First Diabetic Retinopathy Prevalence Study in Portugal: RETINODIAB Study-Evaluation of the Screening Programme for Lisbon and Tagus Valley Region

BACKGROUND/AIMS: In Portugal, so far, there is no study or even accurate data on the prevalence of diabetic retinopathy (DR), based on a large representative sample and on a long-term follow-up. The objective of our study was to determine the prevalence of DR based on a national screening community-based programme. METHODS: A 5-year retrospective analysis of the RETINODIAB screening programme results was implemented in Lisbon and Tagus Valley area between July 2009 and October 2014. We estimated the prevalence of retinopathy for all patients with type 2 diabetes and studied the association between known risk factors and retinopathy emergence at their first screening. RESULTS: Throughout this period, from a total of 103 102 DR readable screening examinations, 52 739 corresponded to patients who attended RETINODIAB screening at entry. Globally, DR was detected in 8584 patients (16.3%). Of these, 5484 patients (10.4%) had mild non-proliferative (NP) DR, 1457 patients (2.8%) had moderate NPDR and 672 (1.3%) had severe NPDR. Finally, 971 patients (1.8%) had proliferative DR requiring urgent referral to an ophthalmologist. The presence of any DR, non-referable DR or referable DR was strongly associated with increasing duration of diabetes and earlier age at diagnosis. CONCLUSIONS: The prevalence rate of DR in our study (16.3%) was slightly lower than other published international data. The RETINODIAB network proved to be an effective screening programme as it improved DR screening in Lisbon and Tagus Valley surrounding area

Assessing the efficacy of the Mental Health Gap Action Programme (mhGAP) training for non-specialized health workers in Ethiopia

RESUMO: A OMS lançou em 2008, o Programa de Acção do Gap em Saúde Mental (mhGAP) para suprir a falta de cuidados, especialmente em países de rendimento baixo e médio, para as pessoas que sofrem de perturbações mentais, neurológicas e de uso de substâncias (MNS). Um componente crucial do mhGAP é representado pelo esforço no sentido da integração da saúde mental nos cuidados de saúde primários. Na Etiópia, o mhGAP foi monitorizado durante 3 anos, graças a um projeto de demonstração implementado em clínicas selecionadas em quatro regiões do país. A fase de demonstração de mhGAP na Etiópia traduziu-se principalmente na formação de profissionais de saúde não especializados, fornecendo-lhes orientação e supervisão apoiada para a utilização de medicamentos psicotrópicos essenciais e na coordenação com o Ministério Etíope Federal da Saúde, Hospital Amanuel de Saúde Mental e as Secretarias Regionais de Saúde ( RHBs ). O presente trabalho investigou a eficácia do pacote de formação mhGAP através de uma análise das pontuações dos participantes no pré- e pós-testes. A análise estatística mostrou - com uma exceção - que a melhoria dos formandos é estatisticamente significativa, o que sugere que os conhecimentos dos participantes é melhorada na fase de pós-teste. A eficácia do pacote de formação mhGAP para profissionais de saúde não especializados é uma evidência promissora de que os mesmos podem ser treinados com sucesso para realizar um pacote básico de intervenções para a prestação de cuidados e tratamento para pessoas com perturbações mentais, neurológicas e de uso de substâncias. Este trabalho destaca, também, várias limitações não apenas inerentes ao próprio projecto de investigação tais como o número limitado de respostas que foram analisadas e a falta de dados de uma das quatro regiões onde mhGAP foi testado na Etiópia. As principais limitações decorrem de facto da abordagem global limitar as intervenções de saúde mental ao programa de formação e supervisão dos trabalhadores de cuidados de saúde primários . Este processo só será bem sucedido se, juntamente com outras intervenções - que vão desde o desenvolvimento de currículos para o desenvolvimento de uma legislação de saúde mental -, fôr incluído numa estratégia mais abrangente para a reforma da saúde mental e desafiar o status quo.-----------ABSTRACT:In 2008, WHO launched the Mental Health Gap Action Programme (mhGAP) to address the lack of care, especially in low- and middle- income countries, for people living with mental, neurological and substance use (MNS) disorders. A crucial component of mhGAP is represented by the endeavor towards integration of mental health into primary health care. In Ethiopia, mhGAP has been piloted for 3 years thanks to a demonstration project implemented in selected clinics in 4 regions of the country. The demonstration phase of mhGAP in Ethiopia has mainly translated into training of non-specialized health workers, providing them with mentorship and supportive supervision, availing essential psychotropic medications and coordinating with the Ethiopian Federal Ministry of Health, Amanuel Mental Health Hospital and the Regional Health Bureaus (RHBs). The present paper investigated the efficacy of the mhGAP training package through an analysis of the participants’ scores at pre-test and post-test. The statistical analysis showed - with one exception - that the improvement of trainees is statistically significant, therefore suggesting that the knowledge of participants is improved in the post-test phase. The efficacy of the mhGAP training package on non-specialized health workers is promising evidence that non-specialized health-care providers can be successfully trained to deliver a basic package of interventions for providing care and treatment for people with mental, neurological and substance use disorders. However, this paper also highlights several limitations, which are not only inherent to the research itself, such as the limited number of scores that was analyzed, or the lack of data from one of the four regions where mhGAP has been piloted in Ethiopia; major limitations occur in fact in the overall approach of confining mental health interventions to training and supervising primary health care workers. This process will only be successful if coupled with other interventions – ranging from curricula development to development of a mental health legislation - and if it is included in a more comprehensive strategy to reform mental health and challenge the status quo.

Brotherly love and filial obedience: the commemorative programme of the Avis princes at Santa Maria da Vitória, Batalha

This dissertation focuses on a rare 15th century commemorative programme that has thus far received little scholarly attention: the collective monument erected in the Founder’s Chapel, at the Monastery of Santa Maria da Vitória, Batalha, to house the remains of four Avis princes, members of what would become known as ‘the Illustrious Generation’. A patron is proposed for the commission of this erudite monument - the princes’ eldest brother, king Duarte I - arguing its integration into a broader propaganda programme to glorify the memory of the Avis dynasty founder, king João I. The dissertation then proceeds to discuss various highly innovative features of the monument, such as its pseudo-architectural character, its use of sophisticated heraldry and personal badges, the apparent absence of religious iconography on the tombs and, importantly, the collective nature of the programme, key to its interpretation. Using a semiotic approach, a discussion is also offered on the way the various formal, iconographic and conceptual novelties of the princes’ monument impacted on the 15th century monumental landscape in Portugal. Finally, the monument and the chapel housing it are looked at through the prism of the various readings that successive generations of viewers have projected onto it, from the time of its creation to the turn of the 20th century, in order to offer a more comprehensive understanding of the object as it stands today.

Portuguese banks and the economic adjustment programme: balance sheet adjustments and impact on profitability

Double Degree. A Work Project presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics and a Masters Degree in Finance from Louvain School of Management

The Portuguese programme ‘one laptop per child’ and its impact on families: a study on parents’ and children’s perspectives

This paper intends to present and reflect upon some of the findings emerging from a research project entitled “Navigating with ‘Magalhães’: Study on the Impact of Digital Media on Schoolchildren” that was conducted at the Communication and Society Research Centre at the University of Minho, Braga, Portugal. The project focused on the politics of the governmental programme “One Laptop per Child” part of the Portuguese Technological Plan for Education, and the uses of the “Magalhães” computer, and other media, by children aged 8-10 years. This paper analyses the impact of this particular public policy on digital literacy of young children based mostly on the perspectives of parents and their modes of mediation. It also debates parents’ and children’s perspectives on parental rules on computer and Internet usage. It ends by concluding that the impact of this programme occurred mainly at the level of access rather than the social and educational uses and practices. It also highlights the importance of family in the way children access and use ICT.

The Portuguese programme one laptop per child: political, educational and social impact

In 2008, the XVII Portuguese Constitutional Government launched the ‘e.escolinha’ programme, within the Technological Plan for Education, which set out the distribution of a computer, called ‘Magalhães’, designed for chil-dren attending the 1st cycle of basic education. Suspended in 2011 by the XIX Government, this programme has allowed, however, almost 500 000 children to have access to a personal computer. It was expected that this political measure would “revolutionise” the national education system by bringing changes to the pedagogical practices of teachers and the learning processes of children and by achieving educational success, in general. Based on documental analysis and on a set of interviews with key decision-makers in conceiving, implementing and monitoring this governmental initiative, the fi rst part of this chapter presents and analyses the ‘e.escolinha’ initiative and the policies be-hind that governmental programme, seeking to disassemble those objectives and provide some insights into the relationship between discourses, rhetoric, and reality. After that, the chapter focuses on children’s uses and practices with the ‘Magalhães’ laptop, at school and at home. Based on the results of questionnaires fi lled in by approximately 1500 children from 32 First Cycle public schools of the municipality of Braga (north of Portugal) and also from questionnaires applied to their parents and teachers, this chapter intends to analyse the real impact of this initiative for children, family and school. It also seeks to discuss the contribution of this educational policy to children’s digital literacy and also to their own and their families’ social and digital inclusion. To understand if it represented an added value to teachers’ pedagogical practice is another of its aims. The fi ndings point out a major focus on technology and access rather than on uses and competences or even on social, educational and cultural change. In fact, a major conclusion is the existence of a strong gap between the policy and the practices, typical of a top-down policy design. This study is an integrant part of a research project titled “Navigating with ‘Magalhães’: Study on the Impact of Digital Media in Schoolchildren” conducted at the University of Minho, Portugal, financed by the Portuguese Foundation for Science and Technology [PTDC/CCI-COM/101381/2008] and co-funded by the European Regional Development Fund [COMPETE: FCOMP-01-0124-FEDER-009056].

A floral and faunal inventory of the Parc national de Marojejy, Madagascar : with reference to elevational variation / Steven M. Goodman, editor.

n.s. no.97(2000)

Alzinar amb marfull o pineda?: estudi comparatiu de 6 zones geobotàniques del parc del Castell de l'Oreneta

S’ha estudiat la vegetació actual del parc de l'Oreneta, l’únic de Barcelona en el qual es conserva en part la vegetació natural que hi havia abans de la seva destinació com a parc. L’objectiu és veure com l'impacte antròpic ha modificat la que segurament era la vegetació natural de la zona - un alzinar amb marfull empobrit- per una pineda de pi blanc. A més, s’analitza les diferents adaptacions de la vegetació del parc als factors del biòtop, i molt en particular del marfull i l'aladern. S’ha començat estudiant els factors ambientals propis del parc. Posteriorment, s’ha dividit el biòtop del parc de l'Oreneta en sis zones de vegetació amb característiques específiques estudiant-ne les espècies existents, els índexs de diversitat de cada zona, l'abundància de les espècies, etc.

Avaluació de l'aprofitament energètic de la biomassa forestal del Parc de Collserola

En aquest treball se sintetitzen els resultats més destacats del projecte de final de carrera de la llicenciatura de Ciències Ambientals sobre l’aprofitament de la biomassa forestal al Parc de Collserola (PCo), realitzat a la Universitat Autònoma de Barcelona (UAB). L’objectiu principal és determinar la disponibilitat de biomassa forestal susceptible a ser extreta del PCo a fi d’aprofitar-la per a l’obtenció d’energia. Els principals factors analitzats són: la producció anual per cada espècie, les limitacions que marquen l’explotació i la tecnologia aplicable per a l’aprofitament en tres possibles escenaris. La proposta d’explotació sostenible dels boscos del PCo s’efectua sobre les espècies de Pinus halepensis, Quercus ilex i Quercus cerrioides, que presenten una producció major de biomassa susceptible a ser aprofitada, 5.500, 4.000 i 300 t psa1/any, respectivament. Per tant, la biomassa extraïble de forma sostenible al PCo s’estima en aproximadament 9.700 tones/any. L’estudi de l’aprofitament forestal està marcat per limitacions d’extracció, tals com les limitacions silvícoles (zones amb una cobertura arbòria igual o superior al 70% i un pendent igual o inferior al 60%) i d’accessibilitat (franges de 25 metres a banda i banda de les vies forestals). Amb la quantitat de biomassa extraïble es poden establir diferents escenaris d’aplicació energètica, mitjançant la seva combustió en calderes amb diverses potències de funcionament. Des del nivell domèstic (calderes domèstiques) fins al d’una gran planta (cogeneració), passant per l’aplicació en un barri residencial (District Heating). D’aquesta manera s’obté energia tèrmica, per calefacció, o elèctrica, aplicable a residències individuals, a barris residencials o a polígons industrials. S’ha escollit l’escenari de District Heating com el més viable, ja que és el que més avantatges presenta dintre del context del parc i un ventall de possibilitats d’aplicació més elevat. Per determinar-ne la viabilitat, s’han integrat diversos aspectes: tecnològics (eficiència, producció energètica, tipus de combustible i requeriment de biomassa), ambientals (impactes generats), socials (percepció dels usuaris) i econòmics (llocs de treball generats i viabilitat econòmica).

Contaminació lumínica al Parc de Collserola

El Parc de Collserola és un espai situat dins de l’Àrea Metropolitana de Barcelona, sotmès a una elevada pressió antròpica. L’existència d’urbanitzacions, infraestructures, i altres tipus d’edificacions, juntament amb la proximitat de diversos municipis poden causar un increment de contaminació lumínica al parc, fet que pot provocar efectes greus sobre les diferents espècies animals vegetals presents al parc, així com un malbaratament de l’energia. Existeix el fals tòpic de què a més llum, més seguretat. S’han mostrejat 19 punts dispersos per tot el parc, a on s’ha mesurat la lluminositat emesa per les estrelles, i el tipus de fanals presents a cada punt, per tal de mesurar el nivell de contaminació lumínica existent al parc. Els resultats indiquen que la principal causa de contaminació lumínica és la resplendor produït pels municipis localitzats al voltant del parc, els quals produeixen resplendor sobre el parc. En referència als fanals trobats, la majoria s’adapten a la normativa. La majoria dels fanals utilitzen làmpades de Vapor de Sodi a Alta Pressió, i en menys quantitat, làmpades de vapor de mercuri.

Ecologia de serveis, càmping i medi ambient, ecoetiquetes: Parc Natural de l'Alt Pirineu

El present projecte té per motiu l’anàlisi de l’estat ambiental dels càmpings a l’entorn del Parc Natural de l’Alt Pirineu. L’estudi del Distintiu de Garantia de Qualitat Ambiental (DGQA) suposa en aquest àmbit una eina d’estudi més que una finalitat, en la qual es basa el projecte per l’anàlisi proposat.

Agroecologia periurbana a Sant Cugat: document base per a la redacció del Pla de Gestió i Desenvolupament del parc rural de la Torre Negra

El parc rural de la Torre Negra ha estat protegit recentment després de 15 anys de lluita ciutadana, gràcies a l’aprovació del Pla Especial de Protecció i Millora el 29 de juny del present any. A partir d’ara, s’obre un ampli ventall de possibilitats per a la seva gestió i desenvolupament. En aquest context és on es situa el present estudi, amb la finalitat de presentar unes línies estratègiques bàsiques per a iniciar l’activitat al parc. Una activitat que té en el punt de mira el desenvolupament rural de l’espai i la transformació social de la ciutadania.

Ecoetiquetes de serveis: establiments de turisme rural en l'àmbit del Parc Natural de l'Alt Pirineu

L’increment del turisme rural i la relació directe amb l’entorn és el que ha motivat l’elaboració d'aquest projecte. L’objectiu del qual és fer un estudi de l’estat ambiental dels 17 establiments de turisme rural (ETR) dels 47 ETR situats a l’àmbit d’influència del Parc Natural de l’Alt Pirineu (PNAP). A partir del qual s’analitzarà la viabilitat d’aplicar el Distintiu de Garantia de Qualitat Ambiental (DGQA).

Evaluation épidémiologique du programme genevois de dépistage du cancer du sein : 2007-2011

A l'instar de nombreux pays industrialisés, le cancer du sein est à Genève le cancer le plus fréquent (environ 460 cas par an) et la première cause de décès chez les femmes entre 45 et 55 ans. Depuis mars 1999, le Programme genevois de dépistage du cancer du sein a pour missions de promouvoir, d'organiser et de mener une action de prévention auprès de la population féminine du canton âgée de 50 à 69 ans. Ce rapport décrit l'évolution de 15 ans d'activité de dépistage (chapitre 2) et analyse l'utilisation (chapitre 3), la qualité (chapitre 4) et l'efficacité (chapitre 5) du programme genevois entre 2007 et 2011. Couvrant 86'720 mammographies et près de 37'000 femmes, ce rapport s'intéresse aussi, au-delà des indicateurs usuels de performance, à mieux estimer certains effets indésirables comme les résultats faussement positifs ou les cancers survenant entre 2 examens de dépistage (dits cancers d'intervalle).