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Full-Text Articles in Medicine and Health Sciences

Community Mobility And Dementia: A Review Of The Literature, Nina M. Silverstein, Megan Vanderbur Nov 2006

Community Mobility And Dementia: A Review Of The Literature, Nina M. Silverstein, Megan Vanderbur

Gerontology Institute Publications

By the year 2030, 70 million Americans will be 65 or older. Approximately 80 percent of this population will likely be driving themselves. And without appropriate and timely interventions, many are likely to be driving with Alzheimer’s disease (AD). Current estimates suggest that 2 percent of the population 65 to 74, 19 percent of the population 75 to 84, and 47 percent of the population 85 and older are likely to suffer from Alzheimer’s disease or a related disorder. By the year 2050, the number of Americans with Alzheimer’s disease could range from 11.3 million to 16 million. This significant …


Demographic Change And Response: Social Context And The Practice Of Birth Control In Six Countries, Sangeeta Parashar, Harriet B. Presser, Megan L. Klein Hattori, Sara Raley, Zhihong Sa Sep 2006

Demographic Change And Response: Social Context And The Practice Of Birth Control In Six Countries, Sangeeta Parashar, Harriet B. Presser, Megan L. Klein Hattori, Sara Raley, Zhihong Sa

Department of Sociology Faculty Scholarship and Creative Works

This paper expands on Kingsley Davis’s demographic thesis of change and re- sponse. Specifically, we consider the social context that accounts for the primacy of particular birth control methods that bring about fertility change during specific time periods. We examine the relevance of state policy (including national family planning programs), the international population establishment, the medical profession, organized religion, and women’s groups using case studies from Japan, Russia, Puerto Rico, China, India, and Cameroon. Some of these countries are undergoing the second demographic transition, others the first. Despite variations in context, heavy reliance on sterilization and/or abortion as a means …


Pregnant Teenager Involvement In Sexual Activity And The Social Context, Maria José Carvalho Sant'anna, Júlia Kerr Catunda, Kepler Alencar Mendes Carvalho, Verônica Coates, Hatim A. Omar Aug 2006

Pregnant Teenager Involvement In Sexual Activity And The Social Context, Maria José Carvalho Sant'anna, Júlia Kerr Catunda, Kepler Alencar Mendes Carvalho, Verônica Coates, Hatim A. Omar

Pediatrics Faculty Publications

Pregnancy during adolescence represents a challenge to society as a whole. Its incidence is increasing and brings about social and medical consequences to both the teen mothers and their children. The purpose of this study was to evaluate pregnant teenager involvement in sexual activity and the social context. The group studied comprised 152 pregnant teenagers attending the Department of Pediatrics, Santa Casa de Sao Paulo (SCSP) General Hospital. All information was analyzed. The age at first intercourse was 14.2 years and the average period between first intercourse and pregnancy was 1.4 years. Most pregnancies (75%) were neither planned nor wanted, …


Voluntary And Involuntary Nursing Home Staff Turnover, Christopher Donoghue, Nicholas G. Castle Jul 2006

Voluntary And Involuntary Nursing Home Staff Turnover, Christopher Donoghue, Nicholas G. Castle

Department of Sociology Faculty Scholarship and Creative Works

The goal of this study was to identify nursing home characteristics that have differential associations to voluntary and involuntary turnover among formal caregivers (i.e., registered nurses, licensed practical nurses, and nurse aides). Primary data from 354 facilities from four states were merged with data from the 2004 Online Survey, Certification and Recording system. Multinomial logistic regression analyses were conducted to determine whether organizational characteristics were related to a greater probability of high or low levels of voluntary and involuntary turnover among formal caregivers. The analysis revealed that a higher ratio of nurses to beds, a smaller number of quality-of-care deficiencies, …


Depression, Sensation Seeking, And Maternal Smoking As Predictors Of Adolescent Cigarette Smoking, Judy Van De Venne, Kay Bradford, Catherine A. Martin, Megan Cox, Hatim A. Omar Jun 2006

Depression, Sensation Seeking, And Maternal Smoking As Predictors Of Adolescent Cigarette Smoking, Judy Van De Venne, Kay Bradford, Catherine A. Martin, Megan Cox, Hatim A. Omar

Family Sciences Faculty Publications

The purpose of this study was to examine maternal and adolescent depression, maternal and teen sensation seeking, and maternal smoking, and their associations with adolescent smoking. Data were collected from a sample of 47 male and 66 female adolescents (ages 11-18 years) and their mothers from three different health clinics. The findings indicated that maternal sensation seeking was linked indirectly with adolescent smoking through teen sensation seeking, both of which were significantly associated with teen smoking (β = 0.29, p < 0.001 and β = 0.32, p < 0.001, respectively). Teen depression was associated positively with teen smoking (β = 0.24, p < 0.01) when controlling for sensation seeking behaviors. Maternal smoking was also directly linked to adolescent smoking (β = 0.20, p < 0.05). These findings underscore a potentially important role of sensation seeking in the origins of adolescent smoking, and clarify pathways of influence with regard to maternal attitudes and behaviors in subsequent teenage nicotine use.


Understanding Barriers To Community Participation In Hiv And Aids Services: Summary Report, Population Council, Health Systems Trust Jan 2006

Understanding Barriers To Community Participation In Hiv And Aids Services: Summary Report, Population Council, Health Systems Trust

HIV and AIDS

In 2003, South Africa announced its intention to roll out possibly the largest HIV and AIDS treatment program in the world. Much attention is currently focused on supply-side issues, particularly drug procurement and pricing. Far less attention has been paid to demand for and delivery of treatment, care, and support services. Further, although the role of the community and community organizations is articulated in government policy there has been little active engagement with NGOs on the development of these roles or on how to encourage community organizations to support and participate in the antiretroviral (ARV) rollout. This study collected data …


Technical Assistance To Organizations In Guinea Seeking To Reduce Female Genital Cutting, Nafissatou J. Diop Jan 2006

Technical Assistance To Organizations In Guinea Seeking To Reduce Female Genital Cutting, Nafissatou J. Diop

Reproductive Health

This reports details the technical assistance the Population Council’s FRONTIERS program provided to WHO’s Africa Bureau to implement a project addressing medicalization of female genital cutting (FGC), and to support Tostan in replicating its program in Guinea. Technical assistance had several aims: to improve the effectiveness of strategies to abandon FGC in Guinea, to assist WHO in developing and implementing a project to reduce FGC medicalization by health providers, to build the capacity of Guinean organizations to appropriately monitor and evaluate their FGC-related activities, and to enable the Comité de Lutte contre les Pratiques Traditionnelles portant Atteinte aux Femmes (CPTAFE) …


Fewer And Better-Educated Children: Expanded Choices In Schooling And Fertility In Rural Pakistan, Zeba Sathar, Cynthia B. Lloyd, Minhaj Ul Haque, Mumraiz Khan, Monica J. Grant Jan 2006

Fewer And Better-Educated Children: Expanded Choices In Schooling And Fertility In Rural Pakistan, Zeba Sathar, Cynthia B. Lloyd, Minhaj Ul Haque, Mumraiz Khan, Monica J. Grant

Poverty, Gender, and Youth

This report presents the results of a longitudinal study of changing educational opportunities in rural Punjab and N.W.F.P. from 1997 to 2004. The purpose of the study was to answer two major research questions: what were the effects of changes in schooling opportunities in the community over the past six years on enrollment and attainment, and what were the effects on family planning and fertility behavior? This study builds on an earlier study undertaken in 1997. As noted in this report, the study is innovative in several ways: (1) it is longitudinal; (2) it combines consideration of three dimensions of …


Baseline Household Survey: Dera Ghazi Khan District, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Baseline Household Survey: Dera Ghazi Khan District, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development (USAID). PAIMAN is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health issues. USAID has provided a grant to implement PAIMAN in ten districts of Pakistan’s four provinces. The goal of the project is to reduce maternal, newborn, and child mortality. The project calls for a multipronged and integrated strategic approach combining individual health care with public health and community-based interventions. To ensure that success is properly …


Baseline Survey: Summary Report Of District Jhelum, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Baseline Survey: Summary Report Of District Jhelum, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

This summary report presents some of the key findings of a 2005 baseline household survey in Jhelum district, one of the ten districts in Pakistan that are the focus of the PAIMAN project. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development. The project is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health (MNH) issues. PAIMAN district survey results are presented individually for each of the ten districts. PAIMAN developed a monitoring and evaluation plan …


Sexual Harassment In The Workplace: Experiences Of Women In The Health Sector, Paramita Chaudhuri Jan 2006

Sexual Harassment In The Workplace: Experiences Of Women In The Health Sector, Paramita Chaudhuri

Reproductive Health

The objective of this report is to explore sexual harassment of women in the health sector in Kolkata, West Bengal, India. Specifically, it explores women’s perceptions of the occurrence of sexual harassment in hospital settings, and probes women’s own experiences of sexual harassment and incidents of sexual harassment in the hospital environment about which women are aware. The study also investigates the nature of action taken to seek redress, and the extent to which working women are aware of the complaint mechanism outlined by the Supreme Court. Findings confirm the persistence of sexual harassment in the workplace, the reluctance of …


Understanding The Hiv/Sti Prevention Needs Of Men Who Have Sex With Men In Kenya, Washington Onyango-Ouma, Harriet Birungi, Scott Geibel Jan 2006

Understanding The Hiv/Sti Prevention Needs Of Men Who Have Sex With Men In Kenya, Washington Onyango-Ouma, Harriet Birungi, Scott Geibel

HIV and AIDS

Understanding the sexual behaviors of populations who are vulnerable to HIV is an important component in the battle against AIDS. Yet policymakers in developing countries, particularly in Africa, have often overlooked men who have sex with men (MSM) as a vulnerable group because of stigmatization of homosexual behavior and denial of the existence of MSM and the role they may play in HIV transmission. A growing body of literature not only documents the presence of this population in Africa but also the importance of reaching them with information and services to prevent HIV and other sexually transmitted infections (STIs). In …


Expanding Pediatric Access To Antiretroviral Therapy In South Africa, Desiree Michaels, Brian Eley, Lewis Ndhlovu, Naomi Rutenberg, Hena Khan Jan 2006

Expanding Pediatric Access To Antiretroviral Therapy In South Africa, Desiree Michaels, Brian Eley, Lewis Ndhlovu, Naomi Rutenberg, Hena Khan

HIV and AIDS

In sub-Saharan Africa, AIDS has become one of the leading causes of death among children under the age of five years. Yet, despite increased availability of antiretroviral therapy (ART), children have been largely ignored or excluded from treatment initiatives. While efforts to get more children on treatment are increasing, important information is lacking to guide program and policy implementation. To address these gaps, the Horizons Program and the University of Cape Town conducted a rapid situational analysis in 2005 of pediatric HIV treatment sites in South Africa. In 2003, the South African government approved a plan for a national HIV …


Understanding Barriers To Community Participation In Hiv And Aids Services: Final Report, Ashnie Padarath, Catherine Searle, Eka Esu-Williams Jan 2006

Understanding Barriers To Community Participation In Hiv And Aids Services: Final Report, Ashnie Padarath, Catherine Searle, Eka Esu-Williams

HIV and AIDS

In 2003, South Africa announced its intention to roll out possibly the largest HIV and AIDS treatment program in the world. Much attention is currently focused on supply-side issues, particularly drug procurement and pricing. Far less attention has been paid to demand for and delivery of treatment, care, and support services. Further, although the role of the community and community organizations is articulated in government policy there has been little active engagement with NGOs on the development of these roles or how to encourage community organizations to support and participate in the antiretroviral (ARV) rollout. As noted in this final …


Context And Dynamics Of Same-Sex Behavior Among Long-Distance Truckers In India: Findings From Qualitative Research, Vaishali Sharma Mahendra, Ravi K. Verma, Pertti J. Pelto, Sarat Chandra Pradhan, Vibha Singh, Asha Rao, Tarun Vij Jan 2006

Context And Dynamics Of Same-Sex Behavior Among Long-Distance Truckers In India: Findings From Qualitative Research, Vaishali Sharma Mahendra, Ravi K. Verma, Pertti J. Pelto, Sarat Chandra Pradhan, Vibha Singh, Asha Rao, Tarun Vij

HIV and AIDS

It is well established that truckers (drivers and helpers) have higher rates of nonmarital sex than any other occupational group. Because of this multipartner sexual activity, truckers form a key group of prevention efforts for HIV and sexually transmitted infections (STIs). Thus far, HIV/STI prevention interventions for truckers have been geared to providing risk-reduction information and services within a heterosexual context. Recent evidence suggests that a significant number of truckers engage in male-to-male (MSM) sexual activity that has implications for HIV/STI transmission. Therefore, information on the nature and extent of MSM activity among these populations is urgently needed for the …


Reducing Stigma And Discrimination In Hospitals: Positive Findings From India, Vaishali Sharma Mahendra, Laelia Gilborn, Bitra George, Luke Samson, Rupa Mudoi, Sarita Jadav, Indrani Gupta, Shalini Bharat, Celine Daly Jan 2006

Reducing Stigma And Discrimination In Hospitals: Positive Findings From India, Vaishali Sharma Mahendra, Laelia Gilborn, Bitra George, Luke Samson, Rupa Mudoi, Sarita Jadav, Indrani Gupta, Shalini Bharat, Celine Daly

HIV and AIDS

People living with HIV (PLHIV) in India face stigma and discrimination in a variety of contexts. Stigma and discrimination against HIV-positive people is common in hospitals and acts as a barrier to seeking and receiving critical treatment and care services. Three New Delhi hospitals, SHARAN, and the Horizons Program collaborated on an operations research project to assess responses to hospital-based stigma and discrimination against PLHIV. A baseline survey to measure HIV/AIDS-related attitudes, knowledge, and practices was conducted in 2000 with a random sample of 884 health workers from four departments: medicine, STD and skin, obstetrics and gynecology, and surgery. Based …


Baseline Survey: Summary Report Of District Buner, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Baseline Survey: Summary Report Of District Buner, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

This summary report presents some of the key findings of a 2005 baseline household survey in Buner district, one of the ten districts in Pakistan that are the focus of the PAIMAN project. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development. The project is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health (MNH) issues. PAIMAN district survey results are presented individually for each of the ten districts. PAIMAN developed a monitoring and evaluation plan …


Baseline Household Survey: Dadu District, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Baseline Household Survey: Dadu District, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development (USAID). PAIMAN is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health issues. USAID has provided a grant to implement PAIMAN in ten districts of Pakistan’s four provinces. The goal of the project is to reduce maternal, newborn, and child mortality. The project calls for a multipronged and integrated strategic approach combining individual health care with public health and community-based interventions. To ensure that success is properly …


Baseline Household Survey: Jaffarabad District, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Baseline Household Survey: Jaffarabad District, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development (USAID). PAIMAN is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health issues. USAID has provided a grant to implement PAIMAN in ten districts of Pakistan’s four provinces. The goal of the project is to reduce maternal, newborn, and child mortality. The project calls for a multipronged and integrated strategic approach combining individual health care with public health and community-based interventions. To ensure that success is properly …


Baseline Survey: Summary Report Of District Dg Khan, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Baseline Survey: Summary Report Of District Dg Khan, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

This summary report presents some of the key findings of a 2005 baseline household survey in Dera Ghazi Khan (DG Khan) district, one of the ten districts in Pakistan that are the focus of the PAIMAN project. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development. The project is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health (MNH) issues. PAIMAN district survey results are presented individually for each of the ten districts. PAIMAN developed a …


Baseline Household Survey: Rawalpindi District, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Baseline Household Survey: Rawalpindi District, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development (USAID). PAIMAN is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health issues. USAID has provided a grant to implement PAIMAN in ten districts of Pakistan’s four provinces. The goal of the project is to reduce maternal, newborn, and child mortality. The project calls for a multipronged and integrated strategic approach combining individual health care with public health and community-based interventions. To ensure that success is properly …


Systematic Screening: A Strategy For Determining And Meeting Clients' Reproductive Health Needs, James R. Foreit Jan 2006

Systematic Screening: A Strategy For Determining And Meeting Clients' Reproductive Health Needs, James R. Foreit

Reproductive Health

Systematic screening is a strategy to integrate reproductive health services at the provider level. Integration is the proactive provision of multiple reproductive health services in the same facility at the same time. Systematic screening is a simple intervention to increase the number of services received at a single client visit. In this strategy, providers use a checklist or questionnaire to identify each client’s needs and desires for reproductive health services. They then provide these services during the same visit, through an appointment at the same clinic, or through referral to another facility. The Population Council’s Frontiers in Reproductive Health Program …


Baseline Household Survey: Lasbela District, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Baseline Household Survey: Lasbela District, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development (USAID). PAIMAN is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health issues. USAID has provided a grant to implement PAIMAN in ten districts of Pakistan’s four provinces. The goal of the project is to reduce maternal, newborn, and child mortality. The project calls for a multipronged and integrated strategic approach combining individual health care with public health and community-based interventions. To ensure that success is properly …


Female Genital Mutilation In Kenya: Evidence Links Health Workers To Fgm, Population Council, Gtz Jan 2006

Female Genital Mutilation In Kenya: Evidence Links Health Workers To Fgm, Population Council, Gtz

Reproductive Health

Female genital mutilation (FGM) is a traditional practice that affects women and girls in several African countries. It is practiced in a variety of ways, classified by WHO into four broad types all found in Kenya. In some communities it is associated with passage into maturity; in others, it is considered a symbol of ethnic identity, a religious obligation, or a necessary prerequisite for marriage, either through symbolizing attainment of womanhood or as a means of preserving and demonstrating virginity. FGM is considered a harmful traditional practice because it may be associated with a variety of short- and long-term health …


Baseline Survey: Summary Report Of District Rawalpindi, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Baseline Survey: Summary Report Of District Rawalpindi, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

This summary report presents some of the key findings of a 2005 baseline household survey in Rawalpindi district, one of the ten districts in Pakistan that are the focus of the PAIMAN project. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development. The project is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health (MNH) issues. PAIMAN district survey results are presented individually for each of the ten districts. PAIMAN developed a monitoring and evaluation plan …


Baseline Survey: Summary Report Of District Upper Dir, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Baseline Survey: Summary Report Of District Upper Dir, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

This summary report presents some of the key findings of a 2005 baseline household survey in Upper Dir district, one of the ten districts in Pakistan that are the focus of the PAIMAN project. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development. The project is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health (MNH) issues. PAIMAN district survey results are presented individually for each of the ten districts. PAIMAN developed a monitoring and evaluation …


Baseline Household Survey: Upper Dir District, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Baseline Household Survey: Upper Dir District, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development (USAID). PAIMAN is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health issues. USAID has provided a grant to implement PAIMAN in ten districts of Pakistan’s four provinces. The goal of the project is to reduce maternal, newborn, and child mortality. The project calls for a multipronged and integrated strategic approach combining individual health care with public health and community-based interventions. To ensure that success is properly …


Baseline Household Survey: Sukkur District, Pakistan Initiative For Mothers And Newborns (Paiman) Jan 2006

Baseline Household Survey: Sukkur District, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by the United States Agency for International Development (USAID). PAIMAN is committed to assisting the Government of Pakistan in implementing the full spectrum of interventions necessary to address maternal and neonatal health issues. USAID has provided a grant to implement PAIMAN in ten districts of Pakistan’s four provinces. The goal of the project is to reduce maternal, newborn, and child mortality. The project calls for a multipronged and integrated strategic approach combining individual health care with public health and community-based interventions. To ensure that success is properly …


Egypt: Are Egyptian Couples Willing To Stop At Two Children? Results Of The Slow Fertility Transition Survey [Arabic], Population Council Jan 2006

Egypt: Are Egyptian Couples Willing To Stop At Two Children? Results Of The Slow Fertility Transition Survey [Arabic], Population Council

Reproductive Health

No abstract provided.


Cómo Identificar Y Satisfacer La Necesidad De Servicios Adicionales: Manual Para Gerentes, Ricardo Vernon, James R. Foreit, Emma Ottolenghi Jan 2006

Cómo Identificar Y Satisfacer La Necesidad De Servicios Adicionales: Manual Para Gerentes, Ricardo Vernon, James R. Foreit, Emma Ottolenghi

Reproductive Health

Este manual está diseñado para ayudar a los encargados de tomar decisiones, los administradores, los supervisores y los proveedores de programas a introducir la detección sistemática en sus servicios de salud. La detección sistemática puede mejorar la salud de la mujer al abordar múltiples necesidades no satisfechas de servicios de salud reproductiva y otros. Este manual proporciona: actividades necesarias para implementar una detección sistemática; cómo seleccionar las instalaciones, los servicios que se examinarán y quién lo hará; desarrollo, adaptación y pruebas preliminares de listas de verificación de detección sistemática; asesoramiento para capacitar a los evaluadores/proveedores y supervisores; y un esquema …