Direito das crianças à convivência com familiares: Em especial, os avós

I | Relevância, noção e enquadramento jurídico. II | Direito comparado. i) Não consagração legislativa. ii) Consagração legislativa de alguns terceiros. iii) Consagração legislativa de alguns casos, completada com uma cláusula geral. iv) Consagração de uma cláusula geral. III | Evolução legislativa e estado da arte em Portugal. i) Titularidade. ii) Fundamento. iii) Finalidade. iv) Natureza Jurídica: a) direito dos avós. b) direito dos netos. v) Conteúdo. vi) Critério. IV | Conclusã

Diagnostic-driven antifungal therapy in neutropenic patients using the D-index and serial serum galactomannan testing

AbstractIntroductionInvasive mold disease is an important complication of patients with hematologic malignancies, and is associated with high mortality. A diagnostic-driven approach has been an alternative to the classical empiric antifungal therapy. In the present study we tested an algorithm that incorporated risk stratification using the D-index, serial serum galactomannan and computed tomographic-scan to guide the decision to start antifungal therapy in neutropenic patients.Patients and methodsBetween May 2010 and August 2012, patients with acute leukemia in induction remission were prospectively monitored from day 1 of chemotherapy until discharge or death with the D-index and galactomannan. Patients were stratified in low, intermediate and high risk according to the D-index and an extensive workup for invasive mold disease was performed in case of positive galactomannan (≥0.5), persistent fever, or the appearance of clinical manifestations suggestive of invasive mold disease.ResultsAmong 29 patients, 6 (21%), 11 (38%), and 12 (41%) were classified as high, intermediate, and low risk, respectively. Workup for invasive mold disease was undertaken in 67%, 73% and 58% (p=0.77) of patients in each risk category, respectively, and antifungal therapy was given to 67%, 54.5%, and 17% (p=0.07). Proven or probable invasive mold disease was diagnosed in 67%, 45.5%, and in none (p=0.007) of high, intermediate, and low risk patients, respectively. All patients survived.ConclusionA risk stratification using D-index was a useful instrument to be incorporated in invasive mold disease diagnostic approach, resulting in a more comprehensive antifungal treatment strategy, and to guide an earlier start of treatment in afebrile patients under very high risk

Validity and reliability of a shorter version of the Geriatric Depression Scale in institutionalized older Portuguese adults

Objectives: Depressive symptoms are common in older adults in institutional contexts; however, there is a lack of validated measures for these settings. Identifying depressive symptoms can help clinicians to manage them and to prevent or delay their complications. This study aimed to validate the Geriatric Depression Scale (GDS) in an institutionalized sample of older adults.Method: 493 institutionalized older people (73% women) aged 60 or over were evaluated through the GDS, the Mini International Neuropsychiatric Interview (MINI) (depression vs. no depression = 11% vs. 89%), the Geriatric Anxiety Inventory (GAI), the Positive Affect (PA) and Negative Affect (NA) Schedule, and the Satisfaction with Life Scale (SWLS). Test-retest reliability was assessed with 57 older adults.Results: An 8-item version presented a Cronbach's alpha value of .87 with a single factor explaining its variance. The correlations (p < .01) attested the concurrent validity (GAI: r = .76; PA: r = -.22; AN: r = .62; SWLS: r = -.32). Test-retest reliability (6.51 months) was adequate (r = .52). ROC analysis (AUC = .82; sensitivity = 80%; specificity = 77%) and Youden index revealed a cutoff of 5/6 for the diagnosis of depression.Conclusion: Results support the validity and the screening capacity of a short version of GDS in institutional contexts. Short screening instruments for depressive symptoms may facilitate their identification, allowing for timely clinical interventions in institutional settings

The assessment of public administration IT governance from the perspective of corporate governance principles

Este estudo se propôs a verificar a avaliação da governança de TI que é realizada nas empresas da administração pública pelo Tribunal de Contas da União (TCU), sob a ótica dos princípios da transparência, da equidade, da prestação de contas e da responsabilidade corporativa. Esses princípios são definidos pelo Instituto Brasileiro de Governança Corporativa (IBGC) para reger os códigos de governança corporativa das organizações. Sendo a governança de TI parte da governança corporativa, buscou-se obter uma medida comum a ambas. Para realizar a análise, o estudo utiliza a fundamentação teórica que subsidia os itens do levantamento identificados pelo TCU como itens que avaliam a governança de TI. Para cada fundamentação, de cada item do levantamento, é feita uma análise qualitativa, na busca da identificação de conceitos que os associe com um ou mais princípios da governança corporativa definidos pelo IBGC. Os dados utilizados são os do levantamento realizado em 2018 pelo TCU e que resultaram no Índice Geral de Governança (iGG) de 2018 e, como parte desse, o iGovTI. Como resultado, foi possível elaborar um mapeamento dos itens de avaliação de governança de TI que geraram o iGovTI de 2018, por princípios de governança corporativa. O estudo identificou haver poucos itens de verificação no levantamento relativos ao iGovTI que se relacionam aos princípios de governança corporativa; e assim, conclui que pouco se avalia a governança de tecnologia sob a ótica dos princípios da governança corporativa definidos pelo IBGC.Este estudio tuvo como objetivo verificar la evaluación de la gobernanza de TI que se realiza en las empresas de la administración pública por el Tribunal Federal de Cuentas (TCU), desde la perspectiva de los principios de transparencia, equidad, rendición de cuentas y responsabilidad corporativa. Estos principios son definidos por el Instituto Brasileño de Gobierno Corporativo (IBGC) para regir los códigos de gobierno corporativo de las organizaciones. Dado que el gobierno de TI es parte del gobierno corporativo, buscamos obtener una medida común para ambos. Para realizar el análisis, el estudio utiliza la base teórica que subsidia los ítems de la encuesta identificados por TCU como ítems que evalúan la gobernanza de TI. Para cada razonamiento, para cada ítem de la encuesta, se realiza un análisis cualitativo, buscando identificar conceptos que los asocien con uno o más principios de gobierno corporativo definidos por el IBGC. Los datos utilizados son los de la encuesta realizada en 2018 por TCU y que dio como resultado el Índice de Gobernanza General (iGG) 2018 y, como parte de este, iGovTI. Como resultado, fue posible elaborar un mapeo de los elementos de evaluación del gobierno de TI que generaron iGovTI en 2018, basado en los principios de gobierno corporativo. El estudio identificó que hay pocos elementos de verificación de la encuesta relacionados con iGovTI que estén relacionados con los principios de gobierno corporativo. Por tanto, concluye que poco se evalúa sobre la gobernanza tecnológica desde la perspectiva de los principios de gobernanza corporativa definidos por la IBGC.This study aimed to verify the assessment of IT governance that is carried out in public administration companies by the Federal Court of Accounts (TCU) from the perspective of the principles of transparency, equity, accountability and corporate responsibility. These principles are defined by the Brazilian Institute of Corporate Governance (IBGC) to govern the organizations' corporate governance codes. Since IT governance is part of corporate governance, we sought to obtain a measure common to both. To carry out the analysis, the study uses the theoretical foundation that subsidizes the survey items identified by TCU as items that evaluate IT governance. Thus, for each survey item, a qualitative analysis was carried out, seeking to identify concepts that associate them with one or more principles of corporate governance defined by the IBGC. The data used are those of the survey carried out in 2018 by TCU and which resulted in the 2018 General Governance Index (iGG) and, as part of this, iGovTI. As a result, it was possible to elaborate a mapping of the IT governance assessment items that generated iGovTI in 2018, based on corporate governance principles. The study identified that there are few survey verification items related to iGovTI that are related to corporate governance principles. Hence, it was concluded that little is evaluated about technology governance from the perspective of the corporate governance principles defined by the IBGC.Revista do Serviço Público - RSP, v. 71, Edição Especial, p. 345-374Análise e Ciência de DadosGestão da Informação e do ConhecimentoGestão PúblicaGovernançaISSN Eletrônico: 2357-8017ISSN Impresso: 0034-924

The at risk child clinic (ARCC): 3 years of health activities in support of the most vulnerable children in Beira, Mozambique

The concept of “children at risk” changes worldwide according to each specific context. Africa has a large burden of overall risk factors related to childhood health and development, most of which are of an infective or social origin. The aim of this study was to report and analyze the volumes of activities of fifteen At Risk Child Clinics (ARCCs) within the Beira District (Mozambique) over a 3 year-period in order to define the health profile of children accessing such health services. We retrospectively analyzed the data from all of the children accessing one of the 15 Beira ARCCs from January 2015 to December 2017. From this, 17,657 first consultations were registered. The motivations for accessing the services were in order of relevance: HIV exposure (n. 12,300; 69.7%), other risk conditions (n. 2542; 14.4%), Moderate Acute Malnutrition (MAM) (n. 1664; 9.4%), Severe Acute Malnutrition (SAM) (n. 772; 4.4%), and TB exposure (n. 542; 3.1%). During the first consultations, 16,865 children were screened for HIV (95.5%), and 7.89% tested HIV-positive. In our three years of experience, HIV exposure was the main indication for children to access the ARCCs in Mozambique. ARCCs could represent a strategic point to better understand health demands and to monitor the quality of care provided to this vulnerable population group, however significant effort is needed to improve the quality of the data collection

Diagnosis of coccidiosis by Eimeria spp. in free-range chickens using Mini-FLOTAC and McMaster techniques - preliminary results

Mini-FLOTAC is emerging as a more sensitive and accurate tool to identify gastrointestinal parasites in faecal samples from domestic animals, in comparison with the McMaster method. However, research regarding its specific application in poultry samples, particularly from free-range chickens, is scarce. The current research aimed to test the use of Mini-FLOTAC for the identification of Eimeria spp. in free-range chickens and compare its results with McMaster. For this study, 40 faecal samples were collected from free-range chickens in a poultry farm located in North-Western Lisbon (Portugal). Each sample was processed with McMaster and Mini-FLOTAC techniques for the detection and count of coccidian Eimeria spp. oocysts. The resulting OPG (oocysts per gram of faeces) data obtained by the two techniques were compared using the Wilcoxon Test and correlated with the Spearman Test, and Mini-FLOTAC’s relative sensitivity was assessed, using a significance level of p<0.05. The average OPG was higher with Mini-FLOTAC and doubled the one obtained using the McMaster method (2669.3 OPG and 1220 OPG, respectively), although these results were not significant. Mini-FLOTAC’s relative sensitivity obtained in this study reached 86% (70.5-95.3%, 95%CI), although this result was not statistically significant. However, correlation of OPG counts between Mini-FLOTAC and McMaster, was significant. These preliminary results suggest the potential interest in the use of Mini-FLOTAC for the diagnosis of coccidiosis by Eimeria spp. in poultry, based on its assessment in a free-range poultry production system.info:eu-repo/semantics/publishedVersio

Persistent dysphonia and constitutional syndrome. Laryngeal amyloidosis

Objetivo: describir un caso de amiloidosis laríngea que se define como una enfermedad por depósito de una determinada proteína, cuyo tratamiento si el diagnóstico no es precoz, puede ser muy incapacitante. Método: presentamos el caso de un paciente de 64 años con disfonía de años de evolución, su diagnóstico fue casual, pues la paciente nunca interpretó el cambio de su voz como patológico. Resultado: comentó pérdida de peso no cuantificada en los últimos meses. Se deriva a ORL que tras laringoscopia se aprecia aspecto granuloso en vestíbulo laríngeo por encima de las bandas ventriculares, sin aspecto neoplásico, pero que precisa biopsia, y posterior laringuectomía por hemorragia. Conclusiones: en la amiloidosis es esencial el diagnóstico precoz. El tratamiento debe ser individualizado, por lo que en estos pacientes son fundamentales el tratamiento de soporte y el manejo multidisciplinar, en especial en pacientes con afectación renal o cardiaca.Purpose: describe a case of laryngeal amyloidosis that is defined as a disease due to the deposition of a certain protein, whose treatment if the diagnosis is not early, can be very disabling. Method: here we present the case of a 64 year old patient with dysphonia of years of evolution, his diagnosis was casual, because the patient never interpreted the change of his voice as pathological. Results: commented on unquantified weight loss in recent months. ENT specialist is derived that after laryngoscopy a granular appearance is seen in the laryngeal vestibule above the ventricular bands, without neoplastic appearance, but that requires a biopsy, and subsequent laryngectomy due to hemorrhage. Conclusions: in early amyloidosis, early diagnosis is essential. The treatment must be individualized, so in these patients, supportive treatment and multidisciplinary management are fundamental, especially in patients with renal or cardiac involvement

Implementation of Mini-FLOTAC in routine diagnosis of Coccidia and Helminth infections in domestic and exotic birds

Mini-FLOTAC (MF) has recently been proposed for the fecal quantification of gastrointestinal (GI) parasites in birds due to its higher sensitivity and precision in comparison with the McMaster method. The current research aimed to test the use of MF in routine diagnosis of coccidia and helminth infections in several domestic and exotic bird collections in Portugal. Between July 2020 and April 2021, a total of 142 fecal samples from organic layers, peacocks and ratites were collected in four Portuguese bird collections and processed using MF and fecal cultures to identify and calculate GI parasite shedding and prevalence. The McMaster method was also used to compare the shedding levels obtained for both quantitative techniques. MF’s relative sensitivity and specificity were also assessed, using McMaster as the reference technique. The implementation of MF resulted in an average Eimeria spp. shedding higher in peacocks from bird collection 2 (502 OPG), followed by peacocks from collection 1 (107 OPG) and organic layers (24 OPG) and peacocks from collection 3 (9 OPG). Peacocks were also positive for Capillaria spp., Trichostrongylus tenuis and Strongyloides pavonis, whereas ostriches and emus were infected by L. douglassii. The MF protocol for exotic animals and the McMaster method did not differ significantly for each parasitic agent and bird species, and MF achieved relative sensitivities and specificities higher than 70% for Galliform Eimeria spp., peacock helminths and ratites’ L. douglassii infections. Higher L. douglassii EPG values were identified using the MF protocol for exotic species (2 g of feces/38 mL of sucrose solution), followed by McMaster 2/28, MF 5/45 and MF 2/18. The use of MF allowed for obtaining different intestinal parasitic populations in several bird species and locations, and MF 2/38 is globally proposed as the most suitable protocol for bird fecal samples as an alternative to the McMaster method in the diagnosis of avian intestinal parasitic infections.info:eu-repo/semantics/publishedVersio

Conocimiento, medidas higiénico-sanitarias y de responsabilidad social frente al Covid-19 del estudiantado universitario de Córdoba, Argentina

Con la pandemia de Covid-19 aún vigente, es necesario continuar con las medidas preventivas con el fin de proteger la salud pública de la población. El objetivo fue analizar la asociación entre conocimiento, medidas higiénico-sanitarias y de responsabilidad social frente a la prevención del Covid-19del estudiantado universitario de carreras afines y no afines a las ciencias de la salud. Se diseñó, en línea, un cuestionario autoadministrado con 34 preguntas de opción múltiple. Participaron 1813 estudiantes universitarios, de universidades públicas y privadas de la ciudad de Córdoba, Argentina, en el periodo octubre-diciembre de 2021. Se utilizó el test Chi-cuadrado para analizar las asociaciones bivariadas entre tipo de carrera universitaria y conocimiento o accionar frente a la prevención de la enfermedad. Se aplicó el coeficiente de Pearson para analizar la correlación entre las puntuaciones de conocimiento y accionar frente a la prevención con un nivel de significación de p<0,05. El 91,1% de los encuestados posee mayor conocimiento y 16,9% mayor accionar en la aplicación de medidas higiénico-sanitarias y de responsabilidad social. Se observó asociación entre tipo de carrera universitaria y conocimiento (p<0,0001), entre tipo de carrera universitaria y accionar (p=0,006) y correlación positiva entre las puntuaciones de conocimiento y accionar frente a la prevención del Covid-19 (r=0,32; p<0,0001). Se concluye que la mayoría del estudiantado de carreras afines y no afines a las ciencias de la salud tiene conocimiento sobre el Covid-19, sin embargo, es bajo el porcentaje de personas que aplican las medidas higiénico-sanitarias y de responsabilidad social.With the Covid-19 pandemic still in force, it is necessary to continue with preventive measures in order to protect the public health of the population. The objective was to analyze the association between knowledge, hygienic-sanitary measures and social responsibility regarding the prevention of Covid-19 of university students of related and non-related careers to health sciences. A self-administered questionnaire with 34 multiple-choice questions was designed online. 1813 university students from public and private universities in the city of Córdoba, Argentina, participated in the period october-december 2021. The Chi-square test was used to analyze the bivariate associations between type of university degree and knowledge or action against disease prevention. Pearson's coefficient was applied to analyze the correlation between knowledge scores and action against prevention with a significance level of p<0.05. 91.1% of those surveyed have greater knowledge and 16.9% greater action in the application of hygienic-sanitary and social responsibility measures. An association was observed between the type of university degree and knowledge (p<0.0001), between the type of university degree and action (p=0.006) and a positive correlation between the knowledge scores and action against the prevention of Covid-19 (r =0.32, p<0.0001). It is concluded that the majority of students in related careers and those not related to health sciences have knowledge about Covid-19, however the percentage of people who apply hygienic-sanitary and social responsibility measures is low