Estudo sobre o consumo de tabaco entre os adolescentes da Ilha Terceira

RESUMO - O objetivo deste estudo foi conhecer o comportamento face ao consumo de tabaco reportado pelos adolescentes escolarizados da ilha Terceira e caracterizar alguns fatores associados. O estudo realizado assumiu uma metodologia de investigação observacional, descritiva, quantitativa e de carácter transversal. Os dados foram recolhidos no ano letivo 2012/2013, nos alunos do 9.º ano de escolaridade, através da aplicação de um questionário de autopreenchimento, anónimo e voluntário, em contexto de sala de aula. A amostra foi constituída por 323 adolescentes, 142 do sexo masculino e 181 do sexo feminino, com idade média de 14,71 anos. Verificou-se que cerca de 16,9% dos adolescentes consome tabaco regularmente, 6,6% ocasionalmente e 76,6% não fuma. Mais de metade dos adolescentes já experimentou fumar tabaco (56%), sendo a idade média de experimentação de 12,49 anos. A maioria dos adolescentes que experimentaram fumar referiram tê-lo feito por curiosidade (84,7%) e, sobretudo, na companhia dos amigos (83,1%). As variáveis associadas ao comportamento tabágico foram: o desempenho escolar, os hábitos tabágicos dos amigos, a permissividade dos pais para se fumar em casa, a frequência à exposição ao tabaco em casa, os conhecimentos da “impotência sexual” como consequência do consumo de tabaco, conhecimento dos danos na saúde em frequentar ambientes com fumo e a crença de que os jovens fumadores são mais atraentes. Os resultados mostram a elevada necessidade de serem desenvolvidas estratégias de prevenção e controlo do tabagismo entre os adolescentes da ilha Terceira.

Corruption: Who pays for the bill?

This paper intends to study who pays for corruption in Brazil from 2005 to 2011. Politicians may decide to charge the spillovers of corruption at a municipal level through taxes or to charge it to the entire country through voluntary transfers. The used measure of corruption is based on audit reports conducted on randomly selected municipalities from 2005 to 2011.In order to address this question an IV strategy was computed using as instrument for the number of observed cases of corruption the dummy variable of being audited or not. We evaluated the impact of corruption on taxes and on voluntary transfers and concluded that with an increase in the number of observed cases of corruption the first decreases and the latest registers an increase. Therefore, considering all Brazilian municipalities, mayors prefer to spread the bill all over the country than charging it locally.

Evaluation of antihypertensive drugs in patients with obstructive sleep apnea and in rats submitted to chronic intermittent hypoxia

RESUMO: A hipertensão arterial (HA) é uma patologia altamente prevalente, embora claramente subdiagnosticada, em doentes com síndrome de apneia obstrutiva do sono (SAOS). Estas duas patologias apresentam uma estreita relação e a monitorização ambulatória da pressão arterial (MAPA), por um período de 24 horas, parece ser o método mais preciso para o diagnóstico de hipertensão em doentes com SAOS. No entanto, esta ferramenta de diagnóstico para além de ser dispendiosa e envolver um número acrescido de meios técnicos e humanos, é mais morosa e, por conseguinte, não é utilizada por rotina no contexto do diagnóstico da SAOS. Por outro lado, apesar da aplicação de pressão positiva contínua nas vias aéreas (CPAP – Continous Positive Airway Pressure) ser considerada a terapêutica de eleição para os doentes com SAOS, o seu efeito no abaixamento da pressão arterial (PA) parece ser modesto, exigindo, por conseguinte, a implementação concomitante de terapêutica anti-hipertensora. Acontece que são escassos os dados relativos aos regimes de fármacos anti-hipertensores utilizados em doentes com SAOS e, acresce ainda que, as guidelines terapêuticas para o tratamento farmacológico da HA, neste grupo particular de doentes, permanecem, até ao momento, inexistentes. A utilização de modelos animais de hipóxia crónica intermitente (CIH), que mimetizam a HA observada em doentes com SAOS, revela-se extremamente importante, uma vez que se torna imperativo identificar fármacos que promovam um controle adequado da PA neste grupo de doentes. No entanto, estudos concebidos com o intuito de investigar o efeito anti-hipertensor dos fármacos neste modelo animal revelam-se insuficientes e, por outro lado, os escassos estudos que testaram fármacos anti-hipertensores neste modelo não foram desenhados para responder a questões de natureza farmacológica. Acresce ainda que se torna imprescindível garantir a escolha de um método para administração destes fármacos que seja não invasivo e que minimize o stress do animal. Embora a gavagem seja uma técnica indiscutivelmente eficaz e amplamente utilizada para a administração diária de fármacos a animais de laboratório, ela compreende uma sequência de procedimentos geradores de stress para os animais e, que podem por conseguinte, constituir um viés na interpretação dos resultados obtidos. O objectivo global da presente investigação translacional foi contribuir para a identificação de fármacos anti-hipertensores mais efectivos para o tratamento da HT nos indivíduos com SAOS e investigar mecanismos subjacentes aos efeitos sistémicos associadas à SAOS bem como a sua modulação por fármacos anti-hipertensores. Os objectivos específicos foram: em primeiro lugar,encontrar novos critérios, baseados nas medidas antropométricas, que permitam a identificação de doentes com suspeita de SAOS, que erroneamente se auto-classifiquem como nãohipertensos, e desta forma promover um uso mais criterioso do MAPA; em segundo lugar, investigar a existência de uma hipotética associação entre os esquemas de fármacos antihipertensores e o controle da PA (antes e após a adaptação de CPAP) em doentes com SAOS em terceiro lugar, avaliar a eficácia do carvedilol (CVD), um fármaco bloqueador β-adrenérgico não selectivo com actividade antagonista α1 intrínseca e propriedades anti-oxidantes num modelo animal de hipertensão induzida pela CIH; em quarto lugar, explorar os efeitos da CIH sobre o perfil farmacocinético do CVD; e, em quinto lugar, investigar um método alternativo à gavagem para a administração crónica de fármacos anti-hipertensores a animais de laboratório. Com este intuito, na primeira fase deste projecto, fizemos uso de uma amostra com um número apreciável de doentes com SAOS (n=369), que acorreram, pela primeira vez, à consulta de Patologia do Sono do CHLN e que foram submetidos a um estudo polissonográfico do sono, à MAPA e que preencheram um questionário que contemplava a obtenção de informação relativa ao perfil da medicação anti-hipertensora em curso. Numa segunda fase, utilizámos um modelo experimental de HT no rato induzida por um paradigma de CIH. Do nosso trabalho resultaram os seguintes resultados principais: em primeiro lugar, o índice de massa corporal (IMC) e o perímetro do pescoço (PP) foram identificados como preditores independentes de “auto-classificação errónea” da HA em doentes com suspeita de SAOS; em segundo lugar, não encontramos qualquer associação com significado estatístico entre os vários esquemas de fármacos anti-hipertensores bem como o número de fármacos incluídos nesse esquemas, e o controle da PA (antes e depois da adaptação do CPAP); em terceiro lugar, apesar das doses de 10, 30 e 50 mg/kg de carvedilol terem promovido uma redução significativa da frequência cardíaca, não foi observado qualquer decréscimo na PA no nosso modelo animal; em quarto lugar, as razões S/(R+S) dos enantiómeros do CVD nos animais expostos à CIH e a condições de normóxia revelaram-se diferentes; e, em quinto lugar, a administração oral voluntária mostrou ser um método eficaz para a administração diária controlada de fármacos anti-hipertensores e que é independente da manipulação e contenção do animal. Em conclusão, os resultados obtidos através do estudo clínico revelaram que o controle da PA, antes e após a adaptação do CPAP, em doentes com SAOS é independente, quer do esquema de fármacos anti-hipertensores, quer do número de fármacos incluídos num determinado esquema. Os nossos resultados salientam ainda a falta de validade da chamada self-reported hypertension e sugerem que em todos os doentes com suspeita de SAOS, com HA não diagnosticada e com um IMC e um PP acima de 27 kg/m2 e 39 cm, respectivamente, a confirmação do diagnóstico de HA deverá ser realizada através da MAPA, ao invés de outros métodos que com maior frequência são utilizados com este propósito. Os resultados obtidos no modelo animal de HA induzida pela CIH sugerem que o bloqueio do sistema nervoso simpático, juntamente com os supostos efeitos pleiotrópicos do CVD, não parece ser a estratégia mais adequada para reverter este tipo particular de hipertensão e indicam que as alterações farmacocinéticas induzidas pela CIH no ratio S/(R+S) não justificam a falta de eficácia anti-hipertensora do CVD observada neste modelo animal. Por último, os resultados do presente trabalho suportam ainda a viabilidade da utilização da administração oral voluntária, em alternativa à gavagem, para a administração crónica de uma dose fixa de fármacos anti-hipertensores.---------------------------- ABSTRACT: Hypertension (HT) is a highly prevalent condition, although under diagnosed, in patients with obstructive sleep apnea (OSA). These conditions are closely related and 24-hour ambulatory blood pressure monitoring (ABPM) seems to be the most accurate measurement for diagnosing hypertension in OSA. However, this diagnostic tool is expensive and time-consuming and, therefore, not routinely used. On the other hand, although continuous positive airway pressure (CPAP) is considered the gold standard treatment for symptomatic OSA, its lowering effect on blood pressure (BP) seems to be modest and, therefore, concomitant antihypertensive therapy is still required. Data on antihypertensive drug regimens in patients with OSA are scarce and specific therapeutic guidelines for the pharmacological treatment of hypertension in these patients remain absent. The use of animal models of CIH, which mimic the HT observed in patients with OSA, is extremely important since it is imperative to identify preferred compounds for an adequate BP control in this group of patients. However, studies aimed at investigating the antihypertensive effect of antihypertensive drugs in this animal model are insufficient, and most reports on CIH animal models in which drugs have been tested were not designed to respond to pharmacological issues. Moreover, when testing antihypertensive drugs (AHDs) it becomes crucial to ensure the selection of a non-invasive and stress-free method for drug delivery. Although gavage is effective and a widely performed technique for daily dosing in laboratory rodents, it comprises a sequence of potentially stressful procedures for laboratory animals that may constitute bias for the experimental results. The overall goal of the present translational research was to contribute to identify more effective AHDs for the treatment of hypertension in patients with OSA and investigate underlying mechanisms of systemic effects associated with OSA, as well as its modulation by AHDs. The specific aims were: first, to find new predictors based on anthropometric measures to identify patients that misclassify themselves as non-hypertensive, and thereby promote the selective use of ABPM; second, to investigate a hypothetical association between ongoing antihypertensive regimens and BP control rates in patients with OSA, before and after CPAP adaptation; third, to determine, in a rat model of CIH-induced hypertension, the efficacy of carvedilol (CVD), a nonselective beta-blocker with intrinsic anti-α1-adrenergic activity and antioxidant properties; fourth, to explore the effects of CIH on the pharmacokinetics profile of CVD and fifth, to investigate an alternative method to gavage, for chronic administration of AHDs to laboratory rats. For that, in the first phase of this project, we used a sizeable sample of patients with OSA (n=369), that attended a first visit at Centro Hospitalar Lisboa Norte, EPE Sleep Unit, and underwent overnight polysomnography, 24-h ABPM and filled a questionnaire that included ongoing antihypertensive medication profile registration. In the second phase, a rat experimental model of HT induced by a paradigm of CIH that simulates OSA was used. The main findings of this work were: first, body mass index (BMI) and neck circumference (NC) were identified as independent predictors of hypertension misclassification in patients suspected of OSA; second, in patients with OSA, BP control is independent of both the antihypertensive regimen and the number of antihypertensive drugs, either before or after CPAP adaptation; third, although the doses of 10, 30 and 50 mg/Kg of CVD promoted a significant reduction in heart rate, no decrease in mean arterial pressure was observed; fourth, the S/(R+S) ratios of CVD enantiomers, between rats exposed to CIH and normoxic conditions, were different and fifth, voluntary ingestion proved to be an effective method for a controlled daily dose administration, with a define timetable, that is independent of handling and restraint procedures. In conclusion, the clinical study showed that BP control in OSA patients is independent of both the antihypertensive regimen and the number of antihypertensive drugs. Additionally, our results highlight the lack of validity of self-reported hypertension and suggest that all patients suspected of OSA with undiagnosed hypertension and with a BMI and NC above 27 Kg/m2 and 39 cm should be screened for hypertension, through ABPM. The results attained in the rat model of HT related to CIH suggest that the blockade of the sympathetic nervous system together with the putative pleiotropic effects of carvedilol is not able to revert hypertension induced by CIH and point out that the pharmacokinetic changes induced by CIH on S/(R+S) ratio are not apparently responsible for the lack of efficacy of carvedilol in reversing this particular type of hypertension. Finally, the results here presented support the use of voluntary oral administration as a viable alternative to gavage for chronic administration of a fixed dose of AHDs.

Ações encobertas

The global and increasingly technological society requires the States to adopt security measures that can maintain the balance between the freedom, on the one hand, and the security and the respect for fundamental rights of a democratic state, on the other. A State can only achieve this aim if it has an effective judicial system and in particular a criminal procedure adequate to the new criminogenic realities. In this context, the national legislator has adopted, following other international legal systems, special means of obtaining proof more stringent of rights. Within those special means are included the covert actions, that, being a means to use sparingly, is a key element to fight against violent and highly organized crime. Therefore, the undercover agent, voluntary by nature, develops a set of activities that enables the investigation to use other means of taking evidence and/or probationary diligences itself, with the purpose of providing sufficient proof to the case file. In this milieu, given the high risks involved during the investigation, as well as after its completion, the undercover agent can act upon fictitious identity. This measure can be maintained during the evidentiary phase of the trial. Similarly, given the latent threat that the undercover agent suffers by its inclusion in criminal organizations, as well as the need for his inclusion in future covert actions it is crucial that his participation as a witness in the trial is properly shielded. Thus, when the undercover agent provides, exceptionally, statements in the trial, he shall do so always through videoconference with voice and image distortion. This measure can guarantee the anonymity of the undercover agent and concomitantly, that the adversarial principle and the right of the accused to a fair trial is not prejudiced since, in those circumstances, the diligence will be supervised in its entirety (in the audience and with the undercover agent) by a judge.

How premium brands should do to upgrade and move to a luxury status

Premium brands’ upgrade process to luxury is a phenomenon still not well analysed. A literature review allowed assessment of what distinguishes premium and luxury brands. We infered five propositions then tested through a case study research. The research investigated three Portuguese brands that successfully moved from premium to luxury - Claus Porto, Josefinas and Vila Joya. We conclude that acquiring social status is the most essential and difficult feature to deal with, when migrating from premium to luxury as it depends on voluntary and involuntary factors.

Eutanásia ativa

Euthanasia, especially the active one, has always been an extremely discussed subject, which goes further pure dogmatics and transcends the strictly legal field. A reflection about such issue makes us re-think on what it implies for all the involved without ever loosing sight of the fact that admitting a legalization is, in a legal system as ours, to admit the lack of punishment of an homicide act or an assistance to suicide. However, burying in mind the foreign experiences, isn’t there a possibility of working on a path that respects both the basis of our legal system and the rest of the interests involved? And what interests would those be? How to admit such a path? Based on what assumptions? The present study proposes a discovery of paths and not the search for dead ends, creating definitive answers. The purpose of this dissertation is to explore the existing structure of the Portuguese legal system on these matters, in a path that is until now mostly in favour of punishment, based on homicide or assisted suicide crimes. Along with the Portuguese dynamic, we want to analyse legal systems that opted by decriminalization and, based on those experiences, shared with our legal culture, scan the viability of a decriminalization procedure. What paths would be viable for such a decriminalization in Portuguese criminal territory? The scope is only to open the eyes of who always wanted to keep them shut, or to who just never tried to open them, because at the end of the day it will always be a discussion that we want to keep light up, since that what we are here discussing is life. We want discussion, not imposition.

A intervenção da seguradora nas acções propostas contra o segurado

The problem to be discussed results from the relationship established between the insurer and insured by the conclusion of an insurance contract, namely an optional liability insurance contract, to cover the risks taken by the insured resulting from the occurrence of a claim, such as those arising from the emergence of the liability and consequent obligation to compensate damages caused to a third party. This thesis concerns thus the debate between those who consider that, in the optional insurance, the third party may require compliance with the provision to both the insured and the insurer (in the case of voluntary joinder, pursuant to Art. 27 CCP, which corresponds Art. 32 of the New Code of Civil Procedure, Law n. 41/2013 of 26 June, which entered into force on 1 September, hereinafter New Code) - insurance contract on behalf of a third party conception - in the same way that the insured defendant can bring the insurer to intervene as co-defendant in the main process, pursuant al. a) of art. 325 of the CCP (corresponding to art. 316 of the New Code - main intervention caused), and those who argue that the insurer may only intervene in the action as an ancillary party, to assist the defendant, lacking interest, therefore, in necessary or volunteer joinder, with the consequence that the insurer cannot be sued as a main party - only ancillary intervention is justifiable (cf. art. 330 CPC, which corresponds to art. 321 of the New Code).

A penectomia como técnica de controlo reprodutivo da espécie invasora Trachemys scripta em contexto zoológico

Dissertação de Mestrado Integrado em Medicina Veterinária

O depoimento da criança no processo civil e sua valoração probatória

O presente trabalho tem por objetivo examinar um dos meios de prova oral do processo civil, que é o depoimento da criança. Diante da existência de uma certa resistência quanto à utilização e validade deste meio de prova, foram destacados argumentos de direito probatório favoráveis à tomada do depoimento infantil, como o direito à prova no sistema da prova livre e na vertente do direito de ação e defesa, além da necessária comparação com o processo penal e o destaque aos princípios da proteção integral e do superior interesse da criança, os quais foram reforçados por outros de natureza médico-psicológica, que visaram a destacar a capacidade cognitiva da criança em recordar fatos e relatá-los. Após a desconstrução do modelo de exclusão prévia do depoimento infantil, a dissertação abordou os modelos de proteção para a audição judicial da criança, para se evitar a vitimização secundária da criança e exposição desnecessária às partes, advogados e juízes. Neste particular, foram revisados os modelos inglês do closed-circuit television - CCTV e argentino da Câmara de Gesell como paradigmas para vários outros países, inclusive o Brasil que tem incentivado o depoimento sem dano. Em derradeiro, foi examinada a valoração desse depoimento da criança, tomando-se por base a justificação lógico-racional da prova consubstanciada nos módulos de constatação, ocasião em que foi possível sublinhar que a utilização dos modelos e métodos de inquirição protetivos culminam em maior credibilidade ao depoimento da criança no processo civil e proporcionam a descoberta de falsidade voluntária ou não. Também no tópico da valoração da prova, o conteúdo do depoimento infantil vai trazer maior confiança quando conjugado com elementos intrínsecos, como a coerência do discurso e a ausência de contradições, e extrínsecos, realizado na modalidade protetiva.

Insertion dans les soins après une première hospitalisation dans un secteur pour psychose [Linkage to care after first hospitalisation for psychosis]

BACKGROUND: First hospitalisation for a psychotic episode causes intense distress to patients and families, but offers an opportunity to make a diagnosis and start treatment. However, linkage to outpatient psychiatric care remains a notoriously difficult step for young psychotic patients, who frequently interrupt treatment after hospitalisation. Persistence of symptoms, and untreated psychosis may therefore remain a problem despite hospitalisation and proper diagnosis. With persisting psychotic symptoms, numerous complications may arise: breakdown in relationships, loss of family and social support, loss of employment or study interruption, denial of disease, depression, suicide, substance abuse and violence. Understanding mechanisms that might promote linkage to outpatient psychiatric care is therefore a critical issue, especially in early intervention in psychotic disorders. OBJECTIVE: To study which factors hinder or promote linkage of young psychotic patients to outpatient psychiatric care after a first hospitalisation, in the absence of a vertically integrated program for early psychosis. Method. File audit study of all patients aged 18 to 30 who were admitted for the first time to the psychiatric University Hospital of Lausanne in the year 2000. For statistical analysis, chi2 tests were used for categorical variables and t-test for dimensional variables; p<0.05 was considered as statistically significant. RESULTS: 230 patients aged 18 to 30 were admitted to the Lausanne University psychiatric hospital for the first time during the year 2000, 52 of them with a diagnosis of psychosis (23%). Patients with psychosis were mostly male (83%) when compared with non-psychosis patients (49%). Furthermore, they had (1) 10 days longer mean duration of stay (24 vs 14 days), (2) a higher rate of compulsory admissions (53% vs 22%) and (3) were more often hospitalised by a psychiatrist rather than by a general practitioner (83% vs 53%). Other socio-demographic and clinical features at admission were similar in the two groups. Among the 52 psychotic patients, 10 did not stay in the catchment area for subsequent treatment. Among the 42 psychotic patients who remained in the catchment area after discharge, 20 (48%) did not attend the scheduled or rescheduled outpatient appointment. None of the socio demographic characteristics were associated with attendance to outpatient appointments. On the other hand, voluntary admission and suicidal ideation before admission were significantly related to attending the initial appointment. Moreover, some elements of treatment seemed to be associated with higher likelihood to attend outpatient treatment: (1) provision of information to the patient regarding diagnosis, (2) discussion about the treatment plan between in- and outpatient staff, (3) involvement of outpatient team during hospitalisation, and (4) elaboration of concrete strategies to face basic needs, organise daily activities or education and reach for help in case of need. CONCLUSION: As in other studies, half of the patients admitted for a first psychotic episode failed to link to outpatient psychiatric care. Our study suggests that treatment rather than patient's characteristics play a critical role in this phenomenon. Development of a partnership and involvement of patients in the decision process, provision of good information regarding the illness, clear definition of the treatment plan, development of concrete strategies to cope with the illness and its potential complications, and involvement of the outpatient treating team already during hospitalisation, all came out as critical strategies to facilitate adherence to outpatient care. While the current rate of disengagement after admission is highly concerning, our finding are encouraging since they constitute strategies that can easily be implemented. An open approach to psychosis, the development of partnership with patients and a better coordination between inpatient and outpatient teams should therefore be among the targets of early intervention programs. These observations might help setting up priorities when conceptualising new programs and facilitate the implementation of services that facilitate engagement of patients in treatment during the critical initial phase of psychotic disorders.

Les temporalités des médicaments : trajectoires en soins palliatifs à l'hôpital

A partir d'un terrain ethnographique réalisé au sein d'une équipe mobile de soins palliatifs d'un hôpital universitaire, cette thèse de doctorat porte sur les médicaments dans le contexte de la fin de vie. Au carrefour d'une socio-anthropologie de la maladie grave, du mourir et des médicaments, elle interroge les rapports à la morphine, ainsi qu'à certains psychotropes et sédatifs utilisés en soins palliatifs. Entre temporalité vécue et temporalité institutionnelle, les manières d'investir le temps lorsqu'il est compté, y sont centrales. Dans une dimension microsociale, les résultats montrent que l'introduction de certains médicaments comme la morphine et l'entrée en scène d'une équipe mobile de soins palliatifs sont des points de repère et peuvent sonner comme une annonce, sorte de sanction, dans la trajectoire incertaine de la personne malade. En outre, les médicaments permettent d'agir sur « le temps qui reste » en plus de soulager les symptômes lorsque la maladie grave bascule en maladie incurable. Ils font l'objet d'usages détournés du but initial de soulagement des symptômes pour repousser, altérer ou accélérer la mort dans une perspective de maîtrise de sa fin de vie. Dans une dimension mésosociale, ce travail considère les médicaments à la base d'échanges entre groupements professionnels sur fond d'institutionnalisation des soins palliatifs par rapport à d'autres segments de la médecine actifs dans la gestion de la fin de vie. Dans une médecine caractérisée par l'incertitude et les décisions -avec une teinte toute particulière en Suisse où le suicide assisté est toléré - les médicaments en soins palliatifs peuvent être considérés comme des instruments de mort, qu'ils soient redoutés ou recherchés. Interrogeant les risques de reproduire un certain nombre d'inégalités de traitements à l'approche de la mort, qui s'accentuent dans un contexte de plus en plus favorable aux pratiques euthanasiques, ce travail se propose, en définitive, de discuter le temps contraint de la mort dans les institutions hospitalo-universitaires, entre acharnement et abstention thérapeutique.¦-¦Based on ethnographie fieldwork conducted within a palliative care mobile team in an academic hospital, this doctoral thesis focuses on medicines used in end of life contexts. At the intersection of a socio-anthropology of illness, dying and pharmaceuticals, the relations to morphine, as well as to some psychotropic and sedative drugs used in palliative care are questioned. Between "lived" experiences of temporality and institutional temporality, the ways by which actors invest time when it is counted, appeared to be central. In a microsocial dimension, the results showed that introducing drugs such as morphine, as well as the arrival of a palliative care mobile team, are landmarks and sound like an announcement, a sort of sanction, during the uncertain trajectory of the ill person. In addition, medicines can act on "the remaining time" when severe illness shifts into incurable illness. Indeed, medicines are being diverted from the initial aim of symptom relief in order to defer, alter or hasten death in a perspective of control over one's death. In a mesosocial dimension, pharmaceuticals are seen as core to professional exchanges and to palliative care institutionalisation compared to other active medical segments in end of life care. In a medical context characterised by uncertainty and decision-taking-with a special shade in Switzerland where assisted suicide is tolerated - palliative medicines can be seen as instruments of death, whether sought or feared. Questioning the risks of reproducing treatment inequalities at the approach of death, which are accentuated in a context increasingly favorable to euthanasia practices, this study aims, ultimately, at discussing death's constrained time in academic hospitals, between therapeutic intervention and abstention.

High Altitude Increases Alteration in Maximal Torque but Not in Rapid Torque Development in Knee Extensors after Repeated Treadmill Sprinting.

We assessed knee extensor neuromuscular adjustments following repeated treadmill sprints in different normobaric hypoxia conditions, with special reference to rapid muscle torque production capacity. Thirteen team- and racquet-sport athletes undertook 8 × 5-s "all-out" sprints (passive recovery = 25 s) on a non-motorized treadmill in normoxia (NM; FiO2 = 20.9%), at low (LA; FiO2 = 16.8%) and high (HA; FiO2 = 13.3%) normobaric hypoxia (simulated altitudes of ~1800 m and ~3600 m, respectively). Explosive (~1 s; "fast" instruction) and maximal (~5 s; "hard" instruction) voluntary isometric contractions (MVC) of the knee extensors (KE), with concurrent electromyographic (EMG) activity recordings of the vastus lateralis (VL) and rectus femoris (RF) muscles, were performed before and 1-min post-exercise. Rate of torque development (RTD) and EMG (i.e., Root Mean Square or RMS) rise from 0 to 30, -50, -100, and -200 ms were recorded, and were also normalized to maximal torque and EMG values, respectively. Distance covered during the first 5-s sprint was similar (P > 0.05) in all conditions. A larger (P < 0.05) sprint decrement score and a shorter (P < 0.05) cumulated distance covered over the eight sprints occurred in HA (-8 ± 4% and 178 ± 11 m) but not in LA (-7 ± 3% and 181 ± 10 m) compared to NM (-5 ± 2% and 183 ± 9 m). Compared to NM (-9 ± 7%), a larger (P < 0.05) reduction in MVC torque occurred post-exercise in HA (-14 ± 9%) but not in LA (-12 ± 7%), with no difference between NM and LA (P > 0.05). Irrespectively of condition (P > 0.05), peak RTD (-6 ± 11%; P < 0.05), and normalized peak RMS activity for VL (-8 ± 11%; P = 0.07) and RF (-14 ± 11%; P < 0.01) muscles were reduced post-exercise, whereas reductions (P < 0.05) in absolute RTD occurred within the 0-100 (-8 ± 9%) and 0-200 ms (-10 ± 8%) epochs after contraction onset. After normalization to MVC torque, there was no difference in RTD values. Additionally, the EMG rise for VL muscle was similar (P > 0.05), whereas it increased (P < 0.05) for RF muscle during all epochs post-exercise, independently of the conditions. In summary, alteration in repeated-sprint ability and post-exercise MVC decrease were greater at high altitude than in normoxia or at low altitude. However, the post-exercise alterations in RTD were similar between normoxia and low-to-high hypoxia.

Capacity and transformational development within the 2005 Canada Summer Games host society

Although capacity has been used in recent federal government accords and policies related to the voluntary and amateur sport sectors, there is little consensus over the meaning of the term. Consequently, the purpose of this qualitative case study was to explore the concept of organizational capacity within a temporary voluntary sport organization. Specifically, the nature of organizational capacity was examined within the case of the Volunteers Division of the 2005 Canada Summer Games (CSG) Host Society. Data were collected from executive planning and middle management CSG volunteers through the use of a variety of methods: verbal journals, interviews, observations, documents and a focus group. Findings indicated several challenges associated with the volunteer management model utilized by the host society, varying levels of importance among six elements of capacity, and key aspects of the relationship between organizational capacity and transformational development. Implications focused upon the importance of highlighting individuals rather than the organizational as a whole in order to build capacity, and utilizing a brain or hybrid brain-machine organizational form to enhance capacity. Recommendations are provided for both the Canada Games Council and Canada Games host societies.

Childlessness in a child-centered environment : the experiences of voluntarily childless female teachers /

In the literature on voluntary childlessness there is a lack of research on the types of occupations held by women who choose not to mother and how their fertility choice influences their occupational experiences. At the same time, the experience ofwomen with regard to the childfree choice has not been adequately addressed in contemporary feminist literature. In the field of education, much has been written about the association between mothering and teaching. Thus, childfree teachers become particularly interesting since they made seemingly paradoxical choices in that they chose not to bear and rear children yet they chose an occupation in which they are surrounded by and responsible for the daily care of many children. To gain an understanding of the work-related experiences of childfree women, in-depth interviews were conducted with 7 voluntarily childless female elementary school teachers from Southern Ontario. In addition, a focus group interview in which 3 of the 7 childfree teachers participated was conducted. Findings revealed that these women's "choice" to be childless was the result of complex circumstances and multiple motivations. Also, despite their decision to forgo the traditional female role of mother, these women held surprisingly conventional beliefs with regard to family and gender roles. In addition, these childfree women at times identified themselves as mother-like when teaching, yet at other times distanced themselves as teachers from mothers. Finally, results showed that these women experienced both direct and indirect pronatalist pressures outside as well as inside the workplace as a result of their childfree status.

Teacher survival : staying alive in the job of teaching /

This study presents information gathered during personal interviews with dynamic and capable teachers in the areas of preparedness for teaching, teaching concerns, survival skills and strategies, and how these teachers support themselves and others in the teaching profession. The data are related to Purkey and Novak's work on invitational education and connections are made to Combs' perceptual orientation. Potential participants were gathered through personal recommendations from their colleagues. All teachers recommended were approached and asked for voluntary participation. Of those who agreed to participate, 6 were selected based on gender and years of experience. There was a male and female participant at each of the following career levels: early, mid, and late. The 4 major survival skills that became apparent were the ability to believe in oneself and others, to act decisively upon that belief through personal and professional goal-setting as well as accessing resources, to actively seek opportunities for interaction with other professionals, and to celebrate personal and professional successes.