Effect of major lifestyle risk factors, independent and jointly, on life expectancy with and without cardiovascular disease: results from the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES)

Seldom have studies taken account of changes in lifestyle habits in the elderly, or investigated their impact on disease-free life expectancy (LE) and LE with cardiovascular disease (CVD). Using data on subjects aged 50+ years from three European cohorts (RCPH, ESTHER and Tromsø), we used multi-state Markov models to calculate the independent and joint effects of smoking, physical activity, obesity and alcohol consumption on LE with and without CVD. Men and women aged 50 years who have a favourable lifestyle (overweight but not obese, light/moderate drinker, non-smoker and participates in vigorous physical activity) lived between 7.4 (in Tromsø men) and 15.7 (in ESTHER women) years longer than those with an unfavourable lifestyle (overweight but not obese, light/moderate drinker, smoker and does not participate in physical activity). The greater part of the extra life years was in terms of "disease-free" years, though a healthy lifestyle was also associated with extra years lived after a CVD event. There are sizeable benefits to LE without CVD and also for survival after CVD onset when people favour a lifestyle characterized by salutary behaviours. Remaining a non-smoker yielded the greatest extra years in overall LE, when compared to the effects of routinely taking physical activity, being overweight but not obese, and drinking in moderation. The majority of the overall LE benefit is in disease free years. Therefore, it is important for policy makers and the public to know that prevention through maintaining a favourable lifestyle is "never too late".

Parker Morris and the Fordist House

6.00 pm. If people like watching T.V. while they are eating their evening meal, space for a low table is needed (Ministry of Housing and Local Government, Space in the Home, 1963, p. 4).

This paper re-examines the 1961 Parker Morris report on housing standards in Britain. It explores the origins, scope, text and iconography of the report and suggests that these not only express a particularly modernist conception of space but one which presupposed very specific economic conditions and geographies.

Also known as Homes for Today and Tomorrow Parker Morris attempted, through the application of scientific principles, to define the minimum living space standards needed to accommodate household activities. But while early modernist research into notions of existenzminimum were the work of avant-garde architects and thinkers, Homes for Today and Tomorrow and its sister design manual Space in the Home were commissioned by the British State. This normalization of scientific enquiry into space can be considered not only as a response to new conditions in the mass production of housing – economies of scale, prefabrication, system-building and modular coordination – but also to the post-war boom in consumer goods. In this, it is suggested that the domestic interior was assigned a key role as a privileged site of mass consumption as the production and micro-management of space in Britain became integral to the development of a planned national economy underpinned by Fordist principles. Parker Morris, therefore, sought to accommodate activities which were pre-determined not so much by traditional social or familial ties but rather by recently introduced commodities such as the television set, white goods, table tennis tables and train sets. This relationship between the domestic interior and the national economy are emblematized by the series of placeless and scale-less diagrams executed by Gordon Cullen in Space in the Home. Here, walls dissolve as space flows from inside to outside in a homogenized and ephemeral landscape whose limits are perhaps only the boundaries of the nation state and the circuits of capital.

In Britain, Parker Morris was the last explicit State-sponsored attempt to prescribe a normative spatial programme for national living. The calm neutral efficiency of family-life expressed in its diagrams was almost immediately problematised by the rise of 1960s counter-culture, the feminist movement and the oil crisis of 1972 which altered perhaps forever the spatial, temporal and economic conditions it had taken for granted. The debate on space-standards, however, continues.

Dedicated severe asthma services improve health-care use and quality of life

Background: Systematic assessment of severe asthma can be used to confirm the diagnosis, identify comorbidities, and address adherence to therapy. However, the prospective usefulness of this approach is yet to be established. The objective of this study was to determine whether the systematic assessment of severe asthma is associated with improved quality of life (QoL) and health-care use and, using prospective data collection, to compare relevant outcomes in patients referred with severe asthma to specialist centers across the United Kingdom. Methods: Data from the National Registry for dedicated UK Difficult Asthma Services were used to compare patient demographics, disease characteristics, and health-care use between initial assessment and a median follow-up of 286 days. Results: The study population consisted of 346 patients with severe asthma. At follow-up, there were significant reductions in health-care use in terms of primary care or ED visits (66.4% vs 87.8%, P < .0001) and hospital admissions (38% vs 48%, P = .0004). Although no difference was noted in terms of those requiring maintenance oral corticosteroids, there was a reduction in steroid dose (10 mg [8-20 mg] vs 15 mg [10-20 mg], P = .003), and fewer subjects required short-burst steroids (77.4% vs 90.8%, P = .01). Significant improvements were seen in QoL and control using the Asthma Quality of Life Questionnaire and the Asthma Control Questionnaire. Conclusions: To our knowledge, this is the first time that a prospective study has shown that a systematic assessment at a dedicated severe asthma center is associated with improved QoL and asthma control and a reduction in health-care use and oral steroid burden.

Stress, eustress and the National Student Survey

The aim was to explore the relationship between sources of stress and a range of coping behaviours on student
satisfaction and motivation. Most research exploring sources of stress construes stress as distress, with little
attempt to consider positive, good stress or ‘eustress’ experiences. A cohort of first-year psychology students (N=88)
were surveyed on a range of stressors. These were amended from the UK National Student Survey (NSS, 2011).
Published university league tables draw heavily on student course satisfaction but study results suggest there was
also merit in measuring students’ intellectual motivation and the extent to which they felt part of a learning
community. Using multiple regression analyses, it was found that even the attributes that normally help one to adjust to change, such as self-efficacy, do little to help the new student adjust to university life, such was the acuteness of perceived stress in the first year. Social opportunities within the university were important to help new students integrate into university life and to help them network and build support. Educators need to consider how course experiences contribute, not just to potential distress but to potential eustress.

Systematic review of tools to measure outcomes for young children with autism spectrum disorder

BACKGROUND: The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children's progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness; skills such as social functioning and play; participation outcomes such as social inclusion; and parent and family impact.

OBJECTIVES: To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents.

METHODS: The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013; systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD; and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers.

RESULTS: The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains 'Impairments', 'Activity Level Indicators', 'Participation', and 'Family Measures'. In review 1, 10,154 papers were sifted - 3091 by full text - and data extracted from 184; in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a 'recommended battery' for use. In particular, there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents).

CONCLUSIONS: This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research.

FUTURE WORK: Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42012002223.

FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Clubes de ciências e o percurso escolar dos alunos

Os factores que levam os alunos, no final da escolaridade obrigatória, a escolher o seu percurso escolar são vários. Neste estudo procurou-se saber em que medida a frequência de Clubes na área das Ciências influenciam essa decisão e, ainda, estudar como potenciar a sua organização no sentido de que estes possam contribuir positivamente para as escolhas dos alunos por percursos escolares na área das Ciências. A investigação decorreu em duas fases. Na primeira fase, foi avaliada a influência dos Clubes de Ciências na decisão do percurso escolar dos alunos, no final da escolaridade básica. Nesta fase foram realizados os seguintes procedimentos: -Entrevista semi-estruturada realizada a sete professoras responsáveis de Clubes na área das Ciências Físicas e Naturais, de 7 Escolas Secundárias da região de Aveiro. -Administração de um questionário, construído com questões maioritariamente fechadas, a uma amostra de 106 alunos, do 10ºAno, provenientes de 11 Escolas Secundárias da região de Aveiro, que frequentaram Clubes na área das Ciências Físicas e Naturais, no 3º Ciclo. -Tratamento estatístico das questões do questionário, com recurso ao programa SPSS (Statistical Package for the Social Science) e análise de conteúdo das questões abertas do questionário e das entrevistas, recorrendose para o efeito à construção de categorias de resposta. Na segunda fase concebeu-se e implementou-se um Clube de Ciências. Nesta fase surgiu a criação do Clube: ”Educação para o Desenvolvimento Sustentável”, no qual foi desenvolvido o projecto: “Construção e dinamização de uma Estação Meteorológica”, numa Escola Básica do 2º e 3º Ciclos do Concelho de Aveiro. Os resultados obtidos na primeira fase do estudo são reveladores da importância que é atribuída às experiências vivenciadas pelos alunos nos Clubes de Ciências que frequentaram. Os temas/assuntos abordados foram essencialmente conteúdos ligados a áreas do conhecimento das disciplinas de Ciências. Predominaram as estratégias com base em trabalho de projecto e em actividades experimentais. Indicadores nacionais e internacionais têm evidenciado um decréscimo no número de jovens que, na sua escolaridade, optam por estudos nas áreas das Ciências e da Tecnologia. Este decréscimo tem sido um factor de preocupação ao nível das políticas educativas, nomeadamente europeias, tornando-se urgente, por um lado, compreender o porquê desse facto e, por outro, encontrar formas de o minimizar. Os Clubes na perspectiva das responsáveis entrevistadas: (a) Surgem como uma oportunidade para melhorar as competências dos alunos ao nível do saber fazer; (b) Permitem confirmar e reforçar a motivação e o gosto pelas Ciências; (c) Podem, também, dar-lhes orientações para o futuro, embora esta não tenha sido uma preocupação explícita; (d) São do agrado dos alunos devido a apresentarem actividades não meramente académicas e formais. Os Clubes, na perspectiva dos alunos respondentes: (a) Aumentaram a motivação para estudar Ciências; (b) Permitiram relacionar as Ciências com o dia-a-dia; (c) Ajudaram na escolha do curso que frequentam no Ensino Secundário; (d) Contribuíram para querer exercer uma profissão na área das Ciências. Na segunda fase do estudo, foi desenvolvido um trabalho de projecto que envolveu alunos do 3º Ciclo. O tema do projecto, proposto e implementado, coincidiu com os dois temas menos abordados, nos Clubes frequentados pelos respondentes da primeira fase do estudo, Meteorologia e Temáticas com Impacto Social. Por outro lado o Clube pretendeu contribuir para a Década da Educação para o Desenvolvimento Sustentado, instituída pelas Nações Unidas, para fazer frente à actual situação de emergência planetária. Uma estratégia privilegiada para formar cidadãos capazes de assumir atitudes e valores com vista ao desenvolvimento sustentável, passa pela Educação em todas as suas vertentes, nomeadamente a do ensino não formal, na qual se incluem os Clubes de Ciências. ABSTRACT: National and international indicators have showed a decrease in the number of youngsters that, during their school course make their choices in the study areas of Science and Technology. This decreasing tendency has been a motive of concern as far as the European educational policies are concerned. Thus, it is urgent to understand the reason behind that situation and find ways to minimize it. There are various factors that make students choose their study areas in the end of their school course. This study aimed to find out how the Science Clubs can influence their decisions as well as to study new ways to improve their organization in such a way that they may contribute positively to the students’ choices of their school careers in the area of Science. The investigation was divided in two parts: in the first part, it was evaluated the level of the influence of the Science Clubs in the students’ school careers at the end of the elementary education. At this stage it was adopted the following procedure: -A semi-structured interview was applied to 7 female teachers that are responsible for the Natural and Physics Science Clubs, in secondary schools, in the region of Aveiro; -A mainly close-question questionnaire was applied to a sample of 106 students, in the 10th grade, in 11 secondary schools, in the region of Aveiro. These students have attended some Natural and Physics Science Clubs, during the 7th, 8th and 9th grades; -Statistical work of the questionnaire was done with the help of the SPSS programme (Statistical Package for the Social Science) as well as the analysis of the contents of the open-questions of the questionnaire and the interviews by means of the answer-category method. In the second part, a Science Club was planned and implemented. At this stage, a club was created - “Education for the Sustainable Development” - within which the following project was developed – “Building and Development of a Meteorological Observatory”, at a 2nd and 3rd Ciclos (Stages) Elementary School, in Aveiro. The results of the first part of this study case have showed clearly the importance given to the experiences of the students while attending the Science Clubs. The themes/subjects studied were mainly science knowledgerelated contents. The strategies adopted were based on project work and experimental activities. A view of the Clubs by the people who are responsible for them: (a)The Clubs mean an opportunity for students to learn the know-how process; (b)They have provided the reinforcement of the motivation and preference for Science; (c)Although it was not the main concern with the clubs, the truth is that they can also give the students a sense of awareness for the future; (d)Students like to make part of the clubs because of their experimental character. A view of the Clubs by the students who make part of them: (a)The clubs have increased the level of motivation to study Science; (b)They have allowed a close perspective of the daily life reality; (c)They have helped with the choice of the Secondary School courses; (d)They have made students want a future professional career in the area of Science. In the second part of this study case, a project work was carried out involving 7th, 8th and 9th grade students. The subject of the project, considered and implemented, coincided with the two less boarded subjects, in the Clubs attended a course for the respondents of the first phase of the study, Meteorology and Thematic with Social Impact. The Club also aimed to contribute to the decade of the “Education for the Sustained Future” as settled by the United Nations in order to face the present emergency situation of the planet. The last but not the least, it is believed that, the best strategy to teach future citizens who are able to take the responsibility of their values and attitudes towards a sustainable future, is to provide them a type of Education that can teach them both the formal curriculum aspects and the informal ones, as it is the case of the Science Clubs.

Educar (para) o pensar : desenvolvimento de competências reflexíveis em professores e alunos do 1º CEB : contributos da "Filosofia para Crianças"

O presente estudo inscreve-se na área científica da Formação de Professores, incidindo, particularmente, na compreensão do processo de desenvolvimento das competências reflexivas percebidas como factor de promoção do seu próprio desenvolvimento profissional e pessoal, do desenvolvimento da capacidade de pensar dos seus alunos, da revalorização dos processos curriculares de ensino-aprendizagem e de inovação dos contextos educacionais. Num contexto de complexidade, incerteza e mudança, importa repensar estratégias de formação de professores e de alunos para que possam constituir-se como fatores potenciadores do desenvolvimento da competência reflexiva. Estratégias que convocam, quer o professor, quer o aluno, para um tipo de questionamento de maior exigência reflexiva e consideradas potenciadoras do pensamento crítico, criativo e de cuidado com o outro, numa perspetiva educativa centrada no cuidar, que valoriza a dimensão humana, a atuação responsável, ética e solidária, em todos os planos da vida. Neste estudo propomo-nos retomar algumas das estratégias de formação já configuradas no movimento Filosofia para Crianças e que se constituíram como um programa de formação em contexto, no qual se procurou aprofundar e compreender as múltiplas dimensões e modos como interatuam os diferentes participantes da relação educativa em práticas curriculares reconfiguradas à luz dos pressupostos que sustentam este estudo. Do ponto de vista metodológico, a investigação inscreve-se num paradigma de natureza qualitativa e interpretativa, de matriz hermenêutica e ecológica, configurando uma abordagem de tipo complexo, e com características de estudo de caso, que considera indispensável a participação ativa do sujeito na construção do conhecimento próprio, bem como o carácter de imprevisibilidade e de recursividade das condições e subsistemas em que tal ocorre. No sentido de construir uma visão integrada do objeto em estudo, foram desenvolvidos procedimentos específicos (mixed-methods), nomeadamente análise documental, entrevista semiestruturada, observação participante e inquirição por questionário. O estudo, que decorreu na região centro do país, envolveu 5 professoras do 1.º Ciclo do Ensino Básico, 100 alunos do mesmo nível de ensino e os seus pais/encarregados de educação, inquiridos através de questionário e desenvolveu-se em duas fases. A primeira destinou-se à formação teórico-prática das professoras e, na segunda, foram desenvolvidas sessões práticas de Filosofia para Crianças com os alunos. Os portfolios reflexivos construídos pelos participantes e pela investigadora principal constituíram outra fonte da informação recolhida no estudo empírico. Os resultados do estudo situam-se a quatro níveis: no que respeita aos saberes básicos, ao perfil de competência dos professores, à sua formação e às estratégias e recursos considerados como potenciadores de um pensar de mais elevada qualidade. Quanto ao primeiro nível, o presente estudo releva o carácter estruturante e epistémico de aprender a pensar (bem), salientando que este se processa numa maior amplitude e profundidade dos conteúdos da própria reflexão, às quais subjaz uma visão ampla de cidadania planetária e socialmente comprometida, evidenciando uma ampliação do quadro referencial dos saberes básicos e considerados imprescindíveis para a educação dos cidadãos. A um segundo nível, salienta-se a exigência de um perfil de competência profissional que permita aos professores desenvolver nos seus alunos um pensar de qualidade e, simultaneamente, melhorar a sua própria competência reflexiva. Neste sentido, o estudo aponta para a continuidade das respostas que têm vindo a ser equacionadas por vários autores nacionais e internacionais que, ao abordarem a problemática da formação, do conhecimento profissional e do desenvolvimento identitário dos professores, têm acentuado a importância dos modelos crítico-reflexivos da formação e de uma supervisão ecológica, integradora, não standard e humanizada, no desenvolvimento das sociedades contemporâneas. Conforme os dados sugerem, admite-se que a formação integral dos cidadãos passa pela inclusão e interligação de diferentes áreas do conhecimento que, concertada e complementarmente, possam contribuir para o desenvolvimento da sensibilidade, do pensamento crítico e criativo, de uma cultura da responsabilidade e de uma atitude ética mais ativa e interventiva. Neste sentido, reafirma-se a importância de um trajeto formativo que promova a efetiva articulação entre teoria e a prática, o diálogo crítico-reflexivo entre saberes científicos e experiência, que focalize o profissional na sua praxis e saliente a sua conexão com o saber situado em contexto vivencial e didático- -pedagógico. Realça-se a pertinência de dinâmicas formativas que, a exemplo de “comunidades de investigação/aprendizagem”, na sua aceção de redes de formação que, na prossecução de projetos e propósitos comuns, incentivam a construção de itinerários próprios e de aprendizagens individuais, mobilizando processos investigativos pessoais e grupais. Evidencia-se a valorização de práticas promotoras da reflexão, do questionamento, da flexibilidade cognitiva como eixos estruturadores do pensamento e da ação profissional e como suporte do desenvolvimento profissional e pessoal, corroborando a importância dos processos transformadores decorrentes da experiência, da ação e da reflexão sobre ela. Finalmente, no que respeita às estratégias e recursos, os dados permitem corroborar a riqueza e o potencial do uso de portfolios reflexivos no desenvolvimento de competências linguísticas, comunicacionais, reflexivas e meta-reflexivas e o entendimento de que o processo de construção da identidade profissional ocorre e desenha-se numa dinâmica reflexiva- -prospetiva (re)confirmadora ou (re)configuradora de ideias, convicções, saberes e práticas, ou seja, identitária. De igual modo, a investigação releva a importância da construção de portfolios, por parte dos alunos, para o desenvolvimento da qualidade do seu pensamento, sublinhando-se o seu carácter inovador nesta área. Evidencia-se, ainda, a diversidade de estratégias que respeitem os interesses, necessidades e expectativas dos alunos e o seu contexto de vida, tal como o recurso a materiais diversificados que, atentos ao conteúdo da mensagem, possibilitem a autonomia do pensamento, o exercício efetivo da reflexão crítica e do questionamento, na sua articulação com as grandes questões que sempre despertaram a curiosidade humana e cuja atualidade permanece. Materiais e recursos que estabeleçam o diálogo entre razão e imaginação, entre saber e sensibilidade, que estimulem o envolvimento dos alunos na resolução de problemas e na procura conjunta de soluções e na construção de projetos individuais na malha dos projetos comuns. Reafirma-se, pois, a importância da humanização do saber, a educação pensada como vivência solidária de direitos e deveres. Uma perspetiva educacional humanista que assenta nas trajetórias de vida, na recuperação de experiências pessoais e singulares, que procura compreender a identidade como um processo em (re)elaboração permanente. O presente estudo integra-se na rede de cooperação científica Novos saberes básicos dos alunos no século XXI, novos desafios à formação de professores sendo que, e na linha das investigações produzidas neste âmbito, destaca que o alargamento das funções do professor do 1.º Ciclo do Ensino Básico, que colocando a tónica da ação pedagógica no como se aprende e para quê e na possibilidade de aprender e incorporar o imprevisível, incide no desenvolvimento de um conjunto de capacidades que vão para além das tradicionalmente associadas ao ensinar a ler, escrever e contar. Releva-se, pois, a pertinência da criação de ambientes educativos nos quais professores e alunos entreteçam, conjunta e coerentemente, conhecer, compreender, fazer, sentir, dizer, ver, ouvir e (con)viver em prol de uma reflexão que nos encaminhe no sentido de ser(mos) consciência.

The Well London program - a cluster randomized trial of community engagement for improving health behaviors and mental wellbeing: baseline survey results

Background The Well London programme used community engagement, complemented by changes to the physical and social neighbourhood environment, to improve physical activity levels, healthy eating and mental wellbeing in the most deprived communities in London. The effectiveness of Well London is being evaluated in a pair-matched cluster randomised trial (CRT). The baseline survey data are reported here. Methods The CRT involved 20 matched pairs of intervention and control communities (defined as UK census lower super output areas; ranked in the 11% most deprived LSOAs in London by Index of Multiple Deprivation) across 20 London boroughs. The primary trial outcomes, sociodemographic information and environmental neighbourhood characteristics were assessed in three quantitative components within the Well London CRT at baseline: a cross-sectional, interviewer-administered adult household survey; a self-completed, school-based adolescent questionnaire; a fieldworker completed neighbourhood environmental audit. Baseline data collection occurred in 2008. Physical activity, healthy eating and mental wellbeing were assessed using standardised, validated questionnaire tools. Multiple imputation was used to account for missing data in the outcomes and other variables in the adult and adolescent surveys. Results There were 4107 adults and 1214 adolescent respondents in the baseline surveys. The intervention and control areas were broadly comparable with respect to the primary outcomes and key sociodemographic characteristics. The environmental characteristics of the intervention and control neighbourhoods were broadly similar. There was greater between cluster variation in the primary outcomes in the adult population compared to the adolescent population. Levels of healthy eating, smoking and self-reported anxiety/depression were similar in the Well London population and the national Health Survey for England. Levels of physical activity were higher in the Well London population but this is likely to be due to the different measurement tools used in the two surveys. Conclusions Randomisation of social interventions such as Well London is acceptable and feasible and in this study the intervention and control arms are well balanced with respect to the primary outcomes and key sociodemographic characteristics. The matched design has improved the statistical efficiency of the study amongst adults but less so amongst adolescents. Follow-up data collection will be completed 2012.

Life after Stroke: Coping mechanisms among African Caribbean Women

In the UK stroke is the third most common cause of death for women and the incidence in African Caribbean women is higher than the general population. Stroke burden has major consequences for the physical, mental and social health of African Caribbean women. In order to adjust to life after stroke individuals affected employ a range of strategies which may include personal, religious (church) or spiritual support (i.e. prayer), individual motivation, or resignation to life with a disability. This study explored these areas through the coping mechanisms that African Caribbean women utilised post stroke in the context of stroke recovery and lifestyle modification efforts needed to promote healthy living post stroke. A qualitative approach using Interpretative Phenomenological Analysis was adopted. Eight women were recruited into the study. Semi structured in-depth interviews were audio recorded and were transcribed verbatim. Data were analysed using a four-stage framework: familiarisation, sense making, developing themes and data refinement and analysis. Three main themes on coping emerged: the need to follow medical rules to manage stroke, strength and determination, and the use of religion and faith to cope with life after stroke. These findings illustrate both a tension between religious beliefs and the medical approach to stroke and highlight the potential benefits that religion and the church can play in stroke recovery. Implications for practice include acknowledgement and inclusion of religion and church based health promotion in post stroke recovery.

The discursive construction of Portuguese national identity in the media thirty years after the 1974 revolution

Tese dout., Philosophy, Lancaster University, 2010

Development of a Parent Version of the Manchester-Minneapolis Quality of Life Survey for use by Parents and Crers of UK Children: MMQL-UK (PF).

Background Although it is now widely endorsed that children should as far as possible rate their own health related quality of life (HRQL), there are situations where proxy information on child HRQL may be useful, especially where a child is too ill or young to provide their own HRQL assessment. There is limited availability of generic HRQL scales that have a parallel child and parent version and that are reliable, valid, brief, comprehensible and suitable for use in UK populations. The aims of this study were therefore to develop and validate a parent version of the anglicised Manchester-Minneapolis Quality of Life child form (MMQL-UK (CF)) and to determine the level of association between the child and parent versions of this form. Methods This study was undertaken concurrently with the anglicisation and validation of the MMQL, a measure of HRQL developed for use with children in North America. At that time, no parent version existed, so the MMQL form for children (MMQL-UK (CF)) was used as the basis for the development of the MMQL-UK parent form (PF). The sample included a control group of healthy children and their parents and five exemplar groups; children diagnosed with asthma, diabetes or inflammatory bowel disease and their parents, children in remission from cancer and their parents and children in public care and their carers. Consistency of the MMQL-UK (PF) components were assessed by calculating Cronbach's alpha. Validation of the parent questionnaire was undertaken by comparing MMQL-UK (PF) component scores with comparable components on the proxy PedsQL™ quality of life scales, comparing MMQL-UK (PF) component scores between parents of healthy and chronic disease children and by comparison of component scores from children and their parents or carers. Reproducibility and responsiveness were assessed by retesting parents by follow-up questionnaires. Results A total of 874 children (completing MMQL-UK (CF)) and 572 parents or carers (completing MMQL-UK (PF)) took part in the study. The internal consistency of all the MMQL-UK (PF) components exceeding the accepted criterion of 0.70 and the construct validity was good with moderate correlations being evident between comparable components of the MMQL-UK (PF) and the proxy PedsQL™. Discriminant validity was demonstrated with significant differences being identified between parents of healthy children and those with chronic conditions. Intra-class correlations exceeded 0.65 for all MMQL-UK (PF) components demonstrating good reproducibility. Weak to moderate levels of responsiveness were demonstrated for all but social functioning. The MMQL-UK (PF) showed moderate parent-child correlation with the MMQL-UK (CF) for all components. The best correlations were seen for those components measuring the same construct (Pearson's r ranged from 0.31 to 0.61, p < 0.01 for equivalent components). Conclusion The MMQL-UK (PF) showed moderate to good correlations with the MMQL-UK (CF) component scores. The MMQL-UK (PF) will be of use when comparing child and parent/carer perception of the impact of a child's condition on their HRQL or where the child is too ill or young to provide their own report.

Methodological Synergy in a National Project: The VITAE Story

VITAE was a four-year research project designed to explore the work and lives of a purposive sample of 300 Key Stage 1, 2 and 3 (English and maths) teachers at different phases of their careers in 100 primary and secondary schools in different socioeconomic contexts, drawn from seven local authorities in England. Its focus was upon identifying variations in different aspects of teachers' lives and work and examining possible connections between these and their effects on pupils as perceived by the teachers themselves and as measured by value-added national test scores. An integrated mixed-method approach was developed in addressing the research questions. The results showed that there were associations between teachers' work, lives and identities, that teachers' perceived and relative (valueadded) effectiveness varied within each of six professional life phases, and that this variation depended upon their capacity to manage a number of moderating and mediating factors. Statistically significant relationships were found between teacher commitment, resilience and the value-added pupil test scores. The findings from the study shed new light upon the meanings and measurement of teacher effectiveness and the complex nature and trajectories of teachers' work, lives and effectiveness in different school contexts.

The Pindaric poetry of Cruz e Silva and the Neoclassical revival among Lusitanian national heroes

António Dinis da Cruz e Silva, member of Arcádia Lusitana, the literary academy he helped to found, introduced the Pindaric ode to the Portuguese literature of the neoclassical period (18th century). This poet imitates the triadic form and the mythological nature of Pindar’s encomiastic poetry, in order to celebrate the deeds of reputed historical figures from the national context, such as sailors, captains, politicians, and even the king himself. As in Pindar’s poetry, the mythological excursus holds an important part in Cruz e Silva’s Pindaric poetry. Winners of athletic games are acclaimed through allusion to the ancient heroes. Likewise, the heroes of the Portuguese history see themselves turned into immortals, since their deeds are reported as comparatively greater than those of Homeric warriors. Among the 44 Cruz e Silva’s Pindaric odes, 18 rewrite the myth of the Trojan War, from its beginnings with Eris (Odes I-II) to its outcome with the imperishable fame of the most conspicuous Homeric fighters (Ode XLII). These 18 compositions (re)tell, in a neoclassical style, the main scenes and themes of the Iliad and Odyssey, alluding directly to their heroes’ deeds. Achilles’ wrath and Hector’s death are topics repeatedly brought up in Cruz e Silva’s Pindaric poetry as models of courage and patriotism for national heroes. This chapter offers a discussion of Cruz e Silva’s neoclassical representation of the Trojan War. To this effect, an interdisciplinary approach is adopted, showing how the Portuguese poet handles the mythological material from Homer and Pindar. In this way, he initiated in 18th-century Portuguese literature a new literary genre, the Pindaric ode. By dealing with Poetry and History, Cruz e Silva perpetuated the life and fame of national heroes long after their deaths.

Synaptic dysfunction in early encephalopathies : from genes to function

Tese de doutoramento, Medicina (Neurologia), Universidade de Lisboa, Faculdade de Medicina, 2015