The clinical manifestation and the influence of age and comorbidities on long-term chikungunya disease and health-related quality of life:a 60-month prospective cohort study in Curaçao

Abstract Background Persistent rheumatic symptoms and its impact on health-related quality of life (QoL), induced by the Indian Ocean Lineage (IOL) chikungunya virus (CHIKV) genotype have been widely studied. In 2014, a major CHIKV outbreak of the Asian genotype occurred in Curaçao, after which we established a longitudinal cohort in 2015, to follow the long-term CHIKV sequalae. Currently, the long-term clinical manifestations and its impact on QoL induced by the Asian CHIKV genotype, followed prospectively through time, and the association of age and comorbidities with rheumatic symptoms persistence, 60 months (M60) after disease onset is unknown. Methods The cohort of 304 laboratory confirmed patients were followed prospectively in time at 3–16 months (M3-16), 30 months (M30), and M60 after disease onset. Demographic and clinical characteristics, and the 36-item short-form survey (SF-36) QoL status were collected through questionnaires. At M60, QoL scores were compared to general population (CHIK-) norms. Results A total of 169 (56%) patients participated (74.6% female, mean age 56.1 years) at all time points, 107 (63%) were classified as recovered and 62 (37%) as affected. The affected patients reported an increase in the prevalence of arthralgia (P .001) and arthralgia in the lower extremities (P < .001), at M30 compared to M3-16. At M60, in comparison to recovered patients, affected patients reported a higher prevalence of recurrent rheumatic symptoms of moderate to severe pain, irrespective of age and comorbidities, and a higher prevalence of non-rheumatic symptoms (P < .001). Arthralgia in the upper (odds ratio (OR): 4.79; confidence interval (CI): 2.01–11.44; P < .001) and lower (OR: 8.68; CI: 3.47–21.69; P < .001) extremities, and headache (OR: 3.85; CI: 1.40–10.54; P = .009) were associated with being affected. The SF-36 QoL scores of the recovered patients were less impaired over time compared to the QoL scores of the affected patients. At M60, the QoL scores of the recovered patients were comparable to the CHIK- QoL scores. Conclusions Rheumatic and non-rheumatic symptoms, and QoL impairment may persist, 60 months following infection with the Asian CHIKV genotype, similar to the IOL genotype disease sequelae. Further research is needed to follow the clinical manifestations and QoL impact of each CHIKV genotype

Architectuur en beschaving

recensie van: Wijburg, G. (2014) Architectuur en beschaving: Het smaakoffensief van de Moderne Beweging. Amsterdam: Stichting de Driehoek

About the "away goals rule" in association football:Does scrapping the rule increase the fairness of the game?

The present study analyzes all major international football tournaments organized by UEFA and CONMEBOL during a period of 30 years to assess the impact of the away goals rule (AGR). The study takes advantage of natural experiment given by the differentiated application of the AGR by both confederations, in order to assess the efficacy and the consequences of the rule in terms of both the total amount of goals being scored (the original intention of the rule) and the teams that progressed onto the next stages. The results show that the AGR seems to have failed to fulfill its original goal of increasing both scoring by teams playing away and scoring in general. The AGR is found to have a significant impact favoring the chances of the team starting the series at home. However, it still does not translate into a higher probability of progressing onto the next stage than the team closing the series at home. Closing the series at home has an intrinsic advantage, which is only countered, although not completely, by the impact of the AGR. Regarding tiebreakers, we observe that closing the series at home has a positive impact no matter whether overtimes with AGR or penalty shootouts are used as tiebreakers. However, playing an overtime, when no AGR is set in place has a determining influence favoring the team closing the series at home

Iniciativa MAP: um emergente movimento social transfronteiriço e sua gestão no desenvolvimento sustentável na Região da Amazônia Sul Ocidental

Dissertação (mestraddo) - Universidade Federal de Santa Catarina, Centro de Ciências Jurídicas. Programa de Pós-Graduação em Direito.Desde o nascimento do capitalismo forças sociais emergem em busca de melhores condições de vida e acesso a direitos. São nesses momentos de efervescências decorrentes das relações sociais, culturais, políticas e econômicas que se formam os movimentos sociais como contraponto de reivindicação e afirmação. Nesse sentido, o presente trabalho analisa o movimento denominado iniciativa MAP # Madre de Dios (Peru), Acre (Brasil) e Pando (Bolívia), e sua gestão para o desenvolvimento sustentável em pleno curso na Amazônia Sul Ocidental, região de fronteira trinacional, nessa era de globalização. A globalização, em sua face econômica, promove um jogo assimétrico em que a ideologia neoliberal é imposta aos Estados-nação, enfraquecendo as economias nacionais e fazendo com que esses atores políticos se submetam a atrair todo e qualquer investimento que, no mais das vezes, não respeitam as regras de proteção ao meio ambiente. Na região fronteiriça MAP realiza-se a construção da Rodovia Interoceânica, que interligará os portos do Brasil a Lima, no Pacífico, concebida no âmbito da Iniciativa de Integración de la Infraestructura de Sudamérica (IIRSA) para promover a integração sul-americana, o desenvolvimento da região da Amazônia Sul Ocidental e, ainda, integrar o Brasil, o Peru e a Bolívia aos mercados da Ásia e Japão. O impacto da realização dessa obra no ecossistema amazônico e nos municípiosdistritos fronteiriços, bem como em suas populações, impulsionou a articulação social denominada iniciativa MAP, fundada nos princípios do desenvolvimento sustentável e direitos humanos, que mobiliza há sete anos instituições, organizações não-governamentais, indígenas e campesinos, enfim, a sociedade fronteiriça, em um movimento de resistência ao desenvolvimento excludente e degradador impulsionado pelo processo da globalização, reivindicando o direito de participar das decisões sobre o desenvolvimento da região. O MAP no atual estágio pode ser considerado um emergente movimento social transfronteiriço de resistência ao modo imperativo pelo qual se constrói a estrada Interoceânica na Amazônia Sul Ocidental, promovendo ações dialéticas de um pensar-agir voltadas para a gestão do desenvolvimento sustentável. Since the advent of Capitalism, social forces emerge in claim better conditions of living and access to their rights. It#s in these moments of agitation, consequences of social, cultural, political and economical relations, that the social movements in counterpoint to claim and affirmation. In this sense, the present paper analyzes the movement called MAP # Madre Dios (Peru), Acre (Brasil) and Pando (Bolívia), and it also aims to analyze the management over the sustainable development, in total course, in the South Occidental Amazon, the three-national-boundary region, in globalization times. Globalization, in its economical stage, promotes an asymmetrical game, in which, the neoliberal ideology is imposed upon the state-nations, as it weakens the national economies and makes these political actors being submitted to all and any kinds of investments that, in most times, don#t comply with the environmental regulations of protection. In the boundary region (MAO), an interoceanic highway has been built, and it will connect to harbors, one in Brazil and the other in Bolivia (Lima), in the Pacific, as the highway had been concepted in the Integración de la Infraestrutura of Sudamerica (IIRSA), in order to promote the South american integration, the development of the South Occidental Amazon, and yet, to integrate the countries: Brazil, Peru and Bolivia, with the market of Asia. The impact of the achievement of this work into the Amazon ecosystem has led to a social articulation called MAP initiative, based on the principles of sustainable development and on the human rights, that has moved institutions, nongovernmental organizations, Indian tribes, countrymen, for over seven years. It also has encouraged the formation of a movement of resistance to the degrading and excluding development driven by the globalization process, claiming the right to taking part on decisions over the development of the region. The MAP, in the recent stage, may be considered as a resistant emergent social movement that aims to protect the environment from the imperative way, in which, the Interoceanic highway has been built, as also a movement that promotes dialectical actions on a way of thinking and acting focused on the management of sustainable development

Long-term Chikungunya sequelae and quality of life 2.5 years post-acute disease in a prospective cohort in Curaçao

BACKGROUND: Little is known about the persistence and impact of non-rheumatic symptoms after acute chikungunya disease. We have studied the clinical presentation and long-term impact of rheumatic and non-rheumatic symptoms on health related quality of life (QoL) 2.5 years after disease onset. Additionally, the validity of the Curaçao Long-Term Chikungunya Sequelae (CLTCS) score in classifying disease severity over time was evaluated. METHODOLOGY/PRINCIPAL FINDINGS: This prospective cohort study followed 248 chikungunya patients. Symptoms and SF-36 QoL were evaluated during baseline and follow-up at 2.5 years using questionnaires. Chikungunya disease status was classified using the CLTCS-score. At 2.5 years after disease onset patients were classified as being recovered (43%), mildly (35%) or highly (22%) affected. In comparison to mildly affected, highly affected patients reported the highest prevalence of ongoing rheumatic and non-rheumatic/psychological symptoms, with increased prevalence of arthralgia in the lower extremities (p = .01) and fatigue (p = .049) over time, and higher pain intensity (p < .001). Compared to mildly affected, being highly affected was associated with weakness in the lower extremities (OR: 1.90; CI: 1.29–2.80, p = .001) and worsened physical and mental QoL impairment. CONCLUSIONS: Patients are both physically and psychologically affected by rheumatic and non-rheumatic symptoms of long-term chikungunya disease. The CLTCS-score is an easy to use instrument for classifying long-term chikungunya disease severity and impact and can facilitate health care providers in identifying highly affected patients who are prone to develop severe QoL impairment. Highly affected patients are recommended to be treated in a multidisciplinary setting to improve physical and psychological functioning, and QoL