Long-term efficacy of a rural community-based integrated intervention for prevention and management of chronic obstructive pulmonary disease: a cluster randomized controlled trial in China's rural areas

This study aimed to assess the efficacy of a rural community-based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China. This 18-year cluster-randomized controlled trial encompassing 15 villages included 1008 patients (454 men and 40 women in the intervention group [mean age, 54 ± 10 years]; 482 men and 32 women in the control group [mean age, 53 ± 10 years]) with confirmed COPD or at risk for COPD. Villages were randomly assigned to the intervention or the control group, and study participants residing within the villages received treatment accordingly. Intervention group patients took part in a program that included systematic health education, smoking cessation counseling, and education on management of COPD. Control group patients received usual care. The groups were compared after 18 years regarding the incidence of COPD, decline in lung function, and mortality of COPD. COPD incidence was lower in the intervention group than in the control group (10% vs 16%, <0.05). A decline in lung function was also significantly delayed in the intervention group compared to the control group of COPD and high-risk patients. The intervention group showed significant improvement in smoking cessation compared with the control group, and smokers in the intervention group had lower smoking indices than in the control group (350 vs 450, <0.05). The intervention group also had a significantly lower cumulative COPD-related death rate than the control group (37% vs 47%, <0.05). A rural community-based integrated intervention is effective in reducing the incidence of COPD among those at risk, delaying a decline in lung function in COPD patients and those at risk, and reducing mortality of COPD.

Educational Intervention Project "R.E.D. Bull(ying)"

Introduction: Adolescence is a stage of life cycle marked by various physical, psychological and social changes. During this stage, young people are faced with the feeling of threat of identity, which may trigger aggressive behaviours. Bullying is a form of school violence with high prevalence, that shouldn't be a "normal" occurrence or a event that young people should experience during the transition between childhood and adolescent. In order to reduce the prevalence of bullying in the school community, we elaborated the Educational Intervention Project "R.E.D. BULL(ying)", with the specific objectives: Evaluate the knowledge level about bullyng, before and after the Project, and increase the level of literacy about the subject in the school community (students and teachers). Methodology: Our target population consisted in a total of 203 students from 5th to 9th grade and 13 teachers of school. It's a cross-sectional study of research - action, with the application of a diagnostic questionnaire, before and after, we conducted the educational sessions. Results: After the educational sessions, 93,1% of students identified what to do in a bullying situation, and 62,6% of students responded that in an assault situation, called an adult; 95,1% said they knew what was bullying, 56,8% associated the concept to physical aggression and 92,6 % mentioned to know the types of bullying, and physical bullying (71,9%) and verbal bullying (69,5%) were the most mentioned types. Meanwhile, the teachers: 76,9% considered that the school environment was pleasant, 84,6% characterized the relationship between the students as "adequate" and 77% said they didn't experience any bullying situation. Conclusions: We found an overall improvement to the level of bullying related knowledge after the educational intervention. So, we verified that the integrated intervention in the school health teams, allows greater attention to the detection, signalling and routing situations of violence.

EDUCATIONAL INTERVENTION PROJECT "R.E.D. BULL(YING)"

Introduction: Adolescence is a stage of life cycle marked by various physical, psychological and social changes. During this stage, young people are faced with the feeling of threat of identity, which may trigger aggressive behaviours. Bullying is a form of school violence with high prevalence, that shouldn't be a "normal" occurrence or a event that young people should experience during the transition between childhood and adolescent. In order to reduce the prevalence of bullying in the school community, we elaborated the Educational Intervention Project "R.E.D. BULL(ying)", with the specific objectives: Evaluate the knowledge level about bullyng, before and after the Project, and increase the level of literacy about the subject in the school community (students and teachers). Methodology: Our target population consisted in a total of 203 students from 5th to 9th grade and 13 teachers of school. It's a cross-sectional study of research - action, with the application of a diagnostic questionnaire, before and after, we conducted the educational sessions. Results: After the educational sessions, 93,1% of students identified what to do in a bullying situation, and 62,6% of students responded that in an assault situation, called an adult; 95,1% said they knew what was bullying, 56,8% associated the concept to physical aggression and 92,6 % mentioned to know the types of bullying, and physical bullying (71,9%) and verbal bullying (69,5%) were the most mentioned types. Meanwhile, the teachers: 76,9% considered that the school environment was pleasant, 84,6% characterized the relationship between the students as "adequate" and 77% said they didn't experience any bullying situation. Conclusions: We found an overall improvement to the level of bullying related knowledge after the educational intervention. So, we verified that the integrated intervention in the school health teams, allows greater attention to the detection, signalling and routing situations of violence.

Avaliação da exposição a fungos e partículas em explorações avícolas e suinícolas: estudo

O projeto “Avaliação da Exposição a Fungos e Partículas em Explorações Avícolas e Suinícolas” contemplou um elevado número de colheitas ambientais e biológicas e respectivo processamento laboratorial, sendo apenas possível a sua concretização graças ao financiamento disponibilizado pela Autoridade para as Condições de Trabalho. Foi realizado um estudo transversal para avaliar a contaminação causada por fungos e partículas em 7 explorações avícolas e 7 explorações suinícolas. No que concerne à monitorização biológica, foram medidos os parâmetros espirométricos, utilizando o espirómetro MK8 Microlab, avaliada a existência de sintomas clínicos associados com a asma e outras doenças alérgicas, através de questionário adaptado European Community Respiratory Health Survey e, ainda, avaliada a sensibilização aos agentes fúngicos (IgE). Foram ainda adicionados dois objetivos ao estudo, designadamente: aferir a existência de três espécies/estirpes potencialmente patogénicas/toxinogénicas com recurso à biologia molecular e avaliar a exposição dos trabalhadores à micotoxina aflatoxina B1 por recurso a indicador biológico de exposição. Foram colhidas 27 amostras de ar de 25 litros nas explorações avícolas e 56 de 50 litros nas explorações suinícolas através do método de impacto. As colheitas de ar e a medição da concentração das partículas foram realizadas no interior e no exterior dos pavilhões, sendo este último considerado como local de referência. Simultaneamente, a temperatura e a humidade relativa também foram registadas. As colheitas das superfícies foram realizadas através da técnica de zaragatoa, tendo sido utilizado um quadrado de metal inoxidável de 10 cm de lado, de acordo com a International Standard ISO 18593 – 2004. As zaragatoas obtidas (20 das explorações avícolas e 48 das explorações suinícolas) foram inoculadas em malte de extract agar (2%) com cloranfenicol (0,05 g/L). Além das colheitas de ar e de superfícies, foram também obtidas colheitas da cama das explorações avícolas (7 novas e 14 usadas) e da cobertura do pavimento das explorações suinícolas (3 novas e 4 usadas) e embaladas em sacos esterilizados. Cada amostra foi diluída e inoculada em placas contendo malte extract agar. Todas as amostras foram incubadas a 27,5ºC durante 5 a 7 dias e obtidos resultados quantitativos (UFC/m3; UFC/m2; UFC/g) e qualitativos com a identificação das espécies fúngicas. Para a aplicação dos métodos de biologia molecular foram realizadas colheitas de ar de 300 litros utilizando o método de impinger com a velocidade de recolha de 300 L/min. A identificação molecular de três espécies potencialmente patogénicas e/ou toxinogénicas (Aspergillus flavus, Aspergillus fumigatus e Stachybotrys chartarum) foram obtidas por PCR em tempo real (PCR TR) utilizando o Rotor-Gene 6000 qPCR Detection System. As medições de partículas foram realizadas por recurso a equipamento de leitura direta (modelo Lighthouse, 2016 IAQ). Este recurso permitiu medir a concentração (mg/m3) de partículas em 5 dimensões distintas (PM 0.5; PM 1.0; PM 2.5; PM 5.0; PM10). Nas explorações avícolas, 28 espécies/géneros de fungos foram isolados no ar, tendo Aspergillus versicolor sido a espécie mais frequente (20.9%), seguida por Scopulariopsis brevicaulis (17.0%) e Penicillium sp. (14.1%). Entre o género Aspergillus, Aspergillus flavus apresentou o maior número de esporos (>2000 UFC/m3). Em relação às superfícies, A. versicolor foi detetada em maior número (>3 × 10−2 UFC/m2). Na cama nova, Penicillium foi o género mais frequente (59,9%), seguido por Alternaria (17,8%), Cladosporium (7,1%) e Aspergillus (5,7%). Na cama usada, Penicillium sp. foi o mais frequente (42,3%), seguido por Scopulariopsis sp. (38,3%), Trichosporon sp. (8,8%) e Aspergillus sp. (5,5%). Em relação à contaminação por partículas, as partículas com maior dimensão foram detectadas em maiores concentrações, designadamente as PM5.0 (partículas com a dimensão de 5.0 bm ou menos) e PM10 (partículas com a dimensão de 10 bm ou menos). Neste setting a prevalência da alteração ventilatória obstrutiva foi superior nos indivíduos com maior tempo de exposição (31,7%) independentemente de serem fumadores (17,1%) ou não fumadores (14,6%). Relativamente à avaliação do IgE específico, foi apenas realizado em trabalhadores das explorações avícolas (14 mulheres e 33 homens), não tendo sido encontrada associação positiva (p<0.05%) entre a contaminação fúngica e a sensibilização a antigénios fúngicos. No caso das explorações suinícolas, Aspergillus versicolor foi a espécie mais frequente (20,9%), seguida por Scopulariopsis brevicaulis (17,0%) e Penicillium sp. (14,1%). No género Aspergillus, A. versicolor apresentou o maior isolamento no ar (>2000 UFC/m3) e a maior prevalência (41,9%), seguida por A. flavus e A. fumigatus (8,1%). Em relação às superfícies analisadas, A. versicolor foi detetada em maior número (>3 ×10−2 UFC/m2). No caso da cobertura do pavimento das explorações suinícolas, o género Thicoderma foi o mais frequente na cobertura nova (28,0%) seguida por A. versicolor e Acremonium sp. (14,0%). O género Mucor foi o mais frequente na cobertura usada (25,1%), seguido por Trichoderma sp. (18,3%) e Acremonium sp. (11,2%). Relativamente às partículas, foram evidenciados também valores mais elevados na dimensão PM5 e, predominantes nas PM10. Neste contexto, apenas 4 participantes (22,2%) apresentaram uma alteração ventilatória obstrutiva. Destes, as obstruções mais graves encontraram-se nos que também apresentavam maior tempo de exposição. A prevalência de asma na amostra de trabalhadores em estudo, pertencentes aos 2 contextos em estudo, foi de 8,75%, tendo-se verificado também uma prevalência elevada de sintomatologia respiratória em profissionais não asmáticos. Em relação à utilização complementar dos métodos convencionais e moleculares, é recomendável que a avaliação da contaminação fúngica nestes settings, e, consequentemente, a exposição profissional a fungos, seja suportada pelas duas metodologias e, ainda, que ocorre exposição ocupacional à micotoxina aflatoxina B1 em ambos os contextos profissionais. Face aos resultados obtidos, é importante salientar que os settings alvo de estudo carecem de uma intervenção integrada em Saúde Ocupacional no âmbito da vigilância ambiental e da vigilância da saúde, com o objetivo de diminuir a exposição aos dois factores de risco estudados (fungos e partículas).

Trends in motor vehicle crash mortality in Europe, 1980-2007.

Recent trends (1980-2007) in mortality from road traffic crashes in European countries, and, for comparative purposes, in the USA and Japan were reviewed. Data came from the World Health Organisation database. Age-standardised rates, at all ages and at 15-24, 25-64, >=65 years, were computed. Joinpoint regression analyses to evaluate significant changes in trends were performed. In the European Union as a whole rates declined from 20.2 in 1987 to 13.5/100,000 in 2007 in men, and from 6.3 to 3.7/100,000 in women; European Union rates remained lower than USA, but higher than Japanese ones. In 2007, the highest male rates were in Lithuania (36.7/100,000), the Russian Federation (35.2), Ukraine (29.8), and Latvia (28.5), and the lowest ones in the Netherlands (6.2) and Sweden (6.9); the highest female rates were in the Russian Federation (11.3), Lithuania (9.7), Belarus, Latvia, and Ukraine (around 8), and the lowest ones in Switzerland (1.7), the UK, and Nordic countries (around 2). Mortality from motor vehicle crashes declined in northern and western European countries and - though to a lesser extent - in southern European countries, too. Mortality trends were also favourable in the Czech Republic and Poland since the mid 1990's, whereas they were still upwards in Romania and the Russian Federation. No trend was observed in Hungary and Ukraine. Trends were consistent in various age groups considered. Thus, additional urgent and integrated intervention is required to prevent avoidable deaths from motor vehicle crashes, particularly in selected central and eastern European countries.

Portrait et analyse des stratégies à base territoriale pour contrer la pauvreté et l'exclusion dans le territoire de La Petite-Patrie à Montréal. Conditions d’une action intégrée

L’objet de la présente thèse est la lutte contre la pauvreté. Elle cherche à identifier les conditions favorisant la sortie de la pauvreté dans un territoire urbain, ici le quartier de la Petite-Patrie. par une approche territoriale intégrée. S’inscrivant dans la mouvance des multiples initiatives de lutte contre la pauvreté et l’exclusion au Québec, le postulat qui fonde cette recherche est le suivant : la lutte contre la pauvreté par l’approche territoriale intégrée permet : 1) d’instaurer des conditions favorisant la sortie de la pauvreté et 2) de renverser les processus qui mènent à l’appauvrissement des personnes et, du même coup, d’améliorer les conditions et la qualité de vie de celles-ci dans un territoire particulier. Les résultats de cette recherche permettent : 1) de contribuer à la compréhension des dynamiques de lutte contre la pauvreté grâce à une approche considérant les acteurs agissant dans un territoire et, 2) d’éclairer les différents niveaux de conception et de mise en œuvre des politiques et des stratégies d’action, tant au niveau de l’État que de la société civile, sachant que les dispositifs d’intervention intégrés se créent à l’interface des initiatives locales ou régionales et des nouvelles formes de politiques publiques en matière de lutte contre la pauvreté. Les grandes conclusions qui émergent de cette recherche sont au nombre de trois : 1) Si la multidimentionnalité de la pauvreté est acceptée par plusieurs auteurs, on ne peut pas parler d’une seule pauvreté, mais de diverses pauvretés. Les visages de la pauvreté dans le territoire de La Petite-Patrie témoignent de cette diversité des pauvretés, et appellent une variété de stratégies d’action ; 2) Les personnes en situation de pauvreté, en fonction de leurs capacités d’agir, peuvent être appréhendées selon un double profil qui structure de façon importante leur processus de sortie de la pauvreté : le premier groupe rassemble les personnes en situation de pauvreté qui ont des initiatives découlant de leurs capacités d’agir, et le second groupe qui réunit les personnes en situation de pauvreté dont la capacité d’initiative est altérée, apparemment de façon durable, par leurs conditions de vie. Toute stratégie publique de sortie de la pauvreté dans un espace donné devrait alors considérer cette dimension relative aux capacités de rapprochement des individus et des ressources pour soutenir le développement d’une stratégie territoriale intégrée de lutte à la pauvreté plus efficace pour les personnes dont le processus de désaffiliation est plus avancé; 3) Les acteurs de lutte contre la pauvreté dans un territoire, pour réunir les conditions d’une action intégrée et mettre en place des conditions favorables de lutte contre la pauvreté, doivent s’appuyer sur la concertation, les alliances intersectorielles, le leadership inclusif et concerté, les passerelles formelles et fonctionnelles entre acteurs institutionnels, et sur une démarche hybride (emploi et défense des droits) qui constituent des ingrédients fondamentaux pour toute action ou intervention en faveur des personnes en situation de pauvreté vivant dans un cadre territorial défini et accepté par l’ensemble des acteurs locaux. Ce caractère hybride de la démarche permet d’agir de façon différenciée sur les deux groupes de la population. L’intégration est donc avant tout stratégique, c’est-à-dire fondée sur l’articulation d’une pluralité de logique d’action.

Sistematización de la experiencia del “Equipo Interdisciplinario de Estudios en Desarrollo local, Interacción - Formación - Investigación”

En el año 2007 el Instituto Rosarista de Acción Social y varios profesores de distintas facultades, en un esfuerzo por integrar la docencia, la investigación y la extensión, crean el Equipo interdisciplinario de estudios en desarrollo local. La iniciativa buscaba contribuir a la formulación de respuestas a problemáticas del desarrollo local por medio de la implementación de proyectos en una comunidad. Para ello, los profesores articularon sus capacidades y conocimientos en la construcción de un programa de intervención integral en el sector de El Codito. La búsqueda por construir, desde un análisis integral, procesos que atiendan los retos que impone el subdesarrollo, hace que la propuesta del Equipo Interdisciplinario sea muy interesante. Es por eso que en el capítulo 1de esta sistematización se considera pertinente rescatar las acciones del equipo a través de una sistematización de su experiencia desde sus inicios en el año 2007, hasta su desintegración en el 2013. En los capítulos 2 y 3, de manera detallada, se recoge el diagnóstico, la planificación y la ejecución de dos de los proyectos que se implementaron en el sector de El Codito: la “Escuela juvenil de formación en democracia, proyectos sociales y trabajo comunitario para el sector El Codito” e “Imaginarios y representaciones sociales en torno a la discapacidad en comunidades vulnerables. Estudio de caso sector El Codito, Bogotá.”. Por último, se presentan algunas conclusiones, lecciones aprendidas y recomendaciones de esta experiencia de trabajo comunitario.

Advances in the Diagnosis of Human Schistosomiasis

Schistosomiasis is a major neglected tropical disease that afflicts more than 240 million people, including many children and young adults, in the tropics and subtropics. The disease is characterized by chronic infections with significant residual morbidity and is of considerable public health importance, with substantial socioeconomic impacts on impoverished communities. Morbidity reduction and eventual elimination through integrated intervention measures are the focuses of current schistosomiasis control programs. Precise diagnosis of schistosome infections, in both mammalian and snail intermediate hosts, will play a pivotal role in achieving these goals. Nevertheless, despite extensive efforts over several decades, the search for sensitive and specific diagnostics for schistosomiasis is ongoing. Here we review the area, paying attention to earlier approaches but emphasizing recent developments in the search for new diagnostics for schistosomiasis with practical applications in the research laboratory, the clinic, and the field. Careful and rigorous validation of these assays and their cost-effectiveness will be needed, however, prior to their adoption in support of policy decisions for national public health programs aimed at the control and elimination of schistosomiasis.

Intervenção Social - Arte ou Ciência?: O Assistente Social como agente de mudança numa autarquia de interior.

O presente trabalho baseia-se na pesquisa documental e na análise crítico-reflexiva sobre o serviço social no Poder Local, a sua evolução, influências e implicações no trabalho desenvolvido no (pelo) Gabinete de Ação Social do Município de Pampilhosa da Serra. O serviço social assume, durante o Estado Novo, um papel de controle, com uma prática associada essencialmente ao Estado e a algumas entidades da sociedade civil, nomeadamente à Igreja Católica. Com a Era Democrática, assiste-se ao crescimento da intervenção do Estado e à descentralização da sua atuação para as Autarquias, assumindo-se o SAAL (1974) como um marco histórico. A intervenção ganha, assim, um caráter “territorial” crescendo as responsabilidades das autarquias, quer no âmbito das transferências de competências por parte do Poder Central, quer ao nível da dinamização de serviços de âmbito municipal e da criação de respostas sociais específicas. O PRS (1997) e a RLIS (2013), apresentam-se como exemplos dessa territorialização, reforçando as atribuições das Autarquias ao nível da ação social. O primeiro, implementado a nível nacional, visa a articulação de recursos e uma intervenção integrada. Tem como princípios, a promoção a participação da população e dos agentes locais quer na elaboração de diagnósticos sociais, quer na criação de respostas adequadas às necessidades. A segunda, em fase de implementação, visa a criação de uma metodologia de trabalho ao nível do atendimento e acompanhamento social. Destaca-se o papel das Autarquias e da Sociedade Civil, na efetivação de uma intervenção social de proximidade. A crescente desresponsabilização do Estado na intervenção social, em particular do Poder Central, motivada pela Crise Económica, provoca alterações nas políticas sociais. Surgem as políticas de inserção direcionadas para públicos específicos, tendencialmente contratualizadas e centradas no sujeito. Estas alterações tiveram, também, implicações na atuação do Município de Pampilhosa da Serra, onde o serviço social se desenvolveu a par da implementação dos programas de âmbito comunitário, nomeadamente do PDIAS e PLCP (1996) e do projecto-piloto do RMG (1997). Sistematizou-se com a implementação das Redes Sociais e operacionaliza-se no Gabinete de Ação Social, atuando em três dimensões: mediação, promoção e execução. Da análise e reflexão em torno da atuação do GAS, no qual inscrevemos a nossa intervenção profissional, consideramos que esta se desenvolve numa relação sociopolítica e operacional, assumindo a Autarquia um papel ativo ao criar e/ou reforçar medidas de apoio socioeducativo e económico, de forma a garantir o bem-estar social e a qualidade de vida dos cidadãos Pampilhosenses. O município assume-se como o patamar de atuação de proximidade por excelência, onde o local se perspetiva como o espaço onde a intervenção social se operacionaliza, enquanto que o Poder Local, em conjunto com a sociedade Civil, assumem o poder de co construir a mudança social. / This work is based on documentary research and critical and reflective analysis of the social service in Local Government, its evolution, influences and implications on the work of the (at) Social Action Office of the municipality of Pampilhosa da Serra. The social service assumes, during the Estado Novo, a paper control, primarily associated with a practice the state and some civil society organizations, including the Catholic Church. With the Democratic Era, we are witnessing the growth of state intervention and the decentralization of its activities to the local authorities, assuming the SAAL (1974) as a historical landmark. Intervention win, so a character "territorial" growing responsibilities of local authorities, or within the transfer of responsibilities from the Central Power, both in terms of promotion of municipal services and the creation of specific social responses. The PRS (1997) and the RLIS (2013), are presented as examples of territorial, strengthening the powers of local authorities to the level of social action. The first, implemented nationally, aimed at articulating features and an integrated intervention. Its principles, promoting the participation of the population and local actors when developing social diagnosis, whether the creation of appropriate responses to the needs. The second, under implementation, aims to create a working methodology in terms of care and social support. It highlights the role of local authorities and civil society in the execution of a social intervention proximity. The growing irresponsibility of the state in social intervention, in particular the Central Power, motivated by the economic crisis, causes changes in social policies. Arise inclusion policies targeting specific audiences tend contracted and centered on the subject. These changes have also implications for the work of the municipality of Pampilhosa da Serra, where the social work developed together with the implementation of Community-wide programs, including the PDIAS and PLCP (1996) and the pilot project of RMG (1997). Systematized with the implementation of Social Networks and made operational in the Social Action Office, working in three dimensions: mediation, promotion and implementation. Analysis and reflection around the GAS operation, in which we inscribe our professional intervention, we believe that this is developed in a socio-political and operational relationship, assuming the Municipality an active role to create and / or strengthen measures of socio-educational and economic support, to ensure the welfare and quality of life of citizens Pampilhosenses. The municipality is assumed as the proximity actuation level par excellence where the location is perspective as the space where social intervention made operational, while the Local Government, together with civil society, assume the co power build social change.

Results of a feasibility study: barriers and facilitators in implementing the Sherbrooke model in France.

International audience

Symposium: Violence in Adults and the elderly: to investigate and intervene

This symposium aims to address some studies on violence in adults, as well as address the job done in an intervention network in domestic violence and a project on the study of violence in the elderly, in Alentejo. Communications: - PREVALÊNCE OF VIOLENCE IN ADULTS- Zangão, Maria Otília; Serra, Isaura; Gemito, Maria Laurência; Pinheiro, Felícia Tavares; Magalhães, Dulce; Marques, Maria de Fátima - SOCIAL REPRESENTATION OF DOMESTIC VIOLENCE - Gemito, Maria Laurência; Pinheiro, Felícia Tavares; Zangão, Maria Otília; Serra, Isaura; Magalhães, Dulce; Marques, Maria de Fátima - DOMESTIV VIOLENCE IN THE PERSPECTIVE OF WOMEN WHO LIVE IT - Magalhães, Dulce; Marques, Maria de Fátima; Zangão, Maria Otília; Serra, Isaura; Gemito, Maria Laurência; Pinheiro, Felícia Tavares - INTEGRATED INTERVENTION NETWORK OF DISTRICT OF ÉVORA (RIIDE): A multidisciplinary response to violence - Gemito, Maria Laurência; Pinheiro, Felícia Tavares; Lopes, Manuel - ESACA - Ageing Safely in Alentejo – Understanding for Action - Mendes, Felismina; Gemito, Maria Laurência; Zangão, Maria Otilia; Chora, Maria Antónia; Pereira, Catarina Symposium goal(s): - To present studies on violence in Alentejo. - To discuss the importance of networks in the problem of violence. - To present Project underway on how to age with security in Alentejo. Symposium moderator(s): Maria Otília Brites Zangão Project affiliation:All three studies have resulted in an intervention project against domestic violence "Love me, love me not- Why does the violence exist and why does it not choose ages?" funded by POPH. ESACA Project - Aging Safely in Alentejo - Understanding to act, co-funded by: Alentejo 2020 Portugal 2020 and the European Union.

Manager's task to support integrated autonomy at the workplace : Results from an intervention

A new managerial task arises in today’s working life: to provide conditions for and influence interaction between actors and thus to enable the emergence of organizing structure in tune with a changing environment. We call this the enabling managerial task. The goal of this paper is to study whether training first line managers in the enabling managerial task could lead to changes in the work for the subordinates. This paper presents results from questionnaires answered by the subordinates of the managers before and after the training. The training was organized as a learning network and consisted of eight workshops carried out over a period of one year (September 2009–June 2010), where the managers met with each other and the researchers once a month. Each workshop consisted of three parts, during three and a half hours. The first hour was devoted to joint reflection on a task that had been undertaken since the last workshop; some results were presented from the employee pre-assessments, followed by relevant theory and illuminating practices, finally the managers created new tasks for themselves to undertake during the following month. The subordinates’ answers show positive change in all of the seventeen scales used to assess it. The improvements are significant in scales measuring the relationship between the manager and the employees, as well as in those measuring interaction between employees. It is concluded that the result was a success for all managers that had the possibility of using the training in their management work.

Phonological and articulation treatment approaches in Portuguese children with speech and language impairments: a randomized controlled intervention study

Background: In Portugal, the routine clinical practice of speech and language therapists (SLTs) in treating children with all types of speech sound disorder (SSD) continues to be articulation therapy (AT). There is limited use of phonological therapy (PT) or phonological awareness training in Portugal. Additionally, at an international level there is a focus on collecting information on and differentiating between the effectiveness of PT and AT for children with different types of phonologically based SSD, as well as on the role of phonological awareness in remediating SSD. It is important to collect more evidence for the most effective and efficient type of intervention approach for different SSDs and for these data to be collected from diverse linguistic and cultural perspectives. Aims: To evaluate the effectiveness of a PT and AT approach for treatment of 14 Portuguese children, aged 4.0–6.7 years, with a phonologically based SSD. Methods & Procedures: The children were randomly assigned to one of the two treatment approaches (seven children in each group). All children were treated by the same SLT, blind to the aims of the study, over three blocks of a total of 25 weekly sessions of intervention. Outcome measures of phonological ability (percentage of consonants correct (PCC), percentage occurrence of different phonological processes and phonetic inventory) were taken before and after intervention. A qualitative assessment of intervention effectiveness from the perspective of the parents of participants was included. Outcomes & Results: Both treatments were effective in improving the participants’ speech, with the children receiving PT showing a more significant improvement in PCC score than those receiving the AT. Children in the PT group also showed greater generalization to untreated words than those receiving AT. Parents reported both intervention approaches to be as effective in improving their children’s speech. Conclusions & Implications: The PT (combination of expressive phonological tasks, phonological awareness, listening and discrimination activities) proved to be an effective integrated method of improving phonological SSD in children. These findings provide some evidence for Portuguese SLTs to employ PT with children with phonologically based SSD

Validation of Two US Risk Scores for Percutaneous Coronary Intervention in a Single-Center Portuguese Population of Patients with Acute Coronary Syndrome

INTRODUCTION: New scores have been developed and validated in the US for in-hospital mortality risk stratification in patients undergoing coronary angioplasty: the National Cardiovascular Data Registry (NCDR) risk score and the Mayo Clinic Risk Score (MCRS). We sought to validate these scores in a European population with acute coronary syndrome (ACS) and to compare their predictive accuracy with that of the GRACE risk score. METHODS: In a single-center ACS registry of patients undergoing coronary angioplasty, we used the area under the receiver operating characteristic curve (AUC), a graphical representation of observed vs. expected mortality, and net reclassification improvement (NRI)/integrated discrimination improvement (IDI) analysis to compare the scores. RESULTS: A total of 2148 consecutive patients were included, mean age 63 years (SD 13), 74% male and 71% with ST-segment elevation ACS. In-hospital mortality was 4.5%. The GRACE score showed the best AUC (0.94, 95% CI 0.91-0.96) compared with NCDR (0.87, 95% CI 0.83-0.91, p=0.0003) and MCRS (0.85, 95% CI 0.81-0.90, p=0.0003). In model calibration analysis, GRACE showed the best predictive power. With GRACE, patients were more often correctly classified than with MCRS (NRI 78.7, 95% CI 59.6-97.7; IDI 0.136, 95% CI 0.073-0.199) or NCDR (NRI 79.2, 95% CI 60.2-98.2; IDI 0.148, 95% CI 0.087-0.209). CONCLUSION: The NCDR and Mayo Clinic risk scores are useful for risk stratification of in-hospital mortality in a European population of patients with ACS undergoing coronary angioplasty. However, the GRACE score is still to be preferred.

A description of the Australian early psychosis intervention model and a proposal to establish a Pilot Early Intervention Program in Santa Cruz de la Sierra, Bolívia

RESUMO: Em 2011, a Associação Psiquiátrica Mundial lançou um programa de bolsas de investigação para psiquiatras em início de carreira a partir de países de renda baixa ou média-baixa, no âmbito deste programa, o autor foi selecionado para uma bolsa de pesquisa no Centre for Youth Mental Health/Orygen Youth Health Research Centre da Universidade de Melbourne. Orygen, é a principal organização de pesquisa e tradução do conhecimento do mundo com foco em problemas de saúde mental em pessoas jovens. O estágio foi baseado em Prevenção e Intervenção Precoce Psychosis Centre (EPPIC), que faz parte do Orygen. EPPIC fornece programa de tratamento abrangente e integrada, baseada na comunidade para o primeiro episódio de psicose. Esta dissertação descreve o modelo EPPIC, e seus componentes essenciais e fatores que são necessários para uma implementação de serviço direito. Além disso, uma proposta de criação de um programa-piloto de intervenção psicose precoce é discutido. Este programa inclui um programa de extensão inovadora que combina princípios comerciais sólidos, com metas sociais, a fim de combater especificamente a maior barreira para o tratamento da psicose precoce na Bolívia: o estigma da doença mental. Ao utilizar uma equipe de tratamento móvel, multidisciplinar, que enfatiza os papéis dos gerentes do caso treinados focada em fornecer indivíduo intensiva e apoio familiar no lar, este programa irá prestar cuidados culturalmente apropriados que irá alavancar contribuições de um suprimento limitado de psiquiatras e mudar longe da dependência um sistema médico fragmentado. ---------------------------- ABSTRACT: In 2011, the World Psychiatric Association launched a programme of research fellowships for early-career psychiatrists from low- or lower-middle income countries, within this programme, the author was selected to a research fellowship at the Centre for Youth Mental Health/Orygen Youth Health Research Centre at University of Melbourne. Orygen, is the world’s leading research and knowledge translation organization focusing on mental ill-health in young people. The traineeship was based on Early Psychosis Prevention and Intervention Centre (EPPIC), which is part of Orygen. EPPIC provides comprehensive, integrated, community-based treatment program for first-episode psychosis. This dissertation describes the EPPIC model, and its core components and factors which are necessary to a right service implementation. Additionally, a proposal to establish a pilot early psychosis intervention programme is discussed. This programme includes an innovative outreach programme that combines sound business principals with social goals in order to specifically target the largest barrier to early psychosis treatment in Bolivia: the stigma of mental illness. By utilizing a mobile, multidisciplinary treatment team that emphasizes the roles of trained case managers focused on providing intensive individual and family support in the home, this programme will provide culturally appropriate care that will leverage contributions from a limited supply of psychiatrists and shift dependence away from a fragmented medical system.