O emprego de uma força de segurança de natureza militar nas missões de paz

The conflicts currently taking place around the world demand that the international intervention fits the intensity and extent of the threat. This is particularly important in post-conflict scenarios, leading to a greater participation of the Security Forces in those scenarios, in order to foster lasting peace, enforce the order and improve law enforcement services in those regions. The transition from armed conflict to peacekeeping may entail high risk situations and greater instability periods, so-called “intermediate situations”. Accordingly, in the face of persisting high volatility, a robust response is still required post-conflict. Therefore, it is appropriate to deploy Security Forces with military nature and status, the gendarmeries, which have training and response capabilities similar to Armed Forces in peacekeeping operations. Their double facet as police and military forces enables them to perform police duties in high risk and unsafe environments. In light of these features, the Portuguese gendarmerie, Guarda Nacional Republicana (GNR), is able to carry out tasks in these scenarios, which it has been doing through individual operatives or larger units. This dissertation focuses on the use of Security Forces of military nature in peacekeeping missions, in particular the Portuguese GNR, relying mostly on the inductive approach and using literature research, document analysis, interviews and statistics. After a brief description of international peacekeeping missions, we describe the contribution of Security Forces of a military nature in such operations. Then we introduce and analyse the GNR, focusing on its deployment in different kinds of peacekeeping operations, from its first participation in 1995 until today. We also report some reactions to the performance of GNR. Finally, we discuss whether there is indeed a unique role for this type of forces in international peacekeeping missions.

How to improve consumer decision skills in children? A case study of an intervention with institutionalized children

The aim of this study is to assess the institutionalized children’s skills as consumers but also to assess how we can improve their knowledge through an intervention. The sample was composed of two subgroups (38 institutionalized children and 36 non-institutionalized children). In order to assess children’s knowledge, a questionnaire and an interview were used. The method used as intervention was a 30-minute class. Results suggested that institutionalized children have lower levels of knowledge regarding consumption-related practices and lower levels of accuracy at estimating prices than non-institutionalized children. However, results also showed that the attitudes of institutionalized children towards advertising and making decisions based on price/quantity evaluation or based on the use of the same strategy in different situations are not significantly different from the non-institutionalized children. Regarding the intervention, it was possible to conclude that one class is not the best method to improve children’s knowledge. Institutionalized children need a longer and more practical intervention.

Essays in health economics: Volume-Outcome Effect, upcoding behaviour and the evaluation of a short-term intervention program

Evidence in the literature suggests a negative relationship between volume of medical procedures and mortality rates in the health care sector. In general, high-volume hospitals appear to achieve lower mortality rates, although considerable variation exists. However, most studies focus on US hospitals, which face different incentives than hospitals in a National Health Service (NHS). In order to add to the literature, this study aims to understand what happens in a NHS. Results reveal a statistically significant correlation between volume of procedures and better outcomes for the following medical procedures: cerebral infarction, respiratory infections, circulatory disorders with AMI, bowel procedures, cirrhosis, and hip and femur procedures. The effect is explained with the practice-makes-perfect hypothesis through static effects of scale with little evidence of learning-by-doing. The centralization of those medical procedures is recommended given that this policy would save a considerable number of lives (reduction of 12% in deaths for cerebral infarction).

Reinvigorating and redesigning early intervention in psychosis services for young people in Auckland

RESUMO: Auckland tem sido pioneira na implementação de modelos de Intervenção Precoce em Psicose. No entanto, esta organização do serviço não mudou nos últimos 19 anos. Segundo os dados obtidos da utilização do serviço, no período de 1996 -2012 foram atendidos 997 doentes, que tinham um número médio de 89 contactos (IQR: 36-184), com uma duração média de 62 horas de contactos (IQR: 24-136). Estes doentes passaram um número médio de 338 dias (IQR: 93-757) em contacto com o programa. 517 doentes (52%) não necessitaram de internamento no hospital, e os que foram internados, ficaram uma mediana de 124 dias no hospital (IQR: 40-380). Os doentes asiáticos tiveram um aumento de 50% de probabilidade de serem internados no hospital. Este relatório inclui 15 recomendações para orientar as reformas para o serviço e, nomeadamente, delinear a importância de uma visão organizacional e dos seus componentes-chave. As recomendações incluem o reforço da gestão e da liderança numa estrutura de equipe mais integrada, com recursos dedicados a melhorar a consciencialização da comunidade, a educação e deteção precoce, bem como a capacidade de receber referenciações diretas. Os Indicadores Chave de Desempenho devem ser estabelecidos, mas os Exames de Estado Mental em risco, devem ser removidos. Auckland deve manter a faixa etária alvo atual. A duração do serviço deve ser aumentada para um mínimo de três anos, com a opção de aumentá-la para cinco anos. A proporção de gestor de cuidados para os doentes deve ser preconizada em 1:15, enquanto o pessoal de apoio não-clínico deve ser aumentado. Os psiquiatras devem ter uma carga de trabalho de cerca de 80 doentes por equivalente de tempo completo. Um serviço local de prestação de cuidados deve ser desenvolvido com, nomeadamente, intervenções culturais para responder às necessidades da população multicultural de Auckland. A capacidade de investigação deve ser incorporada no Serviço de Intervenção Precoce em Psicoses. Qualquer alteração deverá envolver contacto com todas as partes interessadas, e a Administração Regional de Saúde deve comprometer-se em tempo, recursos humanos e políticos para apoiar e facilitar a mudança do sistema, investindo de forma significativa para melhor servir a comunidade Auckland.----------------------------------- ABSTRACT: Auckland has been pioneering in the adoption of Early Intervention in Psychosis models but the design of the service has not changed in 19 years. In service utilisation data from 997 patients seen from 1996 -2012, patients had a median number of 89 contacts (IQR: 36-184), with a median duration of 62 hours of contact (IQR: 24-136). Patients spent a median number of 338 days (IQR: 93-757) in contact with the program. 517 patients (52%) did not require admission to hospital, and those who did spent a median of 124 days in hospital (IQR: 40-380). Asian patients had a 50% increased chance of being admitted to hospital. This report includes 15 recommendations to guide reforms to the service, including outlining the importance of vision and key components. It recommends strengthened managerial leadership and a more integrated team structure with dedicated resources for improved community awareness, education and early detection as well as the capacity to take direct referrals. Key Performance Indicators (KPIs) should be established but At Risk Mental States should be excluded. Auckland should maintain the current target age range. The duration of service should be increased to a minimum of three years, with the option to extend this to five years. The ratio of care co-ordinator to patients should be capped at 1:15 whilst non-clinical supporting staff should be increased. Psychiatrists should have a caseload of about 80 per FTE. A local Service Delivery framework should be developed, as should cultural interventions to meet the needs of the multicultural population of Auckland. Research capacity should be incorporated into the fabric of Early Intervention in Psychosis Services. Any changes should involve consultation with all stakeholders, and the DHB should commit to investing time, human and political resources to support and facilitate meaningful system change to best serve the Auckland community.

Social impact bond feasibility study AEIPS intervention

AEIPS is a Portuguese social organization promoting the integration of people with mental health illnesses and/or substance abuse in the community through the intervention model Housing First. The philosophy of Housing First aims at lifting people out of their homelessness status by providing instant access to individualized and permanent housing as well as support services. Housing First projects from all over the world have proved very positive results in terms of residential stability and community integration of its participants. This feasibility study evaluates the suitability of using a Social Impact Bond to fund the Housing First intervention of AEIPS in Portugal.

Tanztherapie in der Psychoonkologie : Auswirkungen der Intervention auf die gesundheitsbezogene Lebensqualität

Das Ziel der vorliegenden Arbeit ist es zu prüfen, ob Tanztherapie einen Effekt auf dieLebensqualität bei Brustkrebspatientinnen hat. Brustkrebs ist die häufigste Krebserkrankungbei Frauen in Deutschland. Verbesserte Behandlungsformen und Früherkennungsmaßnahmenführen zu einem Anstieg der Überlebensrate. Dennoch bedingen ein langerBehandlungsweg und Unsicherheit über den Verlauf der Krankheit hohe Belastungen undUnsicherheiten. Nebenwirkungen und Langzeitfolgen der Interventionen beeinflussen zudemdie gesundheitsbezogene Lebensqualität. Körper und Psyche werden stark beansprucht undleiden. Die Psychoonkologie stellt dabei einen Teil des Behandlungsweges dar. Sie bildetesich aus der Erkenntnis heraus, dass die Krebserkrankung nicht nur den Körper beeinflusst,sondern den gesamten Menschen mit seiner seelischen und geistigen Verfassung. DieTanztherapie ist eine Maßnahme im Kanon der psychoonkologischen Betreuung. Sie vereintkörperliche Betätigung und kreative Ausdrucksmöglichkeiten. Psyche und Körper werden beidieser Therapieform angesprochen. Im Gruppensetting fließt zudem die soziale Komponentemit ein. Die These lautet demnach, dass Tanztherapie positive Auswirkungen auf diegesundheitsbezogenen Lebensqualität hat. Denn Körper, Psyche und soziales Umfeld sindTeile der Lebensqualität. Das methodische Vorgehen dieser Arbeit setzte sich aus demRecherchieren von relevanten Studien, Reviews und Metaanalysen zusammen. Es wurdendie Datenbanken Google Scholar, PubMed, PsyCONTENT und Springer Link bis zum Jahre2014 durchsucht. Schlüsselworte waren dabei Tanztherapie, Psychoonkologie, Krebspatient,Lebensqualität, gesundheitsbezogene Lebensqualität, künstlerische Therapie,dance/movement therapy, cancer patient, quality of life, health related quality of life.

Intervention précoce dans la phase initiale des troubles psychotiques à Lausanne: quels problèmes et quelles solutions [Early intervention for the initial phase of psychotic disorders in Lausanne: what problems and what solutions?]

Schizophrenia has long been considered with pessimism, but the recent interest in the early phase of psychotic disorders has modified this often unjustified perception. Literature has demonstrated the benefit of the development of programs specialised in the treatment of early psychosis, which tend to be developed in many countries. It is however important to match them to local needs as well as to the structure of local health services. This paper reviews elements that justify such a development in Lausanne, Switzerland, and describe its various elements.

Modularity of auditory spatial representations

Abstract : Auditory spatial functions are of crucial importance in everyday life. Determining the origin of sound sources in space plays a key role in a variety of tasks including orientation of attention, disentangling of complex acoustic patterns reaching our ears in noisy environments. Following brain damage, auditory spatial processing can be disrupted, resulting in severe handicaps. Complaints of patients with sound localization deficits include the inability to locate their crying child or being over-loaded by sounds in crowded public places. Yet, the brain bears a large capacity for reorganization following damage and/or learning. This phenomenon is referred as plasticity and is believed to underlie post-lesional functional recovery as well as learning-induced improvement. The aim of this thesis was to investigate the organization and plasticity of different aspects of auditory spatial functions. Overall, we report the outcomes of three studies: In the study entitled "Learning-induced plasticity in auditory spatial representations" (Spierer et al., 2007b), we focused on the neurophysiological and behavioral changes induced by auditory spatial training in healthy subjects. We found that relatively brief auditory spatial discrimination training improves performance and modifies the cortical representation of the trained sound locations, suggesting that cortical auditory representations of space are dynamic and subject to rapid reorganization. In the same study, we tested the generalization and persistence of training effects over time, as these are two determining factors in the development of neurorehabilitative intervention. In "The path to success in auditory spatial discrimination" (Spierer et al., 2007c), we investigated the neurophysiological correlates of successful spatial discrimination and contribute to the modeling of the anatomo-functional organization of auditory spatial processing in healthy subjects. We showed that discrimination accuracy depends on superior temporal plane (STP) activity in response to the first sound of a pair of stimuli. Our data support a model wherein refinement of spatial representations occurs within the STP and that interactions with parietal structures allow for transformations into coordinate frames that are required for higher-order computations including absolute localization of sound sources. In "Extinction of auditory stimuli in hemineglect: space versus ear" (Spierer et al., 2007a), we investigated auditory attentional deficits in brain-damaged patients. This work provides insight into the auditory neglect syndrome and its relation with neglect symptoms within the visual modality. Apart from contributing to a basic understanding of the cortical mechanisms underlying auditory spatial functions, the outcomes of the studies also contribute to develop neurorehabilitation strategies, which are currently being tested in clinical populations.

Can a targeted psychological intervention be effective for young people following a first manic episode? Results from an 18-month pilot study.

Aim: There is a scarce literature describing psychological interventions for a young, first-episode cohort who have experienced psychotic mania. This study aimed to assess whether a manualized psychological intervention could be effective in reducing symptomatology and relapse, and improve functional outcome in this population. Methods: The study was an open-label design, drawn from a larger pharmacotherapy trial. All participants in the pharmacotherapy trial were offered a manualized psychological intervention in addition to case management. Inclusion in the psychotherapy group was based on participant's choice, and on completion of four or more of the eight modules offered. All clinical files were audited to ensure accuracy of group allocation. Forty young people aged 15 to 25 years old who had experienced a manic episode with psychotic features were recruited into the study, with 20 people in the combined treatment as usual plus psychotherapy group (P+TAU), and an equal number of matched control participants who received treatment as usual (TAU) within the same service. All participants were prescribed antipsychotic and mood-stabilizing medication. Symptomatic, functional and relapse measures were taken both at baseline and at 18-month follow-up. Results: Manic symptoms improved significantly for both groups, with no differences between groups. Depression scores and overall symptom severity were significantly lower in the P + TAU group. No differences were evident between groups with regard to numbers or type of relapse. The P + TAU group had significantly better social and occupational functioning after 18 months. Conclusion: This study suggests that a manualized psychological intervention targeted to a first-episode population can be effective in reducing depression and overall symptom severity, and can improve functional outcome following a first episode of psychotic mania.

Impact of an intervention to control risk associated with patient transfer.

QUESTION UNDER STUDY: Hospitals transferring patients retain responsibility until admission to the new health care facility. We define safe transfer conditions, based on appropriate risk assessment, and evaluate the impact of this strategy as implemented at our institution. METHODS: An algorithm defining transfer categories according to destination, equipment monitoring, and medication was developed and tested prospectively over 6 months. Conformity with algorithm criteria was assessed for every transfer and transfer category. After introduction of a transfer coordination centre with transfer nurses, the algorithm was implemented and the same survey was carried out over 1 year. RESULTS: Over the whole study period, the number of transfers increased by 40%, chiefly by ambulance from the emergency department to other hospitals and private clinics. Transfers to rehabilitation centres and nursing homes were reassigned to conventional vehicles. The percentage of patients requiring equipment during transfer, such as an intravenous line, decreased from 34% to 15%, while oxygen or i.v. drug requirement remained stable. The percentage of transfers considered below theoretical safety decreased from 6% to 4%, while 20% of transfers were considered safer than necessary. A substantial number of planned transfers could be "downgraded" by mutual agreement to a lower degree of supervision, and the system was stable on a short-term basis. CONCLUSION: A coordinated transfer system based on an algorithm determining transfer categories, developed on the basis of simple but valid medical and nursing criteria, reduced unnecessary ambulance transfers and treatment during transfer, and increased adequate supervision.

Influence of clients' personality and individual characteristics on the effectiveness of a career counselling intervention

Clients' personality traits and individual characteristics, such as age, gender, reason for seeking counselling, and further compounding problems in their personal or academic lives, may pose risk factors that render career decision making difficult and may also impact the overall effectiveness of a career counselling intervention. Neuroticism and conscien- tiousness as well as clients' age and gender directly affected clients' satisfaction with life and certain aspects of their career indecision scores before participating in our short-term career counselling intervention. Career counsellors can use personality and career-specific and career-non-specific instruments to tailor career counselling interventions to meet clients' individual needs.