L’audiència del menor als procediments de família. Elaboració d’una guia per a l’exploració judicial del menor. Generació d’un qüestionari d’exploració de les necessitats en les exploracions judicials de menors

Aquest treball pretén oferir als jutges que intervenen en processos de guarda i custodia, evidències empíriques sobre les seves necessitats per a la realització de les entrevistes en les que estan implicats els menors. Aquestes necessitats ha estat detectades mitjançant la generació d’un nou qüestionari que ha permès elaborar una guia específica de recomanacions dirigides als jutges.

A Critical Review on Chagas Disease Chemotherapy

In this "Critical Review" we made a historical introduction of drugs assayed against Chagas disease beginning in 1912 with the works of Mayer and Rocha Lima up to the experimental use of nitrofurazone. In the beginning of the 70s, nifurtimox and benznidazole were introduced for clinical treatment, but results showed a great variability and there is still a controversy about their use for chronic cases. After the introduction of these nitroheterocycles only a few compounds were assayed in chagasic patients. The great advances in vector control in the South Cone countries, and the demonstration of parasite in chronic patients indicated the urgency to discuss the etiologic treatment during this phase, reinforcing the need to find drugs with more efficacy and less toxicity. We also review potential targets in the parasite and present a survey about new classes of synthetic and natural compounds studied after 1992/1993, with which we intend to give to the reader a general view about experimental studies in the area of the chemotherapy of Chagas disease, complementing the previous papers of Brener (1979) and De Castro (1993).

Alzheimer's Disease Biomarkers, 2009

This report gives a comprehensive and up-to-date review of Alzheimer's disease biomarkers. Recent years have seen significant advances in this field. Whilst considerable effort has focused on A�_ and tau related markers, a substantial number of other molecules have been identified, that may offer new opportunities.This Report : Identifies 60 candidate Alzheimer's (AD) biomarkers and their associated studies. Of these, 49 are single species or single parameters, 7 are combinations or panels and 4 involve the measurement of two species or parameters or their ratios. These include proteins (n=34), genes (n=11), image-based parameters (n=7), small molecules (n=3), proteins + genes (n=2) and others (n=3). Of these, 30 (50%) relate to species identified in CSF and 19 (32%) were found in the blood. These candidate may be classified on the basis of their diagnostic utility, namely those which i) may allow AD to be detected when the disease has developed (48 of 75†= 64%), ii) may allow early detection of AD (18 of 75† = 24%) and iii) may allow AD to be predicted before the disease has begun to develop (9 of 75†= 12%). † Note: Of these, 11 were linked to two or more of these capabilities (e.g. allowed both early-stage detection as well as diagnosis after the disease has developed).Biomarkers: AD biomarkers identified in this report show significant diversity, however of the 60 described, 18 (30%) are associated with amyloid beta (A�_) and 9 (15%) relate to Tau. The remainder of the biomarkers (just over half) fall into a number of different groups. Of these, some are associated with other hypotheses on the pathogenesis of AD however the vast majority are individually unique and not obviously linked with other markers. Analysis and discussion presented in this report includes summaries of the studies and clinical trials that have lead to the identification of these markers. Where it has been calculated, diagnostic sensitivity, specificity and the capacity of these markers to differentiate patients with suspected AD from healthy controls and individuals believed to be suffering from other neurodegenerative conditions, have been indicated. These findings are discussed in relation to existing hypotheses on the pathogenesis of the AD and the current drug development pipeline. Many uncertainties remain in relation to the pathogenesis of AD, in diagnosing and treating the disease and many of the studies carried out to identify disease markers are at an early stage and will require confirmation through larger and longer investigations. Nevertheless, significant advances in the identification of AD biomarkers have now been made. Moreover, whilst much of the research on AD biomarkers has focused on amyloid and tau related species, it is evident that a substantial number of other species may provide important opportunities.Purpose of Report: To provide a comprehensive review of important and recently discovered candidate biomarkers of AD, in particular those with potential to reliably detect the disease or with utility in clinical development, drug repurposing, in studies of the pathogenesis and in monitoring drug response and the course of the disease. Other key goals were to identify markers that support current pipeline developments, indicate new potential drug targets or which advance understanding of the pathogenesis of this disease.Drug Repurposing: Studies of the pathogenesis of AD have identified aberrant changes in a number of other disease areas including inflammation, diabetes, oxidative stress, lipid metabolism and others. These findings have prompted studies to evaluate some existing approved drugs to treat AD. This report identifies studies of 9 established drug classes currently being investigated for potential repurposing.Alzheimer’s Disease: In 2005, the global prevalence of dementia was estimated at 25 million, with more than 4 million new cases occurring each year. It is also calculated that the number of people affected will double every 20 years, to 80 million by 2040, if a cure is not found. More than 50% of dementia cases are due to AD. Today, approximately 5 million individuals in the US suffer from AD, representing one in eight people over the age of 65. Direct and indirect costs of AD and other forms of dementia in the US are around $150 billion annually. Worldwide, costs for dementia care are estimated at $315 billion annually. Despite significant research into this debilitating and ultimately fatal disease, advances in the development of diagnostic tests for AD and moreover, effective treatments, remain elusive.Background: Alzheimer's disease is the most common cause of dementia, yet its clinical diagnosis remains uncertain until an eventual post-mortem histopathology examination is carried out. Currently, therapy for patients with Alzheimer disease only treats the symptoms; however, it is anticipated that new disease-modifying drugs will soon become available. The urgency for new and effective treatments for AD is matched by the need for new tests to detect and diagnose the condition. Uncertainties in the diagnosis of AD mean that the disease is often undiagnosed and under treated. Moreover, it is clear that clinical confirmation of AD, using cognitive tests, can only be made after substantial neuronal cell loss has occurred; a process that may have taken place over many years. Poor response to current therapies may therefore, in part, reflect the fact that such treatments are generally commenced only after neuronal damage has occurred. The absence of tests to detect or diagnose presymptomatic AD also means that there is no standard that can be applied to validate experimental findings (e.g. in drug discovery) without performing lengthy studies, and eventual confirmation by autopsy.These limitations are focusing considerable effort on the identification of biomarkers that advance understanding of the pathogenesis of AD and how the disease can be diagnosed in its early stages and treated. It is hoped that developments in these areas will help physicians to detect AD and guide therapy before the first signs of neuronal damage appears. The last 5-10 years have seen substantial research into the pathogenesis of AD and this has lead to the identification of a substantial number of AD biomarkers, which offer important insights into this disease. This report brings together the latest advances in the identification of AD biomarkers and analyses the opportunities they offer in drug R&D and diagnostics.��

End of life care standards for people with dementia

End of life care standards for people with dementiaThis project, funded under Call 1 of CARDI’s Grants Programme and led by Dr Suzanne Cahill, School of Social Work and Social Policy, Trinity College Dublin, highlights the need for guaranteed standards of care for older people with dementia at the end of their lives.The research recommends the introduction of standards as a matter of urgency because of the huge increases in the number of people affected, and the number likely to be affected in the future. It is estimated that the number of people with dementia in the Republic of Ireland will rise from 44,000 to 104,000 by 2036 and in Northern Ireland from 16,000 to 47,000 in 2051.The research draws attention to the importance of agreeing new standards in Ireland, North and South, by proposing guidelines to develop policies and practices that can reflect the best available throughout the world.Research Team:•������ Dr Suzanne Cahill, School of Social Work and Social Policy, Trinity College Dublin•������ Ms Daphne Doran, Quality Initiatives, Belfast•������ Dr Max Watson, University of Ulster and Northern Ireland HospiceResearch briefingFull report��

Protecció pública dels menors desemparats a Catalunya

El treball té per objecte l’estudi de la protecció pública dels menors desemparats a través de la figura de la tutela de l’Administració, com a institució de dret administratiu.

Entrevista y urgencia social: un reto para las competencias profesionales del educador social

Si decimos que los seres humanos sólo son capaces de vivir como tales mediante la reconstrucción narrativa de sus experiencias, estamos teniendo en cuenta conceptos e ideas que recuerdan a algunos autores contemporáneos (Ricoeur, Gadamer) que defienden la importancia de ser reconocido como una creatura hecha de palabras. En la medida en que son interpretadas, traducidas, contextualizadas y ordenadas por los profesionales, la situación dialogal significativa cobra importancia. Desde esta perspectiva hemos planteado las asignaturas: Habilidades Sociales, Técnicas de Entrevista y Gestión de Situación de Crisis diseñadas para integrar los diferentes modelos teóricos y las variables que se presentan en la relación comunicativa con el usuario y en particular en la situación de entrevista. Se mostrará también el modo cómo en nuestro proceso formativo, basado en la simulación de situaciones, se fomenta el compromiso con el trabajo en equipo, la autocomprensión y enseña a crear un clima de trabajo cooperativo en el que se hace más eficaz la relación de ayuda. A través de la presentación en clase de un caso práctico en el cual se describen todos los procedimientos y las fases del que se compone el ejercicio de la práctica profesional –paso a paso-, se busca poner de manifiesto las competencias adquiridas, los modelos empleados y las habilidades sociales que han sido necesarias para afrontar con éxito la situación de urgencia social. Finalmente se deja abierta la cuestión sobre la manera en que incide y beneficia este aprendizaje en las futuras situaciones de manejo del estrés profesional (burn out).

Taking care of the most vulnerable : a descriptive study of patients with 12 attendances or more at a Swiss university hospital emergency department in 2009

Introduction: Patients who repeatedly attend the Emergency Department (ED) often have a distinct and complex vulnerability profile that includes poor somatic, psychological, and social indicators. This profile has an impact on the patients' well-being as well as on hospital costs. The objective of the study was to specify the characteristics of hyper users (HU) and explore the connection with ED care and hospital costs. Methods: The study sample comprised all adult patients with 12 or more attendances at the ED of the Lausanne University Hospital in 2009. The data were collected by retrospectively searching internal databases to identify the patients concerned and then analysing the profiles of these patients. Information gathered included demographic, somatic, psychological, at-risk behaviour, and social indicators, and health system consumption including costs. Results: In 2009, 23 patients (0.1%) attended 12 times or more (425 attendances, 0.8%). The average age was about 43 years, 60.9% were female, and 47.8% single. Of these 95.7% had basic insurance, 87.0% had a general practitioner, and 30.4% were under legal guardianship. The majority attended in the evening or at night (67.1%), and almost one quarter of these attendances resulted in inpatient treatment (24.0%). Most HU had attended the ED in previous years too (95.7% in 2008). The most prevalent diagnoses concerned 'mental disorders' (87.0%). About 30.4% of patients had attempted suicide (all were female patients). Other frequent diagnoses concerned 'trauma' (65.2%), and the 'digestive' and the 'nervous system' (each 56.5%). At-risk behaviour such as severe alcohol consumption (34.8%), or excessive use of medicines (26.1%) was very frequent, and some patients used illicit drugs (21.7%). There was only a weak association between the number of ED attendances and the resulting costs. However, a reduction of one outpatient visit per patient would have decreased ED outpatient costs by 8.5%. Conclusions: HU often have a particularly vulnerable profile. Mental problems are prevalent among them, as are at-risk behaviour and severe somatic conditions. The complexity of the patients' profiles demands specific care that cannot be guaranteed within an everyday ED routine. The use of an interdisciplinary case management team might be a promising approach in diminishing the number of attendances and the associated costs, although the profiles of HU are such that they probably cannot completely give up ED attendance.

Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system.

OBJECTIVES: The objectives were to identify the social and medical factors associated with emergency department (ED) frequent use and to determine if frequent users were more likely to have a combination of these factors in a universal health insurance system. METHODS: This was a retrospective chart review case-control study comparing randomized samples of frequent users and nonfrequent users at the Lausanne University Hospital, Switzerland. The authors defined frequent users as patients with four or more ED visits within the previous 12 months. Adult patients who visited the ED between April 2008 and March 2009 (study period) were included, and patients leaving the ED without medical discharge were excluded. For each patient, the first ED electronic record within the study period was considered for data extraction. Along with basic demographics, variables of interest included social (employment or housing status) and medical (ED primary diagnosis) characteristics. Significant social and medical factors were used to construct a logistic regression model, to determine factors associated with frequent ED use. In addition, comparison of the combination of social and medical factors was examined. RESULTS: A total of 359 of 1,591 frequent and 360 of 34,263 nonfrequent users were selected. Frequent users accounted for less than a 20th of all ED patients (4.4%), but for 12.1% of all visits (5,813 of 48,117), with a maximum of 73 ED visits. No difference in terms of age or sex occurred, but more frequent users had a nationality other than Swiss or European (n = 117 [32.6%] vs. n = 83 [23.1%], p = 0.003). Adjusted multivariate analysis showed that social and specific medical vulnerability factors most increased the risk of frequent ED use: being under guardianship (adjusted odds ratio [OR] = 15.8; 95% confidence interval [CI] = 1.7 to 147.3), living closer to the ED (adjusted OR = 4.6; 95% CI = 2.8 to 7.6), being uninsured (adjusted OR = 2.5; 95% CI = 1.1 to 5.8), being unemployed or dependent on government welfare (adjusted OR = 2.1; 95% CI = 1.3 to 3.4), the number of psychiatric hospitalizations (adjusted OR = 4.6; 95% CI = 1.5 to 14.1), and the use of five or more clinical departments over 12 months (adjusted OR = 4.5; 95% CI = 2.5 to 8.1). Having two of four social factors increased the odds of frequent ED use (adjusted = OR 5.4; 95% CI = 2.9 to 9.9), and similar results were found for medical factors (adjusted OR = 7.9; 95% CI = 4.6 to 13.4). A combination of social and medical factors was markedly associated with ED frequent use, as frequent users were 10 times more likely to have three of them (on a total of eight factors; 95% CI = 5.1 to 19.6). CONCLUSIONS: Frequent users accounted for a moderate proportion of visits at the Lausanne ED. Social and medical vulnerability factors were associated with frequent ED use. In addition, frequent users were more likely to have both social and medical vulnerabilities than were other patients. Case management strategies might address the vulnerability factors of frequent users to prevent inequities in health care and related costs.

A Comparative Study of Transvaginal Tape, Transobturator Tape Outside-in, and Transvaginal Tape-obturator Inside-out Surgical Procedures in the Treatment of Stress Urinary Incontinence

The aim of this work was to use the Urinary Distress Inventory (UDI-6) and Incontinence Impact Quality of Life (IIQ-7) questionnaires to compare 3 surgical techniques for stress urinary incontinence: the transvaginal tape (TVT) (105 women), the transobturator tape outside-in (TOT) (43 women), and the transvaginal tape-obturator inside-out (TVT-O) (54 women). There were no significant differences in frequent urination, urine leakage related to the feeling of urgency, urine leakage related to physical activity, or small amounts of urine leakage. TVT-operated women had a lower percentage of micturition difficulties compared with TOT women. TVT-O-operated women described slight discomfort in the genital area compared with the TVT technique, but this difference was not significant when compared with the TOT technique. When utilizing the UDI-6 and IIQ-7 scoring modifications before and after surgery, no difference among these 3 techniques is apparent.

Social support from the perspective of adolescent victims of domestic violence

Objective: Assess the understanding of adolescents regarding the social support received in situations of domestic violence. Method: A qualitative study with data collection carried out through focus groups with 17 adolescent victims of domestic violence, institutionally welcomed in Campinas-SP, and through semi-structured interviews with seven of these adolescents. Information was analyzed by content analysis, thematic modality. Results: Observing the thematic categories it was found that social support for the subjects came from the extended family, the community, the Guardianship Council, the interpersonal relationships established at the user embracement institution and from the religiosity/spirituality. Conclusion: The mentioned sources of support deserve to be enhanced and expanded. With the current complexity of the morbidity and mortality profiles, especially in children and adolescents, the (re)signification and the (re)construction of health actions is imperative.



A influência do consumo de álcool no insucesso escolar dos alunos do ensino secundário de São Vicente - Cabo Verde

O álcool é a substância mais consumida pelos adolescentes e jovens, e a idade do início e o padrão de consumo têm sido uma das preocupações, particularmente, dos sectores da saúde e da educação. Este consumo está associado a um conjunto de consequências negativas para a vida do adolescente, entre as quais a dificuldade de aprendizagem e o baixo rendimento escolar. Portanto, a prevenção do consumo de álcool nas escolas, constitui uma via consensual para tentar controlar o problema. Esta dissertação tem como objectivo conhecer o padrão de consumo de álcool dos alunos do ensino secundário em São Vicente (Cabo Verde) e estudar a sua relação com o insucesso escolar. Aplicámos um questionário anónimo a uma amostra de 500 alunos, com idade entre 12 e 21 anos, das 5 escolas secundárias públicas da ilha. Após uma análise exploratória dos dados e uma análise univariada verificou-se que o consumo de álcool podia estar relacionado com o insucesso escolar. Neste sentido, construímos modelos de regressão logística para estudar tal relação. Os resultados evidenciam que o primeiro contacto com o álcool ocorre numa idade precoce e o padrão de consumo, genericamente, varia em função da faixa etária e do género. Entretanto, independentemente do género e da faixa etária, o consumo ocorre fundamentalmente aos fins – de – semana e na companhia dos amigos. Após o controlo dos factores de confusão, o consumo de álcool permaneceu como um factor de risco para o insucesso escolar e verificámos que a probabilidade de um aluno ter insucesso escolar aumenta com a frequência de consumo. Os resultados do estudo alertam para a necessidade de uma intervenção de toda a comunidade educativa e dos sectores da saúde no sentido de implementar medidas que visem o combate ao consumo de álcool entre os alunos, e adolescentes de uma forma geral.

Cenários e Tutelas – Perceções do Desenvolvimento da Ilha do Maio – Cabo Verde

Esta dissertação tem como problemática o desenvolvimento em situação insular e como objetivo identificar as perspetivas (cenários) de desenvolvimento da ilha do Maio, no contexto do desenvolvimento de Cabo Verde e o papel que os atores do desenvolvimento desempenham nesta ilha (tutelas). A significativa melhoria dos indicadores socioeconómicos de Cabo Verde, por um lado, e a persistência de algumas carências, por outro, evidenciam as desigualdades no contexto em estudo. Com base nestes pressupostos, e a partir de uma perspetiva integrada do desenvolvimento e da sua perceção pelos atores, serão analisados os fatores que conduziram à boa performance do país, e, especificamente, o caso da ilha do Maio, evidenciando as suas potencialidades, oportunidades, ameaças e fraquezas. Baseado num trabalho de campo na ilha do Maio, com entrevistas aos atores fundamentais do desenvolvimento, pretende-se saber se a situação da ilha do Maio contribui para a boa performance de Cabo Verde ou para acentuar as assimetrias existentes. Isto porque, nalgumas ilhas, o progresso é muito mais lento e também pelo facto de a ilha do Maio apresentar algumas potencialidades que poderão contribuir para o desenvolvimento da ilha e do país em geral. Espera-se que os cenários encontrados e a discussão das tutelas possam servir como instrumento de apoio às tomadas de decisão.

Iowa Commission on the Status of African Americans Annual Report, Fiscal Year 2006

A Public Intellectual recently suggested that I read the book Life Out Of Context by the very productive writer Walter Mosley. In this book, Mosley began to summarize a speech that was given by Harry Belafonte. Belafonte made a comparison between a particular Olympic relay race and the Civil Rights Movement. In the race, an experienced runner stumbled a little while passing the baton, and the race was lost. For Belafonte, this momentary slip was a metaphor for the failure of the Civil Rights Movement to “pass the baton” to the younger generation as “it moved past its original phase and into the latter part of the century.” Regardless of your views of the strengths and weaknesses of the Civil Rights Movement, I think all of us would agree that the current issues facing Black Iowa today--e.g., the need for economic development, increased educational achievement and more political involvement in our communities--demand our immediate attention and action. This urgency requires that we cross generational, class, and territorial boundaries within the state to collaborate among ourselves and with others to deal constructively with these issues. We cannot afford to have another “momentary slip.” Serving as the Administrator for ICSAA allows me to serve Black Iowa in a significant way, and Kimberly Cheeks and I in this Division look forward to the work ahead over the next several months and years. Working closely with Walter Reed, Director of the Department of Human Rights, along with so many others across this state, we are keenly aware that we are provided with a great opportunity to positively impact the quality of life for African-Americans in Iowa.

Reducing Prescription Drug Abuse in Iowa, January 5, 2011

Prescription drug abuse is the nation’s fastest-growing drug problem, as outlined by the White House Office of National Drug Control Policy’s 2011 national plan “Responding to America’s Prescription Drug Abuse Crisis.” The urgency of the challenge is underscored in other reports, including a recent analysis by the Centers for Disease Control (CDC) that said: “Overdoses involving prescription painkillers are at epidemic levels and now kill more Americans than heroin and cocaine combined.” According to the CDC, more than 40 people die in America every day from overdoses involving narcotic pain relievers such as hydrocodone (Vicodin), oxycodone (Oxycontin), methadone and oxymorphone (Opana). In Iowa, the situation is similar, at least in some ways. Prescription drug abuse is one of the fastest-growing forms of substance abuse in our state too, though its scope is smaller and on a more manageable scale when compared with most other states. The Iowa Department of Public Health, Bureau of Vital Statistics, reports the drug overdose deaths of at least 130 Iowans over the last three years (2008-2010) due to non-heroin opioids (i.e., prescription pain relievers such as oxycodone, hydrocodone and methadone), nearly as many as for the previous eight years combined (149 from 2000-2007).

Constructive thinking skills and impulsivity dimensions in conduct and substance use disorders: differences and relationships in an adolescents' sample.

Impact of conduct disorder (CD) and substance use disorder (SUD) on constructive thinking skills and impulsivity was explored. 71 offending adolescents were assessed for CD and SUD. Furthermore, the constructive thinking inventory, the immediate and delayed memory tasks and the UPPS impulsive behaviour scale were administered. Results showed that youths with CD, independently from SUD, presented higher personality impulsivity (urgency) and altered constructive thinking skills (categorical thinking and personal superstitious thinking). Furthermore, trait-impulsivity explained variation in constructive thinking skills. The implications of these results were discussed.