Monumental challenges : local perspectives on world heritage landscape regulation at Angkor Archaeological Park, Cambodia

Trabalho final de mestrado integrado em Medicina (Psicologia Médica), apresentado à Faculdade de Medicina da Universidade de Coimbra.Introdução: Estudos recentes demonstraram que o sono tem implicações na saúde e bem-estar, doença, desempenho e na sobrevivência. O Stresse académico e emocional afecta negativamente a Qualidade de sono nos estudantes universitários sendo frequente o auto-relato de perturbações do sono nesta população. A relação entre as variáveis Stresse, Afecto e Qualidade de sono é complexa e ainda pouco estudada nas suas diversas vertentes. Objectivos: Pretendeu-se com este trabalho estudar se, em estudantes universitários, existia alguma relação entre as variáveis Activação pré-sono (somática e cognitiva), Predisposição para activação, Stresse académico, Reactividade do sono ao stresse, Afecto (positivo e negativo), Neuroticismo, Extroversão, Auto-estima e a Qualidade de sono (IQS). Materiais e Métodos: Neste estudo foram analisadas as respostas de 713 estudantes de Medicina (468; 65.6% do sexo feminino), com a idade média de 19.29±1.256 (variação=17-24) que preencheram questionários que permitiram aferir os seguintes parâmetros: Activação pré-sono (somática e cognitiva), Predisposição para activação, Stresse académico, Reactividade do sono ao stresse, Afecto (positivo e negativo), Tendência para preocupação/ruminação; Neuroticismo, Extroversão, Auto-estima e Qualidade de sono. Para este último parâmetro foi utilizada uma escala multi-dimensional que incluiu os componentes: Profundidade, Qualidade subjectiva, Latência do sono (minutos) e o Número de acordares nocturnos. Resultados e Discussão: No sexo feminino, nos modelos de regressão, demonstraram-se predictoras significativas independentes da Qualidade de sono as variáveis Activação cognitiva pré-sono (β=.340, p<.001), Activação somática pré-sono (β=.126, p=.020) e a Reactividade do sono ao stresse (β=.170, p=0,002). Na análise de mediação as variáveis activação somática (IC95% .0010-.0281) e cognitiva pré-sono (IC95% .0009-.0421) revelaram-se como mediadores parciais significativos da relação entre a Reactividade do sono ao stresse e Qualidade de sono. No sexo masculino os modelos de regressão revelaram que a Activação cognitiva pré-sono (β=.311, p<.001), Reactividade do sono ao stresse (β=.176, p=.023) e Afecto positivo (β=-.214, p=.001) foram predictores significativos independentes da Qualidade de sono. O Afecto Positivo foi mediador parcial significativo da relação entre Activação pré-sono e Qualidade do sono (IC95% .0014-.0373) e também entre a Reactividade do sono ao stresse e Qualidade do sono (IC95% .090-.0623). Conclusões: Na amostra de estudantes analisada foi encontrada uma associação entre a Reactividade do sono ao stresse e Activação pré-sono e a variável independente deste estudo, a Qualidade de sono. Os nossos resultados sugerem, portanto, que tanto a variável Reactividade do sono ao stresse como a Activação pré-sono podem ser determinantes da qualidade geral do sono, nos jovens adultos.Introduction: Recent studies have shown that sleep has implications on health and wellness, disease, performance and survival. Academic and emotional stress adversely affects the Quality of sleep in college students with frequent self-reported sleep disturbances in this population. The relationship between Stress, Affect and Quality of sleep is complex and not well known. Objective: The purpose of this study was to examine the relationship between Pre-sleep arousal, Arousability, coping, Academic stress, Sleep reactivity to stress, Affect, Neuroticism, Extraversion, Self-esteem, and Sleep quality, in university students. Materials and Methods: 713 medical students (468; 65.6% females), mean age 19.29 years, (sd=1.256; range = 17-24) completed a series of questionnaires that assessed Pre-sleep cognitive and somatic arousal, Arousability predisposition, perceived Academic stress Tendency to worry/ruminate, Sleep reactivity to stress, Positive affect/ Negative affect Neuroticism, Extraversion, Self-esteem and a multi-dimensional measure of Sleep quality, including Sleep depth, Subjective sleep quality, Sleep latency (min) and Night awakenings (nr.). Results and Discussion: In females, the regression models showed that Sleep reactivity to stress (β=.170; p=.002), Pre-sleep cognitive arousal (β=.340; p<.001) and Pre-sleep somatic arousal (β=.126; p=.020) were all independent significant predictors of Sleep quality. Mediation analysis revealed that Somatic arousal (95%CI .0010-.0281) and Cognitive arousal (95% CI .0009-.0421) both are significant partial mediators of the relationship between Sleep reactivity to stress and Sleep quality. In males the regression models revealed that Pre-sleep cognitive arousal (β=.311; p<.001), Sleep reactivity to stress (β=.176; p=.023) and Positive affect (β=-.214; p=.001) were all independent significant predictors of Sleep quality. Positive affect was a significant partial mediator of the relationship between Pre-sleep cognitive arousal and Sleep quality (95%CI .0014-.0373) and between Sleep reactivity to stress and Sleep quality (95%CI .0090-.0623). Conclusions: Our findings suggest that Sleep reactivity to stress and Pre-sleep cognitive arousal may be key determinants of overall sleep quality, in young adults

Scottish government equality outcomes:pregnancy and maternity evidence review

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To know or not to know:should crimes regarding photographs of their child sexual abuse be disclosed to now-adult, unknowing victims?

This paper considers the unexplored question of whether unaware crime victims have rights or interests in knowing and not knowing information pertaining to the crime(s) committed against them. Our specific focus is on whether crimes regarding abusive images (AI) should be disclosed to now-adult victims of child sexual abuse who feature in them. Because these issues have not been addressed in the victimology or criminological literature, we utilise literature in another discipline - health care ethics and law - to inform our analysis. Through engaging with the debate on the right to know and not to know information concerning one’s genetic status, we develop a conceptualisation of the issues regarding unknowing AI victims. A rights-based conceptualisation proves to be largely inappropriate; we contend that, instead, it would be more productive to look to unknowing AI victims’ interests. We argue that the interests at stake are grounded in autonomy and/or spatial privacy, and that in order to find a way to resolve the disclosure dilemma, these interests must be considered alongside consequentialist concerns; disclosing information regarding AI could empower now-adult victims but could well cause them (further) harm. Finally, we consider the implications of our analysis for victimology

The "higher" age of consent and the concept of sexual exploitation

Whilst it is often said that the age of consent in England & Wales is 16 this is not always true. In some situations it is 18. This chapter considers the extent to which this higher age is justified and whether it would be better to create a new, stand-alone offence to tackle abuses of a position of trust

Factors Influencing Continued Wearable Device Use in Older Adult Populations: Quantitative Study

Background: The increased use of wearable sensor technology has highlighted the potential for remote telehealth services such as rehabilitation. Telehealth services incorporating wearable sensors are most likely to appeal to the older adult population in remote and rural areas, who may struggle with long commutes to clinics. However, the usability of such systems often discourages patients from adopting these services. Objective: This study aimed to understand the usability factors that most influence whether an older adult will decide to continue using a wearable device. Methods: Older adults across 4 different regions (Northern Ireland, Ireland, Sweden, and Finland) wore an activity tracker for 7 days under a free-living environment protocol. In total, 4 surveys were administered, and biometrics were measured by the researchers before the trial began. At the end of the trial period, the researchers administered 2 further surveys to gain insights into the perceived usability of the wearable device. These were the standardized System Usability Scale (SUS) and a custom usability questionnaire designed by the research team. Statistical analyses were performed to identify the key factors that affect participants’ intention to continue using the wearable device in the future. Machine learning classifiers were used to provide an early prediction of the intention to continue using the wearable device. Results: The study was conducted with older adult volunteers (N=65; mean age 70.52, SD 5.65 years) wearing a Xiaomi Mi Band 3 activity tracker for 7 days in a free-living environment. The results from the SUS survey showed no notable difference in perceived system usability regardless of region, sex, or age, eliminating the notion that usability perception differs based on geographical location, sex, or deviation in participants’ age. There was also no statistically significant difference in SUS score between participants who had previously owned a wearable device and those who wore 1 or 2 devices during the trial. The bespoke usability questionnaire determined that the 2 most important factors that influenced an intention to continue device use in an older adult cohort were device comfort (τ=0.34) and whether the device was fit for purpose (τ=0.34). A computational model providing an early identifier of intention to continue device use was developed using these 2 features. Random forest classifiers were shown to provide the highest predictive performance (80% accuracy). After including the top 8 ranked questions from the bespoke questionnaire as features of our model, the accuracy increased to 88%. Conclusions: This study concludes that comfort and accuracy are the 2 main influencing factors in sustaining wearable device use. This study suggests that the reported factors influencing usability are transferable to other wearable sensor systems. Future work will aim to test this hypothesis using the same methodology on a cohort using other wearable technologies

Respiratory and Bronchitic Symptoms Predict Intention to Quit Smoking among Current Smokers with, and at Risk for, Chronic Obstructive Pulmonary Disease

Rationale: Smoking cessation is the most important intervention for patients with chronic obstructive pulmonary disease (COPD). What leads smokers with COPD to quit smoking remains unknown

Support and Assessment for Fall Emergency Referrals (SAFER 1) trial protocol. Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial

Background: Many emergency ambulance calls are for older people who have fallen. As half of them are left at home, a community-based response may often be more appropriate than hospital attendance. The SAFER 1 trial will assess the costs and benefits of a new healthcare technology - hand-held computers with computerised clinical decision support (CCDS) software - to help paramedics decide who needs hospital attendance, and who can be safely left at home with referral to community falls services. Methods/Design: Pragmatic cluster randomised trial with a qualitative component. We shall allocate 72 paramedics ('clusters') at random between receiving the intervention and a control group delivering care as usual, of whom we expect 60 to complete the trial. Patients are eligible if they are aged 65 or older, live in the study area but not in residential care, and are attended by a study paramedic following an emergency call for a fall. Seven to 10 days after the index fall we shall offer patients the opportunity to opt out of further follow up. Continuing participants will receive questionnaires after one and 6 months, and we shall monitor their routine clinical data for 6 months. We shall interview 20 of these patients in depth. We shall conduct focus groups or semi-structured interviews with paramedics and other stakeholders. The primary outcome is the interval to the first subsequent reported fall (or death). We shall analyse this and other measures of outcome, process and cost by 'intention to treat'. We shall analyse qualitative data thematically. Discussion: Since the SAFER 1 trial received funding in August 2006, implementation has come to terms with ambulance service reorganisation and a new national electronic patient record in England. In response to these hurdles the research team has adapted the research design, including aspects of the intervention, to meet the needs of the ambulance services. In conclusion this complex emergency care trial will provide rigorous evidence on the clinical and cost effectiveness of CCDS for paramedics in the care of older people who have fallen

Musculoskeletal pain characteristics associated with lower balance confidence in community-dwelling older adults

Objective: To determine whether musculoskeletal pain (pain severity and number of chronic pain sites; single or multisite) is associated with balance confidence over and above previously established risk factors. Design: Cross-sectional study. Setting: Ten community sites (five day centres, two sheltered housing schemes and three community ‘clubs’) in the UK. Participants: Two hundred and eighty-nine community-dwelling older adults [response rate 72%, mean age 78 (standard deviation 8) years, 67% female] completed the study assessment. Eligibility criteria were as follows: living in the community; aged ≥60 years; able to walk ≥10 m; able to communicate in English; and no cognitive (e.g. dementia), neurological or mental health conditions. Interventions: Not applicable. Main outcome measure: Balance confidence as measured by the 16-item Activities Balance Confidence (ABC) scale (lower scores indicate less confidence). Results: One hundred and fifty participants had at least one site of chronic musculoskeletal pain (52%), and the remaining 139 (48%) participants did not report chronic musculoskeletal pain. Older people with chronic musculoskeletal pain had significantly lower scores on the ABC scale compared with those without chronic musculoskeletal pain (mean 48.3 vs 71.3, P < 0.001). After adjustment for established risk factors, two separate hierarchical regression models demonstrated that both pain severity (β=-0.106, P = 0.029) and number of chronic musculoskeletal pain sites (β=-0.98, P = 0.023) were significantly associated with lower balance confidence. Conclusion: Both pain severity and number of chronic pain sites (particularly multisite pain) are associated with lower balance confidence in community-dwelling older adults. Further research is needed to target pain symptoms and balance confidence in relation to fall risk in older adults with chronic musculoskeletal pain