results of this study highlight difficulties and problems, as well as motives and other facilitating factors that people experience to donate a living-related kidney. The results of this study might help nurses and other health care workers make effective interventions to facilitate the decision making process for living-related kidney donors. They might also help in establishing appropriate standards and criteria for the psychosocial aspects of living-related kidney donations.

Decision-making process and satisfaction of pregnant women for delivery method / 예방의학회지

This study was conducted to assess the attitude of pregnant women toward delivery method, understanding of the reason for determining her own delivery method, participation in decision-making process and satisfaction with delivery method after labor. Study subjects were 693 pregnant women who had visited obstetric clinic for prenatal care in the last month of pregnancy in one general hospital and one obstetrics-gynecology specialty hospital in Taegu city from February 1 to March 31 in 1998. A questionnaire was administered before and after labor and a telephone interview was done one month after labor. Proportion of women who had health education and/or counselling about delivery method during prenatal care was 24.0% and this proportion was higher for women who had previous c-section(35.5%) than others. Women thought vaginal delivery is better than c-section for both maternal and baby's health regardless of previous delivery method. About 90% of primipara and multiparous women who had previous vaginal delivery wanted vaginal delivery for the index birth, while 85.6% of multiparous women who had previous c-section wanted repeat c-section. Reasons for choosing c-section in pregnant women who preferred vaginal delivery before labor were recommendation of doctors(81.9%), recommendation of husband(0.8%), agreement between doctor and pregnant woman(4.7%), and mother's demand(12.6%). Reasons for choosing vaginal delivery were mother's demand(30.6%) and no indication for c-section(67.2%). Reasons for choosing c-section in pregnant women who preferred c-section before labor were recommendation of doctors(76.2%), mother's demand(20.0%), recommendation of husband(1.3%), and agreement between doctor and pregnant woman(2.5%). Of the pregnant women who had c-section, by doctor's recommendation, the proportion of women who had heard detailed explanation about reason for c-section by doctor was 55.1%. Mother's statement about the reason for c-section was consistent with the medical record in 75.9%. However, over 5% points disparities were shown between mother's statement and medical record in cases of the repeat c-section and mother's demand. In primipara and multiparous women who had previous vaginal delivery, the delivery method for index birth had statistically significant association with the preference of delivery method before labor(p<0.05). All of the women who had previous c-section had delivered the index baby by c-section. Among mothers who had delivered the index baby vaginally, 84.9% of them were satisfied with their delivery method immediately after labor and 85.1% at 1 month after labor. However, mothers who had c-section stated that they are satisfied with c-section in 44.6% immediately after labor and 42.0% at 1 month after labor. Preferred delivery method for the next birth had statistically significant association with delivery method for the index birth both immediately after labor and in 1 month after labor. The proportion of mothers who prefer vaginal delivery for the next birth increased with the degree of satisfaction with the vaginal delivery for the index birth but the proportion of mothers who prefer c-section for the next birth was high and they did not change significantly with the degree of satisfaction with the c-section for the index birth. These results suggest that the current high technology-based, physician-centered prenatal and partritional cares need to be reoriented to the basic preventive and promotive technology-based, and mother-fetus-centered care. It is also suggested that active involvement of pregnant woman in decision-making process for the delivery method will increase the rate of vaginal birth after c-section and decrease c-section rate and improve the degree of maternal satisfaction after delivery.