Reinvigorating and redesigning early intervention in psychosis services for young people in Auckland

RESUMO: Auckland tem sido pioneira na implementação de modelos de Intervenção Precoce em Psicose. No entanto, esta organização do serviço não mudou nos últimos 19 anos. Segundo os dados obtidos da utilização do serviço, no período de 1996 -2012 foram atendidos 997 doentes, que tinham um número médio de 89 contactos (IQR: 36-184), com uma duração média de 62 horas de contactos (IQR: 24-136). Estes doentes passaram um número médio de 338 dias (IQR: 93-757) em contacto com o programa. 517 doentes (52%) não necessitaram de internamento no hospital, e os que foram internados, ficaram uma mediana de 124 dias no hospital (IQR: 40-380). Os doentes asiáticos tiveram um aumento de 50% de probabilidade de serem internados no hospital. Este relatório inclui 15 recomendações para orientar as reformas para o serviço e, nomeadamente, delinear a importância de uma visão organizacional e dos seus componentes-chave. As recomendações incluem o reforço da gestão e da liderança numa estrutura de equipe mais integrada, com recursos dedicados a melhorar a consciencialização da comunidade, a educação e deteção precoce, bem como a capacidade de receber referenciações diretas. Os Indicadores Chave de Desempenho devem ser estabelecidos, mas os Exames de Estado Mental em risco, devem ser removidos. Auckland deve manter a faixa etária alvo atual. A duração do serviço deve ser aumentada para um mínimo de três anos, com a opção de aumentá-la para cinco anos. A proporção de gestor de cuidados para os doentes deve ser preconizada em 1:15, enquanto o pessoal de apoio não-clínico deve ser aumentado. Os psiquiatras devem ter uma carga de trabalho de cerca de 80 doentes por equivalente de tempo completo. Um serviço local de prestação de cuidados deve ser desenvolvido com, nomeadamente, intervenções culturais para responder às necessidades da população multicultural de Auckland. A capacidade de investigação deve ser incorporada no Serviço de Intervenção Precoce em Psicoses. Qualquer alteração deverá envolver contacto com todas as partes interessadas, e a Administração Regional de Saúde deve comprometer-se em tempo, recursos humanos e políticos para apoiar e facilitar a mudança do sistema, investindo de forma significativa para melhor servir a comunidade Auckland.----------------------------------- ABSTRACT: Auckland has been pioneering in the adoption of Early Intervention in Psychosis models but the design of the service has not changed in 19 years. In service utilisation data from 997 patients seen from 1996 -2012, patients had a median number of 89 contacts (IQR: 36-184), with a median duration of 62 hours of contact (IQR: 24-136). Patients spent a median number of 338 days (IQR: 93-757) in contact with the program. 517 patients (52%) did not require admission to hospital, and those who did spent a median of 124 days in hospital (IQR: 40-380). Asian patients had a 50% increased chance of being admitted to hospital. This report includes 15 recommendations to guide reforms to the service, including outlining the importance of vision and key components. It recommends strengthened managerial leadership and a more integrated team structure with dedicated resources for improved community awareness, education and early detection as well as the capacity to take direct referrals. Key Performance Indicators (KPIs) should be established but At Risk Mental States should be excluded. Auckland should maintain the current target age range. The duration of service should be increased to a minimum of three years, with the option to extend this to five years. The ratio of care co-ordinator to patients should be capped at 1:15 whilst non-clinical supporting staff should be increased. Psychiatrists should have a caseload of about 80 per FTE. A local Service Delivery framework should be developed, as should cultural interventions to meet the needs of the multicultural population of Auckland. Research capacity should be incorporated into the fabric of Early Intervention in Psychosis Services. Any changes should involve consultation with all stakeholders, and the DHB should commit to investing time, human and political resources to support and facilitate meaningful system change to best serve the Auckland community.

DISTRIBUTION AND FEEDING ECOLOGY OF THE AFRICAN TILAPIA Oreochromis mossambicus (TELEOSTEI, PERCIFORMES, CICHLIDAE) IN SURINAME (SOUTH AMERICA) WITH COMMENTS ON THE TILAPIA-KWIKWI (Hoplosternum littorale) (TELEOSTEI, SILURIFORMEs, CALLICHTHYIDAE) INTERACTION

The geographical distribution of the African Tilapia Oreochromis mossambicusin Suriname is restricted to a narrow strip of land along the Atlantic coast. Within the coastal plain, O. mossambicusoccurs in brackish lagoons, oligohaline canals, and shell-sand pit lakes. Physico-chemical characteristics and phytoplankton composition of representative Tilapia water bodies are described. Blue-green algae and fine flocculent detritus are dominant food items in the diet of the Tilapia, while Rotifera and microcrustacea are also important in the diet of larvae and juveniles. Intraspecific diet overlap among ontogenetic stages of the Tilapia did not differ significantly from 1, which means that these diets showed complete overlap. Interspecific diet overlap between the Tilapia and the indigenous armoured catfish Hoplosternum littoralewere moderate or low. The results are discussed in relation to recent developments in the Surinamese fisheries and aquaculture sector.

60,000 years of interactions between Central and Eastern Africa documented by major African mitochondrial haplogroup L2

Mitochondrial DNA (mtDNA) haplogroup L2 originated in Western Africa but is nowadays spread across the entire continent. L2 movements were previously postulated to be related to the Bantu expansion, but L2 expansions eastwards probably occurred much earlier. By reconstructing the phylogeny of L2 (44 new complete sequences) we provide insights on the complex net of within-African migrations in the last 60 thousand years (ka). Results show that lineages in Southern Africa cluster with Western/Central African lineages at a recent time scale, whereas, eastern lineages seem to be substantially more ancient. Three moments of expansion from a Central African source are associated to L2: (1) one migration at 70-50 ka into Eastern or Southern Africa, (2) postglacial movements (15-10 ka) into Eastern Africa; and (3) the southward Bantu Expansion in the last 5 ka. The complementary population and L0a phylogeography analyses indicate no strong evidence of mtDNA gene flow between eastern and southern populations during the later movement, suggesting low admixture between Eastern African populations and the Bantu migrants. This implies that, at least in the early stages, the Bantu expansion was mainly a demic diffusion with little incorporation of local populations.

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.

Extensive admixture and selective pressure across the Sahel Belt

Genome-wide studies of African populations have the potential to reveal powerful insights into the evolution of our species, as these diverse populations have been exposed to intense selective pressures imposed by infectious diseases, diet, and environmental factors. Within Africa, the Sahel Belt extensively overlaps the geographical center of several endemic infections such as malaria, trypanosomiasis, meningitis, and hemorrhagic fevers. We screened 2.5 million single nucleotide polymorphisms in 161 individuals from 13 Sahelian populations, which together with published data cover Western, Central, and Eastern Sahel, and include both nomadic and sedentary groups. We confirmed the role of this Belt as a main corridor for human migrations across the continent. Strong admixture was observed in both Central and Eastern Sahelian populations, with North Africans and Near Eastern/Arabians, respectively, but it was inexistent in Western Sahelian populations. Genome-wide local ancestry inference in admixed Sahelian populations revealed several candidate regions that were significantly enriched for non-autochthonous haplotypes, and many showed to be under positive selection. The DARC gene region in Arabs and Nubians was enriched for African ancestry, whereas the RAB3GAP1/LCT/MCM6 region in Oromo, the TAS2R gene family in Fulani, and the ALMS1/NAT8 in Turkana and Samburu were enriched for non-African ancestry. Signals of positive selection varied in terms of geographic amplitude. Some genomic regions were selected across the Belt, the most striking example being the malaria-related DARC gene. Others were Western-specific (oxytocin, calcium, and heart pathways), Eastern-specific (lipid pathways), or even population-restricted (TAS2R genes in Fulani, which may reflect sexual selection).

Girls out of school. State, culture and education in poor rural Lao People's Democratic Republic

Tese de Doutoramento em Sociologia

Design of mechatronic system for handling bedridden people

Dissertação de mestrado em Engenharia Mecatrónica

Psychosocial factors associated with adherence to treatment and quality of life in people living with HIV/AIDS in Brazil

Objective: The objective of this article was to investigate the biopsychosocial factors that influence adherence to treatment and the quality of life of individuals who have been successfully following the HIV/AIDS treatment. Methods: It is a cross-sectional study carried out with 120 HIV positive participants in the south of Brazil. Among the variables studied, of note are: perceived stress, social support, symptoms of anxiety and depression and quality of life. Results: The results show that a moderate to high adherence to the treatment paired with a strong sense of social support indicate a higher quality of life. Conclusion: The combination of social support and antiretroviral treatment have an impact on physical conditions, improving immune response and quality of life.

A genetic perspective on African prehistory

The various genetic systems (mitochondrial DNA, the Y-chromosome and the genome-wide autosomes) indicate that Africa is the most genetically diverse continent in the world and the most likely place of origin for anatomically modern humans. However, where in Africa modern humans arose and how the current genetic makeup within the continent was shaped is still open to debate. Here, we summarize the debate and focus especially on the maternally inherited mitochondrial DNA (mtDNA) and a recently revised chronology for the African mtDNA tree. We discuss the possible origin of modern humans in southern, eastern or Central Africa; the possibility of a migration from southern to eastern Africa more than 100 ka, carrying lineages within mtDNA haplogroup L0; the evidence for a climate-change-mediated population expansion in eastern Africa involving mtDNA haplogroup L3, leading to the “out-of-Africa” migration around 70–60 ka; the re-population of North Africa from the Near East around 40–30 ka suggested by mtDNA haplogroups U6 and M1; the evidence for population expansions and dispersals across the continent at the onset of the Holocene ; and the impact of the Bantu dispersals in Central, eastern and southern Africa within the last few millennia.

The internet in young people's everyday life: listening to portuguese teens' voices

[Excerto] Children and young people today go about their lives in an increasingly mediatized fashion. Their daily lives are inhabited by a variety of media, ranging from the so-called new media to the more traditional ones, which have an impact on how they perceive, get to kno,v and represent the world, how they interact with others, how they build their identity, and how they study, have fun and organize their daily lives. The media ecosystem, namely the digit.:tl environments, opened up opportunities to communicate, participate, create and produce information. Apparently, children and young people now have more means and opportunities at their disposal to express and share their ideas, interests and opinions, but are they actually taking advantage of such potential? \'(that uses are they making of these means? Does the Internet, in fact, enable the younger generations to create a new communication culture of expression and participation (...)?

A gestão do desempenho como prática de implementação participada de um plano estratégico: o caso do Banco de Moçambique

Dissertação de Mestrado em Políticas Desenvolvimento dos Recursos Humanos

Mercados emergentes en el escenario africano: oportunidades y desafíos para la política exterior argentina. Emergent markets in the African scene: opportunities and challenges for the Argentine foreign policy.

Este trabajo parte de la inquietud de cómo organizar y articular los recursos diplomáticos, económicos, tecnológicos y culturales que cuenta la Argentina en África, para incentivar e incrementar las vinculaciones entre ambas regiones. Teniendo en cuenta los nuevos escenarios emergentes del espacio africano y los lineamientos de política exterior ensayados por nuestro país en los últimos años, nuestro período de análisis se concentrará entre los años 2002 y 2007. Sostenemos que el desarrollo de una estrategia articulada y permanente hacia el África requiere un aprovechamiento más eficaz y eficiente de los recursos humanos, financieros y tecnológicos existentes. De esto modo, la Argentina podría posicionarse como un socio relevante en la agenda de los países africanos, proveyendo productos, tecnología y servicios a mercados complementarios y en expansión. El objetivo general del proyecto es reconocer las transformaciones recientes del diseño exterior argentino hacia los mercados emergentes, en particular hacia África.El abordaje de esta investigación tiene características tanto cualitativas como cuantitativas, al tiempo que pretende alcanzar un nivel de explicación debido al tipo de propuesta. Nuestras unidades de observación son aquellas instituciones y personalidades vinculadas a la elaboración e implementación de la política exterior de Argentina hacia los estados africanos en su conjunto (tanto de África Subsahariana como de África del Norte). En cuanto a las técnicas aplicadas se pueden reconocer diversas fases. En primera instancia se llevará adelante una exploración documental en la Cancillería argentina destinada a cubrir los principales lineamientos respecto al tema. Luego se revisarán documentos producidos por organismos privados y por investigadores científicos. Al mismo tiempo se realizarán entrevistas semiestructuradas a los actores claves que participaron en el proceso de toma de decisiones.Con este trabajo nos proponemos concretar un manual que contenga de forma sistemática las normativas y las prácticas que ejercen cada uno de los actores, tanto públicos como privados, en torno a las vinculaciones entre Argentina y los países de África. Este ordenamiento nos permitirá ofrecer a los responsables de tomas de decisiones un marco articulado, accesible y didáctico para el diseño y la ejecución de futuras políticas hacia la región. Actualmente, los lazos políticos, culturales y de cooperación entre los países de ambas regiones manifiestan un creciente dinamismo, poniendo en juego nuevos terrenos de colaboración como las Cumbres América del Sur-África, las reuniones inter-ministeriales, la firma de acuerdos de comercio entre el Mercosur y algunos estados africanos, entre otros. Sin embargo a pesar de estas señales auspiciosas, los mercados africanos no han sido explorados con la suficiente constancia y profundidad. El desarrollo de este proyecto permitirá, en primer lugar, constituir un corpus de información sobre las normativas y las prácticas en torno los vínculos argentino-africanos. Por otro lado, será una herramienta indispensable para la planificación y concreción de futuras políticas en torno al área. Cabe aclarar que no se limita a organismos del Estado sino también involucraría a actores privados implicados o interesados con los mercados emergentes africanos.

Percepción y uso de flora y fauna por parte de los pobladores del sistema Laguna Mar Chiquita - Bañados del Río Dulce y área de influencia: diagnóstico e implicaciones para la conservación. Perception and use of flora and fauna by people of the system "Laguna Mar Chiquita - Bañados del Río Dulce" and it influence area: diagnosis and conservation implications.

La percepción, consumo y manejo de recursos naturales forma parte del conocimiento tradicional de distintas poblaciones humanas e involucra diversidad de actividades (recolección de plantas, caza y pesca, etc). Entre los vegetales, el uso de plantas medicinales se destaca por su persistencia y ubicuidad. El recurso animal, a través de la caza y la pesca, es fundamental como fuente de alimento y empleo. El sistema Mar Chiquita-Bañados del Río Dulce se destaca por su biodiversidad y la existencia de prácticas tradicionales de uso. La presión por conversión de ambientes naturales a tierras dedicadas al cultivo es fuerte, afectando principalmente a los bosques autóctonos, y las especies animales que en él habitan. Además, la desaparición de ambientes naturales conlleva la pérdida de prácticas tradicionales de uso, con la consiguiente deculturación. El presente trabajo evaluará la percepción y utilización de recursos naturales por los pobladores del área de influencia de Bañados del Río Dulce y Laguna Mar Chiquita, centrándose en plantas medicinales, peces, aves y mamíferos, a la vez de indagar sobre la diversidad de percepciones y conductas de apropiación de los recursos, dado que en la región coexisten diferentes pautas socio-culturales de acuerdo al grupo de procedencia. Como metodología básica para la recolección de datos de percepción y uso se utilizarán encuestas semi-estructuradas. Sobre el origen étnico y lazos sociales se relevarán de fuentes escritas sobre procedencia, pautas de elección de pareja y formas de residencia. Los muestreos de fauna a campo se realizarán al azar estratificados en pastizal, bosque, y áreas relacionadas a humedales en busca de huellas, heces y señales de la presencia de especies animales focales, a la vez de prospección visual y auditiva. Los datos obtenidos acerca del conocimiento y uso del ambiente se presentarán y analizarán mediante técnicas específicas para análisis de datos antropológicos cualitativos y madiante ANOVA. Los datos sobre origen y lazos serán analizados según indicadores de endogamia geográfica e indicadores de endogamia reproductiva. Los datos de presencia de las especies se utilizarán para desarrollar modelos de distribución regional y de nicho ecológico. Se espera caracterizar en forma diferencial la percepción y uso del ambiente de acuerdo al origen o área de residencia, a la vez de generar mapas de distribución de especies focales. Asimismo, se propondrán acciones de conservación de la biodiversidad, tales como cartillas o talleres tendientes a reforzar y re-significar los conocimientos locales sobre el uso de flora y fauna.

The Irish pub as a third place : a sociological exploration of people, place and identity

There is considerable interest in alcohol in Irish society, yet minimal sociologcial understanding of its consumption, particularly of the sites where most drinking occurs: the country's 8750 pubs. Despite widespread public discussions on the role of the pub, there is scant social science evidence to better inform debate. Pubs are central to Irish community and are key sites of social interaction. American sociologist Ray Oldenburg has argued that "third places" (neither workplace nor home) are crucial to the maintenance of the community and the enhancement of social capital. According to Oldenburg, the role of the third place in the community is to provide continuity, regularity, a sense of place - all of which conceptually contribute to the construction of the self, the projection of the self within the public sphere, the distribution of social capital and the generation of a collective identity. The pub is the archetypal third place, but Oldenburg is concerned that modern pubs are less able to provide this vital function. Social scientists have suggested that community is in a state of fragmentation and decline due to changes in modes of social interaction and a decrease in shared spaces, resulting in a weakened connection to place. Community without propinquity has been characterised by social alienation, fragmentation and what Oldenburg refers to as the "problem of place" (13). Third places, and thus the Irish pub, have been particularly affected. In order to increase the sociological knowledge of the pub in Ireland, this project critically engages with the pub to assess the importance that public drinking houses have in the everyday. Moreover, this research sets out to investigate the people/place relationship using the pub as an investigative lens and examine the ways in which people shape place, place shapes people and how that relationship is implicated in the construction of irish identities. Furthermore, this is also an articulation of a cultural shift within Ireland and Irish places whose effects are deep and multi-layered. This project aims to explore the development of the contemporary geography of identity as the irish pub as a third place is transformed or disappears from the social landscape.

Silent voices : the recreational needs of disabled young people : an emancipatory approach

The recreational needs of young people with.disabilities in Sligo county were examined using an emancipatory approach that provided an accurate reflection on the perspectives of the disabled young people. The aim of this study included a comparison of access to and attitudes towards leisure activities as between disabled and non-disabled young people in the Sligo area. The hypothesis set out by the researcher was the expectation that findings would include a degree of disadvantage in access and participation in leisure activities for young people with disabilities vis a vis their counterparts. The way in which this was tested was by focus groups and interviews. This hypothesis was adequately proven along with an in-depth range of recommendations for improvement that were made by participants. The study’s emancipatory research methods ensured that the voice of the participants was heard regarding their recreational needs and the disabling barriers that needed to be removed.