Draft for a Mental Health strategy Lebanon

RESUMO: O Líbano é um pequeno país na costa leste do Mar Mediterrâneo, com uma população de aproximadamente 4.350.000 pessoas, incluindo 1,5 milhões de refugiados, 400 mil dos quais são palestinos atendidos pela UNRWA (Agência das Nações Unidas de Socorro aos Refugiados da Palestina) (UNHCR, 2013; OMS, 2010a). Desde 2012, um excedente de 1.000.000 refugiados sírios cruzaram a fronteira com o Líbano, representando um aumento populacional de aproximadamente 25%. Além disso, entre 1975 e 1990, a violenta guerra civil pela qual o Líbano passou, destruiu grande parte da infra-estrutura do país, incluindo os serviços de saúde. O sector da saúde, mais especificamente os serviços de saúde mental, é majoritariamente privado. Serviços especializados em Saúde Mental estão disponíveis em três hospitais psiquiátricos privados, e em 4 unidades psiquiátricas de hospitais gerais, que estão localizados centralmente em torno da capital, Beirute. O Líbano é um dos dois únicos países da região que não tem uma Política de Saúde Mental e um dos seis países que não têm uma Legislação em Saúde Mental. Nos últimos anos, a Saúde Mental está sendo colocada no topo da agenda nacional, apesar das contínuas questões políticas e de segurança. Baseando-se nas informações acima, um projecto de estratégia em Saúde Mental, conduzido pelo Ministério da Saúde e apoiado pela OMS, foi escrito para servir como um guia para trabalhar em diferentes aspectos relacionados tanto em saúde mental quanto em organização dos serviços, revisão de legislação, financiamento e proteção dos direitos humanos básicos dos usuários do serviço. Esta tese descreve o processo pelo qual o projecto de estratégia nacional de Saúde Mental foi desenvolvido, seus principais componentes, os próximos passos a serem tomados para a sua implementação, os desafios e as oportunidades para implementá-lo e propõe alguns passos iniciais a serem tomados em primeiro lugar.----------ABSTRACT: Lebanon is a small country on the eastern shore of the Mediterranean Sea with a population of approximately 4,350,000 including 1,500,000 refugees, 400,000 of whom are Palestinians served by UNRWA (the United Nations Relief and Works Agency for Palestine Refugees) (UNHCR, 2013; WHO, 2010a). Since 2012 an excess of 1,000,000 Syrian refugees have crossed the border into Lebanon accounting for approximately 25% increase in the population. In addition, from 1975 to 1990 Lebanon underwent a violent civil war that had also destroyed much of the country infrastructure including health services. The health sector, more so the mental health services, is mostly private. Specialized Mental Health services are available at three private mental hospitals, and 4 psychiatric units within general hospitals, which are located centrally around the capital, Beirut. Lebanon is one of only two countries of the region that does not have a Mental Health policy and one out of the six countries that does not have a Mental Health legislation. In recent years, Mental Health is getting placed higher on the national agenda despite the ever continuing political and security issues. Based on the above, A Mental Health strategy draft, lead by the Ministry of Health and supported by WHO, was written to serve as a guide to work on different aspects related to Mental Health from service organization, to the revision of legislation, financing and the protection of the basic human rights of service users. This thesis describes the process through which the national Mental Health draft strategy was developed, its main components, the next steps to be taken for its implementation, the challenges and the opportunities to implementing it and proposes a few initial steps to be taken first.

O contributo da farmácia comunitária no envelhecimento ativo

RESUMO: A população mundial está a envelhecer de forma sustentada. O setor das farmácias em Portugal está a passar por um conjunto de alterações que conduzirá a uma ação mais interventiva ao nível da prestação de cuidados de saúde. Deste modo delineou-se um estudo descritivo, transversal e exploratório sem intervenção, de carácter qualitativo e quantitativo que compara diferentes grupos etários com o objectivo de compreender melhor o papel do farmacêutico no âmbito do envelhecimento das populações. Pretendemos assim optimizar práticas e serviços que podem ser realizados nas farmácias e alertar os utentes, para gerir melhor a sua condição de saúde, sensibilizando-os para o próprio processo de envelhecimento. Como principais resultados destacamos o papel de intervenção crucial da farmácia, quer pela sua acessibilidade quer pela contribuição que pode ter para a condição de saúde das populações. Pela amostra estudada em 100% das farmácias são feitos despistes e controlo da hipertensão arterial e hipercolesterolemia, factores fundamentais no controlo da aterosclerose e das doenças cardiovasculares. Podemos ainda concluir que a farmácia pode ser o elemento de otimização, revisão e reconciliação das terapêuticas dos resistentes em lares e ao domicílio, junto da população 65+. Em termos das pessoas idosas, o nosso estudo indicia que, apesar da crise sócio económica dos últimos anos, continuam a tomar os medicamentos mais essenciais, o que se relaciona com a política do medicamento implementada. Este trabalho pretende também, contribuir para o desenvolvimento de uma rede de competências da farmácia ao nível do envelhecimento ativo, podendo ser uma oportunidade futura.--------------ABSTRACT: World population is getting older in a sustained way. Portuguese community pharmacies are going through a change process, leading to a higher intervention in healthcare delivery. The study designed is descriptive, transversal and exploratory, with no intervention, with a qualitative and quantitative component that compares different age groups. The purpose is to better understand pharmacists’ role in population aging. One of our main goals is to optimize practices and services with potential to be performed in pharmacies and aware patients to better manage their health, becoming more conscious of their aging process. As main results we highlight the intervention of pharmacies, not only by its accessibility but also sustained on the unique contribution pharmacies deliver in the best benefit of populations’ health condition. In the sample studied, 100% of pharmacies perform screening and vigilance of hypertension and hypercholesterolemia, essential for the control of atherosclerosis and cardiovascular diseases. We may also determine the importance of pharmacies intervention over therapeutics optimization, revision and reconciliation in nursing homes and in domicile, mostly focusing patients over 65. In what concerns to elderly population our study indicates that, despite social and economic crises of recent years, the elderly keeps taking its essential medicines, which is related with medicines politics implemented at the present moment. This project intends to pay a relevant contribution to the development of a group of core competencies in pharmacies, related to the promotion of an active and healthy aging process, which represents an important future opportunity for Portuguese Pharmacies.

A criação de um guia de estilo: uma proposta de trabalho

Este relatório pretende demonstrar a importância da existência de guias de estilo nas empresas de tradução. Apresenta-se uma proposta de um guia de estilo decorrente do trabalho realizado ao longo de 400 horas de estágio na empresa Found in Translation, Lda., culminando numa seleção de regras com o objetivo de uniformizar e harmonizar o estilo de escrita dos tradutores e revisores. Estas regras visam melhorar a qualidade e a consistência dos textos produzidos pelas equipas de tradutores e revisores da empresa.

Support in decision-making under uncertainty: a project risk assessment tool development and supplementary advances

A foremost dispute that persists on the contemporary world’s agenda is change. The on-going social/technological/economic changes create a competitive and challenging environment for companies to endure. To benefit from these changes, world economies partially depend on emerging Small and Medium Enterprises (SMEs) and their adaptability skills, and subsequently the development of an integrated capability to innovate has become the prime strategy for most of SMEs to subsist and grow. However, innovation and change are always somewhat bonded to an inherent risk development, which subsequently brings on the necessity of a revision of risk management approaches in innovative processes, whose importance SMEs tend to disregard. Additionally, little efforts have been made to improve and create empirical models, metrics and tools to assist SMEs managing latent risks in their innovative projects. This work seeks to present and discuss a solution to support SMEs in engaging on systematic risk management practices, which consists on an integrated risk assessment and response support web-based tool - Spotrisk® - designed for SMEs. On the other hand, an inherent subjectivity is linked with risk management and identification processes, due to uncertainty trait of its nature, for each individual perceives situations according to his own idiosyncrasy, which brings complications in normalizing risk profiles and procedures. This essay aims to bring insights concerning the support in decision-making processes under uncertainty, by addressing issues related with the risk behavior character among individuals. To address such issues, subjects of neuroscience or psychology are explored and models to identify such character are proposed, as well as models to improve presented tool. This work attempts to go beyond the restrictive aim of endeavoring on technical improvement dissertation, and in embraces an exploratory conceptualization concerning micro, small and medium businesses’ traits regarding risk characters and project risk assessment tools.

Measuring social impact: A guideline to implement a tableau de bord

Many impact-seeking organisations cannot measure and demonstrate their social impact because they either lack technical expertise or requisite financial and human resources. This report clarifies the process of social impact measurement to help these organisations engage in social impact measurement practices. It presents a simple guideline to create a measurement approach based on the Tableau de Board. The guideline has been developed through a theoretical revision of best practices in social impact measurement, academic research and the author's individual thoughts and ideas. While a first testing of the approach revealed positive feedback, only future broad-scale testing will demonstrate the approach’s validity and feasibility.

Southern Modernisms. Critical Stances through Regional Appropriations. Conference proceedings

The hegemonic definition of Modernism has been subjected to an intense critical revision process that began several decades ago. This process has contributed to the significant broadening of the modernist canon by challenging its primal essentialist assumptions and formalist interpretations in the fields of both the visual arts and architecture. This conference aims to further expand this revision, as it seeks to discuss the notion of “Southern Modernisms” by considering the hypothesis that regional appropriations, both in Southern Europe and the Southern hemisphere, entailed important critical stances that have remained unseen or poorly explored by art and architectural historians. In association with the Southern Modernisms research project (FCT – EXPL/CPC-HAT/0191/2013), we want to consider the entrenchment of southern modernisms in popular culture (folk art and vernacular architecture) as anticipating some of the premises of what would later become known as critical regionalism. It is therefore our purpose to explore a research path that runs parallel to key claims on modernism’s intertwinement with bourgeois society and mass culture, by questioning the idea that an aesthetically significant regionalism – one that resists to the colonization of international styles and is supported by critical awareness – occurred only in the field of architecture, and can only be represented as a postmodernist turn. (...)

Southern modernisms from A to Z and back again

The book now being published results from a research project entitled Southern Modernisms that ran from March 2014 to May 2015 with FCT funding. The aim of the project was to explore the possibility of constructing a more inclusive, plural notion of modernism through the revision of Modernism’s prevailing definition – its stylistic focus, its formalist and anti-representative bias, as well as its autonomic assumptions, or, as far as architecture is concerned, its functionalist credo. This critical undertaking was grounded on the hypothesis that southern European modernisms featured a strong entrenchment in popular culture (folk art and vernacular architecture), and that this characteristic could be understood as anticipating some of the premises of, what would later become known as, critical regionalismo. (...)

Lovers and Madmen: The Μανία-Φρονεῖν Opposition in Plato’s Phaedrus

In this thesis we propose to examine the first half of the Phaedrus (sc. until the end of the palinode) in light of the opposition between the notions of μανία and φρονεῖν, as they are explicitly and implicitly presented in the erotic speeches. These are read in dialogue with what we have designated as the “implicit speech” or “speeches”, i.e., the plurality of conceptions regarding ἔρως, μανία and φρονεῖν that were part of Ancient Greek culture. Our reading of the two speeches against ἔρως, Lysias’ and Socrates’ first speech, engages with this cultural background, and extracts a conception of μανία and φρονεῖν with which the palinode will primarily confront. Our reading of the palinode divides it into two sections: the first, the presentation of the first three kinds of beneficial μανία; the second, the mythical narrative that deals with erotic μανία. We emphasise the existence of a wide gulf between these two moments in terms of their ontological, theological and anthropological conceptions. The second section of the palinode is revolutionary not only in contrast with the “implicit speech” and the speeches against ἔρως, but also in contrast with the very beginning of the palinode – which preserves many of the conceptions and assumptions found in the previous speeches and in the cultural tradition. It is in order to explain the foundation, meaning and significance of this gulf that we explore and discuss the notion of ὑπόθεσις and its role as an implicit operator in the Phaedrus. From our reading of the second part of the palinode, it is clear how the introduction of the ὑπερουράνιος τόπος brings about a radical revision of the perspectives on the nature of reality and on human nature and condition that were implicit in the previous speeches and in the first part of the palinode. We show that the ὑπερουράνιος τόπος corresponds to the projection of a multiplicity of cognitive and desiderative requirements that our normal perspective demands, but cannot possibly satisfy. In other words, our perspective is shown to be living beyond its means, yearning for something that by far exceeds what it can get in its de facto condition: the superlative. This results in a major revision of the understanding of φρονεῖν and μανία – a revision that challenges the traditional understanding of these two notions as binary opposites, thereby revealing a much more complex landscape.

The use of bone bridges in transtibial amputations

We sought to describe the bone bridge technique in adults, and present a variation for use in children, as well as to present its applicability as an option in elective transtibial amputations. This paper presents a prospective study of 15 transtibial amputations performed between 1992 and 1995 in which the bone bridge technique was employed. The patients' ages ranged from 8 to 48 years, with an average of 22.5 years. This technique consisted of the preparation of a cylinder of periosteum extracted from the tibia and with cortical bone fragments attached to it to promote a tibiofibular synostosis on the distal extremity of the amputation stump. We noted that the cortical bone fragments were dispensable when the technique was employed in children, due to the increased osteogenic capacity of the periosteum. This led to a variation of the original technique, a bone bridge without the use of the cortical bone fragments. RESULTS: The average time spent with this procedure, without any significant variation between adults and children, was 171 minutes. The adaptation to the definitive prosthesis was accomplished between 20 and 576 days, with an average of 180 days. Revision of the procedure was necessary in 3 amputations. CONCLUSIONS: This technique may be employed in transtibial amputations in which the final length of the stump lies next to the musculotendinous transition of the gastrocnemius muscle, as well as in the revision of amputation stumps in children, where the procedure has been shown to be effective in the prevention of lesions due to excessive bone growth.

Implementation of WHO Quality Rights assessment in Kabul Mental Health Hospital

RESUMO: Objetivo Avaliar a qualidade dos serviços de saúde mental e a situação dos direitos humanos no Hospital de Saúde Mental de Kabul (KMHH) e fornecer recomendações para o desenvolvimento de um plano de melhoria, actualização e revisão da Política, Estratégia e Plano Nacionais de Saúde Mental,. Métodos A avaliação foi realizada em Janeiro de 2015 no KMHH e na Burn Ward do Hospital Terciário de Isteqlal por uma equipa multidisciplinar usando Qualidade Direitos Tool Kit da OMS. Antes da avaliação, o protocolo foi aprovado pelo Institutional Review Board e obtido o consentimento informado de cada entrevistado. Realizaram-se entrevistas com 16 utentes do serviço, 17 funcionários do hospital e 7 familiares, além da revisão de documentos e da observação das unidades de internamento do KMHH e das interações interpessoais entre funcionários do hospital e utentes do serviço. A comissão de avaliação reviu também a documentação e observou a Unidade de Queimados do Hospital Terciário de Isteqlal, a fim de avaliar e comparar a paridade entre as duas instalações. Após a avaliação, todos os membros da comissão se reuniram e puseram em conjunto todas as conclusões num relatório final. Resultados Encontrámos algumas lacunas graves no nível de prestação de serviços e no respeito pelos direitos humanos dos utentes dos serviços e dos seus familiares. Uma série de políticas, diretrizes e procedimentos relacionados com os direitos humanos dos pacientes estavam ausentes. O ambiente terapêutico e o padrão de vida eram inadequados, existia má qualidade do atendimento e dos serviços prestados, os utilizadores enfrentavam violações do direito ao exercício da capacidade legal e da liberdade pessoal, eram quimica e fisicamente (uso de correntes) contidos e expostos a abusos verbais, físicos e emocionais, e havia grande ênfase no tratamento institucional. Todos estes aspectos foram considerados como extensa violação dos direitos humanos dos utentes de serviço do KMHH. Conclusão Os serviços disponíveis para utentes dos serviços de saúde mental apresentam alguns problemas devido à desconfiança e falta de consciencialização sobre os direitos das pessoas com doença mental e precisam ser alterados de forma positiva. A Lei de Saúde Mental existente difere muito das recomendações da Convenção sobre os Direitos das Pessoas com Incapacidades (CRPD) e requer revisão e adaptação de acordo com esta Convenção. -------------------------------- ABSTRACT: Objective To assess the quality of mental health services and human rights condition in the Kabul Mental Health Hospital (KMHH) and provide recommendations for development of an improvement plan and to update and revise the National Mental Health Policy, Strategy and Plan. Methods The assessment was conducted in January 2015 in the KMHH and the Burn Ward of Isteqlal Tertiary Hospital by a multidisciplinary team using WHO Quality Rights Tool Kit. Before the assessment, Institutional Review Board approval and informed consent from each interviewee were obtained. Interviews were conducted with 16 service users, 17 hospital staffs and 7 family members in addition to documents review and observation of inpatient units of KMHH plus interpersonal interactions between hospital staff and service users. The assessment committee reviewed the documentation and observed the Burn Ward of Isteqlal Tertiary hospital in order to measure and compare parity between the two facilities. After the assessment, all committee members gathered and synchronized all findings into a final report. Results There were some serious gaps on service provision level and respecting human rights of service users and their family members. A series of policies, guidelines and procedures related to patients’ human rights were absent. Inadequate treatment environment and standard of living, poor quality of care and services, violations of the right to exercise legal capacity and personal liberty, being chemically and physically (e.g. chain) restrained, being exposed to verbal, physical and emotional abuse, and emphasis on institutional treatment were all extensive human rights violation that service users were experiencing in KMHH. Conclusion The available services for mental health service users are questionable due to mistrust and lack of awareness about rights of people with disabilities and need to be positively changed. Existing Mental Health Act has a large number of disparities with the CRPD and requires revision and adaptation in accordance to CRPD.

Trading the changes of stock market index composition: Evidence from European markets

This paper studies the changes in European stock market indexes composition from 1995 to 2015. It was found that there are mixed price effects producing abnormal returns around the effective replacement of added and deleted stocks. The price pressure hypothesis seems to hold for added stocks in some indexes but not for deleted stocks as there is not a clear inversion of behaviour after the replacement. Finally, the building and back testing of a trading strategy aiming to capture some of those abnormal returns shows it yields a Sharpe Ratio of 1.4 and generates an annualised alpha of 11%.

A utilização de indicadores biológicos em saúde ocupacional

RESUMO - A utilização de indicadores biológicos em programas de prevenção dos efeitos decorrentes da exposição profissional a agentes químicos vem, cada vez mais, a ser objecto da investigação científica, no sentido de proporcionar mais e melhores instrumentos de efectiva vigilância da saúde dos trabalhadores expostos. Tendo em conta as mais recentes reflexões a este propósito, os autores apresentam uma revisão conceptual no que diz respeito à monitorização biológica e às suas pertinência, vantagens e limitações, concluindo pela necessidade de tais programas preverem, sempre que disponíveis e de acordo com fundamentos científicos e técnicos validados, um mais frequente recurso aos indicadores biológicos designadamente de dose e de efeito.

Plataforma de gestão educativa de mediação entre a secretaria e a comunidade educativa

O presente Relatório tem como objetivo expor o trabalho desenvolvido durante o estágio, no âmbito da componente não letiva do mestrado em Ciências da Educação, realizado ao abrigo de um protocolo entre a Faculdade de Ciências Socais e Humanas (FCSH) da Universidade Nova de Lisboa (UNL) e a Escola Profissional Gustave Eiffel (EPGE), sob orientação científica do Professor Doutor Luís Manuel Bernardo da FCSH e orientação prática pela Mestre Maria Goreti Freitas, da EPGE. O estágio teve a duração de três meses, com um total de 400 horas. Deste modo, serão descritas as práticas de estágio, sustentadas nos conhecimentos adquiridos nas componentes letivas do mestrado em Ciências da Educação. O relatório está estruturado em três capítulos, finalizando com uma reflexão sobre a produtividade do estágio para a nossa aprendizagem. No primeiro capítulo, pretende-se justificar a escolha da temática deste relatório, procedendo-se à caracterização da secretaria e da escola, fundamentada através de uma revisão de literatura, bem como por algumas entrevistas realizadas durante o estágio. Neste capítulo dá-se importância ao facto deste estágio ter permitido uma interação com toda a comunidade educativa, nas suas respetivas diferenças, em diferentes níveis e situações. No segundo capítulo, efetuou-se a uma contextualização acerca das plataformas de gestão educativas bem como a sua importância para a gestão da comunidade educativa. Evidenciou-se em particular o papel das plataformas de gestão na educação, enquanto elo de ligação entre a secretaria e toda a comunidade educativa. No terceiro capítulo levou-se a cabo a descrição das principais atividades desenvolvidas durante o estágio curricular. Por fim, apresenta-se a uma reflexão crítica sobre o processo de estágio. Todo o trabalho remete para documentos anexos, os quais comprovam a documentação complementar. Alguns destes documentos foram elaborados de forma original, designadamente as entrevistas realizadas no decurso do estágio.

A decision support system for a waste collection vehicle routing problem

The selective collection of municipal solid waste for recycling is a very complex and expensive process, where a major issue is to perform cost-efficient waste collection routes. Despite the abundance of commercially available software for fleet management, they often lack the capability to deal properly with sequencing problems and dynamic revision of plans and schedules during process execution. Our approach to achieve better solutions for the waste collection process is to model it as a vehicle routing problem, more specifically as a team orienteering problem where capacity constraints on the vehicles are considered, as well as time windows for the waste collection points and for the vehicles. The final model is called capacitated team orienteering problem with double time windows (CTOPdTW).We developed a genetic algorithm to solve routing problems in waste collection modelled as a CTOPdTW. The results achieved suggest possible reductions of logistic costs in selective waste collection.

Integrated management systems as complex adaptive systems

It is a difficult task to avoid the “smart systems” topic when discussing smart prevention and, similarly, it is a difficult task to address smart systems without focusing their ability to learn. Following the same line of thought, in the current reality, it seems a Herculean task (or an irreparable omission) to approach the topic of certified occupational health and safety management systems (OHSMS) without discussing the integrated management systems (IMSs). The available data suggest that seldom are the OHSMS operating as the single management system (MS) in a company so, any statement concerning OHSMS should mainly be interpreted from an integrated perspective. A major distinction between generic systems can be drawn between those that learn, i.e., those systems that have “memory” and those that have not. These former systems are often depicted as adaptive since they take into account past events to deal with novel, similar and future events modifying their structure to enable success in its environment. Often, these systems, present a nonlinear behavior and a huge uncertainty related to the forecasting of some events. This paper seeks to portray, for the first time as we were able to find out, the IMSs as complex adaptive systems (CASs) by listing their properties and dissecting the features that enable them to evolve and self-organize in order to, holistically, fulfil the requirements from different stakeholders and thus thrive by assuring the successful sustainability of a company. Based on the revision of literature carried out, this is the first time that IMSs are pointed out as CASs which may develop fruitful synergies both for the MSs and for CASs communities. By performing a thorough revision of literature and based on some concepts embedded in the “DNA” of the subsystems implementation standards it is intended, specifically, to identify, determine and discuss the properties of a generic IMS that should be considered to classify it as a CAS.