Association between freedom of movement and health of nursing home residents with dementia: an exploratory longitudinal study.

BACKGROUND: Locked doors remain a common feature of dementia units in nursing homes (NHs) worldwide, despite the growing body of knowledge on the negative effects of restricted freedom on residents. To date, no previous studies have explored the health effects of opening locked NH units, which would allow residents to move freely within the building and enclosed garden. This study examines the association between increased freedom of movement and the health of NH residents with dementia. METHODS: This longitudinal, pre-post study involved a natural experiment in which NH residents with dementia (N = 46) moved from a closed to a semi-open location. Data on dimensions of positive health were collected at baseline (T0; one month before the relocation), at one (T1), four (T2) and nine (T3) months after the relocation. Linear mixed models were used to examine changes in positive health over time. RESULTS: Cognition, quality of life and agitation scores improved significantly at T1 and T2 compared to the baseline, while mobility scores decreased. At T3, improvements in agitation and quality of life remained significant compared to the baseline. Activities of daily living (ADL) and depression scores were stable over time. CONCLUSIONS: Increasing freedom of movement for NH residents with dementia is associated with improved health outcomes, both immediately and over time. These findings add to the growing evidence supporting the benefits of freedom of movement for the overall health of NH residents with dementia.

How does women's empowerment relate to antenatal care attendance? A cross-sectional analysis among rural women in Bangladesh.

BACKGROUND: In South Asia, roughly half of women attend at least four antenatal care visits with skilled health personnel, the minimum number recommended by the World Health Organization for optimal birth outcomes. A much greater proportion of women attend at least one antenatal care visit, suggesting that a key challenge is ensuring that women initiate antenatal care early in pregnancy and continue to attend after their first visit. One critical barrier to antenatal care attendance may be that women do not have sufficient power in their relationships, households, or communities to attend antenatal care when they want to. The main goals of this paper were to 1) understand the potential effects of intervening on direct measures of women's empowerment-including household decision making, freedom of movement, and control over assets-on antenatal care attendance in a rural population of women in Bangladesh, and 2) examine whether differential associations exist across strata of socioeconomic status. METHODS: We analyzed data on 1609 mothers with children under 24 months old in rural Bangladesh and employed targeted maximum likelihood estimation with ensemble machine learning to estimate population average treatment effects. RESULTS: Greater women's empowerment was associated with an increased number of antenatal care visits. Specifically, among women who attended at least one antenatal care visit, having high empowerment was associated with a greater probability of ≥ 4 antenatal care visits, both in comparison to low empowerment (15.2 pp, 95% CI: 6.0, 24.4) and medium empowerment (9.1 pp, 95% CI: 2.5, 15.7). The subscales of women's empowerment driving the associations were women's decision-making power and control over assets. We found that greater women's empowerment is associated with more antenatal care visits regardless of socioeconomic status. CONCLUSIONS: Empowerment-based interventions, particularly those targeting women's involvement in household decisions and/or facilitating greater control over assets, may be a valuable strategy for increasing antenatal care attendance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04111016, Date First Registered: 01/10/2019.

A timeline of freedom of movement in the European Economic Area.

The European Economic Area (EEA) provides a common market for goods, labour, services, and capital. Promoting integration between countries through the free movement of labour, or more generally persons, pre-dates the previous forms of the EEA. However, during the Southern and Eastern Expansions of the European Union, there have been transition agreements on persons, designed to restrict immigration. Opening up labour markets to the new member states with signifcantly lower GDP per capita than existing states, has been contentious. This is why the use of transition agreements have permitted periods which existing members can limit immigration. Not all existing member states impose restrictions, and during the Eastern Enlargements, the restrictions were imposed for varying lengths of time by different existing members up to a maximum of seven years. During the transition agreement, the economies of new members and existing members can converge, which is ultimately designed to limit the pull factor of migration. In this note, we provide a concise resource of the timeline of the expansion of full free movement of persons for countries in the EEA and Switzerland.

Freedom of Movement and Adolescent Sexual Violence in India.

This study assesses associations between freedom of movement and sexual violence, both in marriage and outside of marriage, among a representative sample of adolescents in India. We analyzed data from girls aged 15 to 19 years (n = 9,593) taken from India's nationally representative National Family Health Survey 2015-2016. We defined freedom of movement using three items on whether girls could go unaccompanied to specified locations; we summated responses and categorized them as restricted, or unrestricted. We used multivariable regression to assess associations between restricted movement and nonmarital violence, and with marital sexual violence among ever-married girls. Results show that only 2% of girls reported nonmarital sexual violence, among married and unmarried girls; 6% of married girls reported marital sexual violence. Most girls (78%) reported some restriction in movement. Restricted movement was negatively associated with nonmarital sexual violence (adjusted odds ratio [AOR] = 0.52, 95% confidence interval [CI] = [0.31, 0.87], p = .01) but positively associated with marital sexual violence (AOR = 3.87, 95% CI = [1.82, 8.25], p < .001). Further analyses highlight that the observed association with nonmarital sexual violence was specific to urban and not rural girls. These findings reveal that approximately one in 30 adolescent girls in India has been a victim of sexual violence. Restricted movement is associated with lower risk for nonmarital sexual violence for urban adolescent girls, possibly due to lower exposure opportunity. Married girls with restricted movement have higher odds of marital sexual violence, possibly because these are both forms of control used by abusive husbands. Freedom of movement is a human right that should not place girls at greater risk for nonmarital violence or be used as a means of control by abusive spouses. Social change is needed to secure girls' safety in India.

Academic-professional mobility and internationalization of nursing: contributions of the bologna process / Movilidad académico-profesional e internacionalización de la enfermería: aportes del proceso de bolonia / Mobilidade acadêmico-profissional e internacionalização da enfermagem: contributos do processo de bolonha

ABSTRACT Objective: to understand the contributions of the Bologna Process to academic-professional mobility of Nursing. Method: a descriptive exploratory qualitative research. Open interviews were conducted with six PhD nurses, nursing professors, with more than 20 years of experience and who experienced the changes that occurred in higher education in post-Bologna nursing. The interviews took place in the Health or Nursing Schools of the north, center and south regions of Portugal, between January and March 2019, until saturation occurred by repetition. Content analysis was performed. Results: three perspectives are presented: 1) Mobility and internationalization as presuppositions to the strengthening of the economic bloc; 2) Mobility and internationalization contribute to the consolidation of a European identity; and 3) Diploma Supplement: fundamental aspect of academic-professional mobility. Conclusion: education proved to be a valid instrument for the construction of a common professional identity, considered indispensable for the strengthening of the block, with regard to the production of knowledge. The guidelines for the harmonization of university systems and the Diploma Supplement promoted scientific and cultural exchange through academic-professional mobility and intensified the dialogue between nations, which reverberate in social practices.

RESUMEN Objetivo: comprender las contribuciones del Proceso de Bolonia a la movilidad académico-profesional de Enfermería. Método: investigación cualitativa exploratoria descriptiva. Se realizaron entrevistas abiertas a seis enfermeros doctores, docentes de enfermería, con más de 20 años de experiencia y que vivieron los cambios que ocurrieron en la educación superior en la enfermería post Bolonia. Las entrevistas se realizaron en las Escuelas de Salud o Enfermería de las regiones norte, centro y sur de Portugal, entre enero y marzo de 2019, hasta que se produjo la saturación por repetición. Se realizó análisis de contenido. Resultados: se presentan tres perspectivas: 1) Movilidad e internacionalización como presupuestos para el fortalecimiento del bloque económico; 2) La movilidad y la internacionalización contribuyen a la consolidación de una identidad europea; y 3) Suplemento al Título: aspecto fundamental de la movilidad académico-profesional. Conclusión: la educación demostró ser un instrumento válido para la construcción de una identidad profesional común, considerada indispensable para el fortalecimiento del bloque, en lo que respecta a la producción de conocimiento. Los lineamientos para la armonización de los sistemas universitarios y el Suplemento al Título promovieron el intercambio científico y cultural a través de la movilidad académico-profesional e intensificaron el diálogo entre las naciones, que repercute en las prácticas sociales.

RESUMO Objetivo: compreender as contribuições do Processo de Bolonha para a mobilidade acadêmico-profissional de Enfermagem. Método: pesquisa descritiva, exploratória e de natureza qualitativa. Realizou-se entrevistas abertas com seis enfermeiros doutores, docentes de Enfermagem, com mais de 20 anos de atuação e que vivenciaram as mudanças ocorridas na formação superior em Enfermagem pós-Bolonha. As entrevistas ocorreram nas Escolas de Saúde ou de Enfermagem das regiões norte, centro e sul de Portugal, entre janeiro e março de 2019, até a saturação por repetição. Realizou-se análise de conteúdo. Resultados: apresentam-se três perspectivas: 1) A mobilidade e a internacionalização como pressupostos ao fortalecimento do bloco econômico; 2) A mobilidade e a internacionalização colaboram para a consolidação de uma identidade europeia; e 3) Suplemento ao Diploma: aspecto fundamental à mobilidade acadêmico-profissional. Conclusão: a educação provou ser um instrumento válido para a construção de uma identidade profissional comum, considerada indispensável para o fortalecimento do bloco, no que tange a produção de conhecimentos. As diretrizes para a harmonização dos sistemas universitários e o Suplemento ao Diploma promoveram o intercâmbio científico-cultural por meio da mobilidade acadêmico-profissional e intensificaram o diálogo entre as nações, que reverberam em práticas sociais.

Harnessing technology to enable all women mobility in labour and birth: feasibility of implementing beltless non-invasive fetal ECG applying the NASSS framework.

BACKGROUND: A new wireless and beltless monitoring device utilising fetal and maternal electrocardiography (ECG) and uterine electromyography, known as 'non-invasive fetal ECG' (NIFECG) was registered for clinical use in Australia in 2018. The safety and reliability of NIFECG has been demonstrated in controlled settings for short periods during labour. As far as we are aware, at the time our study commenced, this was globally the first trial of such a device in an authentic clinical setting for the entire duration of a woman's labour. METHODS: This study aimed to assess the feasibility of using NIFECG fetal monitoring for women undergoing continuous electronic fetal monitoring during labour and birth. Women were eligible to participate in the study if they were at 36 weeks gestation or greater with a singleton pregnancy, planning to give birth vaginally and with obstetric indications as per local protocol (NSW Health Fetal Heart Rate Monitoring Guideline GL2018_025. 2018) for continuous intrapartum fetal monitoring. Written informed consent was received from participating women in antenatal clinic prior to the onset of labour. This single site clinical feasibility study took place between January and July 2020 at the Royal Hospital for Women in Sydney, Australia. Quantitative and qualitative data were collected to inform the analysis of results using the NASSS (Non-adoption, Abandonment, Scale up, Spread and Sustainability) framework, a validated tool for analysing the implementation of new health technologies into clinical settings. RESULTS: Women responded positively about the comfort and freedom of movement afforded by the NIFECG. Midwives reported that when no loss of contact occurred, the device enabled them to focus less on the technology and more on supporting women's physical and emotional needs during labour. Midwives and obstetricians noticed the benefits for women but expressed a need for greater certainty about the reliability of the signal. CONCLUSION: The NIFECG device enables freedom of movement and positioning for labouring women and was well received by women and the majority of clinicians. Whilst measurement of the uterine activity was reliable, there was uncertainty for clinicians in relation to loss of contact of the fetal heart rate. If this can be ameliorated the device shows potential to be used as routinely as cardiotocography (CTG) for fetal monitoring. This is the first time the NASSS framework has been used to synthesise the implementation needs of a health technology in the care of women during labour and birth. Our findings contribute new knowledge about the determinants for implementation of a complex technology in a maternity care setting. TRIAL REGISTRATION: The Universal Trial Number is reU1111-1228-9845 and the Australian and New Zealand Clinical Trial Registration Number is 12619000293167p. Trial registration occurred on the 20 February, 2019. The trial protocol may be viewed at http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377027.

Does the EU COVID Digital Certificate Strike a Reasonable Balance between Mobility Needs and Public Health?

The need to fight a highly aggressive virus such as SARS-CoV-2 has compelled governments to put in place measures, which, in the name of health protection, have constrained many freedoms we all enjoy, including freedom of movement, both nationally and within the European Union. In order to encourage and facilitate the return to free movement, the European Parliament has launched a "COVID-19 digital certificate". A spirited debate centered around the use of this certificate is still ongoing among scholars, many of whom have pointed out the uncertainties relative to COVID-19 immunity, privacy issues and the risk of discriminatory effects. The authors, while highlighting some critical aspects, argue that the COVID digital certificate in its current approved version can effectively help prevent the spread of the infection and promote free movement, while upholding the right to health as much as possible. However, they also stress the need for a thorough information campaign to illustrate the advantages and limitations of this document in order to avoid creating a false sense of security in the public opinion, who may wrongly assume that the emergency has been overcome for good.

African Physician Migration to High-Income Nations: Diverse Motives to Emigrate ("We Are not Florence Nightingale") or Stay in Africa ("There Is No Place Like Home") Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle".

Research in assessing the global and asymmetric flows of health workers in general, and international medical graduates in particular, is fraught with controversy. The complex goal of improving health status of the citizens of home nations while ensuring the right of health workers to migrate generates policy discussions and decisions that often are not adequately informed by evidence. In times of global public health crises like the current coronavirus disease 2019 (COVID-19) global pandemic, the need for equitable distribution and adequate training of health workers globally becomes even more pressing. Brugha et al report suboptimal training and working conditions among Irish and foreign medical doctors practicing in Ireland, while predicting large-scale outward migration. We comment on health personnel migration and retention based on our own experience in this area of research. Drawing from our examination of medical migration dynamics from sub-Saharan Africa, we argue for greater consideration of health workforce retention in research and policy related to resource-limited settings. The right to health suggests the need to retain healthcare providers whose education was typically subsidized by the home nation. The right to migrate may conflict with the right to health. Hence, a deeper understanding is needed as to healthcare worker motives based on interactions of psychosocial processes, economic and material determinants, and quality of work environments.

Terapia ocupacional e o direito à cidade / Occupational therapy and right to the city

Resumo Este ensaio tem como objetivo apresentar reflexões sobre a terapia ocupacional na garantia do "direito à cidade" como um direito humano e social fundamental, diretamente relacionado com as ocupações humanas. Iniciamos este debate com as ocupações coletivas enquanto determinantes na construção do espaço social das cidades. Em seguida, focalizamos as assimetrias do poder e as desigualdades territoriais, frutos da mercantilização da propriedade urbana, que implicam injustiças e privações no envolvimento ocupacional no cotidiano dos sujeitos. Sumarizamos possibilidades teórico-metodológicas, novas e outras já conhecidas, que trazemos à luz das questões urbanas, e que aproximam a terapia ocupacional do campo dos estudos urbanos e das políticas públicas de urbanização. Defendemos que a terapia ocupacional é uma área de significativas contribuições na defesa e garantia do direito à cidade.

Abstract This essay aims to reflect on Occupational Therapy in guaranteeing the "right to the city" as a fundamental human and social right, directly involved in human occupations. We started this debate with collective occupations as determinants in the construction of the social space of cities. Then, we focus on the asymmetries of power and territorial inequalities, fruits of the commercialization of urban property, which imply injustices and deprivations in occupational involvement in the subject's daily lives. We summarize theoretical and methodological possibilities, new and others already, that we bring to the field of urban studies and public urbanization policies. We defend that Occupational Therapy is an area of significant contributions to the defense and guarantee of the right to the city.

O conceito de mobilidade urbana: articulando ações em terapia ocupacional / The concept of urban mobility: articulating actions in occupational therapy

Resumo Mobilidade urbana é um conceito que tem sido empregado em diversas publicações e é utilizado por diferentes áreas do conhecimento. A mobilidade urbana é indispensável para a efetivação do direito à cidade, sendo uma dimensão fundamental para a compreensão do cotidiano dos sujeitos, individuais e coletivos. Este artigo discute a possibilidade de incorporação do conceito de mobilidade urbana na terapia ocupacional. Para tal, apresenta o conceito de mobilidade urbana por diferentes áreas do conhecimento, como o urbanismo, engenharia, geografia e ciências sociais. A partir da construção de seu entendimento ampliado, busca-se refletir sobre como se dá a articulação do conceito com as práticas ou os fundamentos da profissão. Com apoio da literatura da área, categorizou-se quatro possibilidades de articulação entre mobilidade urbana e terapia ocupacional, sendo elas: a mobilidade urbana como: (1) um componente da avaliação da ação do terapeuta ocupacional, (2) um recurso terapêutico-ocupacional, (3) o objetivo da intervenção e (4) no trabalho com políticas públicas de planejamento urbano. Considerando as dimensões relacionadas com a mobilidade urbana, como os fatores sociais, físicos e atitudinais relacionados à sua efetivação, integradas de forma relevante ao cotidiano de vida dos sujeitos, entende-se que este conceito pode ser incorporado por terapeutas ocupacionais em suas práticas profissionais e em seus estudos para a efetivação de uma ação crítica, em busca da participação social dos sujeitos com os quais o profissional trabalha.

Abstract Urban mobility is a concept that has been employed in various publications and is used by different areas of knowledge. Urban mobility is indispensable for the consolidation of the right to the city, being a fundamental dimension for the everyday lives understanding of the individuals and groups. This article discusses the possibility of incorporating the concept of everyday urban mobility in occupational therapy. For this purpose, it is presented the concept of urban mobility by different areas of knowledge, such as urban planning, engineering, geography, and social sciences. Based on the construction of an expanded understanding of this concept, we sought to reflect on how the articulation between the concept of urban mobility and practices or fundamentals of the profession has been doing. With support in the literature of the area, four possibilities of articulation between urban mobility and occupational therapy were categorized: urban mobility as (1) a component of the occupational therapy evaluation, (2) an occupational therapeutic resource/tool, (3) the objective of the intervention and (4) the action in urban planning public policies. Considering the dimensions related to urban mobility, such as the social, physical, and attitudinal factors related to its effectiveness, integrated in a relevant way to the everyday life of the people; it is understood that this concept can be incorporated by occupational therapists in their professional practices and their studies for the realization of a critical action that aims the social participation of the individuals with whom the professional work with.

Contact tracing apps and values dilemmas: A privacy paradox in a neo-liberal world.

Contact tracing apps are presented as a solution, if not the solution, to curb pandemics in the Covid-19 crisis. In France, despite heated public institutional debate on privacy related issues, the app was presented by government as an essential benefit for protecting health and lives, thus avoiding both politicians and citizens to feel morally responsible and looking guilty, and as essential to recover our freedom to move. However we argue that, while detection of cases have still not been reported after 10 days and one million app downloads - a situation comparable to Australia who launched its app a month before -, the adoption of the app generates important risks to our informational privacy, surveillance and habituation to security policies. It also may create discrimination, distrust and generate other health problems such as addiction and others as 5G technology continues to be deployed without prior impact studies. Finally the smartphone app against covid epidemics appears as an extreme case of the privacy paradox where the government plays on the immediate benefits and downplays long-term concerns while inducing a technology of self. Contact tracing apps may become an emblematic case for digital transformation and value changes in the western world.

[Freedom in retirement home, facing confinement]. / Les libertés en EHPAD, à l'épreuve du confinement.

The COVID-19 pandemic has limited the freedom of any citizen, further increased constraint for people in EHPAD - the most widespread type of French Residential care for senior citizens with a high level of dependency, often very aged, suffering multiple pathologies and sometimes psycho-behavioral disorders. "Golden" containment rule was 24/7 confinement in their room, with the very restrictive framework - up to NO visiting by relatives - and very often with a total absence of consent as for screening sample decisions. We can then question the fundamentals of such restriction of freedom, which is a constitutional right for everybody, including for residents in EHPAD, especially non-compliance with self-determination and consent. The principal objective has been a collective interest, before the individual right and the benefit for the patient itself. Nothing would have been justifying to create a possible risk to other residents, generated by another resident's behavior or one of his relatives. But these safety measures were taken despite the underlying risk of deteriorating individual situations through social and emotional isolation, and thus to further reduce autonomy capacities. "Luckily" the know-how and creative spirit of EHPAD professionals limited the consequences of this restriction of freedom. Hard lessons should be learned from share experiences if such a context were to occur again. But above all arises the question of the place of these dependent people in our society. It is essential to think collectively about these living spaces including protocols that should reflect people's choice and on-location adapted to be more open to the outside/foreigners visits. Spaces shall be adapted to their vulnerability, designed to reduce isolation, to repeat such extreme restrictive measures in the event if it shall occur. Of course, rigorous confinement rules allowed to limit deaths linked to the COVID infection, but at the risk of dying in loneliness and grief.

O cotidiano revelado por imagens da cidade / Everyday life revealed through images of the city / El cotidiano revelado por imágenes de la ciudad

Durante uma pesquisa de doutorado, a produção de dados foi realizada em conjunto com os jovens participantes, que narraram sua mobilidade urbana pela cidade do Rio de Janeiro, Brasil. Um desses jovens apresentou, durante o processo, suas fotografias e o desejo de exibi-las, representando os lugares pelos quais circulava na cidade. Elaboramos conjuntamente uma exposição virtual de suas fotografias, nomeada "Cotidiano". A exposição está disponível on-line e pode ser acessada em diferentes redes sociais. Apresentamos aqui o processo de criação da exposição e as histórias de algumas das imagens que a compõem. A partir deste relato, tendo como foco o processo de pesquisa, buscamos refletir sobre a produção colaborativa de dados e a utilização de atividades significativas para os sujeitos participantes do processo. Acreditamos na implicação do pesquisador no processo de pesquisa e na composição conjunta com seus colaboradores.(AU)

During a Doctoral research, data were produced jointly with young participants who narrated their urban mobility across the city of Rio de Janeiro, Brasil. One of these youths presented the photographs he took during the process, which represented the places he visited round the city, and the desire to exhibit them. Together, we created a virtual exhibition of his photographs that was called "Everyday Life". The exhibition is available online and can be accessed in different social media. We present, here, the creation process of the exhibition and the stories of some of the images that compose it. Based on this report and focusing on the research process, we aim to reflect on collaborative data production and on the utilization of significant activities for the subjects who participate in the process. We believe in the researcher's involvement in the research process and in a joint composition with his or her collaborators.(AU)

Durante una investigación de doctorado, la producción de datos se realizó en conjunto con los jóvenes participantes que narraron su movilidad urbana por la ciudad de Río de Janeiro, Brasil. Uno de esos jóvenes presentó, durante el proceso, sus fotografías y el deseo de exhibirlas, representando los lugares por los cuales circulaba en la ciudad. Elaboramos en conjunto una exposición virtual de sus fotografías, denominada "Cotidiano". La exposición está disponible online y el acceso puede realizarse por medio de diferentes redes sociales. Presentamos aquí el proceso de creación de la exposición y las historias de algunas de las imágenes que la componen. A partir de este relato, utilizando como enfoque el proceso de investigación, buscamos reflexionar sobre la producción colaborativa de datos y la utilización de actividades significativas para los sujetos participantes del proceso. Creemos en la implicación del investigador en el proceso de investigación y en la composición conjunta con sus colaboradores.(AU)

How Enclosure and Spatial Organization Affect Residents' Use and Experience of a Dementia Special Care Unit: A Case Study.

AIM:: We aim to gain insight into how a dementia special care unit is used and experienced by its residents and what design aspects are important therein. BACKGROUND:: In Flanders, housing for people with dementia evolves toward small-scale, homelike environments. As population aging challenges the affordability of this evolution, architects and other designers are asked to design dementia special care units that offer the advantages of small scaleness within the context of large-scale residential care facilities. How these units are used and experienced is not systematically evaluated. METHOD:: A case study was conducted in a recently built residential care facility where a dementia special care unit was foreseen on the ground floor, yet after a few months was moved to the top floor. The case study combined architectural analysis, participant observation, and qualitative interviews with residents and care staff. RESULTS:: Comparing the original situation on the ground floor with the new situation on the top floor highlights how enclosure (physical and visual access to outside and the rest of the facility) and spatial organization affect how residents use and experience a dementia special care unit. CONCLUSIONS:: Depending on the type and stage of dementia, residents may have different needs for space to move, sensory stimuli, and social contact. In order to meet these different needs, confining residents to a dementia special care unit to the top floor should be avoided unless it is carefully designed, providing sufficient freedom of movement and connection with the outside world.

Mobilidade urbana ativa de adultos com perda auditiva e a percepção sobre o ambiente: um estudo multicêntrico / Movilidad urbana activa de adultos con pérdida auditiva y percepción sobre el ambiente: un estudio multicéntrico / Active urban mobility in adults with hearing loss and their perception of the environment: a multicenter study

Resumo: O objetivo deste estudo foi estimar a associação entre perda auditiva e mobilidade urbana ativa (a pé e/ou de bicicleta), segundo a percepção sobre o ambiente em adultos de três capitais brasileiras. Trata-se de um estudo transversal com 2.350 adultos (18-59 anos) residentes das cidades de Brasília (Distrito Federal), Florianópolis (Santa Catarina) e Porto Alegre (Rio Grande do Sul), avaliados pelo estudo multicêntrico Mobilidade Urbana Saudável (MUS), em 2017 e 2018. A variável de desfecho foi a mobilidade urbana ativa (≥ 10 minutos/semana), e a exposição principal foi a perda auditiva autorreferida. As análises foram estratificadas pela variável percepção do ambiente - percepção dos lugares para caminhar e andar de bicicleta (negativa; positiva). Utilizou-se a análise de regressão logística, estimando-se as odds ratio (OR) brutas e ajustadas, com intervalos de 95% de confiança (IC95%). A prevalência de perda auditiva autorreferida e de mobilidade urbana ativa foi de 17% (IC95%: 15,4; 18,4) e 55,4% (IC95%: 53,4; 57,4), respectivamente. Adultos com perda auditiva e que percebiam o ambiente de forma negativa para caminhar e andar de bicicleta possuíam 34% menos chance de realizar mobilidade urbana ativa ≥ 10 minutos/semana (OR = 0,66; IC95%: 0,45; 0,97). Conclui-se que houve associação entre perda auditiva e mobilidade urbana ativa dos adultos das três capitais brasileiras, segundo a percepção negativa sobre o ambiente. Pessoas com perda auditiva que percebem negativamente o bairro tendem a se deslocar menos por meios de transportes ativos.

Resumen: El objetivo de este estudio fue estimar la asociación entre la pérdida auditiva y la movilidad urbana activa (a pie y/o en bicicleta), según la percepción sobre el ambiente en adultos de tres capitales brasileñas. Se trata de un estudio transversal con 2.350 adultos (18-59 años), residentes en las ciudades de Brasília (Distrito Federal), Florianópolis (Santa Catarina) y Porto Alegre (Rio Grande do Sul), evaluados por el estudio multicéntrico Movilidad Urbana Saludable (MUS), en 2017 y 2018. La variable de resultado fue la movilidad urbana activa (≥ 10 minutos/semana) y la exposición principal fue la pérdida auditiva autoinformada. Los análisis fueron estratificados por la variable percepción del ambiente -percepción de los lugares para caminar y montar en bicicleta (negativa; positiva). Se utilizó el análisis de regresión logística, estimando las odds ratio (OR) brutas y ajustadas, con intervalos de 95% de confianza (IC95%). La prevalencia de pérdida auditiva autoinformada y de movilidad urbana activa fue de un 17% (IC95%: 15,4; 18,4) y 55,4% (IC95%: 53,4; 57,4), respectivamente. Adultos con pérdida auditiva y que percibían el ambiente de forma negativa para caminar y montar en bicicleta poseían un 34% menos de oportunidad de realizar movilidad urbana activa ≥ 10 minutos/semana (OR = 0,66; IC95%: 0,45; 0,97). Se concluye que hubo asociación entre la pérdida auditiva y la movilidad urbana activa de los adultos de las tres capitales brasileñas, según la percepción negativa sobre el ambiente. Las personas con pérdida auditiva que perciben negativamente el barrio tienden a desplazarse menos a través de medios de transportes activos.

Abstract: This study aimed to estimate the association between hearing loss and active urban mobility (walking and/or bicycling), according to perception of the environment in adults in three Brazilian capital cities. This was a cross-sectional study of 2,350 adults (18-59 years) residing in Brasília (Federal District), Florianópolis (Santa Catarina), and Porto Alegre (Rio Grande do Sul), assessed by the multicenter study Healthy Urban Mobility (MUS) in 2017 and 2018. The outcome variable was active urban mobility (≥ 10 minutes/week), and the principal exposure was self-reported hearing loss. The analyses were stratified by the variable "perception of the environment" - perception of places for walking and bicycling (negative; positive). Logistic regression was used to estimate crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI). Prevalence rates for self-reported hearing loss and active urban mobility were 17% (95%CI: 15.4; 18.4) and 55.4% (95%CI: 53.4; 57.4), respectively. Adults with hearing loss and that perceived the environment negatively for walking and bicycling showed 34% lower odds of active urban mobility ≥ 10 minutes/week (OR = 0.66; 95%CI: 0.45; 0.97). In conclusion, there was an association between hearing loss and active urban mobility in adults in the three capital cities, according to negative perception of the environment. Persons with hearing loss that perceived the neighborhood negatively tend to circulate less by active means.

Creating Undocumented EU Migrants through Welfare: A Conceptualization of Undeserving and Precarious Citizenship.

Following the financial and economic crisis, welfare policies across the EU are increasingly becoming instruments for limiting the mobility of certain EU migrants. In this article, we focus on EU citizens who see their freedom of movement in the EU being restricted after they have applied for social assistance or unemployment benefits in their country of residence. Doing so, we conceptualize undocumented EU migration by means of the concepts of 'non-deportability', 'deservingness' and 'precariousness'. Overall, this article - based on ethnographic fieldwork conducted with Italian migrants in Belgium - expands our understanding of undocumented migration by demonstrating how arbitrary and intimidating bureaucratic processes undermine the exercise of EU citizenship.

["For us, as 'patients/users', the essential point remains the respect of the person"]. / « Pour nous "usagers patients", le point essentiel reste le respect de la personne ¼.

The first organisation to bring together the users of care in the history of the speciality, the French National Federation of Patient Associations in Psychiatry has always campaigned for the respect of users' freedom of movement. Despite the progress made in terms of legislation, the federation presents a mixed picture. For Claude Filkenstein, its president, there remains a long way to go, notably in the field of the culture of psychiatric care. In her opinion, training should be a major advantage.

Oral surgery in the European Union: challenges of diversity in training and practice.

INTRODUCTION: At the crossroads of medicine and dentistry, oral surgery with orthodontics are the only recognised dental specialties by the European Union. The goal of our study is to evaluate the current state of oral surgery in Europe from its teaching to its practice, the hypothesis being that a notable diversity persists despite European Union harmonisation process. MATERIALS AND METHODS: To understand the impact of this diversity applied to European Union freedom of movement and its ethical implications for the practice of oral surgery, English and French questionnaires were sent by email to universities and organisations delivering authorisation to practise in France, Germany, Spain, Sweden and United Kingdom chosen based upon inclusion and exclusion criteria. An analysis of documents on these organisations' official websites was also conducted. Demographic information was obtained from the aforementioned organisations. RESULTS: The profile of practising oral surgeons is different dependent on the country. The university and hospital trainings conform to European recommendations and span 3-4 years. European Board certification is not required. Continuing education is mandatory only in France, Germany and United Kingdom. As for curricula and scope of practice, no consensus can be derived. DISCUSSION: There is potential conflict of interest between European Union principles of freedom of movement and protection of all citizens, as member countries do not uniformly apply Directives and recommendations. A new survey of all European Union oral surgery programmes as well as organisations delivering authorisation to practise is necessary to implement across the board harmonisation of training and practice to insure patient safety in light of the migration of European Union practitioners.

Haemodynamic assessment of human coronary arteries is affected by degree of freedom of artery movement.

Abnormal haemodynamic parameters are associated with atheroma plaque progression and instability in coronary arteries. Flow recirculation, shear stress and pressure gradient are understood to be important pathogenic mediators in coronary disease. The effect of freedom of coronary artery movement on these parameters is still unknown. Fluid-structure interaction (FSI) simulations were carried out in 25 coronary artery models derived from authentic human coronaries in order to investigate the effect of degree of freedom of movement of the coronary arteries on flow recirculation, wall shear stress (WSS) and wall pressure gradient (WPG). Each FSI model had distinctive supports placed upon it. The quantitative and qualitative differences in flow recirculation, maximum wall shear stress (MWSS), areas of low wall shear stress (ALWSS) and maximum wall pressure gradient (MWPG) for each model were determined. The results showed that greater freedom of movement was associated with lower MWSS, smaller ALWSS, smaller flow recirculation zones and lower MWPG. With increasing percentage diameter stenosis (%DS), the effect of degree of freedom on flow recirculation and WSS diminished. Freedom of movement is an important variable to be considered for computational modelling of human coronary arteries, especially in the setting of mild to moderate stenosis. ABBREVIATIONS: 3D: Three-dimensional; 3DR: Three-dimensional Reconstruction; 3D-QCA: Three-dimensional quantitative coronary angiography; ALWSS: Areas of low wall shear stress; CAD: Coronary artery disease; CFD: Computational fluid dynamics; %DS: Diameter stenosis percentage; EPCS: End point of counter-rotating streamlines; FSI: Fluid-structure interaction; IVUS: Intravascular ultrasound; LAD: Left anterior descending; MWSS: Maximum wall shear stress; SST: Shear stress transport; TAWSS: Time-averaged wall shear stress; WSS: wall shear stress; WPG: Wall pressure gradient; MWPG: Maximum wall pressure gradient; FFR: Fractional flow reserve; iFR: Instantaneous wave-free ratio.

Association of Domestic Violence From Husband and Women Empowerment in Slum Community, Mumbai.

Prevalence of violence by husband against wife is an indicator of women's status at household level. The objective of the study is to understand the relationship between domestic violence and women's empowerment in a slum community in Mumbai, India. Data were collected from a sample of 1,136 married women aged 18 to 39 years having at least one child and reporting of unmet need for family planning. Domestic violence by husband against wife was measured in terms of either physical, sexual, or emotional violence. Three logit regression analyses were carried out using decision-making power, freedom of movement, and justified wife beating as dependent variables separately and socio-demographic and economic variables as independent variables. Furthermore, the relationship between domestic violence and women's decision-making power, freedom of movement, and justified wife-beating index has been explored. About 21% of women had ever experienced violence, and 38% of women had decision-making power with respect to own health care, household purchase, or visiting family and relatives. A little more than one fifth of the women reported freedom of movement to market, health facilities, or places outside the community. Women who justified wife beating were 2.29 (95% CI [1.59, 3.29]) times at risk of experiencing violence than women who disagreed with the wife-beating statements. Women not empowered in decision making were 1.15 (95% CI [0.91, 1.46]) times at risk of experiencing domestic violence than women who were empowered in decision making. Women who are empowered are less likely to be at risk of domestic violence. Programs aimed at empowering women must address socio-cultural norms relating to justification of violence in marriage.