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RESUMO Nas últimas décadas, o tema da participação pública em processos de decisão tem estado presente nas agendas políticas, com mais ou menos centralidade, em vários contextos democráticos do mundo. No campo da saúde, a participação pública apresenta-se como estratégia política com potencialidades para garantir maior corresponsabilização entre os atores envolvidos e para incrementar a transparência dos serviços, sendo enfatizada como boa prática que deve ser implementada em prol da qualidade das decisões, mas também de decisões que sejam orientadas para os reais problemas das populações. A pandemia da Covid-19 trouxe pressões adicionais aos sistemas de saúde, constituindo-se como contexto propício à análise da participação cidadã nos processos de decisão que enquadram problemas de saúde na sua relação com a pandemia. Este ensaio apresenta uma análise exploratória sobre a evolução das práticas de participação cidadã nas políticas de saúde em Portugal, destacando alguns dos seus desafios atuais e futuros. Procura-se, assim, compreender como a pandemia teve ressonância na forma como a participação em saúde vinha decorrendo no País, aferindo se, em um período global de crise com características singulares, a pandemia, enquanto problema coletivo, distendeu ou contraiu essas práticas participativas.

O Antropoceno é uma época geológica proposta para ilustrar o impacto humano no sistema terrestre, exemplificado pelas alterações climáticas. Recorrendo a literatura no âmbito dos estudos de ciência e tecnologia, este artigo reflete sobre a heterogeneidade ontológica do Antropoceno, analisando como diferentes respostas sociais, políticas e tecnológicas são mobilizadas para fazer face aos desafios das alterações climáticas. O artigo analisa três estudos de caso que ilustram a heterogeneidade ontológica do Antropoceno : políticas europeias e nacionais em matéria de ação climática ; o movimento de transição, focado em ações à escala local para a descarbonização das sociedades ; a geoengenharia como tecnologia emergente de manipulação climática. Neste trabalho argumentamos que a diversidade de visões, práticas e intervenções associadas aos estudos de caso reforçam o carácter político e controverso do Antropoceno, colocando novos desafios às ciências sociais. The Anthropocene is a proposed geological epoch to illustrate the human impact on Earth systems – exemplified by climate change. Supported by literature within science and technology studies, this article reflects on the ontological heterogeneity of the Anthropocene, analyzing how different social, political and technological proposals are mobilized to face the challenges of climate change. The article delves into three case studies that illustrate the ontological heterogeneity of the Anthropocene : European and national policies regarding climate change ; the Transition Movement, focused on local actions to foster low carbon transitions ; emerging technologies of climate manipulation – geoengineering. We argue that the diversity of visions, practices and interventions related to the case studies reinforce the political and controversial dimensions of the Anthropocene, posing new challenges for the social sciences.

BACKGROUND Hypothermia in trauma patients causes increased morbidity and mortality. Swift recognition and treatment are important to prevent any further heat loss. In addition, patient discomfort from cold decreases satisfaction with care. The administration of active and passive rewarming measures is important in the prevention and treatment of hypothermia, but their use in prehospital trauma patients in Portugal has not been previously reported. OBJECTIVE To assess the prevalence of hypothermia, the impact of rewarming measures, and the management of the discomfort caused by cold. METHODS This is a prospective cohort study conducted in Immediate Life Support Ambulances in Portugal between March 1, 2019, and April 30, 2020. RESULTS This study included records of 586 trauma patients; of whom, 66.2% were men. Cranioencephalic trauma was the most common trauma observed, followed by lower limb and thoracic traumas. Mean body temperature increased 0.12 °C between the first and last assessments (p < .05). Most patients experiencing a level of discomfort of 5 or more on a 0-10 scale reported improvement (from 17.2% to 2.4% after nurses' intervention). Warmed intravenous fluids proved to be effective (p < .05) in increasing body temperature, and passive rewarming measures were effective in preventing hypothermia. CONCLUSIONS Hypothermia management has to consider the initial temperature, the season, the available rewarming measures, and the objectives to be achieved. The optimization of resources for the monitoring and treatment of hypothermia should be a priority in prehospital assistance. The implementation of rewarming measures improves patients' outcomes and decreases the discomfort caused by cold in prehospital care.

Corbicula fluminea, an Asian clam, is one of the worst invasive species in Europe that can survive in very adverse environmental conditions. Despite its negative impacts, the species also has the capacity to bioaccumulate heavy metals, contaminants and can be exploited for wastewater treatment purposes. The capacity of the Asian clam to remove Escherichia coli, used as fecal contamination indicator, was analyzed. Conventional wastewater treatment plants are not suitable to remove bacteria, thus resulting in treated municipal wastewater with high bacterial loads. E. coli clearance rate was analyzed as function of the number of clams. The bivalves can remove bacteria until concentrations below the detection limit in about 6 h. The adsorption on the clam shells’ and bioaccumulation on the soft tissues were also analyzed. The depuration of clams along 48 h were analyzed revealing that no bacteria was detected in the water. Thus, these results suggest that Asian clam can bioprocess E. coli. On the other hand, results obtained by this methodology were compared with ozonation and photocatalytic oxidation using TiO2, Ag, Au, Pd-TiO2. In all treatments it was possible to achieve concentrations of E. coli below the detection limit. However, photocatalytic oxidation demands about 4700 folds more energy than ozonation, besides the costs associated with catalysts. Comparing complexity of ozonation with biofiltration, this study suggests that application of biofiltration using C. fluminea can be a suitable solution to minimize the presence of bacteria in wastewater, reducing environmental and economic impacts.

ObjectivesThere is an unmet need for accurate and user-friendly definitions of systemic lupus erythematosus (SLE) disease activity and remission. We aimed to derive and validate the SLE Disease Activity Score (SLE-DAS) definitions for disease activity categories and clinical remission state.MethodsDerivation was conducted at Padova Lupus Clinic (Italy). Validation was prospectively performed at Cochin Lupus Clinic (France) and by post hoc analysis of BLISS-76 trial. At each clinic, an expert classified patients in three categories: remission, mild or moderate/severe activity. The SLE-DAS cut-offs were derived using the receiver operating characteristic curve analysis in Padova cohort; its performance was assessed against expert classification in Cochin cohort and British Isles Lupus Assessment Group (BILAG) index in BLISS-76. Gold standard for clinical remission state was the fulfilment of Definition Of Remission In SLE. A Boolean and an index-based definitions of remission were sustained by chi-square automatic interaction detection algorithm. An SLE-DAS online calculator was developed and tested.ResultsWe included 1190 patients with SLE: 221 in the derivation cohort and 969 in the validation cohorts (150 from Cochin; 819 from BLISS-76). Derived cut-offs were: remission, SLE-DAS ≤2.08; mild activity, 2.087.64. Regarding validation in Cochin cohort, sensitivity and specificity are above 90%, 82% and 95% for remission, mild and moderate/severe activity, respectively. The SLE-DAS Boolean-based and index-based remission showed sensitivity of 100% and specificity above 97%.ConclusionThe SLE-DAS is an accurate and easy-to-use tool for defining SLE clinical remission state and disease activity categories, validated against expert assessment and BILAG.

Background:Treatment of systemic lupus erythematosus (SLE) is tailored according to the intensity of SLE disease activity and aims to achieve remission. Current definitions of remission and disease activity categories are mostly based on the SLE Disease Activity Index (SLEDAI), which has important limitations. The SLE Disease Activity Score (SLE-DAS) is a validated continuous disease activity score with higher accuracy in measuring SLE activity and higher sensitivity-to-change as compared to SLEDAI1. SLE-DAS is user-friendly with its online calculator.Objectives:To derive and validate the SLE-DAS cut-off values for defining SLE disease activity categories and SLE clinical remission state.Methods:Derivation study was conducted at the Padova Lupus Clinic. Validation was performed prospectively in patients from the Cochin Lupus Clinic and by post-hoc analysis of BLISS-76 (NCT00410384) trial. Gold-standard for clinical remission state was fulfillment of Definition Of Remission In SLE (DORIS). In Padova and Cochin Clinics, at time of inclusion, a senior clinician classified each patient as presenting: (i) remission, (ii) mild, or (iii) moderate/severe disease activity. Derivation of the SLE-DAS cut-offs for disease activity categories was performed using ROC curve analysis against this expert clinical classification. Performance of these SLE-DAS categories of disease activity was assessed as compared with: (i) expert classification (in Cochin cohort); (ii) British Isles Lupus Assessment Group (BILAG) index (in BLISS-76). An index-based and a Boolean definition of remission were tested applying decision trees, using CHAID (chi-square automatic interaction detection) algorithm and their performance estimated.Results:We included 1190 SLE patients (221 in Padova, 150 in Cochin and 819 from BLISS-76 cohorts). In the derivation cohort, best SLE-DAS cut-off values for disease activity categories were: (i) remission, SLE-DAS≤2.08; (ii) mild activity, 2.087.10. Table 1 shows the performance of these SLE-DAS cut-offs. The SLE-DAS Boolean-based definition of remission (all SLE-DAS clinical items scores = 0 and prednisone ≤5mg/day) showed sensitivity and specificity of 100% in the derivation (Padova) and validation (Cochin) clinical cohorts. The SLE-DAS index-based definition of remission (SLE-DAS ≤2.08 and prednisone ≤5mg/day) presented sensitivity =100% and specificity =97.4% in the derivation and validation clinical cohorts. The SLE-DAS definitions of remission were fully substantiated by CHAID.Table 1.Performance of SLE-DAS cut-offs for remission and disease activity categories compared to physician’s classification and BILAG (n =1190).Disease activity categorySensitivity (%)Specificity (%)Accuracy (%)DerivationPadova CohortRemission(SLE-DAS≤2.08)99.397.198.6Mild Disease Activity(2.0874.298.995.5Moderate and Severe Disease Activity(SLE-DAS>7.10)97.496.796.8ValidationCochin CohortRemission(SLE-DAS≤2.08)99.193.998.0Mild Disease Activity(2.0882.699.296.7Moderate and Severe Disease Activity(SLE-DAS>7.10)100.098.698.7ValidationBLISS-76Remission and Mild Disease Activity§vs. Moderate and Severe Disease Activity§§ (SLE-DAS≤7.10 vs. >7.10)91.484.190.8§ Remission/Mild: No BILAG B or A scores§§ Moderate/severe: ≥1 BILAG B or A scoresConclusion:The SLE-DAS is an accurate and easy to use tool for defining clinical remission state and SLE disease activity categories, validated with both the expert assessment and BILAG.References:[1]Jesus D, et al. Derivation and validation of the SLE Disease Activity Score (SLE-DAS): a new SLE continuous measure with high sensitivity for changes in disease activity. Ann Rheum Dis 2019;78:365-71.Acknowledgements:The authors would like to thank GlaxoSmithKline (Uxbridge, UK) for granting access to the data from the BLISS-76 trial through the Clinical Study Data Request consortium.Disclosure of Interests:None declared

Desde 2011, impulsadas por la crisis, han acaecido transformaciones sustanciales en el ámbito de los movimientos sociales y las formas de acción colectiva en el mundo. Las llamadas “Primavera Árabe” y “Primavera de los movimientos” muestran el carácter global de las mismas. La utilización masiva y exponencial por parte de estas de medios y expresiones digitales, nos permitiría avanzar en la conceptualización de un nuevo sujeto de estudio para la teoría de los movimientos sociales. Los movimientos que tuvieron lugar en España y Portugal resultan paradigmáticos para esta nueva propuesta, que desafía las concepciones dominantes sobre los movimientos sociales en las últimas décadas, a partir de la emergencia de esos nuevos actores políticos y de las nuevas formas de movilización y de activismo, que han contribuido a la redefinición de las relaciones entre el Estado y la sociedad civil, así como de las comprensiones clásicas acerca de la participación política y la democracia. Driven by the crisis since 2011, inescapable transformations have occurred in social movements and forms of collective action in the world. The so-called “Arab Spring” and the “Spring of the Movements” show the global character of these transformations, their massive use of exponential and massive use of digital media and expressions, as never had been used in history, allow us to advance in the conceptualization of a new theoretical subject within Social Movements studies. Social movements in Spain and Portugal are paradigmatic of this new proposal, which challenge the dominant conceptions about social movements of the last decades, from the emergence of these new political actors and their new forms of mobilization and activism which have contribute to the redefinition of the linkages between the State and Civil Society and, consequently, in the classical understandings about political participation and democracy.

Today’s workplaces are experiencing a continuous evolution regarding generational differences and so, organisations strive to attract and recruit the best young talent. As a result, Trainee Programmes are becoming more popular and are being implemented by companies which aim to hire high-potential graduates and provide them with a series of organisation-related courses that focus on trainees’ training, development and retention. Despite the growing importance of these programmes, there is a gap in the literature to explain the proper structure that accelerates the achievement of the intended objectives, the reasons of implementation, the impacts on companies’ business and, ultimately, the trainees’ perceptions and expectations about these schemes. Therefore, the purpose of this research is to address these limitations and investigate both companies and trainees’ perspective about Trainee Programmes to understand their evolution and provide accurate and upcoming recommendations. Thus, a mixed-method methodology was used to gain a deeper understanding about this topic by means of interviews to comprehend enterprises’ perspective and through the application of a questionnaire to current and former trainees. The findings disclosed the effectiveness of this tool when constantly monitored so, programmes should be designed to strengthen the psychological contract, set clear goals and expectations, provide career orientation and advancement, training opportunities, supervisory support, challenging tasks, wage-setting and an enjoyable environment to enhance trainees’ intention to stay in the company after the programme’s conclusion. Hoje em dia, os locais de trabalho estão a experienciar uma evolução contínua em relação às diferenças entre gerações e, por isso, as organizações esforçam-se em atrair e recrutar o melhor talento jovem. Como resultado, os Programas de Trainees estão a tornar-se cada vez mais populares e estão a ser implementados pelas empresas com o intuito de contratar recém-licenciados de alto potencial, proporcionando uma série de cursos relacionados com a organização que se focam na formação, desenvolvimento e retenção dos trainees. Apesar da crescente importância destes programas, existe uma lacuna na literatura em explicar a estrutura adequada para alcançar os objetivos pretendidos, as razões da implementação, os impactos nos negócios das empresas e, por último, as perceções e expetativas dos trainees. Assim, o objetivo deste estudo é abordar estas limitações e investigar a perspetiva das empresas e dos trainees acerca dos Programas de Trainee para compreender a sua evolução e sugerir recomendações precisas e futuras. Deste modo, uma metodologia de método misto foi utilizada para obter um conhecimento profundo sobre este tema, por meio da realização de entrevistas para entender a perspetiva das empresas e através de um questionário a trainees. Os resultados revelaram a eficácia desta ferramenta, se monitorizada constantemente, por isso, os programas devem ser desenhados para fortalecer o contrato psicológico, estabelecer metas e expetativas claras, providenciar orientação de carreira, oportunidades de formação e promoção, apoio da supervisão, tarefas desafiantes, remuneração competitiva e um ambiente agradável, de forma a aumentar a intenção dos trainees em permanecer na empresa após a conclusão do programa.

It was with great interest that we read the letter ‘SLE-DAS: Ready for routine use?’ by Mathew and coauthors.1 Mathew et al commented on our recent article reporting the derivation and validation of the Systemic Lupus Erythematosus Disease Activity Score (SLE-DAS),2 which demonstrated a much higher sensitivity to change of SLE disease activity, as compared with SLE Disease Activity Index 2000 (SLEDAI-2K). Mathew et al ’s main concern is in regard of the SLE-DAS scoring of active lupus nephritis (LN). The SLE-DAS renal component is measured continuously, applying a logarithmic scale of proteinuria absolute value (to be scored only if above 500 mg/day and provided it is attributable to active LN). This is very different of the SLEDAI-2K renal component that comprises four dichotomous variables (proteinuria above 500 mg/day, pyuria, haematuria and urinary casts, each one scored solely as present or absent with a weight of 4 points if present and regardless of severity).3 In the derivation of the SLE-DAS, we modelled the renal component using longitudinal data of real patients with active LN from a large, well-characterised tertiary lupus cohort.4 5 The SLE-DAS with its continuous scoring of the absolute value of proteinuria amends risks of major bias of SLEDAI-2K regarding renal involvement. In patients with active LN, the …

Este artigo analisa oito casos de conflitos de mineração em Portugal, destacando as ações de protesto desencadeadas e os impactos que produziram. Metodologicamente privilegia a análise documental. Os resultados revelam a ação pelo protesto como recurso para as populações afetadas transmitirem as suas perceções e argumentos sobre os problemas enfrentados e tornarem visíveis as situações vividas. Os protestos realizados produziram alterações legislativas, embora pontuais e específicas de certos casos, e conferiram maior visibilidade às particularidades de cada caso. This paper analyzes eight cases of mining conflicts in Portugal, focusing on the protest actions triggered, as well as the impacts they have produced. Methodologically, documentary analysis was undertaken. The results revealed collective action as the available resource for the affected populations to communicate their perceptions and arguments about the problems felt and to make their lived situations visible. Protest actions registered were able to produce legislative changes, even concerning specific situations, and gave visibility to the particularities of each case. Cet article analyse huit cas de conflits miniers au Portugal. Le travail met en évidence les actions de contestation déclenchées et les impacts qu'elles ont produits. La méthodologie d'analyse documentaire a été privilégiée. Les résultats révèlent que la mobilisation collective est un moyen pour les populations affectées de transmettre leurs perceptions et arguments et pour rendre visibles les situations vécues. Les manifestations ont conduit à des changements législatifs, bien que ponctuels et spécifiques à certains cas, et ont rendu visibles les particularités de chaque conflit. Este artículo analiza ocho casos de conflictos mineros en Portugal. El trabajo destaca las acciones de protesta desencadenadas y los impactos que éstas produjeron. Metodológicamente se privilegia el análisis documental. Los resultados revelan que la protesta colectiva es utilizada por las poblaciones afectadas para transmitir sus percepciones y argumentos sobre los problemas y hacer visibles las situaciones vividas. Las protestas realizadas confirieron mayor visibilidad a las particularidades de cada conflicto y produjeron cambios legislativos, aunque puntuales y específicos de ciertos casos.

We have sought to understand the current state of the art on smart tourism and on smart cities. Furthermore, we have sought to understand community awareness and the will to embrace innovation, as they are decisive factors to acquire base knowledge and overcome barriers in (soon to be) overpopulated cities and for those who are looking for a limited time culture experience - known as tourists. We live in an age where technology is increasingly present in our lives and provides us solutions to societal problems. Problems such as traffic, infrastructure and natural resources management, or even increasing citizens’ participation in governance, bringing them closer to decision-making. The objective is to understand the current level of people’s knowledge about the impact that technologies have on the society in which we live and their perception of the usefulness in solving these same problems. Therefore, an anonymous questionnaire was carried out (176 valid answers were received), as well as a focus group with two experts on the Smart Cities subject. What future is brought by those who live and breathe technology? Are people willing to accept a paradigm shift? This work is financed by the ERDF – European Regional Development Fund through the Operational Programme for Competitiveness and Internationalisation - COMPETE 2020 Programme and by National Funds through the Portuguese funding agency, FCT - Fundação para a Ciência e a Tecnologia within project POCI-01-0145-FEDER-031309 entitled “PromoTourVR - Promoting Tourism Destinations with Multisensory Immersive Media”. info:eu-repo/semantics/publishedVersion

This chapter presents the characteristics of the southern healthcare systems, namely of Portugal, Spain, Italy and Greece. It briefly identifies the main processes of health reform so that readers can understand the context in which experiences of participation in the health domain were developed.

Nos últimos anos, têm surgido novas formas de mobilização, novos atores e novos reportórios de ação, impulsionados pela agenda política e pelo dinamismo crescente da sociedade civil, que reivindica maior participação cidadã. Simultaneamente, a internet assumiu centralidade na relação dos cidadãos com a política e as instituições e como mecanismo de mobilização pelos coletivos e movimentos sociais. O projeto de investigação-ação MAIS PARTICIPAÇÃO, melhor saúde, que tem como objetivo promover a participação dos cidadãos e/ou seus representantes na definição de políticas públicas de saúde e na organização do SNS, é analisado como dinâmica específica de ativismo na saúde em Portugal, na perspetiva da sua estratégia virtual. Os resultados mostram que a internet constituiu uma alavanca fundamental para a mobilização, ação coletiva e sensibi­lização pública. In the last years, new forms of mobilization, new actors and new forms of collective action have emerged, driven by the political agenda and the growing dynamism of civil society, which calls for greater citizen participation. At the same time, internet has taken the center stage in the relation­ship of citizens with politics and institutions and as a mechanism for mobilization by collectives and social movements. The MORE PARTICIPATION, better health project, which aims at promoting the participation of citizens and/or their representatives in the definition of public health policies and in the organization of the NHS, is analysed in its dynamics as a health collective action in Portugal, in the perspective of its virtual strategy. The results show that the internet was the key for mobilization, collective action and public awareness.

Nos últimos anos, transformações relevantes ocorreram nas formas de ação coletiva pelo protesto em Portugal. Com a crise financeira mundial iniciada em 2008, com graves impactos económico-sociais no país, a ação pelo protesto intensificou-se. Até 2012 registouse no país um drástico aumento do número de ações de protesto. Assim, apesar das oscilações ao longo da última década ao nível das ações de protesto, torna-se clara a importância que o exercício do direito de reunião e de manifestação assume enquanto estratégia de participação nas decisões e na vida política. O recurso à ação pelo protesto, além de uma herança cultural e histórica – sobretudo, em situações em que as pessoas se sentem diretamente afetadas por problemas relacionados com o acesso e a qualidade dos serviços públicos – é uma oportunidade para tentar influenciar determinados processos de decisão, dada a escassez de oportunidades institucionalizadas para participar nos processos deliberativos. Partindo deste enquadramento, este texto avança com algumas questões no âmbito da análise da ação pelo protesto em Portugal, não só enquanto processo de manifestação de desacordo, insatisfação ou indignação da esfera cidadã, mas também enquanto estratégia de participação em processos deliberativos e prática de alta intensidade democrática.

Participation has featured in political agendas in recent decades and the domain of healthcare has not been indifferent to its appeal. Although emerging later than in other European regions, the involvement of civil society in healthcare decision-making procedures has proved one of the biggest challenges facing Southern European health systems. The health systems of the countries considered in this analysis - Italy, Portugal and Spain - underwent reforms that brought citizen participation to the forefront of the health system. Through national laws or health plans, each of these countries has recognised the need to promote participation in order to 'give a voice' to citizens in the health sector. Accordingly, a range of significant activities have been implemented in the region, although they have been developed unequally within national territories, at different paces and involving the mobilisation of different actors. This article focuses on the most relevant experiences of citizen participation designed and implemented in the three selected countries, describing their key features and potential, as well as the main critical issues and contradictions that have emerged over time. Particular emphasis is given to the impact of the current financial crisis on Southern European national health systems, especially in terms of participatory methods, the way in which citizen participation is progressing and civil society's reaction to these important changes.

Background In Portugal, the National Health Plan for 2012–2016 (1) and its extension to 2020 (2) consider citizenship-based strategies, including the involvement of patients/citizens and their representatives, as a key strategic axis to maximize health gains. However, actual policy initiatives and concrete actions have been limited to a couple initiatives without significant patient or public involvement. On the other side, several patient and citizen organizations (3–6) have been advocating for increased and meaningful involvement in health decision-making. Objectives To develop a Charter for Public Involvement in Health that is widely accepted and recognized by health stakeholders. Methods A working group was established with representatives from 13 patient organizations, 1 consumer organization and a research centre. A participatory action research methodology was used. The draft Charter was circulated for review and signature amongst more than 200 non-for-profit health-related organizations and over 50 key individuals publicly renowned for their work in health or public participation. The final version of the Charter was discussed with political and health stakeholders in a Forum held at the Portuguese parliament. Results A Charter for Public Involvement in Health, including the principles, scope, guidelines and means of participation was developed. In January 2017, 30 individuals (former and current political decision-makers, health care professionals, researchers and patients) and more than 82 non-for-profit health-related organizations (the majority being Portuguese disease-specific patient organizations) had signed the Charter. The conclusions of the Forum show that the Charter was recognized as a very important initiative to promote public involvement in health in Portugal. Challenges and barriers to further advancing patient and public engagement were also identified (e.g. political will, recognitions of patients as partners, patient empowerment, capacity-building, etc.). The Charter and the Forum were covered in the media and follow-up initiatives with health care professionals and hospital administrators are ongoing. Conclusions A patient-led Charter, developed by patient and consumer representatives, in collaboration with academia, and the public discussion with other health care stakeholders have proven successful to put public participation in the political and health care agenda. References Direcao-Geral da Saude – Ministerio da Saude. Plano Nacional de Saude 2012–2016. Lisboa, Portugal; 2012. Direcao-Geral da Saude – Ministerio da Saude. Plano Nacional de Saude – Revisao e Extensao a 2020. Lisboa, Portugal; 2015. European Patients Forum. The Value+ Policy Recommendations: Patient Involvement in Health Programmes and Policy [Internet]. Available from: http://www.eu-patient.eu/globalassets/projects/valueplus/doc_epf_policyrec.pdf. European Patients Forum. Patient Empowerment Campaign [Internet]. Available from: http://www.eu-patient.eu/campaign/PatientsprescribE/. International Alliance of Patients9 Organisations. Policy statement. Patient Involvement [Internet]. 2005. Available from: http://iapo.org.uk/sites/default/filesfiles/IAPO Policy Statement on Patient Involvement.pdf. Terzi A. The patients9 involvement in health policies in Europe. Roma; 2013. Disclosure of Interest S. Crisostomo Grant/research support from: Abbvie, Brustol-Meyers Squibb, Janssen, GSK, Pfizer, Roche and ViiV, M. Santos Grant/research support from: Abbvie, Brustol-Meyers Squibb, Janssen, GSK, Pfizer, Roche and ViiV, M. Serapioni: None declared, A. Matos: None declared, E. Mateus: None declared

Resumo: O presente artigo versa sobre a análise de mecanismos de participação pública existentes nos sistemas de saúde dos países do Sul da Europa. Apresentam-se os resultados de uma revisão da literatura incidindo na questão da participação pública nos sistemas de saúde, realçando as potencialidades e os desafios que emergem das principais experiências nacionais identificadas, nos países considerados: Espanha, Grécia, Itália e Portugal. O artigo começa por caracterizar os sistemas de saúde, apresenta a metodologia utilizada e, posteriormente, os resultados da análise em cada país, com destaque para as diferentes formas de participação, institucionalizadas e não institucionalizadas. Como principal resultado da investigação, conclui-se que tem prevalecido um discurso legislativo que, na generalidade dos casos, não corresponde a práticas de participação efetivas, mas, por outro lado, têm emergido, com especial protagonismo na área da saúde, formas de participação não institucionalizada, nas quais se destacam ações de protesto, em grande parte, impulsionadas pela atual crise econômica. Resumen: El presente artículo versa sobre el análisis de mecanismos de participación pública existentes en los sistemas de salud de países del sur de Europa. Se presentan los resultados de una revisión de la literatura, incidiendo en la cuestión de la participación pública en los sistemas de salud, realzando las potencialidades y los desafíos que emergen de las principales experiencias nacionales identificadas en los países considerados: España, Grecia, Italia y Portugal. El artículo comienza por caracterizar los sistemas de salud, presenta la metodología utilizada y, posteriormente, los resultados del análisis en cada país, resaltando las diferentes formas de participación, institucionalizadas y no institucionalizadas. Como principal resultado de la investigación, se concluye que ha prevalecido un discurso legislativo que, en la mayor parte de los casos, no corresponde a prácticas de participación efectivas, sin embargo, por otro lado, ha emergido, con especial protagonismo en el área de la salud, formas de participación no institucionalizada, en las que se destacan acciones de protesta, en gran parte, impulsadas por la actual crisis económica. Abstract: The current article analyzes existing mechanisms for public participation in health systems in the countries of Southern Europe. Results are presented from a literature review focusing on public participation in health systems, highlighting the potentialities and challenges emerging from the principal national experiences in the respective countries: Spain, Greece, Italy, and Portugal. The article begins by characterizing the health systems, then presents the methodology followed by the results of the analysis in each country, emphasizing the different forms of participation, both institutionalized and non-institutionalized. The study's principal conclusion is that a legislative discourse has prevailed, which in most cases has not materialized in actual participatory practices; meanwhile, non-institutionalized forms of participation have emerged with a special leading role in the health area, featuring protests, largely spurred by the current economic crisis.

Tendo já contribuído com outras análises sobre o direito de manifestação e os movimentos de contestação ou protesto, assim como sobre outras questões relacionadas, António Francisco Sousa consegue elevar este livro ao estatuto de verdadeiro manual, tanto na perspectiva da compreensão como do exercício do direito de reunião e de manifestação. De forma simples e eloquente, o autor permite a transposição – para muitos leitores – dos inacessíveis muros da análise jurídica, colocando em diálogo es...

The current article analyzes existing mechanisms for public participation in health systems in the countries of Southern Europe. Results are presented from a literature review focusing on public participation in health systems, highlighting the potentialities and challenges emerging from the principal national experiences in the respective countries: Spain, Greece, Italy, and Portugal. The article begins by characterizing the health systems, then presents the methodology followed by the results of the analysis in each country, emphasizing the different forms of participation, both institutionalized and non-institutionalized. The study's principal conclusion is that a legislative discourse has prevailed, which in most cases has not materialized in actual participatory practices; meanwhile, non-institutionalized forms of participation have emerged with a special leading role in the health area, featuring protests, largely spurred by the current economic crisis.

A participação pública, entendida como o modo mais eficaz de resolver competentemente os problemas coletivos e de melhorar a qualidade das decisões, surge cada vez mais vinculada à necessidade de reforçar a boa governança e a democracia. Desde há 20 anos, aliás, que abordagens deliberativas baseadas na participação cidadã em contextos de decisão se têm assumido essenciais ao aprofundamento da democracia. Com efeito, um vasto conjunto de literatura científica sobre a temática tem a deliberação pública como pedra angular da democracia participativa e do governo representativo. São muitos os autores que, ao longo do tempo, se revelam cada vez mais interessados na ideia de novos espaços públicos emergentes da sociedade civil, esta última entendida como lócus privilegiado de democratização da vida quotidiana (FISHKIN,1995; ELSTER, 1998; FUNG e WRIGHT, 2001; CHAMBERS, 2003; DRYZEK, 2009).

This article explores the controversial decision made by the Ministry of Health to restructure the perinatal emergency services in Portugal in 2006. Particular emphasis is given to the protests held across the country against, the actors involved, and the arguments put forward for and against the measure, in an attempt to understand the forms of knowledge and experiences brought to the discussion about the issues raised by the decision, and how different forms of knowledge are reconciled under a democratic process. In addition, this article explores the importance of citizen participation, including that which emerges from conflicting relations, in the formulation of health policies. O artigo examina o processo de restruturação dos serviços de emergência perinatal implementado pelo Ministério da Saúde em Portugal em 2006 e tem como objetivo analisar essa decisão controversa. Especial ênfase é dada aos protestos desencadeados no país contra essa medida, os atores envolvidos e os argumentos contra e a favor, de forma a compreender os conhecimentos e as experiências trazidos para discussão dos problemas suscitados pela decisão tomada e como diferentes formas de conhecimento podem ser conciliadas no âmbito de procedimentos democráticos. Além disso, explora a relevância da participação cidadã na formulação de políticas de saúde, incluindo aquela que emerge de relações conflitantes.

RESUMO - Este artigo analisa a questão da participação cidadã em saúde, avaliando os principais limites e os desafios identificados, assim como as estratégias apontadas. Este trabalho faz um enquadramento das origens da participação em saúde, o levantamento dos fatores que a incentivaram e identifica as recomendações que têm surgido no âmbito da promoção da saúde. Explora ainda alguns dos principais debates que atravessam esta problemática, designadamente ao nível dos processos que enquadram o envolvimento dos utentes, da questão da sua representatividade, da capacitação dos cidadãos proporcionada pela participação e dos debates sobre a efetividade que a participação em saúde tem suscitado. ABSTRACT - This article analyses the question of citizen participation in health, evaluating the major limits and the challenges already identified, as well as the strategies to be approached. This work outlines the origins of the participation in health, surveys the factors that stimulated it and identifies the recommendations that have been prepared in the scope of health promotion. It also explores some of the main debates related to this subject, namely those associated to the level of the processes that fit the involvement of the consumers, to the question of their representativeness, to the qualification of the citizens given by their participation and to the debates on the affectivity that the participation in health has awakened. info:eu-repo/semantics/publishedVersion

O presente trabalho faz uma breve revisão da literatura enquadradora do protesto enquanto forma de ação coletiva na sua relação com a democracia e enuncia os principais pressupostos que sustentam os protestos enquanto espaços de participação cidadã na definição de políticas públicas recorrendo, para tal, a um caso empírico concreto: os protestos que ocorreram a propósito do encerramento de blocos de parto em Portugal, entre 2006 e 2007. Esta abordagem consagra, assim, espaço à reflexão sobre os potenciais impactos que essa forma de ação coletiva pode exercer em processos deliberativos, na vida pública e na própria democracia. This paper briefly reviews the body of literature that frames protest events as forms of collective action in its relation to democracy, as well as the main assumptions underpinning protests as spaces for citizen participation in public policies conception. These questions are discussed upon a concrete empirical case: the protests that occurred in Portugal between 2006 and 2007 due to the closure of several maternity wards. This approach establishes thus space to reflect on the potential impact that this form of collective action can exercise in deliberative processes, in public life, and on the democracy itself. Cet article fait une brève révision de la littérature de la protestation comme une forme d’action collective dans sa relation avec la démocratie et énonce les principaux arguments qui soutiennent ces manifestations de protestation comme des espaces de participation citoyenne dans la définition des politiques publiques, utilisant un cas empirique concret: les manifestations de protestation qui ont eu lieu au Portugal entre 2006 et 2007 à propos de la fermeture des salles d’accouchement. Cette approche établit ainsi un espace à la réflexion sur les potentiels impacts que cette forme d’action collective peut exercer dans les processus délibératifs, dans la vie publique et dans la démocratie elle-même.

Texto da comunicação apresentada ao Colóquio Internacional “A Mulher em Debate: Passado e Presente", Funchal, Ilha da Madeira, 01 a 04 de Junho de 2011 O presente trabalho analisa os protestos ocorridos a propósito do mais recente processo de requalificação dos serviços de urgência perinatal em Portugal (2006 e 2007)

Mestrado Integrado em Medicina Master Degree in Medicine

Em Portugal, a obrigação de os trabalhadores desempregados se manterem disponíveis para aceitarem um trabalho "conveniente" foi criada em 1985, mas só a partir de 1989 ela dá lugar a uma política mais clara de activação dos trabalhadores que estão a receber subsídio de desemprego. Mais recentemente, a partir de 1996, o Rendimento Mínimo Garantido veio obrigar os beneficiários dessa prestação a assumirem o compromisso expresso de se disponibilizarem para aceitar um trabalho ou uma acção de formação profissional. O texto discute o conceito de activação e avalia as medidas de política que têm procurado desenvolver essa filosofia em Portugal tendo em conta os contextos sociais e políticos da sua aplicação. In Portugal, the mandatory availability of unemployed workers to accept a "convenient" job was created in 1985, but only from 1989 onwards it has given rise to a clearer policy of activating workers on workfare. More recently, from 1996 on, the Rendimento Mínimo Garantido (Minimum Guaranteed Earnings) has forced the beneficiaries to be available to take a job or a professional training activity. Au Portugal a été créée en 1985 l’obligation, pour les chômeurs, d’être disponibles pour accepter un travail "convenable"; mais ce n’est qu’à partir de 1989 que cette obligation donne la place à une politique plus nette d’activation des travailleurs qui reçoivent des allocations chômage. Plus récemment, à partir de 1996, le Revenu Minimum Assuré oblige les bénéficiaires de cette allocation à s’engager expressément à être disponibles pour accepter un travail ou une action de formation professionnelle. Le texte parle du concept d’activation et évalue les mesures de politique qui cherchent à développer cette philosophie au Portugal, en prenant en compte les contextes sociaux et politiques de son application.

Tendo já contribuído com outras análises sobre o direito de manifestação e os movimentos de contestação ou protesto, assim como sobre outras questões relacionadas, António Francisco Sousa consegue elevar este livro ao estatuto de verdadeiro manual, tanto na perspectiva da compreensão como do exercício do direito de reunião e de manifestação. De forma simples e eloquente, o autor permite a transposição – para muitos leitores – dos inacessíveis muros da análise jurídica, colocando em diálogo es...

Este artigo descreve e analisa as diferentes experiências de participação cidadã implementadas nos sistemas de saúde dos países da Europa do Sul, nomeadamente em Espanha, Itália e Portugal. Em termos metodológicos, procedeu-se à análise das políticas e planos de saúde, visando a análisedo gradual processo de reconhecimento dos direitos dos usuários nos três sistemas de saúde, e a uma revisão da literatura sobre experiências de participação publicadas nos últimos 15 anos. Entre os resultados desta análise destacam-se os seguintes: a) somente a partir da década de 1990, a participação cidadã nos processos de tomada de decisão se tornou objeto de atenção no âmbito da política de saúde; b) registouse um avanço significativo tanto no quadro legislativo como no reconhecimento dos direitos dos doentes e usuária nos três países analisados; c) os três sistemas de saúde evidenciam um discurso político que enfatiza a importância doenvolvimento dos usuários, mas que não tem sido acompanhado por um adequado desenvolvimento de práticas participativas. This article describes and analyzes the different experiences of participation that have been implemented in the health systems of Southern European countries, namely in Spain, Italy and Portugal. In methodological terms, it starts from the analysis of the health policies and the health plans consigned in the three national health systems in order to envisage the gradual process of recognition of users’ rights. This work is also focused on a systematic review of the literature on participation experiences in health published in the last 15 years. Among the results achieved it’s interesting to highlight the following: a) only from the 90s on citizens participation in decision-making became an object of interest to health policies; b) there was a significant advance in the regulatory frame as well as in the recognition of patients’ and health consumers rights in the three countries considered; c) in the health systems analyzed prevails a political discourse that emphasizes the relevance of users involvement that does not correspond to a proper development of participatory practices.

Este artigo parte de um trabalho exploratório que tenta estabelecer um diálogo entre a análise de ações de protesto na área da educação em Portugal, a partir do enquadramento teórico conferido pelas abordagens aos movimentos sociais, e a análise sócio-semiótica das representações de atores e ação coletiva. Esta combinação privilegia o recurso a uma metodologia que assenta no levantamento exaustivo de notícias sobre ações de protesto realizadas em Portugal (2005-2015) em dois jornais de referência de circulação nacional – Público e Jornal de Notícias – em relação às quais se analisam as dimensões cronológica, sociológica e semiótica. Estes relatos assumem-se essenciais para a análise que aqui se empreende, dado que contribuem para a reconstituição cronológica da mobilização coletiva na área da educação, ajudando a identificar os motivos e as lógicas que justificam esse tipo de ação. A abordagem sócio-semiótica aplicada às representações das ações de protesto coligidas tenta realçar os padrões e as configurações discursivas que caraterizam a visão da imprensa sobre os atores sociais, as causas e as mensagens dos protestos. This article is based on an exploratory work aiming to establish a dialogue between the analysis of protest events in education in Portugal from the theoretical framework within the social movements’ approaches, and the socio-semiotic analysis of the representations of actors and collective action within the protests. The combined method is based on the comprehensive overview of news stories about protests in Portugal (2005-2015), published in two nation-wide newspapers, Público and Jornal de Notícias, thus making it possible to focus on the chronological, sociological and semiotic dimensions of the protests. The analysis undertaken in the article makes an attempt to inform the reconstitution of collective movements in education across the decade, helping to identify the reasons and the rationale behind the protest action. In its turn, the socio-semiotic approach to the representations of the selected protest actions in the Press seeks to move deeper and highlights the patterns and the discursive configurations of the social actors, causes and messages of protests in Portuguese education.