A Área de Proteção Ambiental ? APA foi instituída no Brasil pela Lei Federal n° 6902, de 27 de abril de 1981. É uma Unidade de Conservação de Uso Sustentável, portanto, pode ser criada em áreas públicas e particulares, sem a necessidade de desapropriação da propriedade. Tem como objetivo conciliar o desenvolvimento das atividades econômicas com a proteção dos recursos naturais. Atualmente, no Estado de São Paulo, existem 23 APAs, sendo que as primeiras foram criadas no inicio da década de 80. Desde então, foram realizados vários trabalhos para a regulamentação das mesmas. Este estudo apresenta a análise das Áreas de Proteção Ambiental ? APAs ? estaduais em São Paulo, dando ênfase à avaliação dos instrumentos legais (leis e decretos) que as criaram, especialmente em relação aos seus perímetros e atributos ambientais, que motivaram a instituição das mesmas, e à analise dos estudos realizados desde o início da década de 1980 até o momento atual, objetivando a proposição de ações para agilizar o processo de regulamentação destas unidades. O trabalho apresenta, também, uma caracterização geral dos atributos do meio físico, históricos e culturais da região de Itararé e Itapeva com o intuito de motivar a criação de uma APA para protegê-los. Essa região do Estado faz parte do Escarpamento Estrutural Furnas, considerado um Sítio Geomorfológico raro no Brasil. É um imponente ressalto topográfico que se estende por cerca de 260 km, desde o sul do Estado do Paraná até o sul do Estado de São Paulo, incluindo os municípios de Itararé e Itapeva. Este escarpamento vem sendo esculpido por processos erosivos há milhões de anos, promovendo um conjunto de feições geomorfológicas interessantes, como morros testemunhos, pináculos, canyons, cavernas de arenitos, incluindo a presença de vestígios arqueológicos. Além disso, foram caracterizados, também, os aspectos da vegetação remanescente, representada pelo cerrado, campos e floresta subtropical. / The Environmental Protected Areas (the so called APA, its acronym in Portuguese) were established in Brazil by Federal Law nº 6902 on the 27th of April 1981. It´s a Conservational Unit for Sustainable Use, therefore it may be created in public or private lands, with no need of expropriation. Its objective is to harmonize the development of economical activities and natural resources protection. At present, there are twenty three APAs in the State of São Paulo, being the first ones created in the early eighties. Since then several studies have been developed as an attempt to regulate them. The present study shows an analysis of all of the Environmental Protected Areas located in the State of São Paulo emphasizing the evaluation of legal instruments (laws and decrees) which established such areas, especially in the aspects related to their boundaries and environmental attributes that motivated their creation. It also analyses the previous studies from the early eighties until present aiming to propose lines of action to shorten the regulatory process. This study shows as well a general characterization of physical, historical and cultural attributes of the Itararé and Itapeva region to motivate the establishment of an APA to protect it. That region is part of the Furnas Structural Scarps and is considered a rare brazilian geomorphological site. It´s a huge salience of rocks stretching out for approximately 260 Km from the south of the State of Parana to the south of the State of São Paulo, including the cities of Itararé and Itapeva. These scarps have been sculpted by erosive processes for millions of years promoting a set of interesting geomorphological features such as hillocks, pinnacles, canyons, sandstone caverns, including the presence of archaeological signs. It has also been done the characterization of the remnant vegetation aspects, represented by savannah, grasslands and subtropical forest.

A Área de Proteção Ambiental ? APA foi instituída no Brasil pela Lei Federal n° 6902, de 27 de abril de 1981. É uma Unidade de Conservação de Uso Sustentável, portanto, pode ser criada em áreas públicas e particulares, sem a necessidade de desapropriação da propriedade. Tem como objetivo conciliar o desenvolvimento das atividades econômicas com a proteção dos recursos naturais. Atualmente, no Estado de São Paulo, existem 23 APAs, sendo que as primeiras foram criadas no inicio da década de 80. Desde então, foram realizados vários trabalhos para a regulamentação das mesmas. Este estudo apresenta a análise das Áreas de Proteção Ambiental ? APAs ? estaduais em São Paulo, dando ênfase à avaliação dos instrumentos legais (leis e decretos) que as criaram, especialmente em relação aos seus perímetros e atributos ambientais, que motivaram a instituição das mesmas, e à analise dos estudos realizados desde o início da década de 1980 até o momento atual, objetivando a proposição de ações para agilizar o processo de regulamentação destas unidades. O trabalho apresenta, também, uma caracterização geral dos atributos do meio físico, históricos e culturais da região de Itararé e Itapeva com o intuito de motivar a criação de uma APA para protegê-los. Essa região do Estado faz parte do Escarpamento Estrutural Furnas, considerado um Sítio Geomorfológico raro no Brasil. É um imponente ressalto topográfico que se estende por cerca de 260 km, desde o sul do Estado do Paraná até o sul do Estado de São Paulo, incluindo os municípios de Itararé e Itapeva. Este escarpamento vem sendo esculpido por processos erosivos há milhões de anos, promovendo um conjunto de feições geomorfológicas interessantes, como morros testemunhos, pináculos, canyons, cavernas de arenitos, incluindo a presença de vestígios arqueológicos. Além disso, foram caracterizados, também, os aspectos da vegetação remanescente, representada pelo cerrado, campos e floresta subtropical. / The Environmental Protected Areas (the so called APA, its acronym in Portuguese) were established in Brazil by Federal Law nº 6902 on the 27th of April 1981. It´s a Conservational Unit for Sustainable Use, therefore it may be created in public or private lands, with no need of expropriation. Its objective is to harmonize the development of economical activities and natural resources protection. At present, there are twenty three APAs in the State of São Paulo, being the first ones created in the early eighties. Since then several studies have been developed as an attempt to regulate them. The present study shows an analysis of all of the Environmental Protected Areas located in the State of São Paulo emphasizing the evaluation of legal instruments (laws and decrees) which established such areas, especially in the aspects related to their boundaries and environmental attributes that motivated their creation. It also analyses the previous studies from the early eighties until present aiming to propose lines of action to shorten the regulatory process. This study shows as well a general characterization of physical, historical and cultural attributes of the Itararé and Itapeva region to motivate the establishment of an APA to protect it. That region is part of the Furnas Structural Scarps and is considered a rare brazilian geomorphological site. It´s a huge salience of rocks stretching out for approximately 260 Km from the south of the State of Parana to the south of the State of São Paulo, including the cities of Itararé and Itapeva. These scarps have been sculpted by erosive processes for millions of years promoting a set of interesting geomorphological features such as hillocks, pinnacles, canyons, sandstone caverns, including the presence of archaeological signs. It has also been done the characterization of the remnant vegetation aspects, represented by savannah, grasslands and subtropical forest.

The overall aim was to study nurses’ and managers’ attitudes towards micro social patient advocacy (I) and factors related to patient advocacy (II, III) with the main focus being on advocacy in the care of older patients in community health care together with psychometric testing of the instrument 'Attitudes toward Patient Advocacy Scale-Attitudes toward MIcrosocial Advocacy' (IV). Methods: A quantiative cross-sectional study and a qualitative study were carried out. Nurses (n=207) and managers (n=23) in community health care responded to a questionnaire about patient advocacy, nursing competence, personal traits, quality of care and organisational climate (I, II, IV). Nurses' (n=18) perceptions of influencers of patient advocacy was studied in a phenomenographic study (III). The results showed that nurses and managers reported positive attitudes to patient advocacy (I, II), especially for patients unable to speak for themselves (I). Two areas of nursing competence (Performing the nursing process, Supervision and cooperation) and a dimension of quality of care of older patients were positively associated with attitudes towards patient advocacy (II). Two organisational dimensions were, negatively (dynamism) respectively positively (playfulness), associated with attitudes towards patient advocacy. The nurses' perceptions of influencers of patient advocacy consist of three hierarchically related levels: The nurse's character traits, The nurse’s bond with the patient and The organisational conditions (III). The Swedish version of APAS-AMIA consists of 33 items in a four-factor structure (APAS-AMIA/SE): Support patients’ beliefs and decision-making, Safeguard patients' health care, Support patients to communicate their wishes and Respect patients’ wishes not to participate in decisions regarding care (IV). Conclusions: Maintaining the continuing professional competence of nurses is important, and is ensuring the organisational prerequisites to enable nurses' advocacy for patients. / Det övergripande syftet var att studera sjuksköterskors och chefers attityder till mikrosocialt företrädarskap för patienter (I), faktorer relaterade med företrädarskap (II, III) med huvudsakligt fokus på företrädarskap för äldre patienter inom kommunal hälso- och sjukvård samt psykometriskt testa instrumentet Attitudes toward Patient Advocacy Scale-Attitudes toward MIcrosocial Advocacy (IV). Metod: En kvantitativ tvärsnittstudie och en kvalitativ studie genomfördes. Sjuksköterskor och chefer (n=230) i kommunal hälso-och sjukvård besvarade frågor om företrädarskap, yrkeskompetens, personlighet, vårdkvalitet och organisationsklimat (I, II, III). Sjuksköterskors (n=18) uppfattningar av vad som påverkar företrädarskap studerades i en fenomenografisk studie (III). Resultat: Sjuksköterskor och chefer rapporterade positiva attityder till företrädarskap (I, II), framför allt för oförmögna patienter (I). Två områden av yrkeskompetens (Att utföra omvårdnadsprocessen, Arbetsledning och samarbete) liksom en dimension av kvalitet i vården av äldre var positivt associerade med attityder till företrädarskap (II). Två organisatoriska dimensioner var negativt (livfullhet) respektive positivt (lekfullhet) associerade med attityder till företrädarskap. Sjuksköterskors uppfattningar av vad som påverkar företrädarskap omfattar tre hierarkiskt relaterade nivåer: Sjuksköterskans karaktärsdrag, Sjuksköterskans förhållande till patienten och Arbetsplatsens beskaffenhet (III). Den svenska versionen av APAS-AMIA omfattar 33 påståenden i en fyrfaktorstruktur (APAS-AMIA/SE): Stödja patienternas önskemål och beslutsfattande, Värna om patienternas vård, Stödja patienterna att kommunicera sina önskemål och Respektera patienternas önskemål om att inte delta i beslut (IV). Konklusioner: Sjuksköterskors yrkeskompetens bör upprätthållas för att de ska ha förutsättningar att företräda patienter. Det är viktigt att skapa organisatoriska förutsättningar för att sjuksköterskor ska kunna etablera en relation till patienten som underlag till företrädarskap.

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Background: Gait initiation is a major issue in Parkinson’s disease (PD). Moreover, the effect of current treatment on motor deficits vary alongside individual differences and disease severity. In some cases, postural instability has been documented as a major side-effect and refractory symptom to dopaminergic medication. Despite these shortcomings, research involving other forms of therapy including deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS), has evidenced the improvement of postural deficits in PD. In this regard, there is a strong rational for the modulation of subcortical brain activity via the application of non-invasive transcranial direct current stimulation (tDCS) to interconnected cortical brain structures. Purpose: Therefore, we sought to determine the effect of tDCS applied to the supplementary motor area (SMA), on gait initiation preparation and performance in PD. Methods: A within subjects repeated measures quasi-experimental design was used to investigate the effects of a 10-minute sham-controlled tDCS intervention. Clinically diagnosed participants (n=12) with idiopathic PD were tested on medication during two sessions that bookended one week. Those who had previously undergone other forms of brain stimulation, had diabetes, severe freezing of gait, or any other neurological or functional limitations that could interfere with gait initiation were excluded from the study. Statistical Analyses/Results: Two-way repeated measures ANOVAs with Bonferroni corrections and a post-hoc analyses when appropriate, revealed a significant reduction in the magnitude of center of pressure (CoP) displacement and velocity in the mediolateral (ML) direction following tDCS. Conclusions: Findings from this study provide insights that may guide scientific research regarding the effects of tDCS on gait initiation among those with PD. Additionally, our work may highlight the importance of ML postural stability for individuals with comorbid and/or pharmacologically induced postural instabilities.