Microvascular Pathology and Morphometrics of Sporadic and Hereditary Small Vessel Diseases of the Brain

Small vessel diseases (SVDs) of the brain are likely to become increasingly common in tandem with the rise in the aging population. In recent years, neuroimaging and pathological studies have informed on the pathogenesis of sporadic SVD and several single gene (monogenic) disorders predisposing to subcortical strokes and diffuse white matter disease. However, one of the limitations toward studying SVD lies in the lack of consistent assessment criteria and lesion burden for both clinical and pathological measures. Arteriolosclerosis and diffuse white matter changes are the hallmark features of both sporadic and hereditary SVDs. The pathogenesis of the arteriopathy is the key to understanding the differential progression of disease in various SVDs. Remarkably, quantification of microvascular abnormalities in sporadic and hereditary SVDs has shown that qualitatively the processes involved in arteriolar degeneration are largely similar in sporadic SVD compared with hereditary disorders such as cerebral autosomal arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Important significant regional differences in lesion location within the brain may enable one to distinguish SVDs, where frontal lobe involvement appears consistently with almost every SVD, but others bear specific pathologies in other lobes, such as the temporal pole in CADASIL and the pons in pontine autosomal dominant microangiopathy and leukoencephalopathy or PADMAL. Additionally, degenerative changes in the vascular smooth muscle cells, the cerebral endothelium and the basal lamina are often rapid and more aggressive in genetic disorders. Further quantification of other microvascular elements and even neuronal cells is needed to fully characterize SVD pathogenesis and to differentiate the usefulness of vascular interventions and treatments on the resulting pathology

Educational interventions for the prevention of eye injuries.

BACKGROUND: Ocular injury is a preventable cause of blindness, yet it remains a significant disabling health problem that affects all age groups. Injuries may occur in the home, in the workplace, during recreational activities or as a result of road crashes. Types of injuries vary from closed globe (contusion or lamellar laceration) to an open globe injury, which includes penetration and even perforation of the globe. To date, the main strategy to prevent these injuries has been to educate people to identify high-risk situations and to take correct action to avoid danger. OBJECTIVES: To assess the evidence for the effectiveness of educational interventions for the prevention of eye injuries. SEARCH STRATEGY: We searched the Cochrane Injuries and the Cochrane Eyes & Vision Group Specialised Registers, CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE, EMBASE, Current Controlled Trials metaRegister (now includes National Research Register), AgeInfo, HMIC Health Management Information Consortium, WHOLIS (World Health Organization Library Information System), LILACS (Latin American and Caribbean Health Sciences), MEDCARIB (Caribbean Health Sciences Literature), ISI Web of Science: (Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI) Conference Proceedings Citation Index-Science (CPCI-S)), ERIC, ZETOC and SPORTdiscus. We also checked reference lists of relevant papers and contacted study authors in an effort to identify published, unpublished and ongoing trials. Searches were last updated in August 2008. SELECTION CRITERIA: We included any randomised controlled trials (RCTs) and controlled before-and-after studies which evaluated any educational intervention aimed at preventing eye injuries. DATA COLLECTION AND ANALYSIS: Four authors independently screened the electronic search results and data extracted. Three authors entered data into RevMan 5. As we judged there to be substantial heterogeneity between participants and interventions, we did not pool the studies' results, but have reviewed the results narratively. MAIN RESULTS: We included two RCTs and three controlled before-and-after studies in this review. One study reported eye injuries as an outcome and four studies reported change in behaviour or knowledge. AUTHORS' CONCLUSIONS: The included studies do not provide reliable evidence that educational interventions are effective in preventing eye injuries. There is a need for well-conducted RCTs with adequate allocation concealment and masking (blinding). Studies should have a longer follow-up time and more studies need to be conducted in low and middle-income countries

Entre la confianza y la transformación: modalidades de intervención social sobre la niñez en riesgo

Este trabajo se desprende de una investigación orientada a la comprensión de las actuales modalidades de intervención social sobre la niñez en riesgo, dentro de la denominada protección de la infancia, desde el enfoque de derechos, en Argentina. Busco comprender dichas modalidades de intervención, al centrarme en las actuaciones de los agentes institucionales de un organismo estatal de protección de derechos de la infancia, en una localidad bonaerense de rango medio. El material aquí presentado es resultado de una aproximación etnográfica y narrativa a las actuaciones desplegadas por dichos agentes sobre las familias con las cuales interactúan, con el fin de acceder a los esquemas de significación que las enmarcan. Realicé mi trabajo de campo, durante el año 2018, a partir de una estadía de cinco meses en el organismo estatal, haciendo uso de la observación participante como principal técnica de investigación. Argumento que la confianza que permea el vínculo entre agentes estatales y familias destinatarias de las intervenciones es concebida como valor moral vehiculizador del trabajo aleccionador realizado, funda-mentalmente, sobre mujeres-madres. Esta característica no flexibiliza, sino que refunda la asimetría propia de la relación, estilizando mecanismos de control y vigilancia. A su vez, las familias hacen uso de la retórica institucional disponible, como modo de traducir su experiencia social al lenguaje de los derechos, ofreciendo así la transformación esperada. Este trabajo muestra elmodo en que los actuales formatos de intervención sobre la infancia y sus familias incorporan novedosos elementos como la confianza y el afecto que, sin embargo, se traman con perdurables mecanismos de poder propios de la dimensión tutelar del Estado. Asimismo, problematiza el lugar de las familias en la interacción con agentes estatales para permitir una comprensión de suaccionar a partir del uso y apropiación del lenguaje de los derechos.This paper is part of a study intended to elucidate the current modalities of social intervention on children at risk in Argentina, as part of what is known as child protection and from a rights-based approach. I attempt to comprehend these modalities of intervention by focusing on the actions of the institutional agents of a state organism for the protection of children’s rights in a mid-range area of Buenos Aires. The material presented here stems from an ethnographic and narrative approach to the actions carried out by these agents in relation to the families with which they interact, in order to access some of the significant schemes that frame them. I conducted my fieldwork in 2018, during a fivemonth internship in the organization, using participant observation as the main research technique.I argue that the trust that permeates the bond between state agents and the families targeted by the interventions is conceived as a moral value that conveys the instructive work carried out, fundamentally, on womenmothers. This characteristic does not serve to make relationships more flexible, but rather reestablishes itself to stylize control and surveillance mechanisms. At the same time, families make use of available institutional rhetoric as a way of translating their social experience into the language of rights, thus effecting the expected transformation. This work shows how current models of intervention involving children and their families incorporate new elements such as trust and affection, which, however, are woven with enduring power mechanisms typical of the scope of the state’s protective services. It also discusses the place of families in the interaction with state agents to enable an understanding of their actions based on the use and appropriation of the language of rights.Este trabalho deriva de uma pesquisa orientada à compreensão das atuais modalidades de intervenção social sobre a infância em risco, no âmbito da denominada “proteção da infância” e sob a abordagem de direitos, na Argentina. Pretendo compreender essas modalidades de intervenção ao me focar nas ações dos agentes institucionais de um órgão estatal de proteção de direitos da criança, em uma localidade bonaerense de classe média. O mate-rial apresentado é resultado de uma aproximação etnográfica e narrativa das ações desenvolvidas por esses agentes sobre as famílias com as quais interagem a fim de ter acesso aos esquemas de significação que as delimitam. Realizei meu trabalho de campo durante 2018, a partir de uma estada de cinco meses na organização estatal, fazendo uso da observação participante como prin-cipal técnica de pesquisa. Argumento que a confiança que permeia o vínculo entre agentes estatais e famílias destinatárias das intervenções é concebida como valor moral mobilizador do trabalho disciplinar realizado, fundamen-talmente, sobre mulheres-mães. Essa característica não flexibiliza, mas sim remodela a assimetria própria da relação, estilizando mecanismos de controle e vigilância. Por sua vez, as famílias fazem uso da retórica institucional dispo-nível, como modo de traduzir sua experiência social para a linguagem dos direitos, oferecendo assim a transformação esperada. Este trabalho mostra o modo em que os atuais modelos de intervenção sobre a infância e suas famí-lias incorporam novos elementos como a confiança e o afeto que, contudo, são estruturados com perduráveis mecanismos de poder próprios da dimensão tutelar do Estado. Além disso, problematiza o lugar das famílias na interação com agentes estatais para permitir uma compreensão de seu agir a partir do uso e da apropriação da linguagem dos direitos.Fil: Larrea, Natalia Jimena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Sociales. Departamento de Antropología Social; Argentin