Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.

Chase over the Nile: The Social Evolution of Riverine Landscape in Urban Egypt

Throughout its history, Cairo evolved as a regional metropolis that sprawls along the banks of the Nile accumulating narratives of evolving social landscape. Overlooking the Nile reflected a privileged social position and place for the urban elite. In spatial terms, the urban bourgeoisie tend to develop living havens in enclaves that are distant from the populace’s everyday life. Ironically, exclusive settlements only attract urban growth further in their direction. This chapter offers an analytical reading of the socio-spatial structure of Cairo following the emergence and decline of a series bourgeoisie quarters along the shores of the Nile. It reports urban narratives based on archival records, documents and investigation of historical texts and travelers’ accounts. This essay argues that cities are essentially social constructs in which hierarchy and connectivity are fundamental aspects of its economic and spatial logic. Through social ambition and desire for upgrade, middle class infiltrate into bourgeoisie havens and sometimes encircle it, seeking better living condition inscribed by social mobility and connectivity to centres of wealth and power. Being both natural barrier and cohesive spine, the Nile helped Cairo to develop successive nucleuses of highly crafted urban experiences that have left their imprints on the contemporary urban scene.

Extending Customer Relationship Management into a Social Context

Informed by the resource-based view, this study draws on customer relationship management (CRM) and value co-creation literature to develop a framework examining the impact of social networking sites on processes to manage customer relationships. Facilitating the depth and networked interactions necessary to truly engage customers, social networking sites act as a means of enhancing customer relationships through the co-creation of value, moving CRM into a social context. Tested and validated on a data set of hotels, the main contribution of the study to service research lies in the extension of CRM processes, termed relational information processes, to include value co-creation processes due to the social capabilities afforded by social networking sites. Information technology competency and social media orientation act as critical antecedents to these processes, which have a positive impact on both financial and non-financial aspects of firm performance. The theoretical and managerial implications of these findings are discussed accordingly.

Combining and integrating life /social sciences and citizen trainers in Nurse Education - a N. Ireland initiative

Before commencement of the academic year 2012/2013 the social sciences, public health and the biomedical sciences were taught to separate modules. This reinforced the idea off separate disciplines certainly for some of the younger students and a failure to appreciate the interconnectedness (whole person) perspective on health; separately modules taught and assessed in separate silos. There was limited understanding by the lecturers of the other areas that they were not teaching to -reflecting perhaps a dis-coordinated approach to health sciences (Mason and Whitehead 2003). As a result of significant discussion and interdisciplinary negotiation the life, social sciences public health/ health education were drawn together in the one module for the academic year 2012/13. The module provides the undergraduate students with an introduction to an understanding of Life Sciences, psychology, sociology and public health and their contribution within the context of nursing and midwifery. Each week’s teaching seeks to reflect against the other module delivered in first year - addressing clinical skills. The teaching is developing innovative e-learning approaches, including the use of a virtual community. The intention is to provide the student with a more integrated understanding and teaching to the individual’s health and to health within a social context (Lin 2001; Iles- Shih 2011). The focus is on health promotion rather than disease management. The module runs in three phases across the student’s first-year and teachers to the field of adult mental health, learning disability, children’s nursing and the midwifery students -progressively building on the student’s clinical experience. The predominant focus of the module remains on health and reflecting aspects of life and social life within N. Ireland. One of the particular areas of interest and an area of particular sensitivity is engaging the students to the context of the Northern Ireland civil unrest (the Troubles); this involves a co-educational initiative with service users, only previously attempted with social work students (Duffy 2012). The service users are represented by WAVE an organisation offering care and support to bereaved, traumatised or injured as a result of the violent civil conflict `the Troubles’. The `Troubles’ had ranged over an extended period and apart from the more evident and visual impact of death and injury, the community is marked by a disproportionate level of civil unrest, the extremes of bereavement, imprisonment, displacement antisocial behaviour and family dysfunction (Coulter et al. 2012). As co-educators with the School of Nursing and Midwifery, WAVE deliver a core lecture (augmented by online material), then followed by tutorials. The tutorials are substantially led by those who had been involved with and experienced loss and trauma as a result of the conflict (Health Service users) as `citizen trainers’ and provide an opportunity for them to share their experience and their recollection of personal interaction with nursing and midwifery students; in improving their understanding of the impact of `The Troubles’ on patients and clients affected by the events (Coulter et al. 2012) and to help better provide a quality of care cognisant of the particular needs of those affected by `the Troubles’ in N.Ireland. This approach is relatively unique to nursing in N. Ireland in that it involves many of those directly involved with and injured by the `Troubles’ as `citizen trainers’ and clearly reflects the School’s policy of progressively engaging with users and carers of nursing and midwifery services as co-educators to students (Repper & Breeze 2006). Only now could perhaps such a sensitive level of training to student nurses and midwives be delivered across communities with potential educative lessons for other communities experiencing significant civil unrest and sectarian conflict.

Reconstructing the Social Fabric amid On-going Violence: Attitudes toward Reconciliation and Structural Transformation in Colombia

Given the increase of reconciliation processes initiated amid on-going violence, this study focuses on community reconciliation and its relation to structural transformation, or social reconstruction through reforming unjust institutions and practices that facilitate protracted violent conflict. Drawing lessons from the Caribbean coast of Colombia, mixed method analyses include eight in-depth interviews and 184 surveys. Four key dimensions of reconciliation – truth, justice, mercy, peace – are examined. In the interviews, participants prioritize reconstructing the truth and bringing perpetrators to justice as essential aspects of reconciliation. Notions of mercy and forgiveness are less apparent. For the participants, sustainable peace is dependent on structural transformation to improve livelihoods. These data, however, do not indicate how this understanding of reconciliation may relate to individual participation in reconciliation processes. Complementing the qualitative data, quantitative analyses identify some broad patterns that relate to participation in reconciliation events. Compared to those who did not participate, individuals who engaged in reconciliation initiatives report higher levels of personal experience with violence, live alongside demobilized paramilitaries, are more engaged in civic life, and express greater preference for structural transformation. The paper concludes with policy implications that integrate reconciliation and structural transformation to deepen efforts to rebuild the social fabric amid violence.

An evaluation of palliative care services for cancer patients in the Southern Health and Social Services Board of Northern Ireland.

An interview study of 55 lay carers of people who died from cancer in the Southern Board of Northern Ireland was undertaken using a combination of closed-format and open-ended questions. The aim of the study was to evaluate palliative care services delivered in the last six months of their lives to cancer patients who died either at home or in hospital. Two-thirds of the deaths (36) occurred in the domestic home, 45 of the deceased were admitted as hospital inpatients, and the great majority were in receipt of community nursing (53) and general practitioner (54) services. Open-ended questions were used to allow respondents to give their views about services in some detail and their views about good and bad aspects of services were sought. While they were generally satisfied with services specific areas of difficulty were identified in each aspect of care addressed by the study. The most favourable assessments were made of community nursing with the greatest number of negative comments being made about inpatient hospital care. Differing interests between some of those who were dying and their lay carers were found in two areas: the receipt of help from nonfamily members and the information that the deceased received about their terminal status.

Personal and Public Involvement and its impact - Monitoring, measuring and evaluating the impact of Personal and Public Involvement (PPI) in Health and Social Care in Northern Ireland.

Introduction
This report details the findings from research conducted across Northern Ireland’s Health and Social Care Trusts during 2015 which examines the current state of Personal and Public Involvement (PPI). This is about how service users, carers and patients engage with staff, management and directors of statutory health and social care organisations. Most statutory health and social care organisations must, under legislation, meet the requirements of PPI. PPI has been part of health and social care policy in Northern Ireland since 2007 and became law two years later with the introduction of the Health and Social Care Reform Act (2009). It is, therefore, timely that PPI is now assessed in this systematic way in order to both examine the aspects which are working well and to highlight those areas where improvements need to be made. As far as possible, this Summary Report is written in an accessible way, avoiding jargon and explaining key research terms, so as to ensure it is widely understood. This is in keeping with established good practice in service user involvement research. This summary, therefore, gives a picture of PPI in Northern Ireland currently. There is also a fuller report which gives a lot more details about the research and findings. Information on this is available from the Public Health Agency and/or the Patient and Client Council.

Stress, suporte social, optimismo e saúde em estudantes de enfermagem em ensino clínico

O stress é um processo presente nas vivências do quotidiano dos indivíduos com implicações a nível do seu bem-estar e saúde. No caso específico dos estudantes de Enfermagem, o ensino clínico tem sido identificado como uma componente de formação geradora de elevados níveis de stress. O presente estudo tem como principal objectivo analisar as inter-relações que se estabelecem entre a percepção de situações de stress, saúde, coping, suporte social, auto-estima e optimismo-pessimismo. Pretende-se construir e validar dois instrumentos, um de avaliação das situações indutoras de stress em ensino clínico de Enfermagem (ECE) e outro de avaliação dos sintomas de stress. Outro objectivo consiste em traduzir e adaptar duas escalas, uma de avaliação da auto-estima e outra do optimismo-pessimismo. Pretende-se ainda estudar referidos constructos em função de variáveis sócio-demográficas e de caracterização do ensino clínico realizado. O estudo desenvolvido, de natureza quantitativo, correlacional e transversal, baseou-se numa amostra de 1283 estudantes do Curso de Licenciatura em Enfermagem, de cinco Escolas Superiores de Saúde da Região Centro de Portugal. Foi utilizado um protocolo de investigação constituído por 7 instrumentos: Caracterização sócio-demográfica e do ECE, Escala de Stress em ECE, Escala de Sintomas de Stress, Questionário de Estratégias de Coping, Escala de Satisfação com o Suporte Social, Escala de Auto-Estima e Escala de Optimismo-Pessimismo. Os resultados obtidos sugerem que, ao nível das escalas, tanto as construídas no âmbito deste trabalho, como as traduzidas apresentam validade e valores satisfatórios ao nível da fidelidade, constituindo-se então como instrumentos adequados e úteis para o estudo dos constructos em questão. As situações percebidas como geradoras de maior stress referem-se à avaliação, aspectos pessoais e gestão do tempo e do trabalho. Em termos de sintomas de stress, os mais frequentes são de natureza física e cognitivoemocional. Em termos de estratégias de coping, os estudantes parecem recorrer com mais frequência às estratégias centradas nos problemas. Os estudantes da nossa amostra referem uma maior satisfação a nível do suporte social com a intimidade e evidenciam níveis positivos em termos de autoestima e optimismo. O sexo dos estudantes, o ano de frequência do curso e variáveis de caracterização do ECE exercem um efeito diferencial nas problemáticas em estudo. Consideramos que a identificação das situações indutoras de stress em ECE, bem como a avaliação dos seus efeitos na saúde dos estudantes e a compreensão dos mecanismos de coping podem contribuir para o desenvolvimento de programas de gestão e controlo do stress que os capacitem para transformar os desafios em potenciais situações de desenvolvimento pessoal, social, académico e profissional.

Roma na poesia de Marcial: imagens e ecos de um espaço físico e social

A presente tese assenta na forma como Roma, considerada nas suas dimensões física e social, se encontra representada na poesia de Marcial. Estruturalmente, o trabalho encontra-se dividido em três partes: I. Marcial: a vida e a obra; II. Enquadramento Urbano: Roma, espaço físico; III. Enquadramento Urbano: Roma, espaço social. Após um momento introdutório, inicia-se a primeira parte do trabalho, centrada em aspectos de cariz biobibliográfico considerados relevantes para a compreensão da obra do epigramatista. A segunda parte da tese é consagrada à análise da representatividade dos diferentes espaços físicos de Roma, na sua poesia. Na terceira parte, a forma como os diferentes tipos sociais, agentes e profissionais se encontram retratados foi o principal alvo de investigação. Deste modo, pretendeu-se contribuir para uma visão de conjunto de uma realidade que, até ao momento, contou sobretudo com estudos parcelares.

Trilhos na floresta: imersões criativas no âmbito do design social

O Design Social assume-se cada vez mais como ferramenta de fortalecimento social e como uma arma na luta contra a fealdade do mundo, o inútil, o disfuncional e outros aspectos da desumanização. Mas não basta só produzir produtos para as pessoas, é preciso produzir com as pessoas. Após uma intervenção institucional da Universidade de Aveiro, em parceria com a Vista Alegre, sobre responsabilidade social corporativa e uma análise do caso paradigmático da Fiskers Village, desenhámos um modelo orientador para o Design Social e definimos directivas para intervir junto da comunidade local da Serra dʼArga, em Portugal: (1) o design como método de acção (2) do local para o global, (3) que identifica, partilha e intervém (4) com a comunidade, (5) em modo sistémico e com base no ciclo de vida, (6) visando construir para a integração máxima nos ciclos da natureza. Estas directivas serviram de pano de fundo à nossa intervenção e deram origem a uma oficina que pretendeu associar design, craft e natureza. Aí foram criados produtos e serviços sustentáveis que ligam produtores e consumidores ao território, sugerem uma outra forma de ocupação do tempo, e, finalmente, ajudam a comunidade a repensar a sua vida social e a sua relação com a floresta.

Exploring the Roles of Technology and Social Play in Art Museums

This co-written chapter was included in an edited book featuring invited authors from different countries and different areas of museum research and practice. The chapter uses a theory of play by Johan Huizinga (1938) to frame case studies of play-based interactive experiences in museums in various countries. The aim was to use theory to ground museum practice, in order to evaluate existing practical implementations as well as to inform the design of new ones. The book was nominated as one of the 10 best museum education books of 2011 by Museum Education Monitor, and the chapter led to a subsequent technology residency the author undertook in the Spike Island gallery, Bristol in 2012, funded by the National Endowment for Science, Technology and the Arts, Arts and Humanities Research Council and Arts Council England. It also informed his subsequent postgraduate teaching, an example of which is a recent MA project, which deconstructs play from a computational perspective. Collaborations have continued with the co-author, which have resulted in a number of invited lectures. In this chapter the authors explore play as a structure for supporting visitor learning, drawing from international research in museums and interaction design. Four aspects of play first proposed by Huizinga are explored – the free-choice aspect of play, play as distinct from real life, play as an ordering structure, and the role of play in bridging communities. The chapter argues that play provides museums with ready-made structures and concepts, which can help planning for visitor learning. The research was equally divided between the co-authors, who developed the conceptual and theoretical aspects of the article by drawing on their own research alongside key examples of museum design and digital media.

It’s time: Generation and temporality in psychoanalytic feminism

In this paper I examine some key aspects of defining one’s generation: transmitting values to younger generations in a way that makes sense to them; cultivating a psychic flexibility that allows us to welcome the future and be prepared for the unexpected whilst not succumbing to the fear of social, political and economic precarity; thinking of generation as both our collective moment in time and as generative potential; reaffirming the value of communication and sharing experience; and maintaining a dialogue between psychoanalytic feminism and other strands of feminist philosophy.

Contribuição para a história social da biotecnologia em Portugal

Tese de doutoramento, Sociologia (Sociologia da Ciência e Tecnologia), Universidade de Lisboa, Instituto de Ciências Sociais, 2014

Development of Social Relationships, Interactions and Behaviours in Early Education Settings

Recent research and policy regarding the advantages of early years provision has focused largely on the enhancement and development of cognitive skills for preschoolers. This study, based in the United Kingdom, focuses on a range of cognitive and social skills and identifies beneficial characteristics of a government pilot scheme for 2-year-olds in areas of social disadvantage. Data were collected from nursery managers and parents across six early years settings using a combination of qualitative and quantitative methods centred around in-depth observational techniques focused on children. Results indicate that in addition to the development of cognitive skills, children showed increased confidence and modes of communication and interaction and that these were associated with the varied activities and routines established within the early years settings. Some variations in terms of frequency and quality of interactions, activities and practice were identified in settings; however, interpersonal support for learning and development was consistent across settings.