Compensatory processes in the development of the retarded child

Neste artigo, originalmente apresentado por Vigotski em um congresso em 1931 e posteriormente convertido em texto escrito a partir de anotações taquigráficas, destaca-se a importância dada pelo autor aos riscos de que pesquisas e programas educacionais dirigidos à criança com deficiência focalizem processos biológicos e disfunções primordiais em detrimento de funções psicológicas superiores. Seu argumento principal é o de que processos compensatórios e caminhos indiretos podem promover o desenvolvimento. Tais processos e caminhos relacionam-se com a inserção das crianças em diversos ambientes culturais e são suscetíveis à ação pedagógica. Destaca-se ainda o fato de que, para Vigotski, os objetivos e tarefas da educação especial devem corresponder àqueles da escola regular, isto é, preparar a criança para enfrentar as diversas demandas da vida em sociedade.This article was originally presented by Vygotsky in a Conference in 1931 and later turned into a written text with basis on tachygraphic notes. The author focuses on the risks of research and educational programs addressed to children with special needs to focus on biological processes and basic dysfunctions, instead of working with higher psychological functions. His main argument is that compensatory processes and indirect paths may promote development. Such processes and paths are related to the inclusion of children in diversified cultural environments and are susceptible to educational action. For Vygotsky, goals and tasks of special education should be similar to the ones of regular school, that is, to prepare children to face different demands of social life

Inequalities in access to safe drinking water in Peruvian households according to city size: an analysis from 2008 to 2018.

BACKGROUND: Peru is one of the countries with the lowest percentage of population with access to safe drinking water in the Latin American region. This study aimed to describe and estimate, according to city size, socioeconomic inequalities in access to safe drinking water in Peruvian households from 2008 to 2018. METHODS: Secondary analysis of cross-sectional data using data from the 2008-2018 ENAHO survey. Access to safe drinking water, determined based on the presence of chlorinated water supplied by the public network, as well as socioeconomic variables were analyzed. A trend analysis from 2008 to 2018, and comparisons between 2008 versus 2018 were performed to understand and describe changes in access to safe drinking water, according to city size. Concentration curves and Erreygers concentration index (ECI) were estimated to measure inequalities in access to safe drinking water. RESULTS: In 2008, 47% of Peruvian households had access to safe drinking water, increasing to 52% by 2018 (p for trend < 0.001). For small cities, access to safe drinking water did not show changes between 2018 and 2008 (difference in proportions - 0.2 percentage points, p = 0.741); however, there was an increase in access to safe drinking water in medium (difference in proportions 3.3 percentage points, p < 0.001) and large cities (difference in proportions 12.8 percentage points, p < 0.001). The poorest households showed a decreasing trend in access to safe drinking water, while the wealthiest households showed an increasing trend. In small cities, socioeconomic inequalities showed an increase between 2008 and 2018 (ECI 0.045 and 0.140, p < 0.001), while in larger cities, socioeconomic inequality reduced in the same period (ECI: 0.087 and 0.018, p = 0.036). CONCLUSIONS: We report a widening gap in the access to safe drinking water between the wealthiest and the poorest households over the study period. Progress in access to safe drinking water has not been equally distributed throughout the Peruvian population. Promoting and supporting effective implementation of policies and strategies to safe drinking water, including equity-oriented infrastructure development and resource allocation for most vulnerable settings, including emerging small cities, is a priority

Vaccination Using Recombinants Influenza and Adenoviruses Encoding Amastigote Surface Protein-2 Are Highly Effective on Protection against Trypanosoma cruzi Infection

In the present study we evaluated the protection raised by immunization with recombinant influenza viruses carrying sequences coding for polypeptides corresponding to medial and carboxi-terminal moieties of Trypanosoma cruzis amastigote surface protein 2 (ASP2). Those viruses were used in sequential immunization with recombinant adenovirus (heterologous prime-boost immunization protocol) encoding the complete sequence of ASP2 (Ad-ASP2) in two mouse strains (C57BL/6 and C3H/He). the CD8 effector response elicited by this protocol was comparable to that observed in mice immunized twice with Ad-ASP2 and more robust than that observed in mice that were immunized once with Ad-ASP2. Whereas a single immunization with Ad-ASP2 sufficed to completely protect C57BL/6 mice, a higher survival rate was observed in C3H/He mice that were primed with recombinant influenza virus and boosted with Ad-ASP2 after being challenged with T. cruzi. Analyzing the phenotype of CD8+ T cells obtained from spleen of vaccinated C3H/He mice we observed that heterologous prime-boost immunization protocol elicited more CD8+ T cells specific for the immunodominant epitope as well as a higher number of CD8+ T cells producing TNF-alpha and IFN-gamma and a higher mobilization of surface marker CD107a. Taken together, our results suggest that immunodominant subpopulations of CD8+ T elicited after immunization could be directly related to degree of protection achieved by different immunization protocols using different viral vectors. Overall, these results demonstrated the usefulness of recombinant influenza viruses in immunization protocols against Chagas Disease.FIOCRUZ/PDTIS-VacinasConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG)Univ Fed Minas Gerais, Inst Ciencias Biol, Dept Bioquim & Imunol, Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Inst Ciencias Biol, Dept Microbiol, Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Inst Ciencias Biol, Dept Morfol, Belo Horizonte, MG, BrazilFiocruz MS, Ctr Pesquisas Rene Rachou, Belo Horizonte, MG, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Ctr Terapia Celular & Mol CTCMol, São Paulo, BrazilUniv Massachusetts, Sch Med, Dept Med, Div Infect Dis & Immunol, Worcester, MA USAUniversidade Federal de São Paulo, Escola Paulista Med, Ctr Terapia Celular & Mol CTCMol, São Paulo, BrazilCNPq: 015/2008CNPq: 064/2008Web of Scienc

Long-term outcomes of the global tuberculosis and COVID-19 co-infection cohort

Background: Longitudinal cohort data of patients with tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19. Methods: We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients were followed-up until cure, death or end of cohort time. All patients had TB and COVID-19; for analysis purposes, deaths were attributed to TB, COVID-19 or both. Survival analysis was performed using Cox proportional risk-regression models, and the log-rank test was used to compare survival and mortality attributed to TB, COVID-19 or both. Results: Overall, 788 patients with COVID-19 and TB (active or sequelae) were recruited from 31 countries, and 10.8% (n=85) died during the observation period. Survival was significantly lower among patients whose death was attributed to TB and COVID-19 versus those dying because of either TB or COVID-19 alone (p&lt;0.001). Significant adjusted risk factors for TB mortality were higher age (hazard ratio (HR) 1.05, 95% CI 1.03-1.07), HIV infection (HR 2.29, 95% CI 1.02-5.16) and invasive ventilation (HR 4.28, 95% CI 2.34-7.83). For COVID-19 mortality, the adjusted risks were higher age (HR 1.03, 95% CI 1.02-1.04), male sex (HR 2.21, 95% CI 1.24-3.91), oxygen requirement (HR 7.93, 95% CI 3.44-18.26) and invasive ventilation (HR 2.19, 95% CI 1.36-3.53). Conclusions: In our global cohort, death was the outcome in &gt;10% of patients with TB and COVID-19. A range of demographic and clinical predictors are associated with adverse outcomes

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Clima e doenças respiratórias: inter-relações no município de Belo Horizonte (MG)

Submitted by Izabela Soares ([email protected]) on 2019-09-18T13:15:41Z No. of bitstreams: 1 CLIMA E DOENÇAS RESPIRATÓRIAS INTER-RELAÇÕES NO MUNICÍPIO DE BELO HORIZONTE (MG) - Denise Marques Sales.pdf: 8854645 bytes, checksum: 7641a053b1dfce70f287b264f9af37e4 (MD5)Approved for entry into archive by Eliane Andrade ([email protected]) on 2019-09-23T11:53:28Z (GMT) No. of bitstreams: 1 CLIMA E DOENÇAS RESPIRATÓRIAS INTER-RELAÇÕES NO MUNICÍPIO DE BELO HORIZONTE (MG) - Denise Marques Sales.pdf: 8854645 bytes, checksum: 7641a053b1dfce70f287b264f9af37e4 (MD5)Approved for entry into archive by Eliane Araujo ([email protected]) on 2019-09-30T13:48:08Z (GMT) No. of bitstreams: 1 CLIMA E DOENÇAS RESPIRATÓRIAS INTER-RELAÇÕES NO MUNICÍPIO DE BELO HORIZONTE (MG) - Denise Marques Sales.pdf: 8854645 bytes, checksum: 7641a053b1dfce70f287b264f9af37e4 (MD5)Made available in DSpace on 2019-09-30T13:48:08Z (GMT). No. of bitstreams: 1 CLIMA E DOENÇAS RESPIRATÓRIAS INTER-RELAÇÕES NO MUNICÍPIO DE BELO HORIZONTE (MG) - Denise Marques Sales.pdf: 8854645 bytes, checksum: 7641a053b1dfce70f287b264f9af37e4 (MD5) Previous issue date: 2019-05-15FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas GeraisPensar a saúde em espaços urbanos é, acima de tudo, entender os elementos que os compõem e a existência de uma trama com diversas interações, confrontos e afinidades de origem ambiental e social. Considerando essa organicidade dos ambientes urbanos, torna-se essencial entender suas relações com a população que ali habita e os determinantes que agravam à saúde. Para tanto é necessário envolver o caráter transdisciplinar que pode resultar em relevantes análises espaço-temporais das cidades. Dentro dessa perspectiva, as condições climáticas vêm ganhando espaço em estudos epidemiológicos, principalmente em relação aos agravos à saúde respiratória. Em paralelo a esse cenário e definindo a escala de análise, percebe-se um grande volume de casos de doenças respiratórias no município de Belo Horizonte (MG), que constitui um problema para a saúde pública e ocupa posição de destaque entre as principais causas de internação no Sistema Único de Saúde (SUS). O objetivo dessa pesquisa é entender em que medida nos ambientes antropizados as condições climáticas desencadeiam ou agravam diretamente o conforto humano e consequentemente a saúde, deixando a população de 0 a 5 anos mais vulnerável. Através das análises dos dados climáticos e de saúde, das análises rítmicas e da modelagem ambiental foi possível identificar algumas inter-relações. Para atingir o objetivo proposto, foram utilizados registros mensais de cinco estações meteorológicas pertencentes à FEAM e de quatro estações meteorológicas do INMET. Os sistemas atmosféricos atuantes no período foram identificados utilizando-se cartas sinóticas, disponibilizadas pela DHN, e imagens de satélite, disponíveis na página do INPE. As informações relacionadas às doenças respiratórias foram disponibilizadas pela SMSA e os dados da malha urbana de Belo Horizonte da PRODABEL. Concluindo-se que elementos do clima (variações de temperatura, baixa umidade relativa do ar, redução da precipitação, a emissão e concentração de poluentes no ar), sazonalidade (características predominantes das estações do ano e a transição entre elas) e alguns tipos de organizações sócio espaciais (zonas de baixa renda, próximas de complexos industriais e classificadas como vulneráveis) sofrem agravos à ocorrência de doenças respiratórias. Nas análises temporais foi possível identificar o mês de abril como o pico de registros de agravos ao aparelho respiratório e janeiro como o mês de menor ocorrência. Já as análises espaciais revelaram que os distritos sanitários em que há potencial de ocorrência de doenças respiratórias são: Venda Nova, Norte, Nordeste, Leste e Barreiro, validadas a partir dos dados empíricos contendo o número de ocorrência de doenças respiratórias por setor censitário. Nesse sentido, espera-se que com os resultados deste trabalho, o poder público possa obter novos olhares para intervir na saúde, possibilitando a diminuição dos gastos e a criação de políticas públicas mais eficazes em áreas vulneráveis à propagação de doenças. Isso é importante para reduzir iniquidades e ampliar a equidade do atendimento, hospitalização, tratamento e prevenção das doenças respiratórias em crianças de 0 a 5 anos e possivelmente para outras faixas etárias também acometidas.Urban health should be considered using a framework that considers the interactions and associations between environmental and social factors. Considering the interconnectedness of the urban environment, it is important to identify factors which jeopardize the health and wellbeing of urban residents. Spatiotemporal analysis from an interdisciplinary perspective is one approach to evaluate these relationships. Climatic variables have been gaining attention among epidemiological studies using this approach, particularly those examining respiratory health. Respiratory diseases are a major concern in Belo Horizonte (MG), where they are one of the leading causes of hospitalization. Accordingly, the aim of this study is to understand how climatic conditions affect respiratory health among a vulnerable population (0 to 5 year-olds) in the urban environment of Belo Horizonte. Monthly records were obtained from nine weather stations, and atmospheric systems were identified using synoptic charts and satellite imagery. Municipal data on respiratory diseases and urban infrastructure by census tract was also utilized. Methods included rhythmic analysis and environmental modeling. Respiratory diseases were associated with seasonality, climatic factors (temperature variations, relative humidity, precipitation, and pollutants), and socio-spatial elements (average income and proximity to industrial complexes). April was the annual peak of respiratory disease occurrence and January was the month of lowest incidence. Spatial analysis by census tract revealed that the districts of Venda Nova, North, Northeast, East, and Barreiro had the highest rates of respiratory disease. The results of this study may be used by the municipal government to reduce costs and enact effective policies in vulnerable areas. These actions are important to reduce inequities in hospitalization, treatment, and prevention of respiratory diseases in both children ages 0 to 5 and other affected age groups

(Re) planejamento urbano em Belo Horizonte: (re)definição dos limites territoriais dos bairros populares como estratégia de gestão para a administração pública

O planejamento urbano objetiva melhorar a qualidade de vida dos habitantes de umacidade, além de consolidar uma melhor organização das suas informações, fato que pode&nbsp;contribuir para a (re)construção de territorialidades urbanas menos antagônicas e conflitivas.&nbsp;Partindo deste pressuposto, este trabalho tem como objetivo apresentar, descrever e discutir&nbsp;um projeto, realizado na cidade de Belo Horizonte entre os anos de 2004 e 2011, a partir da&nbsp;parceria firmada entre empresas dos setores públicos municipal e federal, que buscou (re)definir os limites territoriais dos Bairros Populares do Município de Belo Horizonte, resgatando&nbsp;o modo de (re)construção desses limites e sucessivas atualizações. Ademais, são descritos e&nbsp;analisados ainda todos os principais processos de elaboração e implantação do projeto e&nbsp;algumas das dificuldades para a sua realização, além deexemplificações dos métodos e&nbsp;resultados, a exemplo do memorial de bairros, através de imagens, layouts e tabelas. Ressalta-se a adoção de técnicas de geoprocessamento como um fator para o (re)planejamento e a&nbsp;análise urbana da Capital mineira