Estruturação de uma rede social de combate à pobreza, baseada em SIG e análise espacial, em contexto urbano. O caso da freguesida de Nossa Senhora de Fátima

Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Gestão do Território especialização em Detecção Remota e Sistemas de Informação GeográficaA presente dissertação pretende apresentar e discutir um conjunto de novas metodologias, baseadas nos Sistemas de Informação Geográfica (SIG), de estruturação de redes locais de apoio à população mais carenciada. Nos dias de hoje são inegáveis, no contexto das sociedades urbanas, os profundos problemas sociais e económicos vividos pelas populações de menores recursos. Por outro lado, os programas de ajustamento estrutural levados a cabo pelos governos irão, muito provavelmente, agravar as dificuldades já hoje sentidas por todos aqueles que se posicionam nas franjas do sistema social. Perante um quadro de enormes restrições e problemas, urge procurar novas respostas para melhorar o quadro de vida dos mais pobres. O desafio de partida é apresentar um conjunto de novas metodologias, tendo por base os SIG e tomando como referência espacial a freguesia de Nossa Senhora de Fátima (Lisboa), que poderão ser uma mais-valia e uma ferramenta importante para desenvolver redes de apoio social e assim procurar novas respostas para melhorar o quadro de vida dos mais pobres. Entre os elementos inovadores destacam-se a visualização do problema da pobreza através de mapas gerados em SIG, sendo uma forma mais perceptível de explicar o problema e assim apelar envolvimento e participação das instituições já existentes no território, combinando o tecido empresarial, as associações privadas que prestam auxílio aos mais carenciados e unidades prestadoras de serviços públicos, como as Universidades e Hospitais. Desta forma, espera-se criar um estudo sobre o Risco de Pobreza na freguesia de Nossa Senhora de Fátima o qual transmitirá o risco de pobreza por quarteirão na freguesia e que este seja uma mais-valia para a estruturação de uma possível rede de apoio ao combate da pobreza e exclusão social na freguesia em estudo

Human immunodeficiency virus infection may be a contributing factor to monkeypox infection: Analysis of a 42-case series

Research letter to the Editor.To the Editor: An outbreak of monkeypox has emerged, and more than 13,000 cases have already been confirmed worldwide. In our department, we have 42 confirmed cases so far. All of them are cisgender males presenting with lesions in the genital, perianal, or perioral areas (Fig 1). Interestingly, we observe a disproportionate number of individuals living with the human immunodeficiency virus (HIV). Below, we present a retrospective analysis of our confirmed cases with their clinical and epidemiological characteristics (Table I). Differences between groups were analyzed using the Mann–Whitney U test and the t-test for discrete variables according to distribution. Independence between categorical variables was assessed with Fisher's exact test. All tests were performed for a confidence level of 95% in SPSS 22 (IBM Statistics) [...].info:eu-repo/semantics/publishedVersio

ATLAS OTALEX C

Extremadura, in Spain, and Alentejo and Centro, in Portugal, are tree regions belonging to different countries but with several common interests. They are continuous border areas that share similar ecological, socioeconomic and environmental characteristics. The cooperation between these territories which promotes the collaboration and exchange of information between both sides of the Spanish-Portuguese frontier, has important references in several crossborder projects, such as: COORDSIG “Coordination of Geographical Information Systems and Instruments of Territorial Observation in Low Density Rural Areas”, co-financed by EFRD, program Interreg II C, developed between 1997 and 2001; PLANEXAL “Territorial Recognition for the approach of common urban-territorial management and planning strategies in Extremadura and Alentejo”, co-financed by Interreg III A Spain Portugal Program, between 2003 and 2005; GEOALEX “Geographical model for environmental and territorial management of rural low density areas”, co-financed by Interreg III A (Sub-program Alentejo-Extremadura) from 2004 to 2006; OTALEX “Territorial Observatory Alentejo Extremadura”, co-financed by Interreg III A Spain-Portugal Program, developed from 2006 to 2009; and OTALEX II “Territorial and Environmental Observatory Alentejo Extremadura”, co-financed also by Interreg III A Spain-Portugal Program and developed between 2008 and 2011. Starting in 2009 as the ongoing project of OTALEX II, OTALEX C “Territorial and Environmental Observatory Alentejo Extremadura Centro”, co-financed by the Cross Border Cooperation Operational Program of Spain-Portugal 2007-2013 (POCTEP), has as main purpose the creation of a management and environmental monitoring system thought the SDI – IDE OTALEX (Spatial data infrastructure of the Territorial and Environmental Observatory Alentejo-Extremadura-Centro - www.ideotalex.eu) as an information and institutional sharing platform between Alentejo-Extremadura-Centro administrations. The project is integrated by different spanish and portuguese entities that belong to three levels of administration. At national level the spanish Nacional Centro of Geographical Information / Nacional Geographical Institute (CNIG-IGN) and portuguese General Territory Direction (DGT); at the regional level, the General Direction for Transports, Territorial Management and Urbanism (Consejería of Fomento, Vivienda, Territorial Management and Tourism – Government of Extremadura) and Coordination and Regional Development Commission of Alentejo (CCDR-A); at local level, Intermunicipal Community of Central Alentejo (CIMAC), Intermunicipal Community of Alto Alentejo (CIMAA), O. A. Equality and Local Development Area (Diputación of Badajoz) and Diputación of Cáceres; in the high education, the University of Extremadura, the University of Évora and the Polytechnic Institute of Castelo Branco; and as public enterprise, the Enterprise of Development and Infra-structures of Alqueva Dam, S.A. (EDIA). The publication of this crossborder atlas of Alentejo-Extremadura-Centro regions, the ATLAS OTALEX C, integrates the results of an extensive series of crossborder projects overcoming the fruitful cohesion of territories in the defence of their common interests. The present publication collects and synthetizes the harmonization effort made in bringing in common the information of the distinct partners of OTALEX C project, and aims to contribute in an effective way to the sustainable development of these crossborder regions through the definition of common strategies and of the implementation of crossborder of territorial and environmental observation instruments

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19

BackgroundWe previously reported that impaired type I IFN activity, due to inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity or to autoantibodies against type I IFN, account for 15-20% of cases of life-threatening COVID-19 in unvaccinated patients. Therefore, the determinants of life-threatening COVID-19 remain to be identified in similar to 80% of cases.MethodsWe report here a genome-wide rare variant burden association analysis in 3269 unvaccinated patients with life-threatening COVID-19, and 1373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. Among the 928 patients tested for autoantibodies against type I IFN, a quarter (234) were positive and were excluded.ResultsNo gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7, with an OR of 27.68 (95%CI 1.5-528.7, P=1.1x10(-4)) for biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR=3.70[95%CI 1.3-8.2], P=2.1x10(-4)). This enrichment was further strengthened by (1) adding the recently reported TYK2 and TLR7 COVID-19 loci, particularly under a recessive model (OR=19.65[95%CI 2.1-2635.4], P=3.4x10(-3)), and (2) considering as pLOF branchpoint variants with potentially strong impacts on splicing among the 15 loci (OR=4.40[9%CI 2.3-8.4], P=7.7x10(-8)). Finally, the patients with pLOF/bLOF variants at these 15 loci were significantly younger (mean age [SD]=43.3 [20.3] years) than the other patients (56.0 [17.3] years; P=1.68x10(-5)).ConclusionsRare variants of TLR3- and TLR7-dependent type I IFN immunity genes can underlie life-threatening COVID-19, particularly with recessive inheritance, in patients under 60 years old