Attitudes towards mentally ill in professionals working in Ndera neuropsychiatric hospital in Rwanda

ABSTRACT: This quantitative study investigated the attitudes toward the mentally ill in professionals working in Ndera neuropsychiatric hospital. The research questions explored were centered on the attitudes of directly involved and supportive professionals toward mentally ill clients and also on the difference between the attitudes of directly involved and supportive professionals toward mentally ill clients and demographic variables. The purpose of this study was to determine whether there are differences in attitude between direct care providers and supportive professionals toward the mentally ill clients. The Community Attitudes towards Mentally Ill (CAMI) scale (Dear & Taylor, 1982; Taylor, Dear & Hall, 1979; Taylor & Dear, 1981) was used. A total of 72 members of the staff, including 55 directly involved staff and 17 supportive staff members, participated in the survey. A summary interpretation of the main findings in this thesis reinforces the assumption that negative attitudes towards people with mental illness received in Ndera neuropsychiatric hospital are in existence, even though the majority have favorable attitudes towards the mentally ill. This suggests that persons with mental illness may encounter stigmatizing attitudes from mental health professionals. This study represents one of the first to explore professionals’ attitudes towards the mentally ill. It is hoped that this work will highlight the need to explore the influence of attitudes in the delivery of high quality healthcare. The provider–patient relationship is at the heart of effective treatment and the detrimental impact of prejudicial judgments on this relationship should not be ignored. This study also demonstrates that professionals with different roles report different attitudes and this suggest that they would behave differently towards patients with mental illness. The directly involved professionals have been found to have more positive attitudes than the supportive professional and this seems to show that as individuals improve their ability to interact with persons with mental illness, they become more tolerant. The present study demonstrates that the sociodemographic variables tested have no impact on the attitudes of the professionals working in Ndera neuropsychiatric hospital. The extent of mental health training (as part of general health training) and duration of experience of working in mental health settings did not influence attitudes. Finally, this study demonstrates that there is no correlation between the attitudes towards mentally ill patients and their inclusion in the process of decision-making.

Islão ambivalente: a construção identitária dos Muçulmanos sob o poder colonial português

Este artigo procura contribuir para o estudo dos processos históricos que têm tomado populações muçulmanas como alvos preferenciais da governança e da análise políticas. Baseado em documentação de arquivos portugueses e franceses, o artigo procura assinalar as mais notórias representações identitárias que ideólogos e membros do aparelho colonial português construíram em torno dos grupos islâmicos da Guiné-Bissau e de Moçambique, incidindo especialmente nesta última colónia. Tais imagens articularam-se com as estratégias de governação das populações muçulmanas num quadro colonialista, sobretudo após a eclosão das guerras coloniais. O artigo defende que a posição semiperiférica de Portugal no sistema-mundo conferiu às suas representações e estratégias identitárias, nomeadamente as que se reportam aos muçulmanos colonizados, um carácter de profunda ambivalência.

Avaliação da cultura de segurança do doente em meio hospitalar : investigação ação numa unidade de radioterapia

RESUMO Introdução e objetivos As organizações internacionais responsáveis pela Qualidade na Saúde e Segurança do doente (Organização Mundial da Saúde, União Europeia), recomendam aos Estados membros a avaliação da cultura de segurança, como condição essencial para se introduzir mudanças nos comportamentos dos profissionais e nas organizações prestadoras de cuidados de saúde, e alcançar melhores níveis de segurança e de qualidade nos cuidados de saúde prestados aos doentes. Constitui objetivo geral deste trabalho contribuir para a implementação da cultura de segurança do doente nos profissionais envolvidos na prestação de cuidados de saúde, concorrendo para a avaliação da cultura de segurança do doente e, consequentemente para a garantia da qualidade dos cuidados prestados. Metodologia 1ª fase – pré-estudo: através da revisão de literatura identificamos o instrumento mais adequado para avaliar a cultura de segurança do hospital, traduzimos e validámos o instrumento. 2ª fase – desenvolvemos um estudo exploratório-descritivo, transversal, retrospetivo, em 3 hospitais portugueses e um estudo exploratório-descritivo, longitudinal, prospetivo, de investigação-ação, numa unidade de radioterapia. Resultados O Hospital Survey on Patient Safety Culture é o instrumento que revela as adequadas características para a avaliação da cultura de segurança nos hospitais portugueses. No que diz respeito à avaliação da cultura de segurança em três hospitais portugueses, podemos destacar que o trabalho em equipa, a expectativas do supervisor e a aprendizagem organizacional são as dimensões com melhores resultados apesar da frequência das notificações e das respostas ao erro não punitivas apresentarem os piores resultados. Verificou-se que a URT se encontra em franca evolução, o que se torna visível sobretudo na adesão à notificação que aumentou à medida que o tempo foi passando. O envolvimento de todos no desenho da intervenção e nas atividades a decorrer na unidade, foi preponderante para a melhoria da segurança do doente. Conclusões Temos consciência que existem muitas questões por responder e que na realidade não há receitas nem diretrizes que possam afirmar que existem relações de causalidade, confrontando uma determinada ação com a consequente mudança cultural. No entanto, estamos convictos que o envolvimento de todos os membros da organização/unidade, o compromisso forte da liderança, uma comunicação efetiva e uma notificação não punitiva são ingredientes essenciais para a melhoria contínua da cultura de segurança do doente.

Molecular tools in the diagnostic and epidemiology of infections caused by members of Mycobacterium avium Complex

Mycobacterium avium Complex (MAC) comprises microorganisms that affect a wide range of animals including humans. The most relevant are Mycobacterium avium subspecies hominissuis (Mah) with a high impact on public health affecting mainly immunocompromised individuals and Mycobacterium avium subspecies paratuberculosis (Map) causing paratuberculosis in animals with a high economic impact worldwide. In this work, we characterized 28 human and 67 porcine Mah isolates and evaluated the relationship among them by Multiple-Locus Variable number tandem repeat Analysis (MLVA). We concluded that Mah population presented a high genetic diversity and no correlations were inferred based on geographical origin, host or biological sample. For the first time in Portugal Map strains, from asymptomatic bovine faecal samples were isolated highlighting the need of more reliable and rapid diagnostic methods for Map direct detection. Therefore, we developed an IS900 nested real time PCR with high sensitivity and specificity associated with optimized DNA extraction methodologies for faecal and milk samples. We detected 83% of 155 faecal samples from goats, cattle and sheep, and 26% of 98 milk samples from cattle, positive for Map IS900 nested real time PCR. A novel SNPs (single nucleotide polymorphisms) assay to Map characterization based on a Whole Genome Sequencing analysis was developed to elucidate the genetic relationship between strains. Based on sequential detection of 14 SNPs and on a decision tree we were able to differentiate 14 phylogenetic groups with a higher discriminatory power compared to other typing methods. A pigmented Map strain was isolated and characterized evidencing for the first time to our knowledge the existence of pigmented Type C strains. With this work, we intended to improve the ante mortem direct molecular detection of Map, to conscientiously aware for the existence of Map animal infections widespread in Portugal and to contribute to the improvement of Map and Mah epidemiological studies.

Implementation of WHO Quality Rights assessment in Kabul Mental Health Hospital

RESUMO: Objetivo Avaliar a qualidade dos serviços de saúde mental e a situação dos direitos humanos no Hospital de Saúde Mental de Kabul (KMHH) e fornecer recomendações para o desenvolvimento de um plano de melhoria, actualização e revisão da Política, Estratégia e Plano Nacionais de Saúde Mental,. Métodos A avaliação foi realizada em Janeiro de 2015 no KMHH e na Burn Ward do Hospital Terciário de Isteqlal por uma equipa multidisciplinar usando Qualidade Direitos Tool Kit da OMS. Antes da avaliação, o protocolo foi aprovado pelo Institutional Review Board e obtido o consentimento informado de cada entrevistado. Realizaram-se entrevistas com 16 utentes do serviço, 17 funcionários do hospital e 7 familiares, além da revisão de documentos e da observação das unidades de internamento do KMHH e das interações interpessoais entre funcionários do hospital e utentes do serviço. A comissão de avaliação reviu também a documentação e observou a Unidade de Queimados do Hospital Terciário de Isteqlal, a fim de avaliar e comparar a paridade entre as duas instalações. Após a avaliação, todos os membros da comissão se reuniram e puseram em conjunto todas as conclusões num relatório final. Resultados Encontrámos algumas lacunas graves no nível de prestação de serviços e no respeito pelos direitos humanos dos utentes dos serviços e dos seus familiares. Uma série de políticas, diretrizes e procedimentos relacionados com os direitos humanos dos pacientes estavam ausentes. O ambiente terapêutico e o padrão de vida eram inadequados, existia má qualidade do atendimento e dos serviços prestados, os utilizadores enfrentavam violações do direito ao exercício da capacidade legal e da liberdade pessoal, eram quimica e fisicamente (uso de correntes) contidos e expostos a abusos verbais, físicos e emocionais, e havia grande ênfase no tratamento institucional. Todos estes aspectos foram considerados como extensa violação dos direitos humanos dos utentes de serviço do KMHH. Conclusão Os serviços disponíveis para utentes dos serviços de saúde mental apresentam alguns problemas devido à desconfiança e falta de consciencialização sobre os direitos das pessoas com doença mental e precisam ser alterados de forma positiva. A Lei de Saúde Mental existente difere muito das recomendações da Convenção sobre os Direitos das Pessoas com Incapacidades (CRPD) e requer revisão e adaptação de acordo com esta Convenção. -------------------------------- ABSTRACT: Objective To assess the quality of mental health services and human rights condition in the Kabul Mental Health Hospital (KMHH) and provide recommendations for development of an improvement plan and to update and revise the National Mental Health Policy, Strategy and Plan. Methods The assessment was conducted in January 2015 in the KMHH and the Burn Ward of Isteqlal Tertiary Hospital by a multidisciplinary team using WHO Quality Rights Tool Kit. Before the assessment, Institutional Review Board approval and informed consent from each interviewee were obtained. Interviews were conducted with 16 service users, 17 hospital staffs and 7 family members in addition to documents review and observation of inpatient units of KMHH plus interpersonal interactions between hospital staff and service users. The assessment committee reviewed the documentation and observed the Burn Ward of Isteqlal Tertiary hospital in order to measure and compare parity between the two facilities. After the assessment, all committee members gathered and synchronized all findings into a final report. Results There were some serious gaps on service provision level and respecting human rights of service users and their family members. A series of policies, guidelines and procedures related to patients’ human rights were absent. Inadequate treatment environment and standard of living, poor quality of care and services, violations of the right to exercise legal capacity and personal liberty, being chemically and physically (e.g. chain) restrained, being exposed to verbal, physical and emotional abuse, and emphasis on institutional treatment were all extensive human rights violation that service users were experiencing in KMHH. Conclusion The available services for mental health service users are questionable due to mistrust and lack of awareness about rights of people with disabilities and need to be positively changed. Existing Mental Health Act has a large number of disparities with the CRPD and requires revision and adaptation in accordance to CRPD.

CEO overconfidence and leverage ratio: Evidence from the founder members of Mila

The study investigates the impact of the managerial overconfidence bias on the capital structure of a sample of 78 firms from Chile, Peru and Colombia, during the years 1996-2014. We infer that there is a positive relation between the leverage ratio and a) the overconfidence; b) the experience and c) the male gender of the executive. Overconfidence is measured according to the status of the CEO (entrepreneur or not-entrepreneur) and the hypotheses are tested through dynamic panel data model. The empirical results show a highly significant positive correlation between overconfidence and leverage ratio and between gender and leverage ratio while, in contrast, the relation between experience and leverage ratio is negative.

Fiscalização dos serviços de informações em Portugal

The present work offers a brief historical and evolutionary introduction to the legal basis of the Portuguese Republic Intelligence System (SIRP) which comprises two services – the Security Intelligence Service (SIS) and the Defence Strategic Intelligence Service (SIED) – and two entities responsible for its oversight – the Supervisory Body (CFSIRP) and the Data Monitoring Committee (CFD), also responsible for supervising the Military Intelligence and Security Centre (CISMIL) of the General Staff of the Armed Forces (EMGFA). The initial narrative subsequently leads us to a detailed analysis of the Portuguese Intelligence services' current model of monitoring, as well as of the legislator’s options, namely in the legal drafting field, used within the construction and definition of the legal structure that currently regulates the Portuguese Republic Intelligence System. For the purposes of this study we have broadly examined different models of the European Union, in particular those of Belgium, the Netherlands and Croatia. We have also transposed to the text the valuable contributions collected during the research phase, more precisely the replies to questionnaires and interviews conducted with certain individuals selected according to their knowledge and affinity with the subject of this study, including members and former members of the Supervisory Body and former directors of the three portuguese intelligence services. The present dissertation intends to contribute to the development of this subject, promoting critical analysis, within and beyond the academia, with the aim that some of its reflections might be useful towards the intelligence system’s future reform, particularly in what concerns intelligence services monitoring.

Improving retail banking staff incentive systems

This Work Project seeks to analyze the viability, utility and best way of implementing mechanisms of double accounting and of insertion of low (or null) sales objectives in an incentives program. The main findings are that both processes are possible and to a certain extent advisable, although in very specific ways and with some limitations. Double accounting processes are especially effective between different segments and networks and should have a greater impact in the first evaluation periods of each case and the null objectives, albeit usable, are recommended to be always substituted by positive objectives, even if quite small. Moreover, it is concluded that the formal structure of the incentives program influences significantly these concepts, namely concerning the duration of the evaluation periods and the interaction of the objectives of different entities for both the vertical (hierarchic) and horizontal (individual and collective) levels.