Attachment Style, Therapeutic Alliance and Recovery in forensic mental health: the A-STAR study and clinical research portfolio

Background: Research suggests that forensic mental health services and staff can play an important role in the recognition and intervention with attachment-related behaviours to promote engagement and recovery. There is a lack of literature exploring whether the attachment needs of forensic service-users are recognised and, associations between attachment style and factors predictive of recovery. Aims: This study aimed to examine the extent to which service-users and keyworkers agree about service-users’ attachment and to identify whether attachment was associated with service attachment, working alliance, ward climate and recovery. Methods: Twenty-two service-users from low and medium secure forensic services, completed questionnaire measures of their attachment style, service attachment, working alliance, ward climate and experiences of recovery. Nineteen keyworkers completed measures of the service-users attachment style and working alliance. Results: There was strong agreement between service-users and staff for attachment anxiety (ICC=0.71) but poor agreement for attachment avoidance (ICC=0.39). Service attachment was associated with more positive perceptions of staff support (r=0.49) and avoidant attachment was associated with lower ratings of recovery (r=-0.51). Correlations between attachment style and service attachment, working alliance and ward climate were small and non-significant. Conclusions: A focus on staff training to support recognition of the nature and impact of avoidant attachment styles is indicated. The findings suggest that interventions to enhance staff - service-user relationships may be important for service attachment and indeed promotion of a recovery focused orientation amongst service-users high in avoidant attachment may improve wellbeing and outcomes.

Estimation of whole body muscle, adipose/fat mass, validation in health and during weight loss. Development of prediction equations using MRI as reference method

Background: Body composition is affected by diseases, and affects responses to medical treatments, dosage of medicines, etc., while an abnormal body composition contributes to the causation of many chronic diseases. While we have reliable biochemical tests for certain nutritional parameters of body composition, such as iron or iodine status, and we have harnessed nuclear physics to estimate the body’s content of trace elements, the very basic quantification of body fat content and muscle mass remains highly problematic. Both body fat and muscle mass are vitally important, as they have opposing influences on chronic disease, but they have seldom been estimated as part of population health surveillance. Instead, most national surveys have merely reported BMI and waist, or sometimes the waist/hip ratio; these indices are convenient but do not have any specific biological meaning. Anthropometry offers a practical and inexpensive method for muscle and fat estimation in clinical and epidemiological settings; however, its use is imperfect due to many limitations, such as a shortage of reference data, misuse of terminology, unclear assumptions, and the absence of properly validated anthropometric equations. To date, anthropometric methods are not sensitive enough to detect muscle and fat loss. Aims: The aim of this thesis is to estimate Adipose/fat and muscle mass in health disease and during weight loss through; 1. evaluating and critiquing the literature, to identify the best-published prediction equations for adipose/fat and muscle mass estimation; 2. to derive and validate adipose tissue and muscle mass prediction equations; and 3.to evaluate the prediction equations along with anthropometric indices and the best equations retrieved from the literature in health, metabolic illness and during weight loss. Methods: a Systematic review using Cochrane Review method was used for reviewing muscle mass estimation papers that used MRI as the reference method. Fat mass estimation papers were critically reviewed. Mixed ethnic, age and body mass data that underwent whole body magnetic resonance imaging to quantify adipose tissue and muscle mass (dependent variable) and anthropometry (independent variable) were used in the derivation/validation analysis. Multiple regression and Bland-Altman plot were applied to evaluate the prediction equations. To determine how well the equations identify metabolic illness, English and Scottish health surveys were studied. Statistical analysis using multiple regression and binary logistic regression were applied to assess model fit and associations. Also, populations were divided into quintiles and relative risk was analysed. Finally, the prediction equations were evaluated by applying them to a pilot study of 10 subjects who underwent whole-body MRI, anthropometric measurements and muscle strength before and after weight loss to determine how well the equations identify adipose/fat mass and muscle mass change. Results: The estimation of fat mass has serious problems. Despite advances in technology and science, prediction equations for the estimation of fat mass depend on limited historical reference data and remain dependent upon assumptions that have not yet been properly validated for different population groups. Muscle mass does not have the same conceptual problems; however, its measurement is still problematic and reference data are scarce. The derivation and validation analysis in this thesis was satisfactory, compared to prediction equations in the literature they were similar or even better. Applying the prediction equations in metabolic illness and during weight loss presented an understanding on how well the equations identify metabolic illness showing significant associations with diabetes, hypertension, HbA1c and blood pressure. And moderate to high correlations with MRI-measured adipose tissue and muscle mass before and after weight loss. Conclusion: Adipose tissue mass and to an extent muscle mass can now be estimated for many purposes as population or groups means. However, these equations must not be used for assessing fatness and categorising individuals. Further exploration in different populations and health surveys would be valuable.

Sequence stratigraphy and sea-level history of Kangan formation in south pars field

Dehram group includes Faraghan, Dalan and Kangan formations. Kangan formation ages lower terias. That is one of the important reservoir rocks of southern Iran and Persian Gulf. In this research Kangan formation is studied in two A and B wells. Based on 75 studies on thin section, four carbonate litho acies association A, B, C, D with 12 subfacies are identified. A lithofacies association includes 4 subfacies: A1, A2, A3 and A4. B lithofacies association consists of 3 subfacies: B1, B2 and B3. C lithofacies association consists of 3 subfacies: C1, C2, C3 and D lithofacies association includes 2 subfacies: D1 and D2. On the base of studies lithofacies association of Kangan formations are formed in 3 environments of: Tidal Flat, Lagoon and Barrier Shore Complex in a Carbonated Platform Ramp type. Diagenetic processes have effected this formation. The most important Diagenetic processes are: Cementation, Anhydritization, Micrization, Neomorphism, Bioturbation, Dissolution, Compaction, Dolomitization and Porosity. Sequence staratigraphy studies were performed base on the vertical and horizontal relationship of lithofacies association and well logging in gamma ray and sonic type that causes the identification of two sedimentary sequences: First sedimentary sequence includes: Transgressive System Tract (TST) and High Stand System Tract (HST). The lower boundary of this sequence is in Sequence Boundary 1 (SB1) which shows unconformities of Dalan and Kangan that are Permian-terias unconformities. The upper boundary is in Sequence Boundary 2 (SB2) type that is identified by carbonate facies associated by anhydrite nodular. Second sedimentary sequence includes: TST and HST. Lower and upper boundaries of these sequences are both in SB2 type. The lower and upper boundary is made of carbonate facies with anhydrite nodular.

O associativismo cultural e o impacto na educação artística contemporânea em Portugal : o caso da Associação Cultural d'Orfeu

As associações culturais, como coletividades que emancipam o papel do cidadão na criação e produção de atividades culturais, contribuindo para a dinamização das sociedades, podem ser um veículo de desenvolvimento da educação artística, ao nível do ensino não formal e informal, tendo como ponto de partida o contributo da participação ativa dos cidadãos, que buscam a promoção e dinamização de atividades de teor cultural e artístico. Sendo assim, a seleção do Associativismo Cultural para o estudo da evolução da educação artística é um caminho para a compreensão da dinâmica das coletividades e o seu impacto no desenvolvimento cultural e artístico, a nível local, regional e nacional. Neste estudo, foi selecionada a Associação Cultural d´Orfeu, como estudo de caso, pela sua longevidade como associação e pelo seu destaque a nível cultural e artístico da zona centro do país. Ao nível da metodologia optámos por uma metodologia mista, tanto numa abordagem qualitativa, ao nível da análise de conteúdo, como quantitativa, na análise de dados. As técnicas de recolha de dados consistiram em entrevistas a dirigentes associativos e colaboradores (metodologia qualitativa), inquéritos a sócios, colaboradores e participantes de associações culturais (metodologia quantitativa), registos para diário de campo (acontecimentos, atividades e formação artística), análise de espólio documental da Associação Cultural d´Orfeu e registo audiovisual e fotográfico. Com este estudo, espera-se compreender as dinâmicas que estão inerentes ao associativismo cultural ao nível da educação/formação artística e que impactos apresentam no desenvolvimento cultural, social e artístico da sociedade. Além disso, queremos verificar que estratégias são utilizadas pelas associações culturais para a diversificação da oferta cultural e para o incentivo da cidadania ativa.

Papel do turista na conservação do património cultural e natural

Resumo O estudo realizado no âmbito deste relatório centra-se numa análise do papel do turista na conservação do património natural e cultural, em particular do Parque Nacional da Tijuca, no Rio de Janeiro. Os objetivos definidos para este trabalho são dilucidar o conceito de turismo cultural nas suas inter-relações com o ecoturismo; compreender o estado da arte em relação à intervenção do terceiro setor (ONG associações, fundações) e do turista particular na conservação do património; caracterizar o Parque Nacional da Tijuca; caracterizar a Amigos do Parque; e por fim indagar sobre a predisposição do turista para se associar à Associação dos Amigos do Parque Nacional da Tijuca. Para isso foi concebido um inquérito, realizado pela estagiária aos turistas que visitavam o parque, fazendo assim uma recolha de dados que serviram de base para as conclusões deste trabalho, levando no fim à proposta de algumas estratégias e diretivas a seguir para atrair novos associados, em particular turistas. Os resultados levam a concluir que no geral o turista não está predisposto a contribuir para a conservação e associar-se à Amigos do Parque. A percentagem de turistas que afirmaram estar predispostos a associarem-se foi de apenas 5%, sendo maioritariamente de turistas com idades entre os 25 e os 44 anos, com formação superior e provenientes dos países da América do Sul. O turista foi também questionado quanto à predisposição para fazer uma doação pontual, para a qual a taxa de respostas positiva foi mais elevada com 22%, com a contribuição também de turistas europeus. Apesar destes valores, o número de visitantes anuais do Parque Nacional da Tijuca aumenta a cada ano (prevendo-se que continue a aumentar), sendo que em 2014 foi de 3.086.207 de pessoas, e destes, cerca de 72% foram turistas. É importante conseguir o apoio destes turistas através da associação e através de doação, já que é relevante não só a nível financeiro, como também a nível de internacionalização e reconhecimento da associação e do parque, o que levará a uma maior rede de associados. Palavras-chave: ecoturismo; terceiro setor; conservação; Associação dos Amigos do Parque Nacional da Tijuca vii Abstract The study in this report focuses on an analysis of the tourist role in the conservation of natural and cultural heritage, in particular of the Tijuca National Park in Rio de Janeiro. The goals set for this work are to elucidate the concept of cultural tourism in its interrelations with ecotourism; to understand the state of the art concerning the third sector (NGO associations, foundations) and private tourist in heritage conservation; to characterize the Tijuca National Park; to characterize the Friends of the Park; and finally to inquire about the willingness of the tourist to join the Association of Friends of the Tijuca National Park. For this a survey was designed and conducted by the intern to the tourists visiting the park, thus allowing for a collection of data that formed the basis to the conclusions of this work, leading at the end to the proposal of some strategies and policies to attract new members, particularly tourists. The results lead to the conclusion that as a rule the tourist is not willing to contribute to the conservation and join the Friends of the Park. The percentage of tourists who assumed they were willing to join the association was only 5%, and mostly tourists aged 25 and 44, with higher education, and from the South American countries. Tourists were also asked about their willingness for giving donations, for which the rate of positive responses was higher 22%, with the contribution of European tourists. Despite these numbers, the number of annual visitors to the Tijuca National Park increases every year (and it is expected to continue to increase). In 2014 ir received 3,086,207 visitors, and of these, about 72% were tourists. It is important to get the support of these tourists through association and through donation, since it is relevant not only financially, but also as a tool of the internationalization and recognition of the association and the park, which will lead to a larger network of associates. Keywords: ecotourism; third sector; conservation; Association of Friends of the Tijuca National Park

Physiotherapy practices and third party payers: issues in professional ethics in the Atlantic provinces

[À l'origine dans / Was originally part of : ESPUM - Dép. médecine sociale et préventive - Travaux et publications]

Aldeias de crianças SOS

Dissertação de Mestrado para obtenção do grau de Mestre em Design de Comunicação, apresentada na Universidade de Lisboa - Faculdade de Arquitectura.

Child Health Care in Ireland

The Irish health care system is based on a complex and costly mix of private, statutory, and voluntary provisions. The majority of health care expenditure comes from the state, with a significant proportion of acute hospital care funded from private insurance, but there are relatively high out-of-pocket costs for most service users. There is free access to acute hospital care, but not for primary care, for all children. About 40% of the population have free access to primary care. Universal preventive public health services, including vaccination and immunization, newborn blood spot screening, and universal neonatal hearing screening are free. Major health challenges include poverty, obesity, drug and alcohol use, and mental health. The health care system has been dominated for the last 5 years by the impact of the current recession, which has led to very sharp cuts in health care expenditure. It is unclear if the necessary substantial reform of the system will happen. Government policy calls for a move toward a patient-centered, primary care-led system, but without very substantial transfers of resources and investment in Information and Communication Technology, this is unlikely to occur. The paper has been published as part of an overall report of Child Health in Europe: Diversity of Child Health Care in Europe: A Study of the European Paediatric Association/Union of National European Paediatric Societies and Associations http://www.jpeds.com/issue/S0022-3476(16)X0010-8 . (J Pediatr 2016;177S:S87-106).  

Etapas de cambio conductual relacionado al consumo de frutas y verduras en escolares de Bogotá, Colombia

Objetivo: Describir la relación de las etapas de cambio conductual frente al consumo de frutas y verduras con el estado nutricional en un grupo de escolares de Bogotá, Colombia, pertenecientes al estudio FUPRECOL. Métodos: Estudio de corte transversal en 1.922 niños y adolescentes entre 9 y 17 años, pertenecientes a nueve instituciones educativas oficiales de Bogotá. Se aplicó de manera auto-diligenciada el cuestionario de cambio de comportamiento (CCC-Fuprecol) validado en el “estudio FUPRECOL” y se calculó el Índice de Masa Corporal (IMC) como marcador del estado nutricional. Se calcularon prevalencias y se establecieron asociaciones mediante modelos de regresión logística binaria. Resultados: La muestra estuvo conformada por 1.045 niños-niñas y adolescentes vs hombres (45.6%) y mujeres (54.3%) y 877. La mayor proporción de consumo de frutas en el subgrupo de hombres (niños entre 9 y 12 años vs. adolescentes entre 13 y 17 años) se observó en la etapa de mantenimiento, (53.3 % vs. 38.8 %, X2 p<0.001), seguido de preparación/acción (25.0 % vs. 32.4 %, X2 p<0.001). En mujeres entre 9 y 12 años, la mayor proporción se ubicó en la etapa de mantenimiento (54.4 %), a diferencia de las adolescentes entre 13 y 17 años que acusaron mayor frecuencia la etapa de preparación/acción (42.0 %). Se observó que pertenecer al grupo de mujeres, se asociaba como variable para el cumplimiento de la recomendación mínima de frutas y verduras con valores de OR 1.54 (IC95% 1.22-1.93) y OR 1.48 (IC95% 1.19-1.84), respectivamente. Conclusiones: Aproximadamente, 66 % de los participantes tienen la intención o la voluntad de cumplir las recomendaciones de consumo de frutas y verduras. La identificación temprana de niños y adolescentes con bajo consumo de alimentos vegetales, permitirá implementar intervenciones para promover comportamientos saludables a fin de prevenir el riesgo cardiometabólico en la edad adulta.

Relación entre los factores de riesgo psicosocial con síntomas músculo-esqueléticos en trabajadores vinculados a una empresa social del estado, Bogotá, 2014

Introducción Los lugares de trabajo contribuyen al bienestar del individuo y en algunos casos pueden constituirse en factores que llevan a alteraciones en la condición de salud. Los trabajadores pueden estar predispuestos a algún tipo de desórdenes musculo-esqueléticos que se generan durante la jornada laboral creando molestia y algunas veces estar asociados a factores de riesgo psicosocial. Objetivo Establecer la relación entre los factores de riesgo psicosocial con síntomas músculo-esqueléticos en trabajadores vinculados a una empresa social del estado Bogotá, 2014. Métodos Se realizó un estudio de corte transversal en una muestra de 203 trabajadores. Como instrumentos se utilizó la Batería de riesgo psicosocial y cuestionario Nórdico. Se realizó análisis estadístico empleando medidas de tendencia central y de dispersión y se midieron asociaciones con el fin de conocer las variables que se relacionan con el evento. Se manejó el programa estadístico SPSS 20 para Windows. Resultados El 78,8% de los trabajadores correspondieron al sexo femenino, con una edad media de 38 ±10,28 años. El promedio de años de antigüedad dentro de la empresa fue de 3,9 ±,6553, se encontró que el 90.4% están expuestos a factores psicosocial extra laborales con clasificación de riesgo despreciable y el 91,6% a factores intralaboral con clasificación de riesgo muy alto. Se encontró prevalencia de sintomatología musculo esquelética a nivel de cuello con un 70%, dorso lumbar con el 56,2%, mano o muñeca el 54,7% y hombro con el 51,7%. Se encontró diferencia significativa entre el dominio de demandas del trabajo con síntomas presentes en hombro y mano/muñeca (p<0,05), seguido de las dimensiones de control sobre el trabajo con síntomas en hombro (p<0,05). Conclusiones La población estudiada presento una elevada prevalencia de síntomas musculo esqueléticos y un alto riesgo psicosocial intralaboral probablemente debido a características del trabajo y de su organización que influyen en la salud y bienestar del individuo.

Small states and the promotion of their foreign policy agenda in the international scenario: Trinidad and Tobago and the Kyoto Protocol

Este estudio de caso busca identificar los elementos del portafolio de política exterior de Trinidad y Tobago que le permitieron promover exitosamente sus intereses en el Protocolo de Kioto. Al hacer esto, este texto analizará las limitaciones de Trinidad y Tobago en términos de vulnerabilidades de localización, burocracia y recursos. Posteriormente, una revisión del portafolio de política exterior de este Estado ilustrará el uso de estrategias de creación de capacidades y de organización como lo son el contacto con actores institucionales y no gubernamentales, la formación de coaliciones y estrategias argumentativas, entre otras. Finalmente, este artículo concluirá que dichas acciones permitieron la promoción de la agenda de política exterior de Trinidad y Tobago a través de la creación de hojas de ruta y la coordinación de la incertidumbre con el Protocolo de Kioto. Para hacer esto, este trabajo se concentrará en examinar conceptos como vulnerabilidad y priorización, asimismo contrastando diferentes artículos académicos en la materia junto con documentos oficiales de Trinidad y Tobago.

Engineering a financial bloodbath: how sub-prime securitization destroyed the legitimacy of financial capitalism

"This book investigates the origins and implications of the securitization crisis, described by the chief executive of ANZ as a "financial services bloodbath". Based on extensive interviews it offers an integrated series of case studies drawn from the United States, the United Kingdom and Australia. A central purpose is to not only chart what went wrong with the investment houses and why the regulatory systems failed, but also provide policy guidance. The book therefore combines the empirical with the normative. In so doing, it provides a route map to navigate one of the most significant financial and regulatory failures in modern times."