Modelo Housing First como percursor da mudança social transformativa: Uma perspectiva ecológica sobre o impacto da percepção da qualidade da casa e da escolha na integração comunitária, no recovery e na qualidade de vida

Tese de Doutoramento em Psicologia na área de especialização de Psicologia Comunitária, apresentada no ISPA - Instituto UniversitárioA presente Tese designada Modelo Housing First como percursor da mudança social transformativa: Uma perspectiva ecológica sobre o impacto da percepção da escolha e da qualidade da casa na integração comunitária, no recovery e na qualidade de vida consiste num estudo transversal que recorre a metodologias mistas (de foro quantitativo e qualitativo). A investigação pretendeu analisar o impacto a nível individual do modelo Housing First, enquanto exemplo de inovação social baseado nos fundamentos da Psicologia e da Ciência Comunitária. Este modelo defende a criação de programas orientados para o recovery, assentes numa cultura de empowerment ao providenciarem o acesso a habitações individuais, permanentes e dispersas pela comunidade a pessoas que se encontram em situação de semabrigo com problemáticas adjacentes de saúde mental e/ou problemáticas adictivas. Assim, a análise a nível individual do impacto desta abordagem, reúne as bases necessárias para uma reflexão analítica das ramificações deste modelo no plano organizacional e político de forma a produzir a mudanças sociais transformativas como a criação e difusão de políticas de inclusão e de diversificação. Com o propósito geral de avaliar os resultados a nível individual da eficácia e do impacto do programa “Casas Primeiro”, baseado no modelo Housing First, foram equacionados três objectivos gerais: 1 – Analisar a mudança inerente às experiências vivenciadas no período de situação de sem-abrigo e no período após entrada no programa “Casas Primeiro” pelos diversos residentes, ao nível da integração comunitária, através de uma perspectiva ecológica; 2 – Avaliar através de uma leitura ecológica, o papel e a importância da percepção da escolha e da qualidade da casa na potenciação do recovery; 3- Aprofundar o conhecimento existente acerca da importância do modelo Housing First na catalisação da integração comunitária, do recovery e da qualidade de vida dos residentes. O desenho misto da investigação foi aplicado através dos seguintes instrumentos de recolha de dados: a Perceived Housing Quality (PHQ-PT); a Recovery Assessment Scale (RAS-PT); o Quality of Life Index (QOLI-PT); a Community Integration Scale (CIS-.PT) e a entrevista semi-estruturada de cariz qualitativo, cujos intrumentos podem ser consultados no Anexo 1 e Anexo 2 da Tese. Em termos da recolha de dados, a mesma decorreu no âmbito do programa “Casas Primeiro”, onde participaram 45 residentes nesta investigação. Os resultados permitiram sustentar teóricamente que o modelo Housing First ao adoptar valores orientados para o recovery baseados nos fundamentos da Psicologia Comunitária, como a adopção de uma perspectiva ecológica e o direito à escolha individual que respeite as preferências habitacionais de cada pessoa, contribui em larga medida para a promoção da integração comunitária e do processo de recovery. Verificou-se igualmente que a qualidade de vida pode ser maximizada de acordo com o nível de integração comunitária, uma vez que ao estarem integrados, os residentes demonstram maiores índices de satisfação com a sua vida. A investigação realizada permitiu extrair conclusões e implicações para a prática da intervenção e da investigação no âmbito visando a replicação e consolidação desta abordagem no plano organizacional e político. O relatório de Tese foi composto pelas seguintes partes: a Introdução Geral, onde é apresentada uma Revisão da Literatura geral organizada pelas temáticas dominantes (a operacionalização e framework sócio-politico do modelo Housing First, assim como o efeito desta abordagem na fomentação da integração comunitária, do recovery e da qualidade de vida), os Objectivos e Procedimentos Gerais onde se inscreve o desenho geral da investigação; a Secção Empírica, organizada em Três Capítulos relativos às principais análises desta investigação em formato de artigo; as Conclusões Gerais e Implicações para a Prática, e os respectivos Anexos.The thesis under consideration entitled Housing First model as a precursor of transformative social change: An ecological perspective on the impact of perceived choice and housing quality on community integration, recovery and quality of life is a cross-sectional study using mixed methodologies (quantitative and qualitative). The research aimed to analyze at the individual level the impact of Housing First model, as an example of social innovation, based on the principles of Community Psychology and science. This model advocates the development of recovery-oriented programs based on a empowerment culture by providing access to individual, permanent and scattered-site housing for homeless people with mental illness and/or addiction problems. Therefore, the analysis at individual level on the impact of this approach, gathers the foundation that allows the analysis of this model at organizational and political level, in order to produce transformative social change like the development and dissemination of policies that promotes inclusion and diversity. With the general aim of evaluating individual results of the effectiveness and impact of the "Casas Primeiro" program, based on the Housing First model, three general objetives were established: 1 - To analyze the changes of homeless experiences before and after "Casas Primeiro" program of several residents, considering their community integration, through an ecological perspective; 2 - Considering an ecological leght, to evaluate the role and importance of perceived choice and housing quality on promoting recovery process; 3- To deepen the existing knowledge about the importance of Housing First model in promoting community integration, recovery and also quality of life of their residents. The mixed nature of the research was implemented through the following data collection instruments: Perceived Housing Quality (PHQ-PT); Recovery Assessment Scale (RAS-PT); Quality of Life Index (QOLI-PT); Community Integration Scale (CIS-.PT); and the qualitative semi-structured interview, which may be consulted in Annex 1 and Annex 2 of the present thesis. In terms of data collection, this research was carried out in "Casas Primero" program, which 45 residents participated. The results sustained the theorethical support that Housing First model, through recovery-oriented values based on Community Psychology principles, like the adoption of an ecological perspective and the right to individual choice that matches individual preferences greatly promotes community integration and recovery process. Also, results showed that quality of life can be maximized according the level of community integration, once when residents feel integrated, they demonstrate higher rates of life satisfaction. The research allowed conclusions and implications regarding the practice of interventions and research that can be replicated and consolidated at the organizational and political levels. The main body of the Thesis report was organized by the following sections: a General Introduction, where a Review of the General Literature is presented, organized by themes (conceptualization and socio-political framework of Housing First model, as well as the effect of this approach on promoting community integration, recovery and quality of life), the Procedures in which general structure and Objectives are described; the Empirical Section, organized into Three Chapters according to the main analyzes conducted in this research; the General Conclusions and Implications for the Practice, and the Appendices

Suicide rates and trends in Sao Paulo, Brazil, according to gender, age and demographic aspects: a joinpoint regression analysis

Objective: To evaluate suicide rates and trends in Sao Paulo by sex, age-strata, and methods. Methods: Data was collected from State registry from 1996 to 2009. Population was estimated using the National Census. We utilized joinpoint regression analysis to explore temporal trends. We also evaluated marital status, ethnicity, birthplace and methods for suicide. Results: In the period analyzed, 6,002 suicides were accrued with a rate of 4.6 per 100,000 (7.5 in men and 2.0 in women); the male-to-female ratio was around 3.7. Trends for men presented a significant decline of 5.3% per year from 1996 to 2002, and a significant increase of 2.5% from 2002 onwards. Women did not present significant changes. For men, the elderly (> 65 years) had a significant reduction of 2.3% per year, while younger men (25-44 years) presented a significant increase of 8.6% from 2004 onwards. Women did not present significant trend changes according to age. Leading suicide methods were hanging and poisoning for men and women, respectively. Other analyses showed an increased suicide risk ratio for singles and foreigners. Conclusions: Specific epidemiological trends for suicide in the city of Sao Paulo that warrant further investigation were identified. High-risk groups - such as immigrants - could benefit from targeted strategies of suicide prevention

HOME-MADE FROZEN STENTED ELEPHANT TRUNK FOR ACUTE ARCH DISSECTION: AN HYBRID OFF-THE-SHELF TREATMENT IN AN EMERGENCY SETTING

Introduction: Involvement of the ascending/aortic arch in the thoracic aorta pathology can preclude thoracic endovas- cular aortic repair (TEVAR) due to the absence of an adequate proximal landing zone. Hybrid interventions combining ascending/aortic arch replacement with TEVAR of the descending thoracic aorta (DTA) are associated with good outcomes. Despite the existence of dedicated devices (E-vita®, Thoraflex®), they may not be available in good time in emergent cases that might require inventive solutions, like the one we present. Case Report: A 53-year-old hypertensive, active smoker male was admitted due to a non-A-non-B acute aortic dissection, complicated with a contained rupture at the aortic isthmus and a left haemothorax. Considering the absence of a secure proximal landing zone we decided on an aortic arch replacement and frozen stented elephant trunk using off-the-shelf devices. Debranching of the innominate and left common carotid arteries was performed with a 16×8mm bifurcated graft. The aortic arch replacement was performed with a 28 mm Dacron, under hypothermic circulatory arrest. A 30×30×157mm stent graft was anterogradely advanced to the DTA, under direct vision, with its proximal part parked at the level of the Dacron anastomosis. The proximal arch anastomosis was completed at the level of the sinotubular junction. Completion angiography revealed appropriately reconstructed aortic arch, successful exclusion of the entry tear and rupture site, as well as adequate renal and visceral perfusion. The patient had an uneventful postoperative course, being discharged on postoperative day 23. Control CTA demonstrated successful arch reconstruction, true lumen expansion and no signs of complications. Conclusion: This hybrid approach with off-the-shelf devices was successful and avoided the cumulative morbidity of an additional left thoracotomy as the technical difficulty of a full open surgery in this setting. In the absence of readily available dedicated devices, hybrid techniques will undoubtedly play a role in the treatment of acute aortic syndromes. The existence of an “Aortic Team” available to evaluate, decide and combine the expertise of cardiothoracic and vascular surgery was essential in this case

Genetic and microenvironmental intra-tumor heterogeneity impacts colorectal cancer evolution and metastatic development

© The Author(s) 2022 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.Colorectal cancer (CRC) is a highly diverse disease, where different genomic instability pathways shape genetic clonal diversity and tumor microenvironment. Although intra-tumor heterogeneity has been characterized in primary tumors, its origin and consequences in CRC outcome is not fully understood. Therefore, we assessed intra- and inter-tumor heterogeneity of a prospective cohort of 136 CRC samples. We demonstrate that CRC diversity is forged by asynchronous forms of molecular alterations, where mutational and chromosomal instability collectively boost CRC genetic and microenvironment intra-tumor heterogeneity. We were able to depict predictor signatures of cancer-related genes that can foresee heterogeneity levels across the different tumor consensus molecular subtypes (CMS) and primary tumor location. Finally, we show that high genetic and microenvironment heterogeneity are associated with lower metastatic potential, whereas late-emerging copy number variations favor metastasis development and polyclonal seeding. This study provides an exhaustive portrait of the interplay between genetic and microenvironment intra-tumor heterogeneity across CMS subtypes, depicting molecular events with predictive value of CRC progression and metastasis development.This work was financed by national funds from FCT - Fundação para a Ciência e a Tecnologia, I.P., in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences - UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy - i4HB. This research was also funded by: PTDC/MED-ONC/28660/2017 from Fundação para a Ciência e Tecnologia (FCT) to A.R.G. A.R.G is recipient of Researcher Grant CEECIND/02699/2017 from FCT. The biobanking of CRC samples from Hospital Santa Maria, Lisbon, Portugal was supported by FCT research grant PIC/IC/82821/2007. This work was produced with the support of INCD funded by FCT and FEDER under the project 22153-01/SAICT/2016.info:eu-repo/semantics/publishedVersio

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.info:eu-repo/semantics/publishedVersio