Avaliação e modificação do risco de queda em idosos com recurso à posturografia dinâmica computorizada

RESUMO: Os pontos de corte dos instrumentos de avaliação do equilíbrio são úteis na identificação de idosos ambulatórios na comunidade com elevado risco de queda ou de perda da mobilidade normal. O melhor ponto de corte da Escala CEEA para elevado risco de queda foi de 700 (pontuação total), com uma sensibilidade de 71,8% e uma especificidade de 73,7%. Para mulheres com idade entre 65 e 85 anos, o melhor ponto de corte da Escala CEEA para mobilidade normal foi de 800 (pontuação total), com uma sensibilidade de 70,1% e uma especificidade de 72,2%.--------------- ABSTRACT: Falls are one of the greatest health problems in the elderly, causing high mortality, morbidity, disability and premature institutionalization. The Activities-specific Balance Confidence (ABC) Scale evaluates balance in a broad set of activities. It was translated and adapted for several other languages and settings, including the Portugal-Portuguese “Escala CEEA”. This instrument lacks high risk of falling and normal mobility cut-off points.

Res Publica: Citizenship and Political Representation in Portugal, 1820-1926

The term res publica (literally “thing of the people”) was coined by the Romans to translate the Greek word politeia, which, as we know, referred to a political community organised in accordance with certain principles, amongst which the notion of the “good life” (as against exclusively private interests) was paramount. This ideal also came to be known as political virtue. To achieve it, it was necessary to combine the best of each “constitutional” type and avoid their worst aspects (tyranny, oligarchy and ochlocracy). Hence, the term acquired from the Greeks a sense of being a “mixed” and “balanced” system. Anyone that was entitled to citizenship could participate in the governance of the “public thing”. This implied the institutionalization of open debate and confrontation between interested parties as a way of achieving the consensus necessary to ensure that man the political animal, who fought with words and reason, prevailed over his “natural” counterpart. These premises lie at the heart of the project which is now being presented under the title of Res Publica: Citizenship and Political Representation in Portugal, 1820-1926. The fact that it is integrated into the centenary commemorations of the establishment of the Republic in Portugal is significant, as it was the idea of revolution – with its promise of rupture and change – that inspired it. However, it has also sought to explore events that could be considered the precursor of democratization in the history of Portugal, namely the vintista, setembrista and patuleia revolutions. It is true that the republican regime was opposed to the monarchic. However, although the thesis that monarchy would inevitably lead to tyranny had held sway for centuries, it had also been long believed that the monarchic system could be as “politically virtuous” as a republic (in the strict sense of the word) provided that power was not concentrated in the hands of a single individual. Moreover, various historical experiments had shown that republics could also degenerate into Caesarism and different kinds of despotism. Thus, when absolutism began to be overturned in continental Europe in the name of the natural rights of man and the new social pact theories, initiating the difficult process of (written) constitutionalization, the monarchic principle began to be qualified as a “monarchy hedged by republican institutions”, a situation in which not even the king was exempt from isonomy. This context justifies the time frame chosen here, as it captures the various changes and continuities that run through it. Having rejected the imperative mandate and the reinstatement of the model of corporative representation (which did not mean that, in new contexts, this might not be revived, or that the second chamber established by the Constitutional Charter of 1826 might not be given another lease of life), a new power base was convened: national sovereignty, a precept that would be shared by the monarchic constitutions of 1822 and 1838, and by the republican one of 1911. This followed the French example (manifested in the monarchic constitution of 1791 and in the Spanish constitution of 1812), as not even republicans entertained a tradition of republicanism based upon popular sovereignty. This enables us to better understand the rejection of direct democracy and universal suffrage, and also the long incapacitation (concerning voting and standing for office) of the vast body of “passive” citizens, justified by “enlightened”, property- and gender-based criteria. Although the republicans had promised in the propaganda phase to alter this situation, they ultimately failed to do so. Indeed, throughout the whole period under analysis, the realisation of the potential of national sovereignty was mediated above all by the individual citizen through his choice of representatives. However, this representation was indirect and took place at national level, in the hope that action would be motivated not by particular local interests but by the common good, as dictated by reason. This was considered the only way for the law to be virtuous, a requirement that was also manifested in the separation and balance of powers. As sovereignty was postulated as single and indivisible, so would be the nation that gave it soul and the State that embodied it. Although these characteristics were common to foreign paradigms of reference, in Portugal, the constitutionalization process also sought to nationalise the idea of Empire. Indeed, this had been the overriding purpose of the 1822 Constitution, and it persisted, even after the loss of Brazil, until decolonization. Then, the dream of a single nation stretching from the Minho to Timor finally came to an end.

La Réforme des soins en santé mentale en Belgique: analyse d'un modéle

RESUMO: O relatório anual de 2001 da Organização Mundial de Saúde (OMS), anunciou o interesse social dos problemas crescentes em matéria de saúde mental e relativo à necessidade urgente de uma extensão, como também, para uma melhor organização da oferta de tratamento. Sob proposta da Bélgica, esta observação foi traduzida em uma resolução « Mental health :responding to the call for action » (déclaração de intenção do 18 de maio de 2002). Nós notamos que certos países, como os Estados Unidos ou a Grã Bretanha transformam sistematicamente o tratamento residencial em um tratamento mais dirigido para a comunidade. Eles também se concentram na descoberta prematura dos problemas psiquiátricos. Este fenômeno de désinstitutionalisação obteve resultados concretos e traz um ganho certo, tanto para os atores do campo da saúde mental, como também para os candidatos a um tratamento. O tratamento das pessoas dentro do seu meio de vida é muito claramente reconhecido. As evoluções que marcaram os tratamentos em saúde mental na Bélgica durante estes utimos 40 anos mostram que vários paços importantes já foram feitos. A reforma tem como objetivo converter a oferta hospitalar e montar tratamentos dirigidos para e dentro da comunidade pela criação de equipas móveis que se inscrevem no dispositivo comunitário, historicamente muito activo bem que sub-financiado. A reorganização dos sistemas de tratamento está baseada na criação de redes, para construir um dispositivo flexível e contínuo que considera as necessidades dos pacientes. Esta reforma é, ao mesmo tempo, ambiciosa e complexa,. É uma visão nova, uma mudança de cultura, não só, para todos os atores da saúde mental, mas também para os pacientes e suas famílias. A reforma está baseada numa visão global e integrada que associa no mesmo movimento todas as autoridades competentes relativamente a saúde que elas sejam federais, regionais ou comunitárias.-----------ABSTRACT: The World Health Organization’s (WHO) annual report of 2001 identified a social interest for the increasing problems related to mental health and the urgent need of an extension and a better organization of mental health care. On a proposal of Belgium this statement was transformed into a resolution « Mental health: responding to the call for action» (Declaration of Intent, May 18th, 2002). Some countries such as the USA or the UK systematically dismantled in-patient residential care in favor of more community-based care and a focus on early detection of psychiatric problems. This de -institutionalization has clearly and concretely paid off and the value of bringing mental health care to claimants and treating them in their own residence was acknowledged. In Belgium, the evolutions which have shaped mental health care in the last forty years indicate that a number of important steps are already taken. The Reform aims to convert the supply of hospital care into community-based mental health care services through the creation of mobile teams which offer services in everyday life of the user. These teams take place in the community, historically highly active howbeit underfunded. The reorganization of health care system relies upon the creation of networks in order to build a flexible and continuous device which take into account user’s needs. This Reform can be seen as both ambitious and complex. It is a completely new vision, a major cultural shift for all mental health care stakeholders, but also for users and their relatives. The Reform is based on a global and integrated approach which links I, a same movement all relevant health authorities whether they be federal, regional or community. de-institutionalization – community mental health – recovery - users and families involvement - networking.

PRACTICING ANTHROPOLOGY IN PORTUGAL

The rise of anthropology in Portugal is examined within the framework of several cycles of development. The chapter discusses how the consolidation of anthropology at university level was the main focus until the 90’s. Applied anthropology, as distinctive from academic anthropology received very little attention. Consequently, there was an absence of an institutionalization of applied anthropology in the country. Nowadays, however, two main trends converge that supports the growth of applied anthropology and is providing work for anthropologists outside academia. First, anthropology departments in Portugal have stabilized their staff quotas resulting in very few positions open for anthropologists at the university level. Second, global changes are impacting the social framework of the country and, consequently, opening up new horizons of research and practice for social scientists. Several examples of these opportunities are discussed which is creating an optimism about the various niches for new and relevant anthropological practices.

Responsividade sensível da cuidadora e processamento de expressões faciais emocionais em crianças institucionalizadas: um estudo com potenciais evocados

Dissertação de mestrado em Psicologia Aplicada

O Conceito de Autarquias Locais na Constituição da República de Angola: o caso do Município

Dissertação de mestrado em Direito Administrativo

Quantity or quality? The professionalization of social media communication in Portugal and Germany: a comparison

As the worldwide growth of social media usage and institutionalization by organizations rise worldwide little is known about the degree of professionalization that has occurred. By comparing data between two asynchronous countries this research project offers insights into its strategic usage as well as discovering an interesting dynamic between activity and professionalization.

Abordagem histórica e institucional da mudança em contabilidade de gestão: o caso da normalização nos hospitais públicos portugueses

A teoria institucional constituiu o enquadramento no qual foi suportada a pergunta geral desta investigação: como e porquê a Normalização da Contabilidade de Gestão (NCG) nos hospitais públicos portugueses surgiu e evoluiu? O objetivo geral foi compreender de forma profunda o surgimento e a mudança nas regras de NCG dos hospitais públicos portugueses no período histórico 1954-2011. Face ao enquadramento institucional que justificou uma investigação interpretativa, foi usado como método de investigação um estudo de caso explanatório. A evidência sobre o caso da NCG nos hospitais públicos portugueses foi recolhida em documentos e através de 58 entrevistas realizadas em 47 unidades de análise (nos serviços centrais de contabilidade do Ministério da Saúde e em 46 hospitais públicos, num total de 53 existentes). Quanto aos principais resultados obtidos, no período 1954-1974, as regras criadas pelo poder político para controlo dos gastos públicos e a contabilidade orçamental de base de caixa estiveram na génese dos primeiros conceitos de Contabilidade de Gestão (CG) para os serviços públicos de saúde portugueses. A transição de um regime ditatorial para um regime democrático (25 de Abril de 1974), a criação do Plano Oficial de Contabilidade (POC/77) e a implementação de um estado social com Serviço Nacional de Saúde (SNS) criaram a conjuntura crítica necessária para o surgimento de um Plano Oficial de Contabilidade para os Serviços de Saúde (POCSS/80) que incluiu regras de CG. A primeira edição do Plano de Contabilidade Analítica dos Hospitais (PCAH), aprovada em 1996, não foi uma construção de raiz, mas antes uma adaptação para os hospitais das regras de CG incluídas no POCSS/91 que havia revisto o POCSS/80. Após o início da implementação do PCAH, em 1998, ocorreram sequências de autorreforço institucionalizadoras destas normas, no período 1998-2011, por influência de pressões isomórficas coercivas que delinearam um processo de evolução incremental cujo resultado foi uma reprodução por adaptação, num contexto de dependência de recursos. Vários agentes internos e externos pressionaram, no período 2003-2011, através de sequências reativas para a desinstitucionalização do PCAH em resposta ao persistente fenómeno de loose coupling. Mas o PCAH só foi descontinuado nos hospitais com privatização da governação e rejeição dos anteriores sistemas de informação. Ao nível da extensão da teoria, este estudo de caso adotou o institucionalismo histórico na investigação em CG, quanto se sabe pela primeira vez, que se mostra útil na interpretação dos processos e dos resultados da criação e evolução de instituições de CG num determinado contexto histórico. Na condição de dependência de recursos, as sequências de autorreforço, via isomorfismo coercivo, tendem para uma institucionalização com fenómeno de loose coupling. Como resposta a este fenómeno, ocorrem sequências reativas no sentido da desinstitucionalização. Perante as pressões (políticas, funcionais, sociais e tecnológicas) desinstitucionalizadoras, o fator governação privada acelera o processo de desinstitucionalização, enquanto o fator governação pública impede ou abranda esse processo.

Tendências da pesquisa em comunicação organizacional em Portugal: um estudo desde 1990 a 2009

ISBN 978-972-8932-91-6

Self-esteem, assertiveness and resilience in adolescents institutionalized

The institutionalization of children and adolescents has been an increasingly visible problem in modern society. Unfavourable socio-economic conditions have been joining the behavior problems and school absenteeism. When the family fails in its competence for education, social security or the Court withdraws the child or adolescent to a host institution. The aim of this research was to characterize self-esteem, assertiveness and resilience of institutionalized adolescents in the northern region of Portugal and to establish associations with these dependent variables and gender, scholar level and duration of the institutionalization. For the purpose of this study a wider questionnaire was carried out, and validated with a smaller group. It was a transversal study following a predominantly quantitative methodology, with a convenience sample. The sample included 101 adolescents (55 female and 46 males) from eight institutions, aged between 11 to 21 years old (average 15.45). For self-esteem the Rosenberg Self-Esteem Scale (Rosenberg, 1965), already validate for Portuguese adolescents, was used. For assertiveness and resilience it was applied the Global Evaluation Scale of Assertiveness and the Global Evaluation Scale of Resilience (Jardim & Pereira, 2006) we previously adapted and validated for adolescents. Collected data was introduced in a SPSS database. A descriptive analysis was done to characterize the sample concerning all the variables. To establish associations between individual factors and dependent variables t test, correlations and non-parametric test were applied. Results indicated a relatively low self-esteem (28.03), with girls having a lower value than boys, without significant differences. No correlations were found between self-esteem and the time in the institution. Assertiveness of the sample is average (23.97) and higher for girls than boys, with a positive significant correlation with the scholar grade. Also the resilience is average (25.97), having girls a little lower mean than boys and no significant differences or correlations were found.

A resolução alternativa de litígios e as tecnologias de informação e comunicação: o caso particular da resolução de conflitos na Internet em Portugal e na UE

Dissertação de mestrado em Direito e Informática

Gestão do conhecimento universitário : estudo comparativo entre Portugal e Brasil

Mestrado em Gestão de Recursos Humanos

Which screening strategy using BMD measurements would be most cost effective for hip fracture prevention in elderly women? A decision analysis based on a Markov model.

INTRODUCTION: Hip fractures are responsible for excessive mortality, decreasing the 5-year survival rate by about 20%. From an economic perspective, they represent a major source of expense, with direct costs in hospitalization, rehabilitation, and institutionalization. The incidence rate sharply increases after the age of 70, but it can be reduced in women aged 70-80 years by therapeutic interventions. Recent analyses suggest that the most efficient strategy is to implement such interventions in women at the age of 70 years. As several guidelines recommend bone mineral density (BMD) screening of postmenopausal women with clinical risk factors, our objective was to assess the cost-effectiveness of two screening strategies applied to elderly women aged 70 years and older. METHODS: A cost-effectiveness analysis was performed using decision-tree analysis and a Markov model. Two alternative strategies, one measuring BMD of all women, and one measuring BMD only of those having at least one risk factor, were compared with the reference strategy "no screening". Cost-effectiveness ratios were measured as cost per year gained without hip fracture. Most probabilities were based on data observed in EPIDOS, SEMOF and OFELY cohorts. RESULTS: In this model, which is mostly based on observed data, the strategy "screen all" was more cost effective than "screen women at risk." For one woman screened at the age of 70 and followed for 10 years, the incremental (additional) cost-effectiveness ratio of these two strategies compared with the reference was 4,235 euros and 8,290 euros, respectively. CONCLUSION: The results of this model, under the assumptions described in the paper, suggest that in women aged 70-80 years, screening all women with dual-energy X-ray absorptiometry (DXA) would be more effective than no screening or screening only women with at least one risk factor. Cost-effectiveness studies based on decision-analysis trees maybe useful tools for helping decision makers, and further models based on different assumptions should be performed to improve the level of evidence on cost-effectiveness ratios of the usual screening strategies for osteoporosis.

The Corrosion of Career? - Occupational Trajectories of Business Economists and Engineers in Switzerland

Achievement careers are regarded as a distinctive element of the post-war period in occidental societies. Such a career was at once a modal trajectory of the modern parts of middleclass men and a social emblem for progress and success. However, if the achievement career came to be a biographical pattern with great normative power, its precise sequential course remained vague. Theories of the 1960s and 1970s described it as an orderly advancement within large firms. By the 1990s, scholars postulated an erosion of the organizational structures that once contributed to the institutionalization of careers, accompanied by a weakening of the normative weight of the achievement career by management discourse. We question the thesis of the corrosion of achievement career by analysing the trajectories of 442 engineers and business economists in Switzerland in regard to their orderliness, loyalty, and temporal rhythm. An inspection of types of careers and cohorts reveals that even if we face a decline of loyalty over time, hierarchical orderliness is not touched by those changes. Foremost, technical-industrial careers fit the loyal and regular pattern. Hence, this trajectory-type represents only a minority and is by far the slowest and least successful in terms of hierarchical ascension.

Health services utilization associated with cognitive impairment and dementia in older patients undergoing post-acute rehabilitation.

OBJECTIVE: To investigate the relationship between levels of cognitive impairment and health services utilization in older patients undergoing post-acute rehabilitation. DESIGN: Cross-sectional study. SETTING: Post-acute rehabilitation facility. PARTICIPANTS: Patients (N = 1764) aged 70 years and older admitted over 3 years. MEASUREMENTS: Sociodemographic, medical, and functional data were collected upon admission. Based on discharge diagnoses, patients were classified as cognitively intact, cognitively impaired with no dementia (CIND), and demented. RESULTS: Dementia and CIND were diagnosed in 425 (24.1%) and 301 (17.1%) patients, respectively. Gradients from cognitively intact to cognitively impaired to demented patients were observed in median length of stay (19, 22, and 25 days, P < .001), and institutionalization rates at discharge (4.2%, 7.6%, and 28.8%, P < .001). Among patients discharged home, similar gradients were observed in utilization of home care (68.2%, 79.7%, and 83.3%, P < .001) and day care (3.1%, 7.1%, and 14.3%, P < .001). After adjustment, compared with cognitively intact patients, only those with dementia still had longer stays (+2.7 days) and increased odds of institutionalization (adjOR 6.1, 95% CI 4.0-9.3, P < .001). Among patients discharged home, use of home and day care remained higher in those with dementia (adjOR 1.8, 95% CI 1.2-2.7, P = .005, and adjOR 1.8, 95% CI 1.2-2.7, P = .005, respectively), while CIND patients had higher odds of using home care (adjOR 1.6, 95% CI 1.1-2.4, P = .028). CONCLUSION: Among patients undergoing post-acute rehabilitation, those with dementia had increased use of both institutional and community care, whereas those with CIND had increased use of home care services only. Future studies should investigate specific strategies susceptible to reduce the related burden on health care systems.