Early retirement: the decision and the experience /

Bibliography: p. 287-288.

Early retirement : the decision and the experience, and a second look /

Part 1, Early retirement: the decision and the experience, published separately in 1969. Part 2, The automobile worker and retirement: a second look, published separately in 1970.

Factors influencing Hong Kong Chinese patients' decision-making in seeking early treatment for acute myocardial infarction

The purpose of this study was to identify, through in-depth interview, factors that influenced 27 Hong Kong Chinese patients' decision-making in seeking early treatment for acute myocardial infarction (AMI). The median delay time from the onset of symptoms to arrival at the hospital was 15.6 hours for men and 53.7 hours for women. Three major categories emerged from the data: (a) becoming aware of the threat, (b) maintaining a sense of normality, and (c) struggling to mobilize resources. A variety of decisions were made by patients from the onset of chest Pain to seeking help. These decisions were heavily influenced by healthcare factors (access to emergency medical service (EMS) and treatment), personal factors (cognitive interpretations of symptoms), sociocultural factors (family situation, cultural beliefs, and practices), and coping strategies. (c) 2006 Wiley Periodicals, Inc.

Group decision making and Quality-of-information in e-Health systems

Knowledge is central to the modern economy and society. Indeed, the knowledge society has transformed the concept of knowledge and is more and more aware of the need to overcome the lack of knowledge when has to make options or address its problems and dilemmas. One’s knowledge is less based on exact facts and more on hypotheses, perceptions or indications. Even when we use new computational artefacts and novel methodologies for problem solving, like the use of Group Decision Support Systems (GDSSs), the question of incomplete information is in most of the situations marginalized. On the other hand, common sense tells us that when a decision is made it is impossible to have a perception of all the information involved and the nature of its intrinsic quality. Therefore, something has to be made in terms of the information available and the process of its evaluation. It is under this framework that a Multi-valued Extended Logic Programming language will be used for knowledge representation and reasoning, leading to a model that embodies the Quality-of-Information (QoI) and its quantification, along the several stages of the decision-making process. In this way, it is possible to provide a measure of the value of the QoI that supports the decision itself. This model will be here presented in the context of a GDSS for VirtualECare, a system aimed at sustaining online healthcare services.

Mental health promotion during pregnancy and early childhood : an action- research project in primary health care

ABSTRACT – Background: Primary Health Care (PHC) is usually the first contact with the health system, and health professionals are key mediators for enabling citizens to take care of their health. In Portugal, great improvements have been achieved in the biometric indicators of maternal and child health during the last decades. Nevertheless, scant attention has been paid to the mental health dimension, in spite of the recognition of its importance, being pregnancy and early childhood crucial opportunities in the lifecycle for mental health promotion, especially in the early years of life, with a strong impact in the health of the child. The impact of early attachment between mother and baby on maternal and child health has long been recognized. This attachment can be influenced by some factors, as the mother’s emotional adjustment. Attention to these factors may facilitate implementation of both positive conditions and preventative measures. Family support during the transition to parenthood has been highlighted as an effective measure and PHC professionals are in a privileged position as information sources as well as mediators. Aims: The project we present describes an action-research process developed together among academic researchers and health professionals to embrace these issues. We intend to enable health professionals to support families in the transition to parenthood thereby promoting children’s mental health. Approach: The project is driven by a participatory approach intended to lead to reorganization of health care during pregnancy and early childhood. Effective change happens when those involved are interested and motivated, what makes their participation so important. Reflection about current practices and needs, and knowledge about evidence-based interventions have been guiding the selection of changes to introduce in clinical practice for family support and development of parenthood skills and self-confidence. Development: We summarize the main steps in development: the initial assessment and the picture taken from the community under study; the decision making process; the training programme of PHC professionals in action; the review of the protocols of maternal consultation, home visits and antenatal education; the implementation planning; the plan for evaluation the effectiveness of the changes introduced in the delivery of maternal and child health care units. The already developed work has shown that motivation, leadership and organizational issues are decisive for process development.-------------------------- RESUMO - Os Cuidados de Saúde Primários são habitualmente o primeiro contacto com o sistema de saúde e os profissionais de saúde são mediadores chave na capacitação dos cidadãos para cuidarem da sua saúde. Em Portugal, nas últimas décadas, têm-se alcançado grandes melhorias nos indicadores biométricos de saúde materno-infantil. Contudo, tem-se dedicado pouca atenção à dimensão de saúde mental, apesar do reconhecimento da sua importância. A gravidez e primeira infância têm sido apontadas como uma oportunidade crucial no ciclo de vida para a promoção da saúde mental. É dado especial enfoque aos primeiros tempos de vida, dado o forte impacto na saúde da criança. O impacte da vinculação precoce entre a mãe e o bebé na saúde da mãe e da criança há muito que é reconhecido. Esta vinculação pode ser influenciada por vários factores, nomeadamente pelo ajustamento emocional da mãe. A focalização nestes aspectos pode facilitar a criação de condições favoráveis e a implementação de medidas preventivas. O suporte familiar durante o período de transição para a parentalidade tem sido enfatizado como uma medida eficaz e os Cuidados de Saúde Primários estão numa posição privilegiada como fontes de informação e como mediadores. O projecto que apresentamos descreve um processo de investigação- acção desenvolvido em parceria entre investigadores académicos e profissionais de saúde para abordar os aspectos referidos. Pretende-se capacitar os profissionais de saúde para apoiarem as famílias na transição para a parentalidade, promovendo assim a saúde mental das crianças. O projecto baseia-se numa abordagem participativa, direccionada para a reorganização dos cuidados durante a gravidez e primeiros tempos de vida. A mudança efectiva acontece quando os envolvidos estão interessados e motivados, o que torna a sua participação tão importante. A reflexão acerca das práticas e necessidades actuais e o conhecimento acerca de intervenções baseadas na evidência têm guiado a selecção das alterações a introduzir na prática clínica, no sentido de promover o suporte familiar e o desenvolvimento de competências parentais e auto-confiança. Neste artigo, apresentamos as etapas principais do desenvolvimento do projecto: avaliação inicial da comunidade em estudo; processo de tomada de decisão; programa de formação dos profissionais dos Cuidados de Saúde Primários; revisão dos protocolos da consulta de saúde materna, visita domiciliária e educação pré-natal; planeamento da implementação; plano de avaliação da efectividade das alterações introduzidas na prestação de cuidados. O trabalho já desenvolvido tem mostrado que a motivação, liderança e aspectos

The impact of early retirement reform on firms’ employment adjustment

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

Early holocenic and historic mtDNA african signatures in the iberian peninsula: The andalusian region as a paradigm

Determining the timing, identity and direction of migrations in the Mediterranean Basin, the role of "migratory routes" in and among regions of Africa, Europe and Asia, and the effects of sex-specific behaviors of population movements have important implications for our understanding of the present human genetic diversity. A crucial component of the Mediterranean world is its westernmost region. Clear features of transcontinental ancient contacts between North African and Iberian populations surrounding the maritime region of Gibraltar Strait have been identified from archeological data. The attempt to discern origin and dates of migration between close geographically related regions has been a challenge in the field of uniparental-based population genetics. Mitochondrial DNA (mtDNA) studies have been focused on surveying the H1, H3 and V lineages when trying to ascertain north-south migrations, and U6 and L in the opposite direction, assuming that those lineages are good proxies for the ancestry of each side of the Mediterranean. To this end, in the present work we have screened entire mtDNA sequences belonging to U6, M1 and L haplogroups in Andalusians--from Huelva and Granada provinces--and Moroccan Berbers. We present here pioneer data and interpretations on the role of NW Africa and the Iberian Peninsula regarding the time of origin, number of founders and expansion directions of these specific markers. The estimated entrance of the North African U6 lineages into Iberia at 10 ky correlates well with other L African clades, indicating that U6 and some L lineages moved together from Africa to Iberia in the Early Holocene. Still, founder analysis highlights that the high sharing of lineages between North Africa and Iberia results from a complex process continued through time, impairing simplistic interpretations. In particular, our work supports the existence of an ancient, frequently denied, bridge connecting the Maghreb and Andalusia.

Optimization techniques to detect early ventilation extubation in intensive care units

The decision support models in intensive care units are developed to support medical staff in their decision making process. However, the optimization of these models is particularly difficult to apply due to dynamic, complex and multidisciplinary nature. Thus, there is a constant research and development of new algorithms capable of extracting knowledge from large volumes of data, in order to obtain better predictive results than the current algorithms. To test the optimization techniques a case study with real data provided by INTCare project was explored. This data is concerning to extubation cases. In this dataset, several models like Evolutionary Fuzzy Rule Learning, Lazy Learning, Decision Trees and many others were analysed in order to detect early extubation. The hydrids Decision Trees Genetic Algorithm, Supervised Classifier System and KNNAdaptive obtained the most accurate rate 93.2%, 93.1%, 92.97% respectively, thus showing their feasibility to work in a real environment.

Perceived behavioral changes in early multiple sclerosis.

Acquired behavioral changes have essentially been described in advanced multiple sclerosis (MS). The present study was designed to determine whether behavioral modifications specifically related to the MS pathological process could be identified in the initial phase of the disease, as compared to control patients with chronic, relapsing and progressive inflammatory disorders not involving the central nervous system (CNS). Eighty-eight early MS patients (Expanded Disability Status Scale score <or= 2.5) and 48 controls were tested. Perceived changes by informants in behavioral control, goal-directed behavior, decision making, emotional expression, insight and interpersonal relationships were assessed using the Iowa Scale of Personality Change (ISPC). Executive behavioral disturbances were screened using the Dysexecutive Questionnaire (DEX). The mean change between the premorbid and postmorbid ISPC ratings was similar in the MS [12.2 (SD 15.6)] and in the control [11.5 (SD 15.1)] group. The perceived behavioral changes (PBCs) most frequently reported in both groups were lack of stamina, lability/moodiness, anxiety, vulnerability to stress and irritability. Pathological scores in the DEX were also similar in both groups. Correlations between PBCs and DEX scores were different in MS and control groups. MS patients with cognitive impairment had a marginally higher number of PBCs than control patients (p=0.056) and a significantly higher DEXp score (p=0.04). These results suggest that (1) PBCs occurring in early MS patients were not different from those induced by comparable chronic non-CNS disorders, (2) qualitative differences in the relationship between behavioral symptoms and executive-behavioral changes may exist between MS and control groups, and (3) behavioral symptoms seem associated with cognitive deficits in MS. We further plan to assess these observations longitudinally.

Adjuvant early breast cancer systemic therapies according to daily used technologies.

Prognosis of early breast cancer patients is significantly improved with the use of adjuvant therapies. Various guidelines have been proposed to select patients who will derive the most benefit from such treatments. However, classifications have limited usefulness in subsets of patients such as those with node negative breast cancer. The 2007 St. Paul de Vence Clinical Practice Recommendations proposed to consider adjuvant therapy in accordance with the 10-year relapse-free survival reduction estimated by Adjuvant! Online. However, many limitations remain regarding the use of Adjuvant! Online. Among them, adverse prognostic and/or predictive factors such as vascular invasion, mitotic activity, progesterone receptor negativity, and HER-2 expression are not incorporated in the routine clinical decision process. Our group has therefore issued guidelines based on the consideration of both Adjuvant! Online calculations and the prognostic and/or predictive effects of these markers. In addition, web-accessible comprehensive tables summarizing these recommendations are provided.

Language lateralization in early and late bilinguals using an international vocabulary

In lateralized Lexical Decision Tasks (LDT), accuracy is commonly higher and reaction times are commonly faster for right visual field (RVF) than left visual field (LVF) presentations. This visual field differences are thought to demonstrate the left hemisphere's dominance for language. Unfortunately, different tasks and words are used between studies and languages making direct comparisons difficult. For example, high frequency words show a performance advantage over low frequency words. Moreover, demographic variables impact on lateralized behavior such as language knowledge (one versus several, early acquired versus late acquired). We here aim to alleviate some of these obstacles by presenting results from a lateralized LDT for which we selected words between 4 and 6 letters used in five different languages, i.e. English, French, German, Dutch and Italian. In this first study using these words, we compared performance of right- and left-handed students being either early or late bilinguals (acquired before or after the age of 6 years) from a French-speaking University in Switzerland. Results showed a left hemispheric advantage (accuracy, reaction times) for all groups, with a trend for early as compared to late bilinguals to be less accurate and taking longer in lexical decisions. These results show that the current words result in solid visual field differences, and do so irrespective of how many languages are spoken. While early bilinguals might experience a slight performance disadvantage, it was not affecting visual field differences.

Neurorééducation précoce au Centre hospitalier universitaire vaudois: du rêve à la réalité [Early neurorehabilitation in an acute university hospital: from dream to reality].

The need for an early neurorehabilitation pathway was identified in an acute university hospital. A team was formed to draw up and implement it. A neuro-sensorial, interdisciplinary and coordinated therapy program was developed, focused on tracheostomised patients as soon as they were admitted to the intermediate care in neurology and neurosurgery. The impact of this care plan was evaluated by comparing the results obtained with that pertaining to patients treated previously in the same services. The comparison showed a reduction of 48% of the mean duration of tracheostomy, of 39% in the time to inscription in a neurorehabilitation centre and of 20% in the length of stay in the intermediate care. An early neurorehabilitation care program, with an interdisciplinary and coordinated team, reduces complications and lengths of stay.