Indícios de Abuso e Maus Tratos em Idosos no Distrito de Leiria

A violência é um tema relevante na actualidade. O aumento do número de idosos no nosso país, a existência de factores inerentes à decadência física, psíquica e social dos idosos, podem levar ao agravamento de situações de maus-tratos. Por tudo isto, foi realizado um estudo quantitativo, descritivo, analítico e correlacional, que teve como objectivo, identificar a presença de indícios de abuso nos idosos no distrito de Leiria, relacionando os mesmos com variáveis sócio-demográficas, económicas, psicossociais e de caracterização do estado de saúde. Para o levantamento dos dados utilizamos o Mini Mental State; avaliação; a Questions to Elicit Elder Abuse, o índice de Katz e, por fim, um questionário sobre os dados sócio-demográficos do idoso. Foram inquiridos 85 idosos, com mais de 65 anos e sem défices cognitivos. Os resultados mostram 96% de indícios de abusos na população, sendo que o abuso emocional foi o mais observado. Constatou-se que os idosos que percepcionam o seu estado de saúde como mau têm maiores indícios de negligência. Verificou-se também que quanto maiores as capacidades cognitivas dos idosos, menores os indícios de abusos. / Nowadays, violence is a very important theme to analyse. In our country, the elderly increase as well as the inherent factors on physical, mental and social decay, can provide situations of ill-treatment. For all this, was realized a quantitative, descriptive, analytical and correlational study, who aimed to identify in Leiria district, the presence of abuse signs in the elderly, correlating them with socio-demographic, economic, psychological and health variables. For data collection, we used the Mini Mental State, Questions to Elicit Elder Abuse, Katz index, and a questionnaire about elderly sociodemographic database. 85 elderly patients over 65 years without cognitive deficits, were questioned. The results reveal that 96% of respondents are victims of ill-treatment, mostly on emotional way. It was checked that negligence is more evident in those who perceive their poor health. Also was concluded that the abuse signs of elderly are smaller when their cognitive abilities are greater.

Why do Women Sue?

Statistics published by the National Health Service Litigation Authority relating to ten years of maternity claims provoke a sharp intake of breath. The total value of these claims over the first decade of the 21st century was £3,117,649,888 (NHS Litigation Authority 2012). The United Kingdom is not the only country to witness an astronomical increase in the level of litigation relating to maternity services. As far afield as Saudi Arabia (Henary et al 2012) and the United States (Berkowitz 2011), reports are being published of the demands on maternity budgets as a result of dissatisfaction with care received during pregnancy, labour and birth. The papers referenced above attribute adverse outcomes to negligence, misdiagnosis, surgical blunders and inefficient administration. Berkowitz(2011:7) suggests that what is needed is wholesale and whole-hearted adoption of ‘…electronic fetal monitoring [EFM] certification for all staff working on their Labor and Delivery floor, protocols for managing common clinical scenarios, simulation drills for dealing with uncommon dangerous events, and pre-procedure checklists’. The NHS Litigation Authority (2012:5) recommends that Trusts ‘…engage with the risk management process at all levels; provide suitable learning and training; ensure appropriate supervision and support; have in place up-to-date protocols and guidance with which staff are familiar; learn lessons from claims’. It is relatively easy to ensure that staff are sent on fetal heart rate (FHR) training days (although whether use of EFM produces better outcomes has, of course, never been clearly demonstrated (Alfirevic et al 2013) and that protocols for managing events during labour and birth are drawn up and even put into practice. It’s uncertain, however, whether doing so will make the problem of maternity litigation go away. There is something ‘rotten in the state of Denmark’ that is fuelling women’s dissatisfaction and which ‘the system’ has not been able to get its head round.

Trust, confidence, and equity affect the legitimacy of natural resource governance

Social-ecological systems are often highly complex, making effective governance a considerable challenge. In large, heterogeneous systems, hierarchical institutional regimes may be efficient, but effective management outcomes are dependent on stakeholder support. This support is shaped by perceptions of legitimacy, which risks being undermined where resource users are not engaged in decision-making. Although legitimacy is demonstrably critical for effective governance, less is known about the factors contributing to stakeholders’ perceptions of legitimacy or how these perceptions are socially differentiated. We quantitatively assessed stakeholder perceptions of legitimacy (indicated by support for rules) and their contributory factors among 307 commercial fishers and tourism operators in Australia’s Great Barrier Reef Marine Park. Legitimacy was most strongly associated with trust in information from governing bodies, followed by confidence in institutional performance and the equity of management outcomes. Legitimacy differed both within and among resource user groups, which emphasizes the heterogeneous nature of commonly defined stakeholder groups. Overall, tourism operators perceived higher legitimacy than did commercial fishers, which was associated with higher trust in information from management agencies. For fishers, higher levels of trust were associated with: (1) engagement in fisheries that had high subsector cohesion and positive previous experiences of interactions with governing bodies; (2) location in areas with greater proximity to sources of knowledge, resources, and decision-making; and (3) engagement in a Reef Guardian program. These findings highlight the necessity of strategies and processes to build trust among all user groups in large social-ecological systems such as the Great Barrier Reef Marine Park. Furthermore, the social differentiation of perceptions that were observed within user groups underscores the importance of targeted strategies to engage groups that may not be heard through traditional governance channels.

La inevitable inconsistencia del Zeus/Júpiter épico

Durante años la investigación literaria ha encontrado fruición en buscar y encontrar inconsistencias narrativas en la Tebaida de Estacio. Concretamente, hay cierto grado de consenso respecto a que las incongruencias en que incurre Júpiter son debidas a negligencia o incuria por parte del poeta. De hecho, no se puede negar que el soberano del cielo se contradice en las ocasiones en que alude a su relación con el Destino. No obstante, no será únicamente el poeta flavio el objeto de mi atención en este artículo. Hoy día se continúa acudiendo a la autoridad filosófica de Séneca (fundamentalmente a Dial. 1.5.8) siempre que el Zeus/Júpiter poshomérico (también el virgiliano) incurre en lo que hemos dado en considerar «incoherencias». Sin embargo, excepción hecha de las composiciones hesiódicas, el estatuto teológico de Zeus/Júpiter es altamente inestable en toda la tradición literaria griega y romana. Quizá deberíamos aceptar, entonces, que durante siglos los que estudiamos literatura antigua hemos tendido a prescindir de la voz autorial y de su autoridad omnímoda para manipular el material literario preexistente con el objeto de generar nuevos significados y nuevas cosmovisiones. En definitiva, nos hemos mostrado proclives a calificar de inconsistencias todo aquello que no se adecua a nuestras expectativas o prejuicios.

Student attitudes to plagiarism and collusion within computer science

There is a widespread perception among staff in Computer Science that plagiarism is a major problem particularly in the form of collusion in programming exercises. While departments often make use of electronic detection measures, the time consumed prosecuting plagiarism offences remains a problem. As a result departments continue to seek ways to reduce the amount of plagiarism and collusion that occurs. This paper reports the findings of a questionnaire based study which attempted to assess the students' attitudes to the issues involved in the hope that such an understanding might result in practical measures for minimizing the problem. The study revealed that while students did understand the definition of plagiarism in its most extreme cases they were often confused about less clear-cut situations. Changes in the previous experience of incoming students meeting modules originally designed on the assumption that students already had some programming background and were equipped for self-directed study would also appear to be a contributory factor in the extent of collusion in programming exercises.

Legal disclosure of childhood sexual abuse: what can professionals tell us?

ABSTRACT: Purpose: This study explores how the decision to disclose Childhood Sexual Abuse (CSA) to the legal setting for adult victims is perceived by key informants, specifically factors that are believed to facilitate or prevent legal disclosure from occurring. Background: Prevalence rates of CSA are high (Pereda, Guilera, Forns & Gomez-Benito, 2009) and the negative consequences caused by the abuse acknowledged (Filipas & Ullman, 2006). Disclosure of this crime is understood to be complex and delayed disclosure recognised (Arata, 1998) but little is known about disclosure to the legal system. Rates of legal disclosure of CSA remain low and the attrition rates high (London, Bruck, Ceci & Shuman, 2005), but investigation and understanding of the contributory factors is rare. Disclosure of CSA to the legal system enables prosecution of the abuser and protection of the victim and others. Method: 10 “key informants” consisting of specialised clinicians working with adult victims of CSA were interviewed. Each informant completed an indepth interview exploring their beliefs about factors that facilitated or prevented adult victims of CSA from disclosing their experience to the legal system. Interviews were transcribed and the qualitative data subjected to Thematic Analysis. Conclusions: Two super-ordinate themes (Legal Disclosures Are Rare: “Why would they do that?” and The Anomalies: Acknowledging that this is a crime) and four sub-ordinate themes emerged from the analysis and an analytical narrative constructed. Themes emphasised the rarity of legal disclosure and the significant number of barriers adult victims of CSA perceive. Implications for clinical practice and future research are outlined.

Outcome of childhood malignancies at the University of Port Harcourt Teaching Hospital: a call for implementation of palliative care.

Background: Cancers in children are yet to be recognised as an important cause of childhood morbidity and mortality in developing countries where more than 70% of the world annual cases occur. Despite the limited resources and whatever the projected outcome, children with cancer need treatment, be it curative or palliative. Objectives: To determine outcome of cancers in children at the UPTH; identify factors that influence outcome, highlight the need for palliative care. Method: A retrospective study of cases of childhood malignancies admitted into Paediatric Oncology unit of UPTH over a two year period. Clinical profile of patients and outcome were analyzed using SPSS version 20.0. Results: Sixty cases were analysed: 35(58.3%) males, 25(41.7%) females giving a M:F ratio of 1.4:1. Under-fives constituted 55%. Twenty-seven (45%) patients presented within 4 weeks of onset of symptoms. Median duration of symptoms before presentation was 8 weeks while 36 (60%) had metastatic disease at diagnosis. Twenty patients (33.3%) defaulted with or without specific treatment. Mortality was recorded in 26(43.4%) of cases. Conclusion: There were more cases of cancer amongst under-fives with male preponderance. Late presentation, financial constraints and high default rate were contributory factors to poor outcome in most cases. Lack of palliative care left many families to face their sufferings.

Odpowiedzialność lekarza, podmiotu leczniczego i ubezpieczyciela za nieudane transplantacje

Transplantacje komórek, tkanek i narządów należą do najbardziej kontrowersyjnych procedur medycznych, gdyż dotykają także kwestii etycznych i światopoglądowych. W ostatnich latach niewątpliwie obserwujemy rozwój transplantologii dzięki postępowi w naukach medycznych oraz zmianach w świadomości społeczeństwa. Transplantologia pozostaje jedną z bardziej ryzykownych gałęzi medycyny, ponieważ postępowanie zgodnie z zasadami sztuki lekarskiej nie jest gwarancją powodzenia przeszczepu. Artykuł przybliża problematykę nieudanych transplantacji – zarówno ze względu na zaniedbania lekarza czy placówki medycznej, jak i ze względu na reakcję obronną organizmu. W drugiej części artykułu zostały opisane zasady odpowiedzialności cywilnej lekarzy i innych pracowników podmiotów leczniczych za szkody wyrządzone pacjentom oraz wskazano czym różni się odpowiedzialność sprawcy szkody od odpowiedzialności ubezpieczyciela. Kolejna część artykułu dotyczy specyfiki odpowiedzialności ubezpieczyciela za nieudane transplantacje w oparciu o rozporządzenie Ministra Finansów w sprawie obowiązkowego ubezpieczenia odpowiedzialności cywilnej podmiotów wykonujących działalność leczniczą.

How epidemiology has challenged 3 prevailing concepts about atopic dermatitis

We challenge 3 prevailing concepts in understanding atopic dermatitis using data from epidemiologic studies. First, we show that although atopy is associated with atopic dermatitis to some degree, its importance is not likely to be a simple causeand- effect relationship, especially at a population level. Our epidemiologic data do not exclude a contributory role for IgEmediated immunologic processes, especially in those with existing and severe disease. Second, evidence is presented that does not support a straightforward inverse relationship between infections and atopic dermatitis risk. A link, if present, is likely to be more complex, depending critically on the timing and type of infectious exposure. Third, recent evidence suggests that the risk of subsequent childhood asthma is not increased in children with early atopic dermatitis who are not also early wheezers, suggesting a comanifestation of phenotypes rather than a progressive atopic march. Collectively, these observations underline the importance of epidemiologic studies conducted at a population level to gain a more balanced understanding of the enigma of atopic dermatitis.

Knowing What to Do: School Focus, Teacher Morale, and Teacher Turnover

This study explored how schools’ focus – the collective perception among teachers of clarity and consistency regarding school goals, expectations, and priorities – related to schoolwide morale and school turnover rates. I examined the hypothesis that focus attenuates the deleterious effects of student misconduct on teacher morale and the contributory role of student misconduct leading to teacher turnover. In addition, I examined climate strength regarding perceptions school focus as an indicator of focus itself, as well a potential moderating effect of climate strength on the magnitude of school focus-school morale and school focus-turnover relationships. Data from a national sample of middle and high schools (N schools = 348, N teachers = 11,376) were analyzed using school-level multiple regression models. Schools with higher focus had significantly higher morale, independent of related perceptions of administrative leadership. No significant relationship was found between school focus and school turnover rates. The hypothesized moderating effect of focus on student misconduct and morale was not supported, though there was a significant indication that focus attenuated the positive relationship between student misconduct and turnover. Climate strength of school focus ratings significantly correlated with focus scores, but did not moderate relationships between focus and predicted outcomes. Findings suggest that school-level focus does represent a characteristic of schools that has a meaningful positive relationship with teacher morale but do not necessarily clarify how that relationship manifests in schools or if that relationship presents an avenue for intervention.

Candidaemia or Candidasis: Controversy of Staphylococcus Sexually Transmitted Infection?

Herbal medications are becoming increasingly popular but a most-extraordinary claim by traditional/herbal medical practitioners relates to a Gram-positive bacterium, Staphylococcus , which has been depicted as a deadly sexually transmitted disease that manifest in the form of worms and other symptoms; with contributory roles including infertility, sexual dysfunction and impotency. They further boasted that they are the only ones that possessed the remedy (herbal) for the Staphylococcus sexually transmitted scourge. In the absence of distinguishing phenotypic taxonomic tools, Staphylococcus and Candida spp. may be confused for each other. However, Staphylococcus is a bacterium and not an infection; therefore, there must be more to the traditional medical practitioners’ boasts in ability to cure an infection that was not an infection in the first place. In conclusion, the common sense is that candiaemia or candidiasis is most likely the misdiagnosed sexually transmitted Staphylococcus disease, which is of significant human clinical health issue.

Responsabilidad civil de la persona mayor incapaz y de sus guardadores por los daños causados a terceros: especial referencia a la responsabilidad del incapaz en el sistema del Common Law

Un número considerable de personas mayores padece alguna enfermedad neurodegenerativa que limita sus facultades intelectivas y volitivas, lo que en la práctica suele traducirse en alteraciones de la personalidad con conservación de consciencia, pérdidas de memoria, desorientación, inquietud, confusión o agresividad. Este deterioro progresivo de capacidad que puede afectar a nuestros mayores no sólo los convierte en fácil objetivo de agresiones sino también en potenciales creadores de riesgos y daños a terceros. Es precisamente la responsabilidad que puede derivarse de tales daños la que será analizada en primer lugar en esta sede, exponiendo el estado de la cuestión tanto en el civil como en el common law. Por otro lado, cuando una persona que tiene sus funciones cognitivas mermadas causa un daño a otro, no sólo se debe analizar la responsabilidad civil del propio agente del daño frente al perjudicado, sino también aquélla en que podría incurrir la persona encargada de su cuidado en caso de haberla. Dicha cuestión ocupará la segunda parte del presente trabajo.

Incidence and Pattern of Pneumonia in Goats Slaughtered at the Kumasi Abattoir, Ghana

This study aimed at determining the incidence and pattern of pneumonia, in slaughtered goats in Kumasi abattoir, Ghana. One thousand three hundred and fifty lungs of goats; (1,012 Sahelian and 338 West Africa Dwarf goats (WAD) lungs) of different ages (less than a year to above 4 years) were used in this study. The frequency of occurrence of pneumonia, the degree of consolidation as a percentage of the total lung volume and histological assessment were determined by standard techniques. Fifty five (55) lungs (39 Sahelian, 16 WAD goats) were pneumonic (4.07% prevalence). The right lungs had a significant higher average lung consolidation percentage (19.11) while the right cranial lobes were more affected (9.37). WAD goats of 1-2 years are mostly affected with an average percentage consolidation of 11.73% while Sahelian goats above 4 years of age were the most affected with 32.59% consolidation. Does of both breeds were more while Sahelian goats had higher consolidation than other breeds. Histological examination revealed the presence of giant cell, fibrinous and suppurative bronchointerstitial pneumonia suggesting complicated viral pneumonia which was observed to be the most important caprine pneumonia in slaughtered goats in Ghana. Transportation and pregnancy stress were the major contributory factor to the pneumonia observed hence effective ante-mortem examinations will help to minimize the slaughter of pregnant does and transportation stress in Ghana.

Falls and other geriatric syndromes in Blantyre, Malawi: a community survey of older adults

Background The prevalence of geriatric syndromes (falls, immobility, intellectual or memory impairment, and incontinence) is unknown in many resource-poor countries. With an aging population such knowledge is essential to develop national policies on the health and social needs of older people. The aim of this study was to provide a preliminary survey to explore the prevalence of falls and other geriatric syndromes and their association with known risk factors in people aged > 60 years in urban Blantyre, Malawi. Methods This was a cross-sectional, community survey of adults aged > 60 years. Subjects were recruited at home or in the waiting areas of chronic care clinics. They were interviewed to complete a questionnaire on ageassociated syndromes and comorbid problems. The Abbreviated Mental Test (AMT) and Timed Up and Go (TUG) tests were carried out. Results Ninety-eight subjects were studied; 41% reported falling in the past 12 months, 33% of whom (13% of all subjects) were recurrent fallers. Twenty-five percent reported urine incontinence, 66% self-reported memory difficulties, and 11% had an AMT score < 7. A history of falling was significantly associated with urine incontinence (p=0.01), selfreported memory problems (p=0.004) and AMT score < 7 (p=0.02). Conclusions Geriatric syndromes, including falls, appear to be prevalent in older people in Blantyre, Malawi. Falling is associated with cognitive impairment and urinary incontinence. There is an urgent need for more understanding of geriatric problems in this setting to develop national policies on health and social needs of older people. It is likely that many of the contributory factors to falls would be amenable to multifactorial interventions similar to those found to be effective in developed countries.