Case study - Herdade Vale da Rosa – The fruits of passion: The role of a positive entrepreneur vision in the success of an organization from a depressed sector and region

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Determinants of mother-baby relationship evaluated during pregnancy

ABSTRACT Background Mental health promotion is supported by a strong body of knowledge and is a matter of public health with the potential of a large impact on society. Mental health promotion programs should be implemented as soon as possible in life, preferably starting during pregnancy. Programs should focus on malleable determinants, introducing strategies to reduce risk factors or their impact on mother and child, and also on strengthening protective factors to increase resilience. The ambition of early detecting risk situations requires the development and use of tools to assess risk, and the creation of a responsive network of services based in primary health care, especially maternal consultation during pregnancy and the first months of the born child. The number of risk factors and the way they interact and are buffered by protective factors are relevant for the final impact. Maternal-fetal attachment (MFA) is not yet a totally understood and well operationalized concept. Methodological problems limit the comparison of data as many studies used small size samples, had an exploratory character or used different selection criteria and different measures. There is still a lack of studies in high risk populations evaluating the consequences of a weak MFA. Instead, the available studies are not very conclusive, but suggest that social support, anxiety and depression, self-esteem and self-control and sense of coherence are correlated with MFA. MFA is also correlated with health practices during pregnancy, that influence pregnancy and baby outcomes. MFA seems a relevant concept for the future mother baby interaction, but more studies are needed to clarify the concept and its operationalization. Attachment is a strong scientific concept with multiple implications for future child development, personality and relationship with others. Secure attachment is considered an essential basis of good mental health, and promoting mother-baby interaction offers an excellent opportunity to intervention programmes targeted at enhancing mental health and well-being. Understanding the process of attachment and intervening to improve attachment requires a comprehension of more proximal factors, but also a broader approach that assesses the impact of more distal social conditions on attachment and how this social impact is mediated by family functioning and mother-baby interaction. Finally, it is essential to understand how this knowledge could be translated in effective mental health promoting interventions and measures that could reach large populations of pregnant mothers and families. Strengthening emotional availability (EA) seems to be a relevant approach to improve the mother-baby relationship. In this review we have offered evidence suggesting a range of determinants of mother-infant relationship, including age, marital relationship, social disadvantages, migration, parental psychiatric disorders and the situations of abuse or neglect. Based on this theoretical background we constructed a theoretical model that included proximal and distal factors, risk and protective factors, including variables related to the mother, the father, their social support and mother baby interaction from early pregnancy until six months after birth. We selected the Antenatal Psychosocial Health Assessment (ALPHA) for use as an instrument to detect psychosocial risk during pregnancy. Method Ninety two pregnant women were recruited from the Maternal Health Consultation in Primary Health Care (PHC) at Amadora. They had three moments of assessment: at T1 (until 12 weeks of pregnancy) they filed out a questionnaire that included socio-demographic data, ALPHA, Edinburgh post-natal Depression Scale (EDPS), General Health Questionnaire (GHQ) and Sense of Coherence (SOC); at T2 (after the 20th weeks of pregnancy) they answered EDPS, SOC and MFA Scale (MFAS), and finally at T3 (6 months after birth), they repeated EDPS and SOC, and their interaction with their babies was videotaped and later evaluated using EA Scales. A statistical analysis has been done using descriptive statistics, correlation analysis, univariate logistic regression and multiple linear regression. Results The study has increased our knowledge on this particular population living in a multicultural, suburb community. It allow us to identify specific groups with a higher level of psychosocial risk, such as single or divorced women, young couples, mothers with a low level of education and those who are depressed or have a low SOC. The hypothesis that psychosocial risk is directly correlated with MFAS and that MFA is directly correlated with EA was not confirmed, neither the correlation between prenatal psychosocial risk and mother-baby EA. The study identified depression as a relevant risk factor in pregnancy and its higher prevalence in single or divorced women, immigrants and in those who have a higher global psychosocial risk. Depressed women have a poor MFA, and a lower structuring capacity and a higher hostility to their babies. In average, depression seems to reduce among pregnant women in the second part of their pregnancy. The children of immigrant mothers show a lower level of responsiveness to their mothers what could be transmitted through depression, as immigrant mothers have a higher risk of depression in the beginning of pregnancy and six months after birth. Young mothers have a low MFA and are more intrusive. Women who have a higher level of education are more sensitive and their babies showed to be more responsive. Women who are or have been submitted to abuse were found to have a higher level of MFA but their babies are less responsive to them. The study highlights the relevance of SOC as a potential protective factor while it is strongly and negatively related with a wide range of risk factors and mental health outcomes especially depression before, during and after pregnancy. Conclusions ALPHA proved to be a valid, feasible and reliable instrument to Primary Health Care (PHC) that can be used as a total sum score. We could not prove the association between psychosocial risk factors and MFA, neither between MFA and EA, or between psychosocial risk and EA. Depression and SOC seems to have a clear and opposite relevance on this process. Pregnancy can be considered as a maturational process and an opportunity to change, where adaptation processes occur, buffering risk, decreasing depression and increasing SOC. Further research is necessary to better understand interactions between variables and also to clarify a better operationalization of MFA. We recommend the use of ALPHA, SOC and EDPS in early pregnancy as a way of identifying more vulnerable women that will require additional interventions and support in order to decrease risk. At political level we recommend the reinforcement of Immigrant integration and the increment of education in women. We recommend more focus in health care and public health in mental health condition and psychosocial risk of specific groups at high risk. In PHC special attention should be paid to pregnant women who are single or divorced, very young, low educated and to immigrant mothers. This study provides the basis for an intervention programme for this population, that aims to reduce broad spectrum risk factors and to promote Mental Health in women who become pregnant. Health and mental health policies should facilitate the implementation of the suggested measures.

As imagens do envelhecimento e as práticas idadistas em Cuidados de Saúde Primários: implicações na actividade física dos idosos

RESUMO: O envelhecimento demográfico tem vindo a aumentar em todo o mundo. Porém, constata-se que os últimos anos de vida são, frequentemente, acompanhados de situações de incapacidade que poderiam ter sido prevenidas. Apesar da importância da actividade física na saúde, verifica-se que uma grande proporção de idosos são sedentários, aumentando o risco de incapacidade. Os profissionais de saúde podem ser influenciados por imagens negativas relativas ao envelhecimento. Tal pode conduzir a práticas de discriminação, com repercussão na forma como os idosos se vêem a si próprios e, consequentemente, no seu comportamento na prática de actividade física. Este estudo tem como objectivo analisar o modo como as imagens do envelhecimento e dos idosos, bem como as práticas idadistas percebidas pelos idosos no contacto com profissionais de saúde influenciam a sua prática de actividade física. Realizou-se um estudo qualitativo, com recurso à entrevista semi-estruturada e de associação livre das palavras, sendo entrevistados 18 utentes que recorreram a um Centro de Saúde. Pelos resultados, constatou-se que uma parte considerável dos participantes (n=8) mencionou que a forma como são vistos pelos profissionais de saúde e como estes lidam consigo influencia a sua prática de actividade física. A imagem mais referida como favorecendo esta prática foi o facto de se considerarem pessoas com vontade de viver. Como principal prática favorecedora identificou-se o aconselhamento/educação para a saúde. A imagem mais mencionada como dificultando a actividade física foi a de os idosos serem deprimidos/tristes/aborrecidos e rabugentos/teimosos. As práticas mais identificadas como dificultando a actividade física foram: o desinteresse face aos problemas de saúde; o não encaminhamento para intervenções adequadas às necessidades; a indicação de que o problema de saúde é devido à idade, não o sendo; a postura autoritária em que só o profissional decide a opção terapêutica; e a verbalização de que o utente já tem muita idade para realizar uma actividade. Conclui-se que as imagens negativas do envelhecimento e dos idosos bem como a existência de práticas idadistas por parte dos profissionais de saúde, condicionam de forma negativa a prática de actividade física nos idosos.---------------ABSTRACT: The aging population has been increasing around the world. However, it appears that the last years of life are often accompanied by situations of disability, which could have been prevented. Despite the importance of physical activity on health, it appears that a large proportion of elderly people are sedentary, increasing the risk of disability. Health professionals may be influenced by negative images related to aging and that may lead to discriminatory practices with repercussion in how older people see themselves and thus their behavior as related to physical activity. This study aims to examine how the images concerning aging and older people, as well as ageist practices perceived by older people in contact with health professionals, do influence their physical activity. A qualitative study was conducted using a semi-structured interview and techniques of free word association. Eighteen primary care elderly users were interviewed. A considerable proportion of the sample (n=8) mentioned that the way health professionals see them and deal with them influences their level of physical activity. The image that most favoured this practice was that people are willing to live. Counseling/health education was identified as the main favouring practice. The image which was most often mentioned as hindering physical activity was that of elderly as being depressed, sad or bored, and grumpy or stubborn.The practices most often identified as hindering physical activity were: lack of interest regarding health problems; non-referral to appropriate intervention needs; indicating that the health problem is due to age, not being the case; authoritarian professional attitudes regarding who decides the treatment options; verbalization that the user is already to old to perform an activity. This study concludes that the negative images of aging and older people as well the existence of ageist practices by health professionals negatively affect the practice of physical activity in the elderly.

Dynamics of serotonergic neurons revealed by fiber photometry

This work was developed in the context of the MIT Portugal Program, area of Bioengineering Systems, in collaboration with the Champalimaud Research Programme, Champalimaud Center for the Unknown, Lisbon, Portugal. The project entitled Dynamics of serotonergic neurons revealed by fiber photometry was carried out at Instituto Gulbenkian de Ciência, Oeiras, Portugal and at the Champalimaud Research Programme, Champalimaud Center for the Unknown, Lisbon, Portugal