Promoção e proteção de crianças e jovens : distrito de Aveiro

Mestrado em Psicologia ForenseO presente trabalho tem como objetivo saber se existe relação entre a história familiar e a problemática da criança e jovem, se há diferenças na distribuição de sexos, se as percentagens da problemática variam com as idades, com o tipo de família, com a escolaridade dos progenitores, com a situação económica e com a caraterização urbanística, se as percentagens da medida aplicada variam com o suporte de retaguarda e com os anos estudados. Os maus-tratos a crianças e jovens são referidos na literatura como uma forma de tratamento físico ou emocional, não acidental e inadequado, resultante de disfunções ou carências na relação entre família/criança, podendo manifestar-se através de comportamentos ativos físicos, psicológicos ou sexuais, ou passivos na negligência ou omissão de cuidados físicos e/ou afetivos. Para concretizar este objetivo foi recolhida uma amostra de conveniência constituída por 814 processos arquivados de crianças e jovens em risco, com idades que variam entre dias de vida e 21 anos, com medida de Promoção e Proteção, acompanhados pela equipa do Setor de Assessoria Técnica a Tribunais do Centro Distrital de Segurança Social de Aveiro, a quem foi elaborado um pedido de consentimento. Foram recolhidos dados de processos arquivados de 2007 a 2012, do relatório social de avaliação diagnóstica, de informação social, de informação clinica (quando aplicável), da ficha cronológica de registos e da notificação de despacho/ata de conferência (tribunal).Estes instrumentos pretendem descrever os dados relativos à criança e jovem, à sua família e à medida de promoção e proteção que lhe é aplicada, bem como informação acerca das diligências efetuadas no âmbito do processo. Os resultados obtidos indicam que na maioria dos casos de maus-tratos, predomina uma história familiar com antecedentes de violação, prostituição, falta de hábitos de trabalho, consumo de substâncias/detenções, agressão, violência doméstica e doença do foro psíquico. A negligência é a problemática mais frequente, com 61,1%., sendo o sexo masculino o que predomina em todas as problemáticas identificadas, à exceção do abuso sexual mais predominante no sexo feminino, entre os 11 e os 15 anos, seguindo-se a faixa etária dos 6 aos 10 anos, mais frequente na família nuclear e reconstituída. Constatamos também que perante as medidas de promoção aplicadas (apoio junto dos pais, apoio junto de outro familiar, acolhimento institucional) o suporte de retaguarda mais frequente são os avós. Nos casos de confiança a pessoa idónea é inexistente e no apoio para a autonomia de vida são os outros familiares.The present work aims to find out if there is a relationship between the family history and the issue of the child and the young, if there are differences in the distribution of genders, if the percentages of the problem vary with age, with the type of family, with education of parents, with the economic situation and the urban features, if the percentages of the measure applied vary with the background support and the time of studies. The maltreatment of children and young people are referred to in the literature as a form of emotional or physical treatment, not accidental and inappropriate, resulting from malfunctions or deficiencies in the relationship between family / child, and may manifest itself through active physical, psychological or sexual behaviours or liabilities in negligence or omission of physical and / or affective care. To achieve this objective, a convenience sample consisting of 814 archived files at risk children and youth, ages ranging from days of life and 21 years was taken in, with a measure of promotion and protection, accompanied by a team from the Division of Technical Assistance courts Center Social Security District of Aveiro, who had elaborated a request for consent. Data were collected from archived files from 2007 to 2012, the social report diagnostic assessment, social information, clinical information (when applicable), chronological records and notification of a conference (court) order. These instruments aim at describing the data relating to children and young people, their families and as a measure of promotion and protection applied to it, as well as information about the steps taken in the process. The results indicate that in most cases of abuse, a family history predominates with a history of rape, prostitution, poor working habits, substance use / arrests, assault, domestic violence and mental illness. Neglect is the most common problem, with 61.1%., with males which predominate in all identified problem, except for the sexual abuse more prevalent in females, between 11 and 15 years, followed by the age group of 6 to 10 years, more frequent in the nuclear family and reconstituted. We also note that given the promotion measures applied (with parental support, support from another family, institutional care), the most common rear support are the grandparents. In cases of confidence, the competent person is inexistent and support for independent living are the other family members

a longitudinal study for public hospitals, 2009-2014

BACKGROUND: The global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which also included the health sector. The aim of this study was to analyse factors associated with HIV/AIDS patients' length of stay (LOS) among Portuguese hospitals, and the potential impact of the EFAP measures on hospitalizations among HIV/AIDS patients. METHODS: Data used in this analysis were collected from the Portuguese database of Diagnosis Related Groups (DRG). We considered only discharges classified under MCD 24 created for patients with HIV infection. A total of 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals were included in the analysis. The outcome was the number of days between hospital admission and discharge dates (LOS). Hierarchical Poisson regression model with random effects was used to analyse the relation between LOS and patient, treatment and setting characteristics. To more effectively analyse the impact of the EFAP implementation on HIV/AIDS hospitalizations, yearly variables, as well as a variable measuring hospitals' financial situation (current ratio) was included. RESULTS: For the 5% level, having HIV/AIDS as the principal diagnosis, the number of secondary diagnoses, the number of procedures, and having tuberculosis have a positive impact in HIV/AIDS LOS; while being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital's current ratio contribute to the decrease of LOS. Additionally, LOS between 2010 and 2014 was significantly shorter in comparison to 2009. Differences in LOS across hospitals are significant after controlling for these variables. CONCLUSION: Following the EFAP, a number of cost-containment measures in the health sector were implemented. Results from our analysis suggest that the implementation of these measures contributed to a significant decrease is LOS among HIV/AIDS patients in Portuguese hospitals.publishersversionpublishe

The longitudinal association between co-residential care provision and healthcare use among the Portuguese population aged 50 and over: a SHARE study

Co-residential care is associated with poor caregiver health and a high burden. Although Portugal relies heavily on co-residential care by individuals aged 50 and over, studies on the impact of co-residential care provision on Portuguese caregivers’ healthcare use are lacking. This study aims to analyze the impact of co-residential care (spousal and non-spousal care) on healthcare use of the Portuguese population aged 50 plus. Data from waves 4 (n = 1697) and 6 (n = 1460) of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used. Negative Binomial Generalized Linear Mixed Models with random (individual level) and fixed (covariates) effects were performed. The results show that the number of visits to the doctor decrease significantly over time for the co-residential spousal caregivers as compared to the non-co-residential caregivers. This result highlights the fact that the Portuguese co-residential spousal caregiver group is at a higher risk of not using healthcare, thus jeopardizing their own health and continuity of care. Promoting more accessible healthcare services and implementing public policies adjusted to the needs of informal caregivers are important to improve the health and healthcare use of Portuguese spousal co-residential caregivers.This paper uses data from SHARE waves 4 and 6 (https://doi.org/10.6103/SHARE.w4.710, https://doi.org/10.6103/SHARE.w6.710). The SHARE data collection has been funded by the European Commission, DG RTD through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006- 062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N◦211909, SHARE-LEAP: GA N◦227822, SHARE M4: GA N◦261982, DASISH: GA N◦283646) and Horizon 2020 (SHARE-DEV3: GA N◦676536, SHARE-COHESION: GA N◦870628, SERISS: GA N◦654221, SSHOC: GA N◦823782, SHARE-COVID19: GA N◦101015924) and by DG Employment, Social Affairs & Inclusion through VS 2015/0195, VS 2016/0135, VS 2018/0285, VS 2019/0332, and VS 2020/0313. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740- 13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C, RAG052527A) and from various national funding sources is gratefully acknowledged (see https://share-eric.eu/data/data-access/citation-requirements, accessed on 20 February 2023). In Portugal, this study was financially supported by Calouste Gulbenkian Foundation and by the Portuguese Foundation for Science and Technology through national funds (PIDDAC) and co-financed by the European Regional Development Fund (ERDF), through the Operational Programme PORNorte and PORLisboa, AAC No 01/SAICT/2016, Application No 022209-DATALAB

Nutrition education strategies to promote vegetable consumption in preschool children: The Veggies4myHeart project

Objective: To test the efficacy of three nutrition education strategies on the intake of different vegetables in preschool children. Design: This is an experimental study conducted in four Portuguese preschools. The intervention consisted of 20-min educational sessions, once a week, for 5 weeks, with one of the following randomised educational strategies: Portuguese Food Wheel Guide (control), digital game, storybook, storybook and reward (stickers). All groups had repeated exposure to vegetables in all sessions. A preand post-test were conducted to determine vegetable intake, and a 6-month follow-up was realised. Setting: Preschools of Leiria district, Portugal. Participants: A sample of 162 children aged 3 to 6 years. All eligible children attending the preschools were invited to participate. Results: All interventions tested were effective in increasing vegetable consumption both in the short and medium term, without statistically significant differences, compared to the control group. Stickers were more effective in the short term than in the medium term. Conclusions: The nutritional education strategies associated with repeated exposure tested in this study were effective in promoting vegetable consumption in preschool children. The use of stickers may be a valid strategy to promote the consumption of vegetables less recognised by children.info:eu-repo/semantics/publishedVersio

Nutrition education strategies to promote vegetable consumption in preschool children - The Veggies4myHeart Project

Funding: We are very grateful to the principals, teachers, staff, and families of the preschools with which we partnered on this project. Financial support: This work was funded by ‘Challenges in Cardiology Accelerator Program 2018’and by Portuguese national funds provided by Fundação para a Ciência e Tecnologia (FCT) (UIDB/ 05704/2020 and UIDP/05704/2020).Objective: To test the efficacy of three nutrition education strategies on the intake of different vegetables in preschool children. Design: This is an experimental study conducted in four Portuguese preschools. The intervention consisted of 20-minutes educational sessions, once a week, for five weeks, with one of the following randomized educational strategies: Portuguese Food Wheel Guide (control), digital game, storybook, storybook and reward (stickers). All groups had repeated exposure to vegetables in all sessions. A pre- and post-test were conducted to determine vegetable intake and a 6-month follow-up was realized. Setting: Preschools of Leiria district, Portugal. Participants: A sample of 162 children aged 3 to 6 years. All eligible children attending the preschools were invited to participate. Results: All interventions tested were effective in increasing vegetable consumption both in the short and medium-term, without statistically significant differences, compared to the control group. Stickers were more effective in the short-term than in the medium term. Conclusions: The nutritional education strategies associated with repeated exposure tested in this study were effective in promoting vegetable consumption in preschool children. The use of stickers may be a valid strategy to promote the consumption of vegetables less recognized by children.publishersversionpublishe

a role for hospital statistics for better estimates and surveillance

PMID: 25548715Background. Although eradicated in Portugal, malaria keeps taking its toll on travelers and migrants from endemic countries. Disease notification is mandatory but is compromised by underreporting. Methods. A retrospective study on malaria hospitalizations for 10 consecutive years (2000-2009) was conducted. Data on hospitalizations and notifications were obtained from Central Administration of Health System and Health Protection Agency, respectively. For data selection ICD-9 CM and ICD-10 were used: codes 084(*), 647.4, and B50-B54. Variables were gender, age, agent and origin of infection, length of stay (LOS), lethality, and comorbidities. Analysis included description, hypothesis testing, and regression. Results. There were 2003 malaria hospitalizations and 480 notified hospitalized cases, mainly in young male adults. P. falciparum was the main agent of infection acquired mainly in sub-Saharan Africa. Lethality was 1.95% and mean LOS was 8.09 days. Older age entailed longer LOS and increased lethality. Discussion. From 2000 to 2009, there were 2003 malaria hospitalizations with decreasing annual incidence, these numbers being remarkably higher than those notified. The national database of diagnosis related groups, reflecting hospitalizations on NHS hospitals, may be an unexplored complementary source for better estimates on imported malaria.publishersversionpublishe

Risk of Readmission Among HIV Patients in Public Portuguese Hospitals: Longitudinal Multilevel Population-Based Study

Background: Thirty-day hospital readmission is receiving growing attention as an indicator of the quality of hospital care. Understanding factors associated with 30-day hospital readmission among HIV patients in Portugal is essential given the high burden cost of HIV hospitalizations in Portugal, a country suffering from financial constrains for almost 10 years. Objectives: We aimed to estimate the 30-day hospital readmission rates among HIV patients in Portugal and to identify its determinants using population-based data for Portuguese public hospitals. Study Design: A multilevel longitudinal population-based study. Methods: Between January 2009 and December 2014, a total of 37,134 registered discharges in the Portuguese National Health Service (NHS) facilities with HIV/AIDS as a main or secondary cause of admission were analyzed. Logistic regression was used to compare 30-day hospital readmission categories by computing odds ratio (OR) and corresponding 95% confidence intervals (95% CIs). A normal random effects model was used to determine unmeasured factors specific to each hospital. Results: A total of 4914 (13.2%, 95% CI: 12.9%-13.6%) hospitalizations had a subsequent 30-day readmission. Hospitalizations that included exit against medical opinion (OR = 1.18, 95% CI: 1.01-1.39), scheduled admissions (OR = 1.71, 95% CI: 1.58-1.85), and tuberculosis infection (OR = 1.20, 95% CI: 1.05-1.38) exhibited a higher risk of hospitalizations with subsequent 30-day readmission. In contrast, hospitalizations that included females (OR = 0.87, 95% CI: 0.81-0.94), a transfer to another facility (OR = 0.78, 95% CI: 0.67-0.91), and having a responsible financial institution (OR = 0.63, 95% CI: 0.55-0.72) exhibited a lower risk of hospitalizations with subsequent 30-day readmission. Hospitalizations associated with higher number of diagnosis, older ages, or hospitalizations during the economic crisis showed an increasing trend of 30-day readmission, whereas an opposite trend was observed for hospitalizations with higher number of procedures. Significant differences exist between hospital quality, adjusting for other factors. Conclusion: This study analyzes the indicators of 30-day hospital readmission among HIV patients in Portugal and provides useful information for enlightening policymakers and health care providers for developing health policies that can reduce costs associated with HIV hospitalizations.info:eu-repo/semantics/publishedVersio

Determinação da idade crítica para o aparecimento de obesidade infantil

A obesidade infantil constitui atualmente um grave problema de saúde pública. De acordo com a Organização Mundial de Saúde a obesidade infantil é um forte preditor de obesidade no adulto, incrementando o risco de desenvolvimento de doenças crónicas e representando um dos mais sérios desafios que a Europa terá de superar nos próximos anos. O estudo tem como objetivos: determinar a idade crítica para o aparecimento de excesso de peso e obesidade numa população de crianças dos 2 aos 10 anos de idade, avaliar fatores de risco para o aparecimento de obesidade na população em estudo hábitos tabágicos e ganho de peso da mãe durante a gravidez, diabetes gestacional, peso à nascença, ganho de peso durante os primeiros meses de vida, duração do aleitamento materno, número de horas de sono da criança, estatuto socioeconómico e IMC dos pais, hábitos alimentares e de atividade física da criança. Este estudo será realizado numa amostra de crianças dos 2 aos 10 anos de idade que frequentam instituições de ensino da região de Leiria. Os dados serão obtidos através de avaliações antropométricas e de um questionário aos pais. A análise estatística será realizada através do Programa SPSS e do Programa R. Será solicitado consentimento informado aos pais das crianças envolvidas no estudo. Perspetivam-se as implicações para a prática em saúde: Desenvolver estratégias de educação alimentar mais eficazes na idade considerada crítica para o desenvolvimento de obesidade.info:eu-repo/semantics/publishedVersio

GESTÃO DOS RECURSOS NATURAIS NA REGIÃO DO BAIXO TOCANTINS ATRAVÉS DE ACORDOS DE PESCA

The article deals with the construction of public action as the product of multiple forms of interaction between collective action and government ac­tion, in which processes represents organization systems of farmers for the use and appropriation of natural resources. We used qualitative methods, participant observation and semi-structured interviews. The analysis of or­ganizational processes as the creation of associations to improve governance system in general and fisheries agreements for the sustainable management of fishery resources, in particular, shows how the peasants structure their modes of reproduction through public action, to reduce environmental im­pacts and expropriation processes. As the main impact in the last decades has been Tucuruí hydroelectric power plant construction fish agreement has become a way to cope with intensification of fishing and consequent impact of the hydroelectric plant. The successes of the two agreements studied here was a result of the genuine process initiated in the communities. Other expe­riences of similar agreements organized by governmental institution has not resulted in successful experiences. Keywords: collective action, natural resources, fishing agreement.El artículo trata de la construcción de la acción pública como producto de las múltiples formas de interacción entre la acción colectiva y la acción guberna­mental, en las cuales se inscriben procesos traductores de los modos de or­ganización de los campesinos para el uso apropiado de los recursos naturales en nivel del territorio. Se optó por la investigación cualitativa, apoyada en la observación participante y en la realización de entrevistas semiestructuradas. El análisis de los procesos organizacionales, como la constitución de asocia­ciones en la búsqueda de alternativas económicas y de seguridad alimentaria, de los acuerdos de la pesca para la gestión sustentable de los recursos pesque­ros, muestra cómo los campesinos recomponen sus modos de producción por medio de la acción pública, presentado las formas de resistencia de esos campesinos frente a impactos socioambientales y procesos de expropiación. Los datos nos permitirán identificar que uno de los principales impactos en las últimas décadas en la gestión de los recursos naturales fue la construcción de la hidroeléctrica de Tucuruí; además, los acuerdos de pesca se tornaron una manera de lidiar con la intensificación de la pesca debido al consecuente impacto de la central hidroeléctrica. El éxito de los acuerdos estudiados aquí fue resultado de un proceso genuino iniciado en las comunidades. Otras ex­periencias semejantes, organizadas por la institución gubernamental (estilo de arriba hacia abajo) no resultaron en experiencias muy exitosas. Palabras-clave: acción colectiva, recursos naturales, acuerdos de pescaThe article deals with the construction of public action as the product of multiple forms of interaction between collective action and government ac­tion, in which processes represents organization systems of farmers for the use and appropriation of natural resources. We used qualitative methods, participant observation and semi-structured interviews. The analysis of or­ganizational processes as the creation of associations to improve governance system in general and fisheries agreements for the sustainable management of fishery resources, in particular, shows how the peasants structure their modes of reproduction through public action, to reduce environmental im­pacts and expropriation processes. As the main impact in the last decades has been Tucuruí hydroelectric power plant construction fish agreement has become a way to cope with intensification of fishing and consequent impact of the hydroelectric plant. The successes of the two agreements studied here was a result of the genuine process initiated in the communities. Other expe­riences of similar agreements organized by governmental institution has not resulted in successful experiences. Keywords: collective action, natural resources, fishing agreement.O artigo trata da construção da ação pública como produto das múltiplas formas de interação entre a ação coletiva e a ação governamental, nas quais se inscrevem processos tradutores dos modos de organização dos camponeses para o uso e apropriação dos recursos naturais em nível do território. Optou-se pela pesquisa qualitativa, apoiada na observação participante e na realização de entrevistas semiestruturadas. A análise dos processos organizacionais, como a constituição de associações na busca de alternativas econômicas e de segurança alimentar, dos acordos de pesca para a gestão sustentável dos recursos pesqueiros, mostra como os camponeses recompõem seus modos de reprodução por meio da ação pública, apresentando as formas de resistência desses camponeses frente a impactos socioambientais e processos de expropriação. Os dados nos permitiram identificar que um dos principais impactos nas últimas décadas na gestão dos recursos naturais foi a construção da hidrelétrica de Tucuruí; além disso, os acordos de pesca tornaram-se uma maneira de lidar com a intensificação da pesca devido ao consequente impacto da usina hidrelétrica. O sucesso dos acordos estudados aqui foi resultado de um processo genuíno iniciado nas comunidades. Outras experiências semelhantes, organizadas pela instituição governamental (estilo de cima para baixo) não resultaram em experiências bem sucedidas. Palavras-chave: ação coletiva, recursos naturais, acordos de pesca

Disease mapping models for data with weak spatial dependence or spatial discontinuities

Recent advances in the spatial epidemiology literature have extended traditional approaches by including determinant disease factors that allow for non-local smoothing and/or non-spatial smoothing. In this article, two of those approaches are compared and are further extended to areas of high interest from the public health perspective. These are a conditionally specified Gaussian random field model, using a similaritybased non-spatial weight matrix to facilitate non-spatial smoothing in Bayesian disease mapping; and a spatially adaptive conditional autoregressive prior model.info:eu-repo/semantics/publishedVersio