Inappropriate medication use in long-term care facility residents with advanced Alzheimer’s disease and other dementias

Les personnes atteintes de démence sévère, résidant dans un centre d’hébergement et de soins de longue durée (CHSLD) et approchant la fin de leur vie, ne reçoivent pas systématiquement des soins palliatifs, malgré que ce niveau de soins soit le plus approprié. La plupart de ces personnes reçoivent également un grand nombre de médicaments dont les effets indésirables peuvent contribuer à des souffrances évitables. Une approche axée sur les soins palliatifs serait possiblement associée à une réduction de la charge médicamenteuse et, du même coup, à une prescription plus appropriée. Les objectifs de ce projet de recherche étaient de décrire l’usage des médicaments chez les résidents atteints de démence sévère en CHSLD, de comparer leur usage de médicaments à des critères de pertinence et d’évaluer si la mise en œuvre d’une approche axée sur les soins palliatifs était associée aux médicaments prescrits. Cette étude décrit l’usage des médicaments chez 215 sujets atteints de démence sévère et en fin de vie qui ont participé à une étude d’intervention quasi expérimentale menée dans quatre CHSLD du Québec sur la mise en œuvre d’une approche axée sur les soins palliatifs. L’utilisation des médicaments a été comparée à trois listes de critères pertinents publiés, soit ceux de Holmes, Rancourt et Kröger, en utilisant des statistiques descriptives. Les analyses sur l’usage de 412 médicaments différents chez 120 sujets du groupe expérimental et 95 sujets du groupe témoin ont montré que cette approche axée sur les soins palliatifs n’est pas associée à une prescription plus appropriée des médicaments chez ces personnes particulièrement vulnérables.

L’expérience des intervenants dans l’accompagnement vers le rétablissement des personnes vivant dans les milieux de soins de longue durée en psychiatrie

Cette étude qualitative porte sur l’expérience des intervenants dans l’accompagnement au rétablissement dans les unités d’hébergement et de soins de longue durée en psychiatrie de l’Institut universitaire en santé mentale de Québec, avec un intérêt particulier pour les difficultés et les éléments facilitant cette expérience. Neufs intervenants de différentes professions (infirmiers, professionnels, éducateurs spécialisés) ont été rencontrés entre février et juin 2014. Chacun a participé à une entrevue semi-dirigée et complété le Recovery Attitude Questionnaire, version à 7 items (RAQ-7). Les entrevues ont fait l’objet d’une analyse de contenu thématique, complétée par une analyse des pointages provenant du RAQ-7. Résultats : Trois composantes de l’expérience d’accompagnement sont inter-reliées et s’inter-influencent : l’espoir (croire), l’implication et l’attachement envers la personne aidée. Une attitude positive envers le rétablissement, la compréhension de ce concept comme processus personnel et le fait de côtoyer des collègues qui croient en la possibilité d’un rétablissement influencent positivement l’expérience. En parallèle, le fait d’être confronté à des usagers-résidents présentant des symptômes importants, une culture d’intervention orientée vers la stabilisation des symptômes et un vécu d’intervention marqué par l’échec influencent négativement l’expérience. Conclusions et implications : L’expérience d’accompagnement au rétablissement est donc influencée par différents facteurs individuels et environnementaux (voir : environnement organisationnel). La connaissance de ces facteurs peut favoriser une implantation réussie de modes d’intervention favorables au rétablissement des usagers dans les milieux d’hébergement et de soins de longue durée en psychiatrie. Mots clés : rétablissement, maladie mentale sévère, Centre d’hébergement et de soins de longue durée, vécu des intervenants, intervenants, interventions, pratiques orientées vers le rétablissement.

Dynamics and dilemmas in social psychology: social relations, identities and cognition

This paper aims to provide a systematised overview of the paradigmatic orientations in social psychology in Portugal by identifying the most cited publications. Results show that the eight most cited thematic are: (1) deviance and reactions to deviance, (2) methodology, (3) prejudice and discrimination, (4) gender studies, (5) risk, environment and safety, (6) information processing, social judgment, familiarity and mood, (7) social representations and (8) social justice and belief in a just world. These eight most salient thematics can be sorted into three current paradigmatic orientations in contemporary social psychology: (a) social cognition; (b) the study of collective beliefs, ideologies and social representations; and (c) the study of identity and its impact on intra- and intergroup processes. The paper finishes with a reflection on the future developments of the discipline and the dilemmas that social psychology in Portugal could face.

Student’s Engagement in School: Conceptualization and relations with Personal Variables and Academic Performance

This article reviews the literature regarding Student’s Engagement in School (SES), its relationship with personal variables, as well as with academic performance. Although SES’ conceptualization may vary across studies, there is general agreement concerning the multidimensional nature of this construct, encompassing three dimensions – cognitive, affective and behavioural. It is seen as an antecedent of several required outcomes, at academic level, but also as a valorous construct itself, both as mediator and product. More particularly, this concept has been the focus of debate concerning academic success and school dropout. There can also be found a significant number of studies which suggest that personal (self-efficacy, self-concept), as well as contextual (peers, school, family) factors are related with school engagement; additionally, the lack of engagement is linked with low academic performance, behavioural problems and school dropout. Thus, Student’s Engagement in School is perceived as a potentially effective response to the problems affecting schools and their students, and an aspect to be considered in preventing problematic patterns related to scholary contexts.

Reciprocal relations across time between basic values and value-expressive behaviors: A longitudinal study among children

Tracing children’s values and value-expressive behavior over a sixth-month period, we examined stability and change of values and behavior and the reciprocal relations between them. Three hundred and ten sixth-grade students in Italy completed value and value-expressive behavior questionnaires three times in three-month intervals during the scholastic year. We assessed Schwartz's (1992) higher-order values of conservation, openness to change, self-enhancement, and self-transcendence, as well as their respective expressive behaviors. Reciprocal relations over time between values and behaviors were examined using a cross-lagged longitudinal design. Results showed that values and behaviors had reciprocal longitudinal effects on one another, after the stability of the variables was taken into account (i.e., values predicted change in behaviors, but also behaviors predicted change in values). Our findings also revealed that: (1) values were more stable over time than behaviors, and (2) the longitudinal effect of values on behaviors tended to be stronger than the longitudinal effect of behaviors on values. Findings are discussed in light of the recent developmental literature on value change.

Survival or Sustainability? Contributions of Innovatively-Managed News Ventures to the Future of Egyptian Journalism

In the repressive political climate prevailing in Egypt in 2013-15, news ventures aspiring to high standards of reporting were forced to innovate. This paper analyses three Egyptian start-ups that experimented with novel revenue streams and news services during that period, to gain insights into their approaches to managing journalism. In the process it compares different criteria for assessing sustainability and concludes that, in adverse political environments, narrow economic measures of profitability and survival may give a misleading picture as to the sustainability of the kind of journalism conducive to democratic practice. Operating collaboratively, transparently and ethically may slow productivity and profitability in the short term while laying stronger foundations for durable relations among media teams, as well as with readers and advertisers, in the long run.

Real-time energy resources scheduling considering short-term and very short-term wind forecast

This paper proposes an energy resources management methodology based on three distinct time horizons: day-ahead scheduling, hour-ahead scheduling, and real-time scheduling. In each scheduling process it is necessary the update of generation and consumption operation and of the storage and electric vehicles storage status. Besides the new operation condition, it is important more accurate forecast values of wind generation and of consumption using results of in short-term and very short-term methods. A case study considering a distribution network with intensive use of distributed generation and electric vehicles is presented.

As relações públicas para além das guest relations: relatório de estágio no grupo Porto Bay Hotels & Resorts

Foi realizado um estágio no grupo Porto Bay Hotels & Resorts, um grupo hoteleiro da Região Autónoma da Madeira, com a duração de três meses. Apresenta-se assim no presente trabalho uma perspectiva das Relações Públicas no sector do turismo e hotelaria bem como a discussão do porquê do afunilamento desta função de gestão das relações entre as organizações e os seus públicos nas Guest Relations em algumas das unidades hoteleiras em que trabalhámos. O turismo é actualmente um dos principais sectores da economia mundial. A sobrevivência de um destino turístico, unidade hoteleira ou mesmo de um resort, depende em muito da percepção que os seus stakeholders têm da qualidade dos seus serviços. Assim as Relações Públicas, como em outros sectores, assumem um papel de destaque sendo que estas têm a capacidade de trabalhar a relação entre uma organização e os seus stakeholders, gerindo conflitos e expressando uma identidade positiva sobre a mesma e trabalhando a sua reputação e visibilidade. Em suma este trabalho pretende compreender e reflectir sobre as relações públicas no sector do turismo e hotelaria mesmo quando não o são assim entendidas. Defender-se-á uma perspectiva global, integrada e proactiva das Relações Públicas no sector hoteleiro.

Optimização da lista de células vizinhas em redes LTE

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia de Electrónica e Telecomunicações

Use of a fluorescence-based approach to assess short-term responses of the alga Pseudokirchneriella subcapitata to metal stress

This work explores the use of fluorescent probes to evaluate the responses of the green alga Pseudokirchneriella subcapitata to the action of three nominal concentrations of Cd(II), Cr(VI), Cu(II) and Zn(II) for a short time (6 h). The toxic effect of the metals on algal cells was monitored using the fluorochromes SYTOX Green (SG, membrane integrity), fluorescein diacetate (FDA, esterase activity) and rhodamine 123 (Rh123, mitochondrial membrane potential). The impact of metals on chlorophyll a (Chl a) autofluorescence was also evaluated. Esterase activity was the most sensitive parameter. At the concentrations studied, all metals induced the loss of esterase activity. SG could be used to effectively detect the loss of membrane integrity in algal cells exposed to 0.32 or 1.3 μmol L−1 Cu(II). Rh123 revealed a decrease in the mitochondrial membrane potential of algal cells exposed to 0.32 and 1.3 μmol L−1 Cu(II), indicating that mitochondrial activity was compromised. Chl a autofluorescence was also affected by the presence of Cr(VI) and Cu(II), suggesting perturbation of photosynthesis. In conclusion, the fluorescence-based approach was useful for detecting the disturbance of specific cellular characteristics. Fluorescent probes are a useful diagnostic tool for the assessment of the impact of toxicants on specific targets of P. subcapitata algal cells.

Three essays in risky behaviors

A PhD Dissertation, presented as part of the requirements for the Degree of Doctor of Philosophy from the NOVA - School of Business and Economics

What hides behind the fixed-term contracts wage gap?

In Portugal, about 20% of full-time workers are employed under a fixed-term contract. Using a rich longitudinal matched employer-employee dataset for Portugal, with more than 20 million observations and covering the 2002-2012 period, we confirm the common idea that fixed-term contracts are not desirable when compared to permanent ones, by estimating a conditional wage gap of -1.7 log points. Then, we evaluate the sources of that wage penalty by combining a three way high-dimensional fixed effects model with the decomposition of Gelbach (2014), in which the three dimensions considered are the worker’s unobserved ability, the firm’s compensation wage policy and the job title effect. It is shown that the average worker with a fixed-term contract is less productive than his/her permanent counterparts, explaining -3.92 log points of the FTC wage penalty. Additionally, the sorting of workers into lower-paid job titles is also responsible for -0.59 log points of the wage gap. Surprisingly, we found that the allocation of workers among firms mitigates the existing wage penalty (in 4.23 log points), as fixed-term workers are concentrated into firms with a more generous compensation policy. Finally, following Figueiredo et al. (2014), we further control for the worker-firm match characteristics and reach the conclusion that fixed-term employment relationships have an overrepresentation of low quality worker-firm matches, explaining 0.65 log points of the FTC wage penalty.

Long-term outcome after cognitive and behavioral regression in nonlesional epilepsy with continuous spike-waves during slow-wave sleep.

PURPOSE: To present the long-term follow-up of 10 adolescents and young adults with documented cognitive and behavioral regression as children due to nonlesional focal, mainly frontal, epilepsy with continuous spike-waves during slow wave sleep (CSWS). METHODS: Past medical and electroencephalography (EEG) data were reviewed and neuropsychological tests exploring main cognitive functions were administered. KEY FINDINGS: After a mean duration of follow-up of 15.6 years (range, 8-23 years), none of the 10 patients had recovered fully, but four regained borderline to normal intelligence and were almost independent. Patients with prolonged global intellectual regression had the worst outcome, whereas those with more specific and short-lived deficits recovered best. The marked behavioral disorders resolved in all but one patient. Executive functions were neither severely nor homogenously affected. Three patients with a frontal syndrome during the active phase (AP) disclosed only mild residual executive and social cognition deficits. The main cognitive gains occurred shortly after the AP, but qualitative improvements continued to occur. Long-term outcome correlated best with duration of CSWS. SIGNIFICANCE: Our findings emphasize that cognitive recovery after cessation of CSWS depends on the severity and duration of the initial regression. None of our patients had major executive and social cognition deficits with preserved intelligence, as reported in adults with early destructive lesions of the frontal lobes. Early recognition of epilepsy with CSWS and rapid introduction of effective therapy are crucial for a best possible outcome.

Relations intergroupes : attribution à la discrimination et perception d'hostilité chez autrui

Résumé: La thèse que nous présentons s'intéresse aux phénomènes d'attribution d'intentions hostiles. Dodge (1980) observe que les individus agressifs ont tendance, en situation ambiguë, à sur-attribuer des intentions hostiles à leurs pairs, ce qui induit des réponses agressives. Pour l'auteur, l'attribution d'intentions hostiles est un médiateur entre certaines caractéristiques personnelles (l'agressivité) des individus, et le type de réponses qu'ils apportent aux situations. Cependant, les informations concernant l'appartenance groupale des "pairs" ne sont jamais prises en compte dans leurs études. Si ce processus est perméable à l'influence des normes et croyances (Bègue et Muller, 2006), aucune étude ne met en évidence quel serait l'impact d'informations groupales sur l'élaboration des réponses aux situations, dans le cadre de ce modèle. L'objectif de cette thèse est de montrer que l'attribution d'intentions hostiles peut être envisagée comme un processus agissant également à un niveau intergroupes et donc prenant en compte des informations groupales sur les individus. En s'inspirant du modèle de Dodge, nous avons émis l'hypothèse que les logiques intergroupes intervenaient dans l'interprétation des intentions des acteurs impliqués dans les interactions, afin de produire une réponse adaptée aux logiques intergroupes. Afin de tester cette hypothèse, nous avons suivi trois axes de recherches: Dans le premier de ces axes, nous avons introduit, dans le paradigme de Dodge, des informations .sur l'appartenance groupale des protagonistes de l'interaction (endogroupe vs exogroupe). Nous avons montré que le type de situation (ambiguë vs hostile) est moins important que l'information groupale dans la production d'une réponse à la situation (Étude 1). En outre, nous avons mis en évidence des processus différents selon la position des individus dans leur groupe (Étude 2). Dans le second axe, nous avons montré que si les différences de statut entre groupes n'influençaient pas directement le modèle de Dodge, elles interagissaient avec l'appartenance groupale et la clarté de la situation au niveau de l'attribution d'intentions hostiles (étude 3) et des intentions comportementales (Ettide 4). Dans le troisième et deriúer axe, nous avons introduit l'attribution d'intentions hostiles dans un processus de dévalorisation d'une cible expliquant un échec par la discrimination (Kaiser et Miller, 2001; 2003). Nous avons alors montré que l'attribution d'intentions hostiles médiatisait le lien entre l'attribution mobilisée pour expliquer l'événement et l'évaluation de la cible (Étude 5), et que ce type d'attribution était spécifique, aux intentions comportementales agressives (Études 6). Nous avons alors conclu sur la dimension sociale de l'attribution d'intentions hostiles et sur le fait qu'il s'agissait d'un élément permettant la construction d'une représentation des interactions sociales. Abstract The present thesis focuses on the phenomena of hostile intents attribution. Dodge (1980) observes that in ambiguous situations, aggressive people tend to over attribute hostile intents to others. This attribution leads them to respond aggressively. According to the author, hostile intents attribution mediates the link between some personal characteristics (aggressiveness for example) of individuals and their responses to the situation. However information related to participants group membership is always neglected in these studies. Begue and Muller (2006) showed that some beliefs could moderate the interaction between aggressiveness and hostile intents attribution on behaviors, but no study exhibited evidence of a similar effect with social information. The aim of this thesis is to show that hostile intents attribution needs to be considered at an intergroup level by taking into account people's group ineinbership. Based on the Dodge model, we formulated the hypothesis that intergroup strategies had an impact on actors' intents interpretations which in return should lead to different but adapted reactions to the situation. To test this hypothesis, three lines of research were developed. In the first line, we introduced, in the Dodge's paradigm, some information about the participants group membership (ingroup vs outgroup). We showed that when elaborating a response to a specific situation its nature (ambiguous vs hostile) had less impact than group membership information (Study 1). In addition, we highlighted some different processes according to the position of individuals in their group (Study 2). In the second line, we showed that if the differences between groups status didn't influence the Dodge model, they interacted with group membership and situation nature to influence hostile intents attribution (Study 3) and behaviors intents (Study 4). In the last line of research, we introduced hostile intents attribution within the process of derogation of a target explaining its failure by discrimination (Kaiser and Miller, 2001; 2003). We showed that hostile intents attribution mediated the link between the attibution mobilized to explain the failure and the derogation of the target (Study 5), and that this attribution type was specifically linked to aggressive behavior intents (Study 6). We finally concluded that hostile intents attribution imply an important social dimension which needs to be taken into account because involved in the construction of a representation of social interactions.

Impaired left ventricular function as a predictive factor for mid-term survival in octogenarians after primary coronary artery bypass surgery.

BACKGROUND: The impact of preoperative impaired left ventricular ejection fraction (EF) in octogenarians following coronary bypass surgery on short-term survival was evaluated in this study. METHODS: A total of 147 octogenarians (mean age 82.1 ± 1.9 years) with coronary artery diseases underwent elective coronary artery bypass graft between January 2000 and December 2009. Patients were stratified into: Group I (n = 59) with EF >50%, Group II (n = 59) with 50% > EF >30% and in Group III (n = 29) with 30% > EF. RESULTS: There was no difference among the three groups regarding incidence of COPD, renal failure, congestive heart failure, diabetes, and preoperative cerebrovascular events. Postoperative atrial fibrillation was the sole independent predictive factor for in-hospital mortality (odds ratio (OR), 18.1); this was 8.5% in Group I, 15.3% in Group II and 10.3% in Group III. Independent predictive factors for mortality during follow up were: decrease of EF during follow-up for more that 5% (OR, 5.2), usage of left internal mammary artery as free graft (OR, 18.1), and EF in follow-up lower than 40% (OR, 4.8). CONCLUSIONS: The results herein suggest acceptable in-hospital as well short-term mortality in octogenarians with impaired EF following coronary artery bypass grafting (CABG) and are comparable to recent literature where the mortality of younger patients was up to 15% and short-term mortality up to 40%, respectively. Accordingly, we can also state that in an octogenarian cohort with impaired EF, CABG is a viable treatment with acceptable mortality.