Theoretical pluralism in psychoanalytic case studies

The aim of this study is to provide an overview of the scientific activity of different psychoanalytic schools of thought in terms of the content and production of case studies published on ISI Web of Knowledge. Between March 2013 and November 2013, we contacted all case study authors included in the online archive of psychoanalytic and psychodynamic case studies (www.singlecasearchive.com) to inquire about their psychoanalytic orientation during their work with the patient. The response rate for this study was 45%. It appears that the two oldest psychoanalytic schools, Object-relations psychoanalysis and Ego psychology or “Classical psychoanalysis” dominate the literature of published case studies. However, most authors stated that they feel attached to two or more psychoanalytic schools of thought. This confirms that the theoretical pluralism in psychoanalysis stretches to the field of single case studies. The single case studies of each psychoanalytic school are described separately in terms of methodology, patient, therapist, or treatment features. We conclude that published case studies features are fairly similar across different psychoanalytic schools. The results of this study are not representative of all psychoanalytic schools, as some do not publish their work in ISI ranked journals

Lack of evidence does not justify neglect. how can we address unmet medical needs in calciphylaxis

Calcific uraemic arteriolopathy (CUA), or calciphylaxis, is a rare disease predominantly occurring in comorbidity with dialysis. Due to the very low frequency of CUA, prospective studies on its management are lacking and even anecdotal reports on treatment remain scarce. Therefore, calciphylaxis is still a challenging disease with dismal prognosis urgently requiring adequate strategies for diagnosis and treatment.In an attempt to fill some of the current gaps in evidence on various, highly debated and controversial aspects of dialysis-associated calciphylaxis, 13 international experts joined the 1st Consensus Conference on CUA, held in Leuven, Belgium on 21 September 2015. The conference was supported by the European Calciphylaxis Network (EuCalNet), which is a task force of the ERA-EDTA scientific working group on Chronic Kidney Disease-Mineral and Bone Disorders (CKD-MBD). After an intense discussion, a 9-point Likert scale questionnaire regarding 20 items on calciphylaxis was anonymously answered by each participant. These 20 items addressed unsolved issues in terms of diagnosis and management of calciphylaxis. On the one hand, the analysis of the expert opinions identified areas of general consensus, which might be a valuable aid for physicians treating such a disease with less experience in the field. On the other hand, some topics such as the pertinence of skin biopsy and administration of certain treatments revealed divergent opinions. The aim of the present summary report is to provide some guidance for clinicians who face patients with calciphylaxis in the current setting of absence of evidence-based medicin

Translocations of threatened plants in the Mediterranean Basin: current status and future directions

The Mediterranean Basin is one of the World's plant diversity hotspots and a region prone to several anthropic pressures, besides being one of the World's areas most susceptible to climate change. In this region, which hosts a high percentage of threatened species, there has been a large increase in practical conservation actions to prevent the extinction of many plants or improve their conservation status. In this framework, plant translocations have become increasingly important. To obtain a picture of the status and to depict possible directions, data on plant translocations was collected through the available databases, national experts, and the grey literature available online. Overall, a list of 836 translocations relating to 572 plant species was found. These actions are mainly concentrated in Spain, France, and Italy (c. 87%) and, except for some pioneering actions, translocations have strongly increased starting from 2010. A subsequent in-depth bibliographic search of the scientific databases was conducted to determine how much information about plant translocations was documented in the scientific literature. This search resulted in a list of 133 peer-reviewed papers, of which only 17 describing one or more translocations and, as a whole, reporting 101 experiences carried out on 56 plant species. Our research highlighted a great discrepancy between the scarce scientific documentation in comparison to the large number of practical conservation actions carried out. The great experience gained in these translocations constitutes an enormous heritage potentially available to implement the necessary conservation actions to preserve the plant diversity of the Mediterranean Basin

Trends in social and demographic inequalities in the prevalence of chronic diseases in Brazil. PNAD: 2003-2008.

The aims of this study are: to evaluate the prevalence of chronic diseases in the Brazilian population comparing data of 2008 with those of 2003; to estimate the impact of chronic conditions on the use of health services and on the restriction of daily activities and to measure the differentials in the prevalence of specific diseases according to educational strata and the affiliation to a private health plan. Data were obtained from PNAD 2008 and 2003. The analysis included estimations of crude and adjusted prevalence ratios, using svy commands from Stata 11 software. The prevalence of at least one disease was higher in: the elderly, women, low schooling level, black or indigenous people, urban residents, migrants and people living in the south region of Brazil. The most frequent diseases were: hypertension, back and spinal cord disorders, arthritis and depression. Between 2003 and 2008, an increase in the prevalence of diabetes, hypertension, cancer and cirrhosis was observed, and there was a reduction in chronic kidney failure and tuberculosis. All the diseases analyzed, with the exception of cancer and tendinitis/tenossinovitis, revealed a higher prevalence in low educational level strata. The greatest social inequalities were in chronic kidney failure, cirrhosis, tuberculosis and arthritis/rheumatism.1693755376

Nutritional interventions for the treatment of frailty in older adults: a systematic review protocol

Background: Frailty has been defined as a clinical syndrome of multicausal origin characterized by a reduction of physiologic reserves that increase the vulnerability of an individual to adverse outcomes such as the development of functional dependence and death. Considered one of the most important geriatric syndromes, frailty’s prevention and management represent important goals for gerontology and geriatrics. Although nutrition plays an important role within the multifactorial susceptibility for this syndrome, up to the present no systematic review specifically addressed the effectiveness of nutritional interventions for the treatment of frailty. Therefore, we propose the present systematic review with the aim to assess the effectiveness of nutritional interventions for the treatment of frailty in older adults living in the community or in long-term care facilities. Methods:We will search Medline (via Pubmed), Embase, Cinahl, Central, Lilacs, Web of Science, and sources of gray literature. We will accept trials whereby the unit of randomization consisted of individuals or clusters of individuals. Our primary outcome is all-cause mortality. Secondary outcomes are quality of life, functional status, cognitive function, frailty status, body composition, and physical activity. Risk of bias will be assessed using the Cochrane Collaboration tool. We will analyze the overall strength of the evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Two independent researchers will conduct all evaluations and any disagreements will be resolved through the participation of a 3rd author. If possible, we will perform random-effects meta-analyses and subgroup analyses concerning specific details of nutritional interventions (e.g., components and duration), research scenario, risk of bias, and criteria used to diagnose frailty. Conclusion: In this systematic review protocol we outline the details of the aims and methods of a systematic review on the effectiveness of nutritional interventions for the management of frailty in older adults living in the community or in long-term care facilities”. We believe this wording to be more objective and balanced than the previous one. We understand that it is not ideal to propose changes to the text after manuscripts have been accepted. However, we feel that the new wording of the conclusion section of the abstract is more consistent with the overall content of the main text of the review than its previous version. Hence, we hope you may accept our request

Os serviços ecossistêmicos dos recursos hídricos da Bacia Amazônica como Bens Públicos Globais

This article analyzes the ecosystem services of water resources in the Amazon basin (water supply, waste processing, climate regulation, nutrient cycle) according to the theoretical scope of global public goods, identifying the spatial extent of ecosystem benefits and their beneficiaries. Four groups of beneficiaries were found: Brazil's trading partner countries that use the mouth of the Amazon River, the South American countries that receive moisture from the Amazon basin through “aerial rivers”; the Atlantic Ocean due to the contributions of sediments and organic matter from the “Amazon Plume” and the countries that integrate the Amazon basin that use water resources for direct consumption or to produce goods and services. Due to spatial dimension of benefits from ecosystem services studied, the Amazon Basin, must be understood as Global Natural Common.Este articulo analiza los servicios ecosistémicos de los recursos hídricos de la cuenca Amazónica (provisión de agua, procesamiento de residuos, regulación del clima, ciclo de nutrientes) conforme el alcance teórico de bienes públicos globales, identificando la extensión espacial de los beneficios ecosistémicos y sus beneficiarios. Cuatro grupos de beneficiarios fueron identificados: Los países socios comerciales de Brasil que usan la desembocadura del rio Amazonas, los países de Suramérica que reciben humedad de los “ríos aéreos” provenientes de la cuenca Amazónica; el Océano Atlántico debido a las contribuciones de sedimentos y materia orgánica de la “Pluma Amazónica”, y los países que integran la cuenca Amazónica que usan los recursos hídricos para consumo directo o para producir bienes y servicios. Debido a la extensión espacial de los beneficios de los servicios ecosistémicos estudiados, la Cuenca Amazónica debe ser entendida como un Global Natural Common.Cet article analise les services écosystémiques des ressources hydriques du bassin amazonien (approvisionnement d'eau, traitement de déchets, régulation du climat, cycle des nutriments). Ceci en accord avec l'approche théorique de biens publics à l'échelle mondiale et identifiant l'extension spatiale des bénéfices écosystémiques ainsi que ses bénéficiaires. Il existe quatre groupes de bénéficiaires identifiés: les pays en partenariat commercial avec le Brésil qui se servent de l'embouchure du fleuve Amazone ; les pays de l'Amérique du Sud qui reçoivent de l'humidité du bassin amazonien à travers ses “rivières volantes”; l'océan Atlantique, dû aux sédiments et matières organiques apportés par l'Amazonie ; et les pays intégrant le bassin amazonique, qui utilisent les ressources hydriques pour leur consommation directe ou encore pour produire de biens et de services. En raison de l'extension spatiale des bénéfices des services écosystémiques nommés ci-dessus, le bassin amazonique doit être considéré comme faisant partie Global Natural Common.Il presente articolo analizza i servizi ecosistemici delle risorse idriche del bacino amazzonico (approvvigionamento d’acqua, trattamento dei rifiuti, regolazione del clima, ciclo dei nutrienti) secondo la teoria dei beni comuni mondiali. Si identifica anche l’estensione spaziale dei benefici ecosistemici e i loro beneficiari. Quattro gruppi di beneficiari sono stati identificati: i paesi “partner commerciali” del Brasile che si servono della foce del Rio delle Amazzoni; i paesi dell’America del Sud che ricevono l’umidità del bacino amazzonico attraverso i fiumi volanti; l’oceano Atlantico (grazie ai contributi di sedimenti e di materia organica dell’Amazzonia); e finalmente i paesi membri del bacino amazzonico che utilizzano le sue risorse idriche sia per il loro consumo diretto sia per produrre beni e servizi. A causa della sua estensione spaziale e dei benefici ecosistemici studiati, il bacino amazzonico dovrebbe essere considerato come parte delle Global Natural Common.Neste artigo analisa-se os serviços ecossistêmicos dos recursos hídricos da Bacia Amazônica (provisão de água, processamento de resíduos, regulação de clima e ciclo de nutrientes), conforme o escopo teórico de bens públicos globais, identificando a extensão espacial dos benefícios ecossistêmicos e seus beneficiários. Quatro grupos de beneficiários foram encontrados: os países parceiros comerciais do Brasil que usam a desembocadura do rio Amazonas; os países da América do Sul que recebem umidade da Bacia Amazônica através dos “rios aéreos”; o oceano Atlântico, devido às contribuições de sedimentos e matéria orgânica da “Pluma Amazônica”; e os países que integram a Bacia Amazônica que usam os recursos hídricos para consumo direto ou para produzir bens e serviços. Devido à extensão espacial dos benefícios dos serviços ecossistêmicos estudados, a Bacia Amazônica deve ser entendida como um Global Natural Common

Prevalence of chronic obstructive pulmonary disease and risk factors in Sao Paulo, Brazil, 2008-2009

OBJECTIVE: To assess the prevalence of chronic obstructive pulmonary disease and related risk factors. METHODS:A population-based cross-sectional study with 1,441 individuals of both sexes aged 40 years or more was conducted in the city of Sao Paulo, Brazil, between 2008 and 2009. A two-stage (census tract, household) cluster random sampling stratified by sex and age was used and data was collected through home interviews. Multiple Poisson regression was used in the adjusted analysis. RESULTS: Of all respondents, 4.2% (95%CI: 3.1;5.4) reported chronic obstructive pulmonary disease. After adjustment the following factors were found independently associated with self-reported chronic obstructive pulmonary disease: number of cigarettes smoked in their lifetime (>1,500 vs. none) (PR=3.85; 95%CI: 1.87;7.94); easily fatigued (yes vs. no) (PR=2.61; 95%CI: 1.39;4.90); age (60;69 vs. 50;59) (PR 3.27; 95%CI: 1.01;11.24); age (70 and over vs. 50;59) (PR 4.29; 95%CI: 1.30;11.29); health conditions in the last 15 days (yes vs. no) (PR=1.31; 95%CI: 1.02;1.77); leisure-time physical activity (yes vs. no) (PR-0.57; 95%CI: 0.26;0.97). CONCLUSIONS: The prevalence of chronic obstructive pulmonary disease is high in the population studied and is associated with smoking and age over 60. Frequent health conditions and low leisure-time physical activity are a consequence of the disease.45588789

Bone biopsy practice patterns across Europe: the European renal osteodystrophy initiative - a position paper

Renal osteodystrophy (ROD) is a heterogeneous group of metabolic bone diseases complicating progressive chronic kidney disease (CKD). Bone biomarkers and bone imaging techniques may help to assess bone health and predict fractures in CKD but do have important inherent limitations. By informing on bone turnover and mineralization, a bone biopsy may help to guide prevention and treatment of ROD and its consequences. According to a recent survey conducted among European nephrologists, bone biopsies are performed rather exceptionally, both for clinical and research purposes. Obviously, clinical research in the field of ROD is threatened by vanishing clinical and pathological expertise, small patient cohorts and scientific isolation. In March 2016, the European Renal Osteodystrophy (EU-ROD) initiative was created under the umbrella of the ERA-EDTA CKD-mineral and bone disorder (MBD) Working Group to revitalize bone biopsy as a clinically useful tool in the diagnostic workup of CKD-MBD and to foster research on the epidemiology, implications and reversibility of ROD. As such, the EU-ROD initiative aims to increase the understanding of ROD and ultimately to improve outcomes in CKD patients

Private finance for the delivery of school projects in England

This paper analyses the use of the private finance initiative (PFI) approach to deliver school projects in England. The findings are based on case-study research in the Building Schools for the Future scheme (BSF), the largest single capital investment in SO years to rebuild and renew all of England's secondary schools. Up to half of the school infrastructure is to be procured by PFI contracts. A major concern has been the high cost associated with PFI procurement and any subsequent changes to scope. Furthermore, in some cases PFI-funded schools have been closed soon after completion; at great cost to the public sector. The aim of this research was therefore to understand the underlying reasons for these problems. The main conclusion is that the difficulties in BSF arise from not sorting out strategic issues and instituting appropriate organisational frameworks before engaging the private sector. The result of this is a lack of clarity about the long-term needs and end user aspirations. A brief outline of current programme management methods is given and it is suggested that this might be integral to the successful delivery of schools using private finance. A clear strategic vision that cascades into projects via programmes will ensure that the school infrastructure is appropriate for the anticipated strategic benefits and is aligned to the overall service delivery ambitions

Baseline Characteristics And Risk Factors For Ulcer, Amputation And Severe Neuropathy In Diabetic Foot At Risk: The Brazupa Study

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Studies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation. Methods: This study presents cross sectional, baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications. Results: Patients with ulcer had longer disease duration (17.2 +/- 9.9 vs. 13.2 +/- 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 +/- 2.03 vs. 8.35 +/- 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2-3.7), smoking (OR 1.78; 95 % CI 1.09-2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31-44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47-3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08-2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65-13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2-3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01-11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43-112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14-0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1-4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67-19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64-7.33). There was no association between either outcome and ethnicity. Conclusions: Ulcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population.8National Institutes for Science and Research (INCT)-Diabetes and ObesityNational Center for Science and Technology Development (CNPq)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq