The Political and Social Dynamics of Poverty, Poor Relief and Health Care in Early-Modern Portugal

By the end of the fifteenth century most European countries had witnessed a profound reformation of their poor relief and health care policies. As this book demonstrates, Portugal was among them and actively participated in such reforms. Providing the first English language monograph on this topic, Laurinda Abreu examines the Portuguese experience and places it within the broader European context. She shows that, in line with much that was happening throughout the rest of Europe, Portugal had not only set up a systematic reform of the hospitals but had also developed new formal arrangements for charitable and welfare provision that responded to the changing socioeconomic framework, the nature of poverty and the concerns of political powers. The defining element of the Portuguese experience was the dominant role played by a new lay confraternity, the confraternity of the Misericórdia, created under the auspices of King D. Manuel I in 1498. By the time of the king's death in 1521 there were more than 70 Misericórdias in Portugal and its empire, and by 1640, more than 300. All of them were run according to a unified set of rules and principles with identical social objectives. Based upon a wealth of primary source documentation, this book reveals how the sixteenth-century Portuguese crown succeeded in implementing a national poor relief and health care structure, with the support of the Papacy and local elites, and funded principally through pious donations. This process strengthened the authority of the royal government at a time which coincided with the emergence of the early modern state. In so doing, the book establishes poor relief and public health alongside military, diplomatic and administrative authorities, as the pillars of centralisation of royal power.

Adesão a recomendações de ingestão de água, em idosos: preditores psicossociais e efeitos da comunicação de informação com uso de âncoras de referência

Sendo os idosos um grupo de risco face a desidratação, torna-se particularmente relevante desenvolver estratégias eficazes de comunicação em saúde para o incremento da adesão a recomendações médicas para ingestão de água. Com este objetivo procurámos avaliar os efeitos da comunicação de uma recomendação, com recurso a uma referência familiar (e.g. garrafa de 1.5 Litros) na qual os idosos pudessem “ancorar” o seu julgamento e decisão de adesão à recomendação, com base numa mais eficaz compreensão de informação de quantidade. Dos 70 idosos que participaram no estudo, apenas 56 foram considerados na análise, por cumprirem os critérios de inclusão na amostra. Esta amostra incluiu idosos autónomos, não institucionalizados, responsáveis pelas suas escolhas alimentares e com indicadores de hidratação aceitáveis. Os resultados mostraram que numa condição com âncora familiar (mas não na condição sem), a adesão associada ao próprio nível de consumo existente, do idoso aumentou após a recomendação. Análises adicionais identificaram as crenças face à água e as suas várias funções, como um preditor psicossocial positivo da adesão, o mesmo não acontecendo com atitudes face à água, evitamento de informação alimentar negativa e numeracia; Abstract: Being the elderly a risk group with regard to dehydration it is necessary to develop effective health communication strategies to increase adherence to health recommendations concerning water intake. Accordingly, we aimed to assess the effects of communicating a recommendation with the addition of a familiar reference (e.g. bottle of 1.5 Liters) in which the elderly could anchor their judgment and decision making to adhere to the recommendation, based on a better comprehension of the quantified information presented. From the 70 older adults that have participated in the study, only 56 were considered in the analysis, for fulfilling the sample inclusion criteria. This sample included older adults considered to be autonomous, non-institutionalized, responsible for their good choices and with acceptable hydration levels. Results showed that in a condition with a familiar anchor (but not in a condition without) the adherence in line with the elderly own current consumption level, increased after the recommendation. Additional analysis identified beliefs concerning water and its various functions as a positive psychosocial predictor of adherence, the same not happening for attitudes towards water, avoidance of negative food information and numeracy.

Qualidade e triagem de Manchester : Estudo de caso Hospital CUF Descobertas

A saúde em Portugal encontra-se no caminho da mudança, rumo à excelência, pois questiona-se o sistema, a sua estrutura, os seus processos e os resultados. Uma das condições que mais influencia a competitividade entre instituições da saúde é a qualidade. Sendo a sociedade cada vez mais exigente, medi-la e avalia-la é um imperativo da época actual. O presente estudo teve como objectivo, contribuir para a realização de um diagnóstico de um processo de melhoria implementado num hospital privado de Lisboa - Hospital CUF Descobertas (HCD), no Serviço de Atendimento Permanente (SAP), à luz dos princípios da qualidade total. O procedimento da Triagem de Manchester é um processo que tem como principal objectivo o estabelecimento de prioridades, ou seja, identificar critérios de gravidade, de forma objectiva e sistematizada, que indicam a prioridade clínica com que o cliente deve ser atendido e o respectivo tempo de espera alvo recomendado até observação médica. Não se trata de estabelecer diagnósticos. Para o efeito, utilizou-se uma abordagem metodológica, suportada pelo modelo de auto-avaliação, designado Modelo Common Assessment Framework (CAF). Neste sentido, privilegiando-se a utilização dos critérios de meios deste modelo. Foi aplicado um questionário aos colaboradores do Serviço de Atendimento Permanente do Hospital CUF Descobertas. O Tratamento de dados estatísticos foi realizado com o apoio do SPSS, versão 16.0 e do Microsoft Excel. Os resultados deste estudo culminam com a identificação de pontos fortes, pontos fracos e sugestões de melhorias para o serviço em estudo. Neste sentido, este trabalho serviu de diagnóstico para se poder identificar em que ponto se situa e que rumo se deve seguir para se atingir um patamar de excelência relativamente à qualidade. Abstract: Health in Portugal finds itself on the path toward change, trying to find excellence while challenging the system and its structure, processes, and results. One of the conditions that most influences the competitiveness between the institutes of health is quality because society is becoming more demanding. Measuring and evaluating this change is happening in this current time. The present study has the objective of contributing and establishing a diagnostic tool relative to the process of improvement. This tool was used in a private hospital in Lisbon, Hospital CUF Descobertas, in the Emergency Room, in looking at the principles of total quality. This process designed through the Manchester Triage System has the main objective of the establishment of priorities through which we want to identify criteria of seriousness in an objective and systematic way that indicate a clinical priority with which the client is attended to in respect to the waiting time, giving a recommended time until medical observation. ln this sense, we do not diagnose patients in triage. For this effect, we used a methodological overview supported by the model of self-evaluation, the Common Assessment Framework (CAF}, in which we used the criteria: Leadership, Planning and Strategy, People, Resources and Processes. To arrive at this, a questionnaire was used by the collaborators of the emergency room of Hospital CUF Descobertas. The statistical analysis of the data was performed using SPSS version 16.0 and Microsoft Excel. The results of this study culminated with the identification of strong points, weak points, and suggestions for improvements for the work in study. ln this way, with this study, we can identify in where an organization finds itself and the path it should take in order to achieve a high level of quality excellence.

A Case-Based Approach to Nosocomial Infection Detection

The nosocomial infections are a growing concern because they affect a large number of people and they increase the admission time in healthcare facilities. Additionally, its diagnosis is very tricky, requiring multiple medical exams. So, this work is focused on the development of a clinical decision support system to prevent these events from happening. The proposed solution is unique once it caters for the explicit treatment of incomplete, unknown, or even contradictory information under a logic programming basis, that to our knowledge is something that happens for the first time.

A Soft Computing Approach to Acute Coronary Syndrome

Acute Coronary Syndrome (ACS) is transversal to a broad and heterogeneous set of human beings, and assumed as a serious diagnosis and risk stratification problem. Although one may be faced with or had at his disposition different tools as biomarkers for the diagnosis and prognosis of ACS, they have to be previously evaluated and validated in different scenarios and patient cohorts. Besides ensuring that a diagnosis is correct, attention should also be directed to ensure that therapies are either correctly or safely applied. Indeed, this work will focus on the development of a diagnosis decision support system in terms of its knowledge representation and reasoning mechanisms, given here in terms of a formal framework based on Logic Programming, complemented with a problem solving methodology to computing anchored on Artificial Neural Networks. On the one hand it caters for the evaluation of ACS predisposing risk and the respective Degree-of-Confidence that one has on such a happening. On the other hand it may be seen as a major development on the Multi-Value Logics to understand things and ones behavior. Undeniably, the proposed model allows for an improvement of the diagnosis process, classifying properly the patients that presented the pathology (sensitivity ranging from 89.7% to 90.9%) as well as classifying the absence of ACS (specificity ranging from 88.4% to 90.2%).

Auditoria e controlo interno no exército: Relatório de estágio

O Sector Público em Portugal atravessa um momento de viragem. O antigo modelo de gestão, burocrático e autoritário vai, aos poucos, dando lugar a um novo modelo assente no princípio dos três "E(s)"1, economia, eficiência, eficácia, ao qual se pode juntar a sustentabilidade e o respeito pelo ambiente, procura tomar os serviços públicos amigos dos cidadãos e das boas práticas. Esta metamorfose exige, contudo, uma acção concertada não só ao nível das práticas, mas também das mentalidades num trabalho conjunto de governantes gestores e auditores. É hoje indiscutível a importância que a auditoria interna tem no seio das organizações. O sector público começa agora a dar os primeiros passos nesta área procurando através da auditoria, não só evitar fraudes e detectar erros mas também apoiar a gestão através de uma actuação directa e eficaz sobre o que está a acontecer, garantindo que os recursos que são de todos, estão a ser gastos de forma adequada. No Exército já existe uma cultura de auditoria na sua vertente tradicional, ou seja, verificação do passado, efeito persuasor, verificação da legalidade detecção de erros e fraudes. A instituição só pode ganhar se nesta área for pioneira alargando o âmbito, da sua intervenção ao nível da verificação da eficácia e da eficiência melhorando e criando uma cultura de rigor e boas práticas na sua gestão. /ABSTRACT: The public sector in Portugal is at a turning point. The old management, bureaucratic and authoritarian model is gradually giving way to a new model based on the principle of the three "E (s)2”, economy, efficiency, effectiveness and, to which we can join sustainability and environmental respect. It aims at making the public service friendly for citizens and promoting better practices. This metamorphosis, however, requires a harmonized action not only at the practice level but also in the attitudes within a joint effort of governing managers and auditors. It is nowadays· indisputable the importance that internal audit has within organizations. The public sector is beginning to take the first steps in this area, seeking in the audit not only to prevent fraud and detect errors but also to support the management by working directly and effectively on what is happening, ensuring that the resources belong to everyone, and are all being spent properly. ln the Army there is already an audit culture in its traditional area, i.e., verification of the past, persuasive effect, verification of the legality, detecting errors and fraud. The institution can only win if it is pioneer in this area by expanding the scope of its intervention at the level of verification, effectiveness and efficiency, improving and creating a culture of rigor and better practices in its management. (1-Vectores chaves para o aumento da produtividade e da riqueza suporte do chamado Value for Money (VFM) - 2-Key vectors that increase the support productivity and wealth of the so called Value for Money (VFM) )

Social Representations of Violence against the Elderly

The repercussions of violence on the mental, social, and physical well-being of the elderly are some of the most challenging problems in public health today. Using a qualitative design, we conducted a study in Portugal and the United States that applied both descriptive and comparative methods in order to understand the social representations of violence against the elderly. Utilizing the Theory of Social Representations, we explored the perspectives of the elderly, their families, and healthcare professionals on the subject of violence against the elderly. The data on which the findings were based were obtained in two very different cultural contexts, yet the representations of violence against the elderly revealed no significant cross-cultural differences. However, conceptualizations regarding expectations of care and protection for the elderly proved to be distinct. We discussed concerns about the general attitudes of tolerance toward violence, including those of the elderly who self-identified as eventual victims. Violence against the elderly was portrayed as a part of old age and also somehow was justified by it. The results also indicated the need to better prepare healthcare professionals and society in general to deal with the consequences of the problem and not, as we would like to report, to prevent it from happening.

How can the land managers and his multi-stakeholder network at the farm level influence the multifunctional transitions pathways?

The changing role of agriculture is at the core of transition pathways in many rural areas. Productivism, post-productivism and multifunctionality have been targeted towards a possible conceptualization of the transition happening in rural areas. The factors of change, including productivist and post-productivist trends, are combined in various ways and have gone in quite diverse directions and intensities, in individual regions and localities. Even, in the same holding, productivist and post-productivist strategies can co-exist spatially, temporally, structurally, leading to a higher complexity in changing patterns. In south Portugal extensive landscapes, dominated by traditionally managed agro-forestry systems under a fuzzy land use pattern, multifunctionality at the farm level is indeed conducted by different stakeholders whose interests may or not converge: a multifunctional land management may indeed incorporate post-productivist and productivist agents. These stakeholders act under different levels of ownership, management and use, reflecting a particular land management dynamic, in which different interests may exist, from commercial production to a variety of other functions (hunting, bee-keeping, subsistence farming, etc.), influencing management at the farm level and its supposed transition trajectory. This multistakeholder dynamic is composed by the main land-manager (the one who takes the main decisions), sub land-managers (land-managers under the rules of the main land-manager), workers and users (locals or outsiders), whose interest and action within the holding may vary differently according to future (policy, market, etc.) trends, and therefore reflect more or less resilient systems. The goal of the proposed presentation is to describe the multi-stakeholder relations at the farm level, its spatial expression and the factors influencing the land management system resilience in face of the transition trends in place.

“The most artistic lesson I ever heard” - a contribution to the reflection on the comment made by William James regarding a lesson by Ernst Mach

On November the 2nd 1882, William James visited Ernst Mach in Prague, and attended one of his lectures. The conversation with Mach and the lecture were marking events for James. Based, namely, on James’s lectures for teachers and on Mach’s lectures for the general public, we propose a reflection on the defining traits that made that event "the most artistic lesson [James] ever heard". We shall remark on the imaginative joy contained in these texts, which appear to embody some of James' key ideas on Education. The experience of knowledge about the world contained in the texts, reveals that "to experiment" means "not coldly to observe a thing happening outside us, but to undergo, to feel within oneself, to live oneself this or that manner of being".

Improved model of an electric calciner for carbon materials

Teknova have 2D steady-state models of the calciner but wish, in the long term, to have a 3D model that can also cover unsteady conditions, and can can model the loss of axisymmetry that someties occurs. Teknova also wish to understand the processes happening around the tip of the upper electrode, in particular the formation of a lip on it and the the shape of the empty region below it. The Study Group proposed potential models for the degree of graphitization, and for the granular flow. Also the Study Group considered the upper electrode in detail. The proposed model for the lip formation is by sublimation of carbon from the hottest parts of the furnace with redeposition in the region around the electrode, which may stick particles onto the electrode surface. In this model the region below the electrode would be a void, roughly a vertex-down conical cavity. The electric field near the lower rim of the electrode will then have a singularity and so the most intense heating of the charge will be around the rim. We conjecture that the reason why the lower electrode lasts so much longer than the upper is that it is not adjacent to a cavity like this, and therefore does not have a singularity in the field.

Aspetos da comunicação não-verbal usados pelo psicomotricista para o sucesso da sua intervenção terapêutica – um estudo de caso

Resumo: A psicomotricidade tem como objeto de estudo o corpo e as suas relações com o exterior. Inserido num determinado contexto ambiental, o corpo é um dos veículos centrais na transmissão de mensagens. O conhecimento do psicomotricista, acerca da utilização e identificação dos aspetos não-verbais, é determinante para melhorar a qualidade da intervenção, especialmente quando estamos perante a psicomotricidade com enfâse na qualidade da relação. Neste trabalho temos como objetivo conhecer a ocorrência não-verbal, toque e sua tipologia, a partir de Watson (1975), operada nos braços de uma criança, com paralisia cerebral (hemiparesia direita), pelo psicomotricista durante a sua intervenção. Esta análise consiste num estudo de caso realizado através da visualização sistemática e sistematizada de um vídeo durante uma sessão, na qual o psicomotricista interage com a criança com fins terapêuticos. A recolha de dados foi feita por vídeo-gravação e transcritos, verbalmente, para o papel e analisados e categorizados, posteriormente. Os resultados obtidos levaram-nos a concluir que o psicomotricista utilizou todos os aspetos não-verbais relacionados com o toque nos braços. A maioria destes toques foi do tipo Instrumental/Afetivo. Emergiram dados os quais se revelaram pertinentes como contributos para a melhoria da qualidade da intervenção, quando conhecidos e utilizados, adaptadamente, pelo psicomotricista.Abstract: The object of psychomotricity is the study of the body and its relationships with the outside world. Within a certain environmental context, the body is one of the central vehicles in the transmission of messages. The psychomotricity therapist's knowledge about the use and identification of non-verbal aspects is the key to improve the efficiency of the intervention, especially when we face psychomotricity with emphasis on the quality of the relationship . The aim of this work is to reckon the non-verbal happening of touch and its typology, according to Watson(1975), operated by the psychomotricist on the arms of a child with cerebral palsy,(right hemiparesis) during his/her intervention. This analysis consists of a case study based on the systematic and systematized viewing of a video made during one session, in which the therapist interacts with the child for therapeutic purposes. The collection of data was made through vídeo recording and verbally set down transcrptions for later analysis and categorization. The results obtained let us conclude that the psychomotricity therapist used all the non-verbal aspects related to arm touching . Most of these touches were of the instrumental/affective kind. Data have emerged that were considered relevant as contributing to improve the quality of the intervention if they are known and aproppriately used by the psychomotricity therapist.

"Portuguese Observatory of Taeniasis and Cysticercosis": A "One Health" example for epidemiological surveillance of one neglected disease in a European country

Cysticercosis results from the ingestion Taenia solium eggs directly by faecal-oral route or contaminated food or water. Human tapeworm carriers who have become infected after ingesting pork meat contaminated with cysticerci release these eggs. Cysticercosis occurs after tapeworm eggs are ingested by an intermediate host (pig or human) and then hatch, migrate, and lodge in the host's tissues, where they develop onto larval cysticerci. When they lodged in the central nervous system of humans, results in the disease condition called Neurocysticercosis (NCC), with a heterogeneous manifestations depending of the locations of cysts, number, size and their stage of evolution (1). Consequently the prognostic ranges from asymptomatic to situations leading to death in 2% to 9.8%. of cases (7) In swine’s there are few studies, but recent works have proved that animals, for the same reasons, also have neurological abnormalities, expressed by seizures, stereotypic walk in circles, chewing motions with foamy salivation included tonic muscle contractions followed by a sudden diminution in all muscle tone leading to collapse (2). Conventional domestic wastewater treatment processes may not be totally effective in inactivating parasites eggs from Taenia solium, allowing some contamination of soils and agricultural products (11). In Portugal there are some evidence of aggregation of human cysticercosis cases in specific regions, bases in ecological design studies (6). There are few information about human tapeworm carriers and social and economic factors associated with them. Success in knowledge and consequently in lowering transmission is limited by the complex network of biological and social factors that maintain the spread. Effective control of mostly zoonosis require One Health approach, after a real knowledge and transparency in the information provided by the institutions responsible for both animal and human health, allowing sustained interventions targeted at the transmission cycle's crucial nodes. In general, the model used to control, reflects a rural reality, where pigs are raised freely, poor sanitation conditions and incipient sanitary inspection. In cysticercosis, pigs are obligate intermediate hosts and so considered as first targets for control and used as sentinels to monitor environmental T. solium contamination (3). Usually environmental contamination with Taenia spp. eggs is a key issue in most of studies with landscape factors influencing presence of Taenia spp. antigens in both pigs and humans (5). Soil-related factors as well as socio-economic and behavioural factors are associated with the emergence of significant clustering human cysticercosis (4,5). However scarce studies has been produced in urban environmental and in developed countries with the finality to characterize the spatial pattern. There are still few data available regarding its prevalence and spatial distribution; Transmission patterns are likely to exhibit correlations as housing conditions, water supply, basic sanitation, schooling and birthplace of the individual or relatives, more than pigs rearing free, soil conditions (9). As a matter of fact, tapeworm carriers from endemic zones can auto-infect or transmit infection to other people or arrive already suffering NCC (as a result of travelling to or being a citizen from an endemic cysticercosis country) to a free cysticercosis country. Transmission is fecal-oral; this includes transmission through person-to-person contact, through autoinfection, or through contaminated food This has been happening in different continents as North America (5.4–18% been autochthonous), Europe and Australia (7). Recently, case reports of NCC have also emerged from Muslim countries. (10). Actually, different papers relate an epidemic situation in Spain and Portugal (7, 8). However the kind of study done does not authorize such conclusion. There are no evidence that infections were acquired in Portugal and there are not characterized the mode of transmission. Papers with these kind of information will be allow to have economic consequences resulted from artificial trade barriers with serious consequences for pig producers and pig meat trade. We need transparency in information’s that allow provide the basis to support the development and targeting of future effective control programmes (and prove we need that). So, to have a real picture of the disease, it is necessary integrate data from human, animal and environmental factors surrounding human and pig cases to characterize the pattern of the transmission. The design needs to be able to capture unexpected, and not common outcomes (routine data). We need to think “One Health” to get a genuine image of the situation.