Doença renal crónica: uma abordagem fenomenológica das experiências de pessoas transplantadas

Dissertação de mestrado em EnfermagemA Doença Renal Crónica é um problema de saúde pública em todo o mundo que consiste na lesão renal e, geralmente, na perda progressiva e irreversível da função dos rins. Vivenciar uma transição saúde-doença, nomeadamente a Doença Renal Crónica (DRC), comporta alterações profundas na vida de quem experimenta um processo desta natureza. O número de horas que passam nas unidades de diálise altera a rotina de vida diária, os efeitos secundários dos tratamentos são sentidos como incapacitantes e todo o sistema familiar vive o sofrimento da pessoa com esta doença. A investigação de índole exploratória e fenomenológica visou explorar, descrever e interpretar o significado que as pessoas transplantadas atribuem às experiências vividas durante a frequência de um programa regular de hemodiálise. Participaram no estudo 6 pessoas submetidas a transplante renal após hemodiálise, tendo sido inquiridas através de entrevista não estruturada. As narrativas foram analisadas à luz da perspetiva de van Manen (2014). Da análise efetuada emergiram três temas principais e respetivos subtemas, os quais ajudam a compreender a estrutura da experiência em estudo: Disrupção da Vida, Adaptação e O (re)começo. Os resultados permitem uma compreensão mais abrangente das experiências vividas pelas pessoas com DRC e contribuem para a orientação das práticas dos enfermeiros no sentido de que mais e melhores cuidados possam ser prestados às pessoas que vivenciam transições saúdedoença motivadas pela DRC e, consequentemente, que as vivenciem de forma mais saudável.Chronic Kidney Disease is a worldwide public health problem, which consists of renal injury and, usually, progressive and irreversible loss of kidney function. Experiencing a transition health-disease, namely Chronic Kidney Disease (CKD), involves profound changes in the lives of those who experience such a process. The number of hours spent in dialysis units changes the daily life routine, treatments’ side effects are felt as disabling and the entire family system lives the pain of people with CKD. The phenomenological and exploratory research’s nature has the purpose to study the meaning that people transplanted give to the experiences during the frequency of a regular haemodialysis program. 6 people submitted to renal transplantation after haemodialysis participated in the study, having been surveyed through unstructured interview. The narratives were analysed under Max van Manen’s (2014) perspective. From the analysis performed emerged three main themes and their respective subthemes, which helped to understand the structure of the experience under study: Disruption of Life, Adaptation and The (re) start. The results allow a more comprehensive understanding of the people with CKD’s experiences, and can make a contribution in guiding the practices of nurses by being able to provide more and better care to people who live transitions health-disease motivated by CKD and, thereafter, experience them in a healthier way

O consentimento das crianças nos termos do artigo 8.º do Regulamento Geral da Proteção dos Dados: Realidade ou mito?

Com o crescente uso das tecnologias pelos mais jovens e a consequente disseminação dos seus dados pessoais no mundo online, torna-se fundamental avaliar a eficácia das disposições do Regulamento Geral da Proteção de Dados (“RGPD”) relativas ao consentimento das crianças e à sua capacidade de exercer controlo sobre os seus dados pessoais. A rápida evolução do ambiente digital trouxe consigo um aumento significativo na quantidade e na diversidade de dados pessoais gerados e compartilhados por crianças e adolescentes em plataformas online, desde redes sociais até jogos e aplicativos móveis. O mundo digital, embora tenha trazido inúmeras comodidades e oportunidades, também deu origem a preocupações crescentes sobre a privacidade e a segurança dos dados pessoais, especialmente no que diz respeito aos mais vulneráveis, como as crianças. Os abusos e práticas de tratamento de dados inadequadas por parte de organizações e provedores de serviços da sociedade da informação tornaram-se uma preocupação central, para a qual o RGPD tentou oferecer uma resposta regulatória robusta. Neste contexto, este estudo explora o conceito de consentimento, com especial ênfase no consentimento das crianças conforme abordado no artigo 8.º do RGPD. Pretende-se compreender não apenas a natureza e o alcance do consentimento no contexto digital, mas também os desafios enfrentados tanto pelas crianças quanto pelos seus responsáveis legais em relação ao tratamento de dados pessoais por parte dos serviços da sociedade da informação. Como tal, este estudo tem como objetivo identificar as limitações e implicações do consentimento, enquanto fundamento legal para o tratamento dos dados pessoais, especialmente no que diz respeito aos direitos das crianças, em particular, o direito à privacidade. Ao examinar a relação intrínseca entre os direitos das crianças, a privacidade e a proteção de dados, esta investigação visa contribuir para o debate sobre a garantia da privacidade e segurança das crianças no ambiente digital.With the increasing use of technology by young people and the consequent dissemination of their personal data in the online world, it is crucial to assess the effectiveness of the provisions of the General Data Protection Regulation ("GDPR") regarding children's consent and their ability to exercise control over their personal data. The rapid evolution of the digital environment has brought with it a significant increase in the amount and diversity of personal data generated and shared by children and adolescents on online platforms, from social networks to mobile games and apps. While the digital world has brought countless conveniences and opportunities, it has also given rise to growing concerns about the privacy and security of personal data, especially with regard to the most vulnerable, such as children. Abuses and inappropriate data processing practices by organisations and service providers in the information society have become a central concern, to which the GDPR has attempted to offer a robust regulatory response. In this context, this study explores the concept of consent, with special emphasis on children's consent addressed in Article 8 GDPR. Furthermore, it attempts to understand the challenges faced by children and holders of parental responsibilities in relation to the processing of their personal data by information society services. As such, this study aims to identify the limitations and implications of consent as a legal ground for the processing of personal data, especially regarding children's rights, in particular, their right to privacy. By examining the intrinsic relationship between children's rights, privacy and data protection, this research aims to contribute to the debate on ensuring children's privacy and security in the digital environment

Retinal capillary nonperfusion in preclinical diabetic retinopathy

The aim of the study was to identify retinal microvascular changes using optical coherence tomography angiography (OCTA) in type 2 diabetes (T2D) patients with preclinical retinopathy identified by ultra-widefield fundus photography (UWF-FP). This is a cross-sectional observational study. All patients underwent UWF-FP 200° examinations with OPTOS California (Optos, Dunfermline, UK) and Cirrus AngioPlex® spectral-domain (SD)-OCTA 3 × 3 mm acquisitions (ZEISS, Dublin, CA, USA). The absence of visible lesions was identified using UWF-FP. One hundred and ninety three eyes of individuals with T2D with no visible lesions in the fundus and identified in a screening setting were included in the study. Skeletonized vessel density (SVD), perfusion density (PD), and areas of capillary nonperfusion (CNP) values on SD-OCTA were significantly decreased when compared with healthy population (p < 0.001). SVD and CNP values of the superficial capillary plexus (SCP) were more frequently decreased (35% and 45%, respectively) than SVD values of the deep capillary plexus (DCP) (9% and 15%, respectively), demonstrating that diabetic microvascular changes occur earlier in the SCP than in the DCP. The ischemic phenotype, identified by a definite decrease in SVD or CNP in the SCP may, therefore, be identified in the preclinical stage of diabetic retinal disease. Retinal capillary nonperfusion detected by OCTA metrics of SVD and CNP can be identified in the central retina in eyes with T2D before development of visible lesions in the retina. Our findings confirm the relevance of OCTA to identify macular microvascular changes in the initial stages of diabetic retinopathy, allowing the identification of its ischemic phenotype very early in the disease process.info:eu-repo/semantics/publishedVersio

EAIR 41st Annual Forum in Leiden, The Netherlands 25 till 28 August 2019

Trabalho apresentado em EAIR 41st Annual Forum, 25-28 agosto 2019, Leiden, Países Baixos.Polytechnic Institutes in Portugal: research on the impact of twelve institutes on the local economy Higher Education Institutions are recognized as important actors in regional development. The Portuguese higher education system comprises both Universities and Polytechnic Institutes, which face an increasing pressure to demonstrate that their presence has an impact on the surrounding communities contributing to their economic development. This paper presents the estimation of the economic impact of twelve Polytechnic Institutes, located in quite diverse regions, based on a shared model so that comparisons have a collective framework of analysis. The main results obtained show that the economic impact ranged from 1.8% to 10.6% of the local GDP and that these Institutes are major local employers.info:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials