Resolução de conflitos internacionais: estudo com militares em missões de paz

Tese de Doutoramento em Psicologia na área de especialidade em Psicologia Comunitária

Factors contributing to defaulting scheduled therapy sessions by caregivers of children with congenital disabilities

Background Defaulting scheduled rehabilitation therapy may result in increased adverse outcomes such as permanent disability and increased healthcare costs. Concomitantly, there is evidence to suggest that early and continued rehabilitation of children with congenital disabilities can improve outcomes significantly. This study was conducted to determine factors contributing to caregivers’ defaulting scheduled rehabilitation therapy sessions. Methods A descriptive cross sectional study was carried out at Chitungwiza Central Hospital, a tertiary facility offering in and outpatient rehabilitation services in Zimbabwe. Caregivers of children who had congenital disabilities (N=40) and who had a history of defaulting treatment but were available during the data collection period responded to an interviewer administered questionnaire. Data were analysed for means and frequencies using STATA 13. Results Factors that contributed to caregivers defaulting scheduled therapy included economic constraints (52%), child related factors (43%), caregiver related factors (42%), service centred factors (30%) and psychosocial factors (58%). Majority of the caregivers (98%) were motivated to attend therapy by observable improvements in their children. Other motivators were incentives given in the rehabilitation department (45%), availability of rehabilitation personnel to provide the required services (48%) and psychosocial support from fellow caregivers, families and the rehabilitation staff (68%). Although all the caregivers could not distinguish occupational therapy from physiotherapy services they all reported that therapy was important. Conclusions A combination of psychosocial, economic, child centred and service centred factors contributed to caregivers defaulting scheduled therapy. Interventions that may potentially improve caregiver attendance to scheduled therapy include community outreach services, efficient rehabilitation service provision at the hospitals, and facilitation of income generating programmes for caregivers.

Les valves sans suture dans le traitement de la sténose aortique sévère

Rapport présenté en vue de l’obtention du grade de M.Sc.A génie biomédical option génie clinique

Co-creation of tourism experience: attention, involvement and memorability

Tese de Doutoramento, Turismo, Faculdade de Economia, Universidade do Algarve, 2016

A cooperação institucional na prevenção do consumo/tráfico juvenil de estupefacientes : Zona de ação do Destacamento Territorial de Sintra

A presente investigação visa aferir formas de cooperação institucional entre o Destacamento Territorial de Sintra e os atores locais na prevenção do consumo/tráfico juvenil de estupefacientes. Pretende-se verificar que ações são desenvolvidas para prevenir este comportamento desviante; que vulnerabilidades são identificadas ao nível da cooperação institucional e melhorias para colmatar essas mesmas vulnerabilidades; e ainda propor possíveis ações ou medidas a serem realizadas, no âmbito da cooperação institucional, na prevenção do consumo/tráfico de estupefacientes. Neste sentido, a Guarda Nacional Republicana, enquanto força de segurança, tem incumbências na prevenção destes comportamentos e na criação de laços cooperativos com outros atores, para que este tipo de ações contribua para a promoção do sentimento de segurança. Além do patrulhamento que os militares efetuam diariamente, os militares das secções de programas especiais do Destacamento Territorial são os que mais lidam com esta problemática, essencialmente na prevenção desenvolvida junto da comunidade escolar. O presente estudo adota uma metodologia de tipo qualitativo. Combina a análise documental sobre a atividade policial do Destacamento Territorial de Sintra com as entrevistas realizadas a militares com funções de chefia e a entidades externas que atuam na zona de ação da subunidade. Os resultados decorrentes das entrevistas revelam sintonia no balanço da cooperação institucional, que tanto a Guarda Nacional Republicana como os atores locais consideram ser positiva. As ações de sensibilização junto dos jovens contam-se entre as atividades realizadas conjuntamente, mas a cooperação também proporciona a partilha de informação que permite agir mais rapidamente. Entre as potencialidades desta cooperação elencadas pelos entrevistados salientou-se assim a experiência adquirida e a facilitação das relações entre instituições, que desbloqueia situações e permite resolver problemas de forma mais célere. No âmbito das potencialidades referiu-se ainda o duplo papel da Guarda Nacional Republicana, que por atuar na prevenção e na aplicação da lei causa mais impacto junto dos jovens. No que diz respeito às vulnerabilidades da cooperação existente, foram apontadas limitações quanto aos recursos humanos e materiais e foi salientada a ausência de uma política de prevenção nas escolas. Mencionaram-se ainda algumas dificuldades pontuais de articulação entre entidades, o que também ocorre por via da falta de interoperabilidade entre sistemas de informação. Por último, no que concerne a recomendações de ações a desenvolver apurou-se a necessidade de reforçar a formação específica no sentido de qualificar um leque mais abrangente de intervenientes; considerou-se pertinente a celebração de contratos locais de segurança; e a especialização dos militares da Guarda Nacional Republicana para se dedicarem unicamente a este tipo de temas. Em suma, a prevenção do consumo/tráfico juvenil de estupefacientes passa, cada vez mais, pela cooperação institucional entre atores, visto que é desta forma que se consegue alcançar um maior número de indivíduos e pelo facto de esta realidade ser um problema socialmente relevante na estruturação social, pelo que reclama esforços e ações conjuntas.

Helping someone with problem drinking: mental health first aid guidelines - a Delphi expert consensus study.

BACKGROUND: Alcohol is a leading risk factor for avoidable disease burden. Research suggests that a drinker's social network can play an integral role in addressing hazardous (i.e., high-risk) or problem drinking. Often however, social networks do not have adequate mental health literacy (i.e., knowledge about mental health problems, like problem drinking, or how to treat them). This is a concern as the response that a drinker receives from their social network can have a substantial impact on their willingness to seek help. This paper describes the development of mental health first aid guidelines that inform community members on how to help someone who may have, or may be developing, a drinking problem (i.e., alcohol abuse or dependence). METHODS: A systematic review of the research and lay literature was conducted to develop a 285-item survey containing strategies on how to help someone who may have, or may be developing, a drinking problem. Two panels of experts (consumers/carers and clinicians) individually rated survey items, using a Delphi process. Surveys were completed online or via postal mail. Participants were 99 consumers, carers and clinicians with experience or expertise in problem drinking from Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States. Items that reached consensus on importance were retained and written into guidelines. RESULTS: The overall response rate across all three rounds was 68.7% (67.6% consumers/carers, 69.2% clinicians), with 184 first aid strategies rated as essential or important by > or =80% of panel members. The endorsed guidelines provide guidance on how to: recognize problem drinking; approach someone if there is concern about their drinking; support the person to change their drinking; respond if they are unwilling to change their drinking; facilitate professional help seeking and respond if professional help is refused; and manage an alcohol-related medical emergency. CONCLUSION: The guidelines provide a consensus-based resource for community members seeking to help someone with a drinking problem. Improving community awareness and understanding of how to identify and support someone with a drinking problem may lead to earlier recognition of problem drinking and greater facilitation of professional help seeking.

Profiling nursing resources in Australian emergency departments

BACKGROUND: Emergency nurses have a key role in managing the large numbers of patients that attend Australian emergency departments (EDs) annually, and require adequate educational preparation to deliver safe and quality patient care. This paper provides a detailed profile of nursing resources in Australian EDs, including ED locations, annual patient attendances, nurse staffing including level of education, and educational resources. METHODS: Data were collected via online surveys of emergency Nurse Unit Managers and Nurse Educators and the MyHospitals website. Data were analysed by hospital peer group and state or territory. Comparisons were made using the Kruskal-Wallis Test and Spearman Rank Order Correlation. RESULTS: In 2011-2012, there were a median of 36,274 patient attendances to each of the 118 EDs sampled (IQR 28,279-46,288). Most of the nurses working in EDs were Registered Nurses (95.2%). Organisations provided educational resources including Clinical Nurse Educators (80.6%), learning packages (86%) and facilitation of postgraduate study (98%), but resources, both human and educational varied substantially between states and territories. One-third of emergency nurses held a relevant postgraduate qualification (30%). CONCLUSION: There are important variations in the emergency nursing resources available between Australian states and territories. The high percentage of RNs in Australian EDs is a positive finding, however strategies to increase the percentage of nurses with relevant postgraduate qualifications are required.

A succession of theories : purging redundancy from disturbance theory

The topics of succession and post-disturbance ecosystem recovery have a long and convoluted history. There is extensive redundancy within this body of theory, which has resulted in confusion, and the links among theories have not been adequately drawn. This review aims to distil the unique ideas from the array of theory related to ecosystem change in response to disturbance. This will help to reduce redundancy, and improve communication and understanding between researchers. We first outline the broad range of concepts that have developed over the past century to describe community change in response to disturbance. The body of work spans overlapping succession concepts presented by Clements in 1916, Egler in 1954, and Connell and Slatyer in 1977. Other theories describing community change include state and transition models, biological legacy theory, and the application of functional traits to predict responses to disturbance. Second, we identify areas of overlap of these theories, in addition to highlighting the conceptual and taxonomic limitations of each. In aligning each of these theories with one another, the limited scope and relative inflexibility of some theories becomes apparent, and redundancy becomes explicit. We identify a set of unique concepts to describe the range of mechanisms driving ecosystem responses to disturbance. We present a schematic model of our proposed synthesis which brings together the range of unique mechanisms that were identified in our review. The model describes five main mechanisms of transition away from a post-disturbance community: (i) pulse events with rapid state shifts; (ii) stochastic community drift; (iii) facilitation; (iv) competition; and (v) the influence of the initial composition of a post-disturbance community. In addition, stabilising processes such as biological legacies, inhibition or continuing disturbance may prevent a transition between community types. Integrating these six mechanisms with the functional trait approach is likely to improve the predictive capacity of disturbance theory. Finally, we complement our discussion of theory with a case study which emphasises that many post-disturbance theories apply simultaneously to the same ecosystem. Using the well-studied mountain ash (Eucalyptus regnans) forests of south-eastern Australia, we illustrate phenomena that align with six of the theories described in our model of rationalised disturbance theory. We encourage further work to improve our schematic model, increase coverage of disturbance-related theory, and to show how the model may link to, or integrate with, other domains of ecological theory.

Central proopiomelanocortin but not neuropeptide Y mediates sympathoexcitation and hypertension in fat fed conscious rabbits

OBJECTIVE: High-fat diet (HFD)-induced hypertension in rabbits is neurogenic because of the central sympathoexcitatory actions of leptin. Hypothalamic melanocortin and neuropeptide Y (NPY) neurons are recognized as the major signalling pathways through which leptin exerts its central effects. In this study, we assessed the effects of specific antagonists and agonists to melanocortin and NPY receptors on HFD-induced sympathoexcitation and hypertension. METHODS: Rabbits were instrumented with intracerebroventricular cannula, renal sympathetic nerve activity (RSNA) electrode, and blood pressure telemetry transmitter. RESULTS: After 3 weeks HFD (13.5% fat, n = 12) conscious rabbits had higher RSNA (+3.8  nu, P = 0.02), blood pressure (+8.6  mmHg, P < 0.001) and heart rate (+15  b/min, P = 0.01), and brain-derived neurotrophic factor levels in the hypothalamus compared with rabbits fed a control diet (4.2% fat, n = 11). Intracerebroventricular administration of the melanocortin receptor antagonist SHU9119 reduced RSNA (-2.7  nu) and blood pressure (-8.5  mmHg) in HFD but not control rabbits, thus reversing 100% of the hypertension and 70% of the sympathoexcitation induced by a HFD. By contrast, blocking central NPY Y1 receptors with BVD10 increased RSNA only in HFD rabbits. Intracerebroventricular α-melanocortin stimulating hormone increased RSNA and heart rate (P < 0.001) in HFD rabbits but had no effect in control rabbits. CONCLUSION: These findings suggest that obesity-induced hypertension and increased RSNA are dependent on the balance between greater activation of melanocortin signalling through melanocortin receptors and lesser activation of NPY sympathoinhibitory signalling. The amplification of the sympathoexcitatory effects of α-melanocortin stimulating hormone also indicates that the underlying mechanism is related to facilitation of leptin-melanocortin signalling, possibly involving chronic activation of brain-derived neurotrophic factor.

Owner-driven reconstruction in India: a case-study of Kosi River floods in Bihar

An Owner-Driven Reconstruction (ODR) approach was adopted in the Indian state of Bihar, post 2008 Kosi River floods. This ODR was unique as it was piloted prior to policy formation. The paper discusses preliminary observations from empirical investigations conducted in two settlements of Bihar - Orlaha and Puraini, during 2012 and 2014. The aim was to identify ‘key processes’ or effectiveness of ODR approaches that enhance long-term disaster-resilience of housing and community autonomy. From the case-study investigations, one of the themes – community facilitation is discussed, with its positives and negatives for future replication.

Design of fucoidan functionalized - iron oxide nanoparticles for biomedical applications

This research aims to develop an iron oxide nanoparticle drug delivery system utilizing a recent material discovered from ocean, fucoidan. The material has drawn much interest due to many biomedical functions that have been proven for human health. One interesting point herein is that fucoidan is not only a sulfated polysaccharide, a polymer for stabilization of iron oxide nanoparticles, but plays a role of an anticancer agent also. Various approaches were investigated to optimize the high loading efficiency and explain the mechanism of nanoparticle formations. Fucoidan was functionalized on iron oxide nanoparticles by a direct coating or via amine groups. Also, a hydrophobic part of oleic acid was conjugated to the amine groups for a more favorable loading of poorly water-soluble anticancer drugs. This study proposed a novel system and an efficient method to functionalize fucoidan on iron oxide nanoparticle systems which will lead to a facilitation of a double strength treatment of cancer.

Les interactions vestibulo-corticales qui sous-tendent le contrôle de la posture chez les sujets sains

Le système vestibulaire et le cortex moteur participent au contrôle de la posture, mais la nature de leurs interactions est peu documentée. Afin de caractériser les interactions vestibulo-corticales qui sous-tendent le contrôle de l’équilibre en position debout, l’activité électromyographique (EMG) du soléaire (SOL), du tibial antérieur (TA) et du péronier long (PERL) de la jambe droite a été enregistrée chez 14 sujets sains. La stimulation galvanique vestibulaire (GVS) a été appliquée avec la cathode derrière l’oreille droite ou gauche à différents intervalles inter-stimulus (ISIs) avant ou après la stimulation magnétique transcrânienne induisant des potentiels moteurs évoqués (MEPs) au niveau des muscles enregistrés. Lorsque que la cathode était à droite, une inhibition des MEPs a été observée au niveau du SOL à un ISI de 40 et 130 ms et une facilitation des MEPS a été observée au niveau TA à un ISI de 110 ms. Lorsque la cathode était à gauche, une facilitation des MEPs a été observée au niveau du SOL, du TA et du PERL à un ISI de 50, -10 et 0 ms respectivement. L’emplacement de ces interactions sur l’axe neural a été estimé en fonction des ISIs et en comparant l’effet de la GVS sur les MEPs à son effet sur l’EMG de base et sur le réflexe-H. Selon ces analyses, les modulations observées peuvent avoir lieu au niveau spinal ou au niveau supraspinal. Ces résultats suggèrent que les commandes de la voie corticospinale peuvent être modulées par le système vestibulaire à différents niveaux de l’axe neuronal.

Standardised tobacco packaging:a health policy case study of corporate conflict expansion and adaptation

Objectives: To investigate opposition to standardised tobacco packaging in the UK. To increase understanding of how transnational corporations are adapting to changes in their access to policymakers precipitated by Article 5.3 of the Framework Convention on Tobacco Control (FCTC). Design: Case study web-based documentary analysis, using NVivo V.10. Examination of relationships between opponents of standardised packaging and transnational tobacco companies (TTCs) and of the volume, nature, transparency and timing of their activities. Setting: UK standardised packaging policy debate 2011-2013. Participants: Organisations selected on basis of opposition to, or facilitation thereof, standardised tobacco packaging in the UK; 422 associated documents. Results: Excluding tobacco manufacturing and packaging companies (n=12), 109 organisations were involved in opposing standardised packaging, 82 (75%) of which had a financial relationship with 1 or more TTC. These 82 organisations (43 actively opposing the measure, 39 facilitating opposition) were responsible for 60% of the 404 activities identified, including the majority of public communications and research production. TTCs were directly responsible for 28% of total activities, predominantly direct lobbying, but also financially underwrote third party research, communication, mass recruitment and lobbying. Active organisations rarely reported any financial relationship with TTCs when undertaking opposition activities. Conclusions: The multifaceted opposition to standardised packaging was primarily undertaken by third parties with financial relationships with major tobacco manufacturers. Low levels of transparency regarding these links created a misleading impression of diverse and widespread opposition. Countries should strengthen implementation of Article 5.3 of the FCTC by systematically requiring conflict of interest declarations from all organisations participating in political or media debates on tobacco control.

Les interactions vestibulo-corticales qui sous-tendent le contrôle de la posture chez les sujets sains

Le système vestibulaire et le cortex moteur participent au contrôle de la posture, mais la nature de leurs interactions est peu documentée. Afin de caractériser les interactions vestibulo-corticales qui sous-tendent le contrôle de l’équilibre en position debout, l’activité électromyographique (EMG) du soléaire (SOL), du tibial antérieur (TA) et du péronier long (PERL) de la jambe droite a été enregistrée chez 14 sujets sains. La stimulation galvanique vestibulaire (GVS) a été appliquée avec la cathode derrière l’oreille droite ou gauche à différents intervalles inter-stimulus (ISIs) avant ou après la stimulation magnétique transcrânienne induisant des potentiels moteurs évoqués (MEPs) au niveau des muscles enregistrés. Lorsque que la cathode était à droite, une inhibition des MEPs a été observée au niveau du SOL à un ISI de 40 et 130 ms et une facilitation des MEPS a été observée au niveau TA à un ISI de 110 ms. Lorsque la cathode était à gauche, une facilitation des MEPs a été observée au niveau du SOL, du TA et du PERL à un ISI de 50, -10 et 0 ms respectivement. L’emplacement de ces interactions sur l’axe neural a été estimé en fonction des ISIs et en comparant l’effet de la GVS sur les MEPs à son effet sur l’EMG de base et sur le réflexe-H. Selon ces analyses, les modulations observées peuvent avoir lieu au niveau spinal ou au niveau supraspinal. Ces résultats suggèrent que les commandes de la voie corticospinale peuvent être modulées par le système vestibulaire à différents niveaux de l’axe neuronal.

The value of peer support and a strengths-based approach in a groupwork programme for fathers in a family support setting

This paper seeks to share and critically explore the learning gained through the genesis, realisation, and facilitation process of Just for Dads, a groupwork programme for fathers, run in a family support setting. It highlights the importance of and challenges involved in engaging men in practice, and in groupwork aimed at fathers in particular. It recounts the significance of using a strengths perspective as a framework for engaging fathers in groupwork and highlights its value as experienced by participants and facilitators. The dynamic of peer learning which developed as a key part of the groupwork process is discussed, both in relation to how it was experienced by participants and also the degree to which the facilitators were part of that dynamic. Overall the paper aims to document and air key issues arising in this relatively unexplored arena of groupwork and family support practice.