Urban wastewater as a source of reclaimed water for irrigation: barriers and future possibilities

Water resources are under pressure worldwide, resulting in scarcity and deterioration of freshwater quality. According to European directives, we could reduce the pressure on water resources in urban areas by increasing the reuse of treated wastewater, reducing the impact on water bodies, and promoting water recycling through multiple uses of urban wastewater. Besides the need to address water supply challenges, wastewater treatment systems show environmental stewardship and innovative practices. Using reclaimed water for agricultural irrigation is gaining interest because of the drought conditions experienced in Europe over the past few years. Furthermore, using treated wastewater for agricultural irrigation may help to restore nutrients (N and P) to natural biogeochemical cycles. This review highlights the importance of water reuse, current legislation, and existing technologies to implement in wastewater treatment systems to meet the minimum requirements to produce reclaimed water to reuse in agricultural irrigation.info:eu-repo/semantics/publishedVersio

7th International Conference on Ethics Education: Conference Proceedings

info:eu-repo/semantics/publishedVersio

Spiritual needs of Brazilian children and adolescents with chronic illnesses: a thematic analysis

Purpose: To identify the spiritual needs of children and adolescents with chronic illnesses and how these needs are met by health professionals during hospitalization. Design and methods: A qualitative descriptive study was developed with 35 children and adolescents, between 7 and 18 years old, diagnosed with cancer, cystic fibrosis, and type 1 diabetes. Interviews with photo-elicitation were conducted during the hospitalization at a Brazilian public pediatric hospital. Findings were treated using thematic analysis, and the Consolidated Criteria for Reporting Qualitative Research (COREQ) was followed for quality reporting. This research was approved by a research committee. Results: Two themes emerged. The first, entitled ‘Spiritual needs’, encompasses five types of needs: (1) need to integrate meaning and purpose in life; (2) need to sustain hope; (3) need for expression of faith and to follow religious practices; (4) need for comfort at the end of life; and (5) need to connect with family and friends. The second theme was the ‘Definition of spiritual care’. Conclusions: Children and adolescents with chronic illnesses have spiritual needs while in hospital. Meeting these needs is essential for finding meaning, purpose and hope in the experience of living with chronic illnesses and at the end of life, based on their faith, beliefs and interpersonal relationships. But, these needs have not been fully addressed during hospitalization. Practice implications: These results emphasize the need to implement spiritual care when caring for hospitalized pediatric patients, which includes addressing spiritual needs.info:eu-repo/semantics/publishedVersio

Evidence of validity of internal structure of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12) in Brazilian adolescents with chronic health conditions

This study explored the evidence of validity of internal structure of the 12-item Functional Assessment of Chronic Illness Therapy—Spiritual Wellbeing Scale (FACIT-Sp-12) in Brazilian adolescents with chronic health conditions. The study involved 301 Brazilian adolescents with cancer, type 1 diabetes mellitus, or cystic fibrosis. Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and Item Response Theory (IRT) were used to test the internal structure. Reliability was determined with Cronbach’s Alpha and McDonald’s Omega. The EFA suggested a one-dimensional scale structure in contrast to the original 2-factor model or the 3-factor model which were not reproduced in the current CFA. All quality indicators for the EFA one-factor exceeded the required criteria (FDI = 0.97, EAP = 0.97, SR = 3.96 and EPTD = 0.96, latent GH = 0.90. and the observed GH = 0.85). The FACIT-Sp-12 for adolescents yielded strong evidence for a 1-factor model and with good reliability.info:eu-repo/semantics/publishedVersio

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.(SFRH/BPD/115169/2016) funded by Fundação para a Ciência e Tecnologia (FCT); ERDF (European Regional Development Fund) through the operations: POCI-01-0145-FEDER-029130 ('mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases—generalisation and evaluation of gamification, peer support and advanced image processing technologies') cofunded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).info:eu-repo/semantics/publishedVersio

Os portugueses e o Testamento Vital

Introduction: It has taken some years since the law (25/2012) was passed and we still do not know about the portuguese population ́s knowledge regarding the Living Will (LW), nor the law effects. Aim; To identify the Portuguese population fraction that believes to know what the LW is and, from those, the fraction that actually knows what it is; to classify the information resources that allowed the Portuguese to know the LW; to identify the number of Portuguese citizens who made the LW and those who registered it in RENTEV; to identify the reasons that led the Portuguese to perform, or not, the living will; to analyze witch factors may influence the knowledge about the law and the decision of doing the LW. Methods:Stratified random sampling, in order to be representative of the portuguese population over 18 years (n=1064); Analytical, cross-sectional, observational study; It has been done trough face-by-face interviews performed. Results: Only 22% of Portuguese Citizens know what Living Will is; This lack of knowledge is not influenced by gender, age or familiar conditions, but it appears to be influenced (p<0.05) by the regional area along the country. The education seems to influence the knowledge about the LW. The ones who have a high level education are those who know more. Respondents reported that the media was the main information source about this document – law (66.2%); Family doctors were responsible for 2.8% of the information and Nurses for only 2.9%. From the 22% that know what Living Will is, only 50.4% know how to do it and who to ask for help. So, only one in ten portuguese know what LW is, how to do it and who to ask for help. Only 1.4 % of the respondents say that have already done the LW, with no registration in the RENTEV; All of those say that had included specific instructions regarding medical care and two thirds (2/3) also included an Healthcare proxy. From those who had not performed the LW 32% think about doing it; 41.1% choose not to do it; 26.1% do not know yet and are not thinking about doing it. The district size and gender do not influence with statistical significance. All of other factors influence de decision about to do or not to do the living will. From the respondents who intend to do the LW, 17.6% want to include that they do not want to be submitted to any futile treatment. Also from this 16.2% intend to authorize the participation in clinical trials; 13.2%, do not want to be submitted to artificial life support; 10.3% wishes to have palliative care; 4.4% does not want to be part of scientific research programs or clinical trials. From the respondents who do not intend to do the LW, 63.5% justify their choice by have not thought about it yet: 22.4% accept life at each moment; 2.4% by mistrusting the healthcare system and its professionals; 11.8% pointed other reasons. Conclusions: There is significant deficit of knowledge about the LW – regarding, not only, the portuguese society, but also the healthcare providers who should never dismiss this responsibility. On the other hand, the respondents who know what LW is did not obtain this knowledge by healthcare providers. In our opinion, because the living will is about healthcare wishes, we consider that the healthcare providers should be the main information source.Introdução: Decorreram alguns anos desde que a Lei 25/2012 foi aprovada e ainda se sabe muito pouco em relação ao conhecimento que a população portuguesa tem em relação ao Testamento Vital e ou seus efeitos. Objetivo: Identificar a proporção da população portuguesa que pensa conhecer em que consta o Testamento Vital (TV) e a que realmente conhece; identificar as fontes que contribuíram para o conhecimento sobre este assunto; identificar o n.º de portugueses que fizeram o TV e que estão registados no RENTEV; identificar as razões que levam os portugueses a realizar ou não o TV e que fatores influenciam o conhecimento e decisões relativas ao TV. Métodos: Estudo observacional, transversal, analítico com amostragem aleatória estratificada representativa da população portuguesa (n=1064), cujo critério de inclusão era ter 18 ou mais anos de idade. A colheita de dados foi efetuada através de questionário preenchido durante entrevista presencial. Resultados: Apenas 22% dos portugueses conhecem de facto o que é o TV; esta ausência de conhecimento não é influenciada pelo género, idade ou situação familiar, mas é-o pela região de residência e pelo nível das habilitações literárias. Foram os meios de comunicação social as principais fontes de conhecimento da Lei (66.2%); os médicos de família foram-no para 2.8% e os enfermeiros para 2.9%. Dos 22% que sabem o que é o TV, apenas 50.4% sabem como o fazer e a quem pedir ajuda. Deste modo, apenas 1:10 portugueses sabe o que é o TV e como o fazer. Apenas 1.4 % tinha feito o TV e sem registo no RENTEV; todos registaram indicações relativas a cuidados médicos e cerca de 2/3 indicaram procurador de cuidados de saúde. Dos que não fizeram o TV, 32% pensam fazê-lo; 41.1% não o farão e 26.1% não querem ainda pensar nisso. A região do país e o género não influenciam a decisão. Todos os restantes fatores influenciam. Dos que pretendem vir a fazer o TV, 17.6% desejam incluir que não querem ser submetidos a terapêuticas fúteis; 16.2% desejam autorizar a sua participação em ensaios clínicos; 13.2%, não desejam estar submetidos a medidas de suporte artificial de vida; 10.3% desejam ter cuidados paliativos; 4.4% não querem fazer parte de estudos de investigação. Dos que não pretendem vir a fazer o TV, 63.5% justificam-no por não terem ainda pensado nisso; 22.4% porque aceitam a vida a cada momento; 2.4% por desconfiança no sistema de saúde e seus profissionais; 11.8% por outras razões. Conclusões: Existe uma significativa falta de conhecimento acerca do Testamento Vital, não apenas na população portuguesa, mas também nos profissionais de saúde que não se deverão demitir desta responsabilidade de informar. Por outro lado, os participantes que têm o adequado conhecimento não o obtiveram a partir dos profissionais de saúde. Em nossa opinião, e porque o TV tem a ver com desejos e preferências sobre cuidados de saúde, os profissionais de saúde deveriam e devem ser a principal fonte de informação da população

Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.publishersversionpublishe

PROT-OVT: Plano Regional de Ordenamento do Territorio do Oeste e Vale do Tejo

Os princípios, objectivos e orientações consagrados no Programa Nacional da Política de Ordenamento do Território (PNPOT), aprovado pela Lei n.º 58/2007, de 4 de Setembro, são desenvolvidos nos vários planos regionais de ordenamento do território (PROT) que, por sua vez, constituem um quadro de referência estratégico para os planos directores municipais (PDM). No processo de elaboração e revisão articulada destes três pilares fundamentais do sistema de gestão territorial, em que assenta a política de ordenamento do território e do urbanismo, cabe aos PROT uma posição de charneira fundamental. O significado e as potencialidades dos PROT são ainda significativamente ampliados pela articulação com a revisão dos PDM. Face a uma nova geração de PDM, que se pretendem mais estratégicos, os PROT fornecem um quadro de referência estratégica de longo prazo que permite aos municípios estabelecerem as suas opções de desenvolvimento e definirem regras de gestão territorial compatíveis com o modelo consagrado para a região. Os PROT, além de um pilar da política de desenvolvimento territorial, são documentos fundamentais para a definição dos programas de acção das intervenções co-financiadas pelos Fundos Estruturais e de Coesão da União Europeia. Os PROT são instrumentos de desenvolvimento territorial e de natureza estratégica. Em matéria de conteúdo, estabelecem a estrutura regional do sistema urbano, das redes de infra‑estruturas e dos equipamentos de interesse regional e definem os objectivos e princípios quanto à localização das actividades e os grandes investimentos públicos; as suas normas fixam o quadro estratégico, as orientações de carácter genérico e as directrizes para o ordenamento do território regional. O PROT do Oeste e Vale do Tejo (PROT OVT) visa, neste contexto, a espacialização de estratégias de desenvolvimento territorial nos territórios das NUTS III do Oeste, Médio Tejo e Lezíria do Tejo. Por isso, ocupa, entre o nível nacional e o nível municipal, uma posição chave para a definição das estratégias e das opções de desenvolvimento e de ordenamento regional. O PROT OVT é pois um instrumento privilegiado para promover a reflexão estratégica do desenvolvimento do Oeste e do Vale do Tejo e acolher a tomada de decisão quanto às opções de desenvolvimento territorial [...]info:eu-repo/semantics/publishedVersio