A influência do ambiente urbano na geracao de viagens: análise de pesquisa realizada em niteroi, RJ / The influence of the urban environment on travel generation: analysis of research conducted in niteroi, RJ

Este artigo tem por objetivo analisar a influência de fatores relacionados ao ambiente urbano sobre a geração de viagens, a partir de pesquisa realizada no município de Niterói que definiu as taxas de geração de viagens e a distribuição modal para o uso residencial em diferentes regiões da cidade. A análise revela que fatores relacionados ao ambiente urbano, como a densidade, a tipologia das edificações, o uso do solo, o desenho urbano e a acessibilidade ao sistema de transportes têm grande influência na geração e na distribuição modal das viagens. Com base nesses fatores, são definidos e comparados dois modelos de ocupação urbana: O Sprawl, característico da área de expansão urbana, com tipologia horizontal e baixa densidade, e o Transit Oriented Development - TOD, característico da área de ocupação mais antiga, de tipologia vertical e alta densidade. A análise mostra que o modelo do tipo Sprawl apresenta taxas de geração de viagens motorizadas muito superiores ao modelo do tipo TOD

Certificações, padrões e códigos: instrumentos voluntários para análise de projetos urbanos sustentáveis, um balanço dos critérios do casbee no contexto brasileiro / Certifications, standards and codes: voluntary instruments for the analysis of sustainable urban projects, a balance of the casbee criteria in the brazilian context

Muito tem sido estudado no que diz respeito ao desempenho, eficiência e eficácia do ambiente construído. No entanto, a maioria desses estudos têm levado em consideração a avaliação de desempenho da edificação, sem abordar ou abordando de maneira insuficiente, o contexto urbano na qual está inserida: a vizinhança, o bairro, a cidade. Como causa e consequência dessa situação, muitas das políticas de promoção do ambiente construído são direcionadas unicamente à edificação, enquanto projetos de maior escala ficam a mercê de poucos indicadores, dificultando o trabalho de avaliação dos órgãos financiadores. No entanto, pode-se afirmar que, assim como vem acontecendo nos países centrais há quase três décadas, também no Brasil, mais recentemente, têm aumentado a quantidade de estudos relativos à construção de critérios e indicadores para avaliação da cidade. Muitos desses estudos vem sendo tratados dentro da temática da sustentabilidade urbana. Esses critérios têm sido definidos pelas várias instituições que desenvolvem métodos de avaliação ambiental, algumas das quais conferindo certificação ao empreendimento. Este artigo tem por objetivo analisar um desses métodos, o método CASBEE – Comprehensive Assessment System for Building Environmental Efficiency, administrado pelo IBEC – Institute for Building Environment and Energy Conservation, com sede no Japão, o único, até o momento, que avalia a escala da cidade ao invés da escala da vizinhança/bairro. Como resultado, este trabalho apresenta os ajustes que devem ser feitos em alguns critérios do método em questão, de modo que o mesmo possa ser utilizado em contexto brasileiro. Este estudo espera contribuir para a construção de critérios que auxiliem o poder público, os profissionais do setor do ambiente construído e os órgãos financiadores a promover, conceber, financiar e produzir projetos urbanos mais sustentáveis

Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience

Abstract In idiopathic thrombocytopenic purpura (ITP), corticosteroids have been widely recognized as the most appropriate first-line treatment, even if the best therapeutic approach is still a matter of debate. Recently, a single high-dose dexamethasone (HD-DXM) course was administered as first-line therapy in adult patients with ITP. In this paper we show the results of 2 prospective pilot studies (monocentric and multicentric, respectively) concerning the use of repeated pulses of HD-DXM in untreated ITP patients. In the monocenter study, 37 patients with severe ITP, age at least 20 years and no more than 65 years, were enrolled. HD-DXM was given in 4-day pulses every 28 days, for 6 cycles. Response rate was 89.2%; relapse-free survival (RFS) was 90% at 15 months; long-term responses, lasting for a median time of 26 months (range 6-77 months) were 25 of 37 (67.6%). In the multicenter study, 95 patients with severe ITP, age at least 2 years and no more than 70 years, were enrolled. HD-DXM was given in 4-day pulses every 14 days, for 4 cycles; 90 patients completed 4 cycles. Response rate (85.6%) was similar in patients classified by age (< 18 years, 36 of 42 = 85.7%; ≥ 18 years, 41 of 48 = 85.4%, P = not significant), with a statistically significant difference between the second and third cycle (75.8% vs 89%, P = .018). RFS at 15 months 81%; long-term responses, lasting for a median time of 8 months (range 4-24 months) were 67 of 90 (74.4%). In both studies, therapy was well tolerated. A schedule of 3 cycles of HD-DXM pulses will be compared with standard prednisone therapy (eg, 1 mg/kg per day) in the next randomized Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA) trial

Métodos de avaliação ambiental e experiências construídas: uma revisão da teoria e prática sobre sustentabilidade urbana / Environmental assessment methods and built experiences: a review of the theory and practice on urban sustainability

Ao mesmo tempo em que os estudos sobre desenvolvimento sustentável se tornam cada vez mais presentes no âmbito da construção civil e da arquitetura brasileiras, presencia-se o surgimento de empreendimentos habitacionais de grandes dimensões que apresentam características muito distantes do que se conceitua por sustentabilidade no meio urbano. Essa realidade ocorre principalmente em empreendimentos destinados à população de baixa renda que, apesar de contribuírem para a diminuição do déficit habitacional brasileiro, pouco têm ajudado no surgimento de uma cidade mais bela e eficiente, socialmente mais inclusiva, menos consumidora de recursos naturais e com menor impacto no ambiente natural. Este artigo tem por objetivo apresentar uma revisão bibliográfica dos conceitos de sustentabilidade urbana e dos critérios presentes nos métodos de avaliação ambiental mais utilizados atualmente na escala urbana no Brasil e no exterior, com destaque na literatura e na prática profissional na França, por seu avanço em termos de certificação para edificações sustentáveis e por apresentar referências mais acessíveis à área de pesquisa dos autores deste artigo. Espera-se, a partir dos dados levantados no âmbito desta pesquisa, obter um entendimento mais claro a respeito do conceito e dos critérios de sustentabilidade urbana, na teoria e na prática, e identificar elementos que serão utilizados para a futura elaboração de um modelo de referência para a análise da sustentabilidade urbana em escala de bairro. 

The Impact of the COVID-19 Pandemic on Women's Perinatal Mental Health: Preliminary Data on the Risk of Perinatal Depression/Anxiety from a National Survey in Italy

Increasing evidence suggests that during the COVID-19 pandemic, anxiety and depression during the perinatal period increased. The aim of the study is to estimate the prevalence of risk for both maternal depression and anxiety among women attending 18 healthcare centres in Italy during the SARS-COV-2 pandemic and to investigate the psychosocial risks and protective factors associated. It was divided into a retrospective phase (2019, 2020, and the first nine months of 2021) and a prospective phase (which began in November 2021 and it is still ongoing), which screened 12,479 and 2349 women, respectively, for a total of 14,828 women in the perinatal period. To evaluate the risk of anxiety and depression, the General Anxiety Disorder-7 (GAD-7), the Edinburgh Postnatal Depression Scale (EPDS), and an ad hoc form were used to collect sociodemographic variables. In the prospective study, the average age of the women is 31 (range 18-52) years. Results showed that the percentage of women who had EPDS score ≥9 increased from 11.6% in 2019 to 25.5% in the period ranging from November 2021 to April 2022. In logistic regression models, the variables associated with the risk of depression at a level ≤0.01 include having economic problems (OR 2.16) and not being able to rely on support from relatives or friends (OR 2.36). Having the professional status of the housewife is a lower risk (OR 0.52). Those associated with the risk of anxiety include being Italian (OR 2.97), having an education below secondary school level (OR 0.47), having some or many economic problems (OR 2.87), being unable to rely on support from relatives or friends (OR 2.48), and not having attended an antenatal course (OR 1.41). The data from this survey could be useful to determine the impact of the SARS-COV-2 pandemic on women and to establish a screening program with common and uniformly applied criteria which are consistent with national and international women's mental health programs

Prednisone vs high-dose dexamethasone in newly diagnosed adult primary immune thrombocytopenia: a randomized trial

A debate exists regarding which type of corticosteroids (standard-dose prednisone [PDN] or high-dose dexamethasone [HD-DXM]) is the best first-line treatment for adult patients with newly diagnosed untreated primary immune thrombocytopenia (pITP). An ad hoc study compared PDN with HD-DXM in newly diagnosed untreated patients with pITP (aged &gt;= 18 but &lt;= 80 years, platelet count of &lt;= 20 or &gt;20 but &lt;50 x 10(9)/L, and bleeding score of &gt;= 8). Patients were randomised to receive PDN 1 mg/kg per day from days 0 to 28 (Arm A) or HD-DXM 40 mg per day for 4 days, every 14 days, for 3 consecutive courses (Arm B). Fifty-nine of 113 patients (52.2%) were randomized to Arm A and 54 of 113 (47.8%) to Arm B. In evaluable patients, total initial responses (complete response [CR], partial response [PR], minimal response [MR]) were 44 of 56 (78.57%) in Arm A and 46 of 49 (93.88%) in Arm B at days 42 and 46, respectively (P = 0.0284). Total final responses (at day 180 from initial response) were 26 of 43 (60.47%) in Arm A and 23 of 39 (58.97%) in Arm B (P = 0.8907). Total persistent responses (at 12 months from initial response) were 25 of 31 (80.65%) in Arm A and 20 of 36 (55.56%) in Arm B (P = 0.0292). Seven relapses occurred. Median follow-up was 44.4 months. Overall survival was 100% at 48 months, overall disease-free survival was 81.11% at 48 months from day 180. PDN and pulsed HD-DXM were well tolerated; HD-DXM allows effective initial responses but less long lasting than PDN. This trial was registered at www.clinicaltrials.gov as #NCT00657410

Therapeutic DNA vaccination of vertically HIV-infected children: Report of the first pediatric randomised trial (PEDVAC)

Subjects: Twenty vertically HIV-infected children, 6–16 years of age, with stable viral load control and CD4+ values above 400 cells/mm³. Intervention: Ten subjects continued their ongoing antiretroviral treatment (ART, Group A) and 10 were immunized with a HIV-DNA vaccine in addition to their previous therapy (ART and vaccine, Group B). The genetic vaccine represented HIV-1 subtypes A, B and C, encoded Env, Rev, Gag and RT and had no additional adjuvant. Immunizations took place at weeks 0, 4 and 12, with a boosting dose at week 36. Monitoring was performed until week 60 and extended to week 96. Results: Safety data showed good tolerance of the vaccine. Adherence to ART remained high and persistent during the study and did not differ significantly between controls and vaccinees. Neither group experienced either virological failure or a decline of CD4+ counts from baseline. Higher HIV-specific cellular immune responses were noted transiently to Gag but not to other components of the vaccine. Lymphoproliferative responses to a virion antigen HIV-1 MN were higher in the vaccinees than in the controls (p = 0.047), whereas differences in reactivity to clade-specific Gag p24, RT or Env did not reach significance. Compared to baseline, the percentage of HIV-specific CD8+ lymphocytes releasing perforin in the Group B was higher after the vaccination schedule had been completed (p = 0.031). No increased CD8+ perforin levels were observed in control Group A. Conclusions: The present study demonstrates the feasibility, safety and moderate immunogenicity of genetic vaccination in vertically HIV-infected children, paving the way for amplified immunotherapeutic approaches in the pediatric population. Trial registration: clinicaltrialsregister.eu 2007-002359-18; 2007-002359-18/I

Sudden Unexpected Deaths and Vaccinations during the First Two Years of Life in Italy: A Case Series Study

Background The signal of an association between vaccination in the second year of life with a hexavalent vaccine and sudden unexpected deaths (SUD) in the two days following vaccination was reported in Germany in 2003. A study to establish whether the immunisation with hexavalent vaccines increased the short term risk of SUD in infants was conducted in Italy. Methodology/Principal Findings The reference population comprises around 3 million infants vaccinated in Italy in the study period 1999–2004 (1.5 million received hexavalent vaccines). Events of SUD in infants aged 1–23 months were identified through the death certificates. Vaccination history was retrieved from immunisation registries. Association between immunisation and death was assessed adopting a case series design focusing on the risk periods 0–1, 0–7, and 0–14 days after immunisation. Among the 604 infants who died of SUD, 244 (40%) had received at least one vaccination. Four deaths occurred within two days from vaccination with the hexavalent vaccines (RR = 1.5; 95% CI 0.6 to 4.2). The RRs for the risk periods 0–7 and 0–14 were 2.0 (95% CI 1.2 to 3.5) and 1.5 (95% CI 0.9 to 2.4). The increased risk was limited to the first dose (RR = 2.2; 95% CI 1.1 to 4.4), whereas no increase was observed for the second and third doses combined. Conclusions The RRs of SUD for any vaccines and any risk periods, even when greater than 1, were almost an order of magnitude lower than the estimates in Germany. The limited increase in RRs found in Italy appears confined to the first dose and may be partly explained by a residual uncontrolled confounding effect of age

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations