As dinâmicas dos clusters como potenciadoras da competitividade empresarial regional : o caso do cluster hortícola do Ribatejo & Oeste : análise comparativa com Almeria (Espanha)

Mestrado em Gestão e Estratégia Industrial

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian metaregression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Evaluation of two instruments of perceived symptom intensity in palliative care patients in an outpatient clinic

AIMS AND OBJECTIVES: To evaluate the test-retest stability in assessments of perceived symptom intensity on the Edmonton Symptom Assessment System-revised and the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. The possible interchangeability between the instruments and the patients' experiences of completing the instruments were also studied. BACKGROUND: The two instruments assess the same symptoms, but the symptom intensity is assessed on 11-point numerical scales on the Edmonton Symptom Assessment System-revised and on four-point verbal descriptive scales on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative. Both instruments are commonly used; however, uncertainty exists about which instrument should be recommended and about the interchangeability of the instruments. DESIGN: This study used a test-retest design with inter-scale comparisons. METHODS: Data from 54 patients with cancer who were receiving palliative care in an oncology outpatient clinic were self-reported by the patients in the clinic, at home and when patients returned to the clinic. RESULTS: The assessments on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative verbal rating scales showed a higher level of test-retest stability than the assessments on the Edmonton Symptom Assessment System-revised numerical scoring scales, indicating higher reliability. The correspondence between the verbal categories and the numerical scores of symptom intensity were low because different verbal categories were used by patients who assessed the same numerical score. CONCLUSIONS: The test-retest stability in the assessments was higher on the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative and the results show that assessments on the two instruments could not be used interchangeably. Therefore, the symptom instrument chosen must be specified and unchanged within a patient to improve efficacy in clinical practice. RELEVANCE TO CLINICAL PRACTICE: The Edmonton Symptom Assessment System-revised or the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core 15 Palliative can be used for initial assessments of patients, but should not be compared or used interchangeably. It is vitally important to have individual follow-up for all patients who score an instrument.

Time use clusters of New Zealand adolescents are associated with weight status, diet and ethnicity

OBJECTIVE: To describe New Zealand adolescent time use clusters and correlate cluster profiles. METHODS: Data were from the cross-sectional 2008/2009 National Survey of Children and Young People's Physical Activity and Dietary Behaviours, which surveyed a random sample of 10-16 year-old New Zealanders (study subset n=679). Time use data were collected using the Multimedia Activity Recall for Children and Adults, and collapsed into 17 age-adjusted variables for sex-specific cluster analysis. Cluster associations with socio-demographic, anthropometric, physical activity and dietary variables were analysed. RESULTS: Three time use clusters were discovered for both boys and girls. For boys, the Techno-active cluster was characterised by high levels of team sports and TV; the Quiet movers cluster by transport (active and passive) and quiet time; and the Social studious cluster by reading, study activities and social interaction. The boys' clusters were associated with ethnicity. The girls'Social sporty cluster was characterised by sports and social interaction; the Screenie tasker cluster by TV, computer, chores and work; and the Super studious cluster by reading, study and school-based activities. The girls' time use cluster membership was associated with weight status and serves of extra foods. CONCLUSIONS: Distinct sex-specific time use clusters and correlate profiles exist among NZ adolescents. IMPLICATIONS: These findings may assist the development of targeted time use interventions to improve adolescent health and well-being.

Statistically modelling the relationships between Type D personality and social support, health behaviors and symptom severity in chronic illness groups

OBJECTIVE: The study aimed to develop a predictive model of how Type D personality influences health behaviours, social support and symptom severity and assess its generalisability to a range of chronic illnesses.

DESIGN: Participants were classified as either healthy (n = 182) or having a chronic illness (n = 207). Participants completed an online survey measuring Type D and a range of health-related variables. Chronic illness participants were classified as having either a functional somatic syndrome (i.e. chronic fatigue syndrome or fibromyalgia), where the underlying pathological processes were unclear, or illnesses such as type 2 diabetes, osteoarthritis or rheumatoid arthritis, where the causes are well understood.

MAIN OUTCOME MEASURES: Outcome measures were health behaviours, social support and both physical and psychological symptoms.

RESULTS: The rate of Type D was higher in chronic illness participants (53%) than in healthy controls (39%). Negative affectivity (NA) and social inhibition (SI) both correlated with outcome measures, although NA was generally the stronger predictor. Using NA and SI as independent subscales led to superior prediction of health outcomes than using categorical or continuous representations.

CONCLUSION: Findings suggest that the relationship between Type D and health outcomes may generalise across different chronic illnesses.

Clusters of suicides and suicide attempts: detection, proximity and correlates.

BACKGROUND: A suicide cluster is defined as a higher number of observed cases occurring in space and/or time than would typically be expected. Previous research has largely focused on identifying clusters of suicides, while there has been comparatively limited research on clusters of suicide attempts. We sought to identify clusters of both types of behaviour, and having done that, identify the factors that distinguish suicide attempts inside a cluster from those that were outside a cluster. METHODS: We used data from Western Australia from 2000 to 2011. We defined suicide attempts as admissions to hospital for deliberate self-harm and suicides as deaths due to deliberate self-harm. Using an analytic strategy that accounted for the repetition of attempted suicide within a cluster, we performed spatial-temporal analysis using Poisson discrete scan statistics to detect clusters of suicide attempts and clusters of suicides. Logistic regression was then used to compare clustered attempts with non-clustered attempts to identify risk factors for an attempt being in a cluster. RESULTS: We detected 350 (1%) suicide attempts occurring within seven spatial-temporal clusters and 12 (0.6%) suicides occurring within two spatial-temporal clusters. Both of the suicide clusters were located within a larger but later suicide attempt cluster. In multivariate analysis, suicide attempts by individuals who lived in areas of low socioeconomic status had higher odds of being in a cluster than those living in areas of high socioeconomic status [odds ratio (OR) = 29.1, 95% confidence interval (CI) = 6.3-135.5]. A one percentage-point increase in the proportion of people who had changed address in the last year was associated with a 60% increase in the odds of the attempt being within a cluster (OR = 1.60, 95% CI = 1.29-1.98) and a one percentage-point increase in the proportion of Indigenous people in the area was associated with a 7% increase in the suicide being within a cluster (OR = 1.07, 95% CI = 1.00-1.13). Age, sex, marital status, employment status, method of harm, remoteness, percentage of people in rented accommodation and percentage of unmarried people were not associated with the odds of being in a suicide attempt cluster. CONCLUSIONS: Early identification of and responding to suicide clusters may reduce the likelihood of subsequent clusters forming. The mechanisms, however, that underlie clusters forming is poorly understood.

A cluster analytic approach to identifying predictors and moderators of psychosocial treatment for bipolar depression: results from STEP-BD

Background We sought to address how predictors and moderators of psychotherapy for bipolar depression - identified individually in prior analyses - can inform the development of a metric for prospectively classifying treatment outcome in intensive psychotherapy (IP) versus collaborative care (CC) adjunctive to pharmacotherapy in the Systematic Treatment Enhancement Program (STEP-BD) study. Methods We conducted post-hoc analyses on 135 STEP-BD participants using cluster analysis to identify subsets of participants with similar clinical profiles and investigated this combined metric as a moderator and predictor of response to IP. We used agglomerative hierarchical cluster analyses and k-means clustering to determine the content of the clinical profiles. Logistic regression and Cox proportional hazard models were used to evaluate whether the resulting clusters predicted or moderated likelihood of recovery or time until recovery. Results The cluster analysis yielded a two-cluster solution: 1) "less-recurrent/severe" and 2) "chronic/recurrent." Rates of recovery in IP were similar for less-recurrent/severe and chronic/recurrent participants. Less-recurrent/severe patients were more likely than chronic/recurrent patients to achieve recovery in CC (p=.040, OR=4.56). IP yielded a faster recovery for chronic/recurrent participants, whereas CC led to recovery sooner in the less-recurrent/severe cluster (p=.034, OR=2.62). Limitations Cluster analyses require list-wise deletion of cases with missing data so we were unable to conduct analyses on all STEP-BD participants. Conclusions A well-powered, parametric approach can distinguish patients based on illness history and provide clinicians with symptom profiles of patients that confer differential prognosis in CC vs. IP.

Creativity, Clusters and the Competitive Advantage of Cities

Purpose – This paper aims to marry Michael Porter’s industrial cluster theory of traded and local clusters to Richard Florida’s occupational approach of creative and routine workers to gain a better understanding of the process of economic development. Design/methodology/approach – Combining these two approaches, four major industrial-occupational categories are identified. The shares of US employment in each – creative-in-traded, creative-in-local, routine-in-traded and routine-in-local – are calculated, and a correlation analysis is used to examine the relationship of each to regional economic development indicators. Findings – Economic growth and development is positively related to employment in the creative-in-traded category. While metros with a higher share of creative-in-traded employment enjoy higher wages and incomes overall, these benefits are not experienced by all worker categories. The share of creative-in-traded employment is also positively and significantly associated with higher inequality. After accounting for higher median housing costs, routine workers in both traded and local industries are found to be relatively worse off in metros with high shares of creative-in-traded employment, on average. Social implications – This work points to the imperative for the US Government and industry to upgrade routine jobs, which make up the majority of all employment, by increasing the creative content of this work. Originality/value – The research is among the first to systematically marry the industry and occupational approaches to clusters and economic development.

Monomanias - auto-narrativas e auto-ficções: estudo sobre as manias do eu como sintoma civilizacional e seu reflexo nas artes plásticas : Monomanias - auto narratives and auto-fictions: study on the manias of the self as a civilizational symptom and their reflection in contemporay art

A palavra monomania provém do grego monos que se traduz por "um" e mania que significa "mania". O emprego do termo em psiquiatria deve-se a Esquirol e mais tarde a Pierre Janet. Contudo, o uso da palavra não se circunscreve ao campo da psiquiatria, o conceito de monomania é também usado para definir as denominadas "manias do eu". Nos dias de hoje, a subjectividade, a particularidade de cada indivíduo apartou-se da noção de Homem como um todo objectivo. A massificação gerou a sociedade do narcisismo. A World Wide Web permitiu ao sujeito dar a conhecer ao mundo a sua individualidade. O sujeito é livre de se mostrar, de se fazer ouvir, de contar as suas histórias e principalmente a sua própria. À semelhança do nosso quotidiano, podemos encontrar na arte contemporânea propostas artísticas que se prendem com o conceito de monomania, como o exemplo das mitologias individuais, auto-narrativas e auto-ficções de Sophie Calle: "de vivre sa vie pour faire ceuvre et de faire ceuvre pour vivre sa vie." ABSTRACT: Etymologically, "monomania" originates from the Greek words "monos" and "mania". The former refers to the notion of "one" and the latter to "mania". The term's introduction in the field of psychiatry is attributed first to Esquirol and later Pierre Janet. Usage of the word isn’t, however, exclusive to psychiatric jargon: the concept of monomania is also used to define so called "manias of the self’. Today, the subjectivity and specificity of each individual have distanced themselves from the notion of Man as an objective whole. Massification has led to a society of narcissism. The World Wide Web has allowed the subject to make her individuality known to the world at large. The subject is free to exhibit herself, make herself heard, tell her stories, and especially her own. ln a way similar to daily life, we find agendas in contemporary art that approach the concept of monomania, such as the personal mythologies, self-narratives and selffictions of Sophie Calle: "de vivre sa vie pour faire oeuvre et de faire oeuvre pour vivre sa vie."

ENCADENAMIENTOS PRODUCTIVOS Y CLUSTERS: UNA ESTRATEGIA PARA FORTALECER LAS MICRO Y PEQUEÑAS EMPRESAS DEL TURISMO RURAL

Los modelos de gestión empresarial deben estar en constante actualización según las diversas exigencias del entorno globalizador, razón por la cual, las micro y pequeñas empresas requieren de una visión estratégica y de  generación de calidad y oportunidad en los productos y servicios que deben ofrecer.  Para esto, requiere una capacidad de romper los paradigmas de gestión que le funcionaron en otros momentos de la historia, para poder enfrentar las exigencias del entorno actual. Dentro de éste escenario de mercado, se encuentran muchas micro y pequeñas empresas dedicadas a la actividad del turismo, y particularmente del turismo rural, sector que es uno de los más dinámico en las economías que han generado estrategias para estimularlo y conservarlo; unas de esas estrategias de organización son la conformación de clusters y los encadenamientos productivos, los cuales son empresas que se encuentran dentro de un mismo sector y en una determinada zona geográfica, con el propósito de optimizar sus recursos y brindar servicio integrado y mejor al segmento de mercado que atienden.Palabras claves: Turismo rural, clusters, encadenamientos productivos, micro y pequeñas empresas, gestión turística.Abstracts: Business management models must be under continuous updating to keep up with the different requirements from a globalizing environment.  For this reason micro and small businesses need a strategic vision and the generation of quality and opportunity in the products and services they must offer.  To accomplish this end, they need the capacity to break management models that worked in other times of history, to be able to meet all the challenges from the current environment.  It is within this market scenario that many micro and small businesses are found, businesses that are dedicated to the activity of tourism, and particularly rural tourism, a sector which happens to be one of the most dynamic in the economies that have generated strategies to stimulate it and keep it; one of these organization strategies are the design of clusters and productive chains, that are those businesses found within one single sector and in a particular geographical region, in order to optimize its resources and be able to give an integrated and better service to the market segment they serve.Key words: Rural, tourism., clusters, productive chains, micro and small businesses., tourism management.

Chemical characteristics of the clusters and production of 'BRS Clara' grapevine under protected cultivation during out of season crop.

2011