Maus-tratos em crianças e adolescentes com deficiência e/ou perturbações do desenvolvimento

A presente investigação tem como principal objetivo analisar as características da associação entre deficiência e/ou perturbações do desenvolvimento e maus-tratos na população infanto-juvenil portuguesa, e destacar as respetivas implicações no domínio da educação especial. A amostra é constituída por 198 crianças e adolescentes com deficiência e/ou perturbações do desenvolvimento, que foram vítimas de maus-tratos. A informação foi recolhida através de um questionário, elaborado para este fim, e respondido por psicólogos e assistentes sociais. Em termos dos resultados obtidos, verificou-se que o maltrato misto (associação entre duas ou mais formas de maltrato) foi o mais comum, seguindo-se a negligência. Os agentes de maltrato mais frequentes foram os progenitores. A deteção dos maus-tratos foi efetuada, em regra, na etapa pré-escolar, sendo as suas principais fontes as instituições/serviços que já acompanhavam a família. Foi também detetada uma elevada percentagem de problemas de saúde física e mental, de dependências e de dificuldades de inserção social nos pais destas crianças/adolescentes. A quase generalidade das crianças e famílias beneficiou de alguma intervenção após a sinalização dos maus-tratos. No que respeita a conclusões, e uma vez que os maus-tratos tendem a ocorrer cedo e em famílias com múltiplos fatores de risco, apontam-se estratégias de intervenção familiar e sublinha-se a importância que os programas de intervenção precoce podem revestir. Também se indica o papel que os professores podem desempenhar na deteção dos maus-tratos e realça-se a relevância e a composição dos programas direcionados para o ensino de estratégias de proteção e autodefesa

The case of Cape Verde

The continental urban clusters followed models based on rules and standards that influenced the environment, which were in turn the result of consolidated growth and available technology. The successful models tend to be replicated, with examples seen in urban island clusters which adapted these guidelines, giving rise to a unique morphology resulting from models that à priori were not suited to the region. The urban fabric of these clusters maintained regular and sustainable growth until the last quarter of the 20th century, when the increase in immigration made it difficult to control the urban space. This phenomenon was responsible for the impact on the constructed as well as the social environment, resulting in the degradation of the quality of life for the communities. In the island regions, works were implemented in urban areas, using imported models, in the expectation of attaining a better quality of life. The constant changes that emerged in the cities of continental and insular regions, with the results observed deemed as excellent, encouraged entities in charge to follow guidelines that would foster social inclusion, although this led to a weakening of the local identity. This research focuses on the identification of the parameters that should constitute the basis for the construction of the sustainable insular city. The parameters identified were applied to two case studies related to two neighbourhoods on the northern outskirts of the city of Praia with different terrains with distinctly different characteristics in terms of their genesis, terrain and infrastructure systems. The application of the parameters resulted in the conclusion that it is possible to apply them to the local reality and that they are simple enough to be widely implemented in the context of developing insular countries.publishersversionpublishe

O Consentimento e a Recusa Esclarecidos na Cirurgia Endonasal Avançada: O Dilema Ético do Sacrifício do Olfacto na Cirurgia da RinoSinusite Crónica com Pólipos

INTRODUCTION: Olfaction is frequently affected in chronic rhino-sinusitis with polyposis and has been recognised to have important impact on quality of life. Surgical resolution on cases of maximal medical therapy failure is an option to relieve symptoms, with debates as to how extensive surgery should be. A more radical approach will achieve better disease control with less relapse, but can also compromise olfaction. This decision about a more radical surgical approach should be shared with the patient. Thorough informed consent regarding disease control and hyposmia should be taken. MATERIAL AND METHODS: Literature review and consultation with a board of experts. RESULTS AND DISCUSSION: We propose some elements to be included in the informed consent discussion, in order to broadly address the surgical limitations regarding anosmia as a frequent complaint, as well as the different options and their associated consequences. CONCLUSION: Radical surgery decision making should be shared with the patient and the informed consent should be as thorough as possible regarding disease control and hyposmia resolution

Diagnostic Accuracy of Anthropometric Markers of Obesity for Prediabetes: A Systematic Review and Meta-Analysis

Introduction: Prediabetes is a significant public health concern due to its high risk of progressing to diabetes. Anthropometric measures of obesity, including body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) have been demonstrated as key risk factors in the development of prediabetes. However, there is a lack of clarity on the diagnostic accuracy and cut-off points of these measures. Objective: To determine the diagnostic accuracy of these anthropometric measures for their most effective use in identifying prediabetes. Methodology: A systematic review (SR) with metanalysis of observational studies was carried out. The search was conducted in four databases: Pubmed/Medline, SCOPUS, Web of Science, and EMBASE. For the meta-analysis, sensitivity and specificity, together with their 95% confidence intervals (CI 95%) were calculated. Results: Among all the manuscripts chosen for review, we had four cross-sectional studies, and three were classified as cohort studies. The forest plots showed the combined sensitivity and specificity for both cross-sectional and cohort studies. For cross-sectional studies, the values were as follows: BMI had a sensitivity of 0.63 and specificity of 0.56, WC had a sensitivity of 0.59 and specificity of 0.58, and WHtR had a sensitivity of 0.63 and specificity of 0.73. In the cohort studies, the combined sensitivity and specificity were: BMI at 0.70 and 0.45, WC at 0.68 and 0.56, and WHtR at 0.68 and 0.56, respectively. All values are provided with 95% confidence intervals. Conclusions: This systematic review and meta-analysis evaluated the diagnostic accuracy of BMI, WC, and WHtR in identifying prediabetes. The results showed variations in sensitivity and specificity, with WHtR having the highest specificity in cross-sectional studies and BMI having improved sensitivity in cohort studies

A profusion of upstream open reading frame mechanisms in polyamine-responsive translational regulation

In many eukaryotic mRNAs one or more short ‘upstream’ open reading frames, uORFs, precede the initiator of the main coding sequence. Upstream ORFs are functionally diverse as illustrated by their variety of features in polyamine pathway biosynthetic mRNAs. Their propensity to act as sensors for regulatory circuits and to amplify the signals likely explains their occurrence in most polyamine pathway mRNAs. The uORF-mediated polyamine responsive autoregulatory circuits found in polyamine pathway mRNAs exemplify the translationally regulated dynamic interface between components of the proteome and metabolism

Comorbidities in Chilean patients with psoriasis: a Global Healthcare Study on Psoriasis

Background: Psoriasis is a chronic inflammatory skin disease associated with several important medical comorbidities. There are scant data available on the comorbidities of patients with psoriasis in South America. Aim: To examine the comorbidity profile of adult patients with psoriasis in Chile and its association with severity of psoriasis. Methods: This was a multicentre, cross-sectional study involving 16 hospitals and clinics in Chile, which used a 48-item questionnaire to study clinician- and patient-reported outcomes and comorbidities. Inferential analyses were performed by psoriasis severity, using Fisher exact test, Student t-test and multivariable logistic regression. Results: In total, 598 adult patients with psoriasis were included (51.1% male; mean age 49.2 ± 15.1 years); 48.5% mild and 51.4% moderate to severe; Psoriasis Area and Severity Index 11.6 ± 11.5; body surface area 14.7 ± 18.2%. Plaque psoriasis was the most common phenotype (90.2%), followed by guttate (13.4%). Psoriatic arthritis occurred in 27.3% of patients. Comorbidities were reported in 60.2% of all patients with psoriasis. Frequent concomitant diseases were obesity (25.3%), hypertension (24.3%), Type 2 diabetes mellitus (T2DM) (18.7%), dyslipidaemia (17.4%), metabolic syndrome (16.7%) and depression (14.4%). After adjustment, significant associations were found between moderate to severe psoriasis and obesity, T2DM and nonalcoholic fatty liver disease (NAFLD) compared with mild psoriasis. Conclusions: We report a large study of comorbidities, including depression, dyslipidaemia, T2DM and NAFLD, in people with psoriasis in Chile. The prevalence of comorbidities with psoriasis in Chile appears similar to that found in Western countries, and emphasizes the importance of assessing patients with psoriasis for risk factors for and presence of, comorbid disease in a multidisciplinary setting

Relationship among medical student resilience, educational environment and quality of life

Resilience is a capacity to face and overcome adversities, with personal transformation and growth. In medical education, it is critical to understand the determinants of a positive, developmental reaction in the face of stressful, emotionally demanding situations. We studied the association among resilience, quality of life (QoL) and educational environment perceptions in medical students. We evaluated data from a random sample of 1,350 medical students from 22 Brazilian medical schools. Information from participants included the Wagnild and Young's resilience scale (RS-14), the Dundee Ready Educational Environment Measure (DREEM), the World Health Organization Quality of Life questionnaire - short form (WHOQOL-BREF), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Full multiple linear regression models were adjusted for sex, age, year of medical course, presence of a BDI score >= 14 and STAI state or anxiety scores >= 50. Compared to those with very high resilience levels, individuals with very low resilience had worse QoL, measured by overall (beta=-0.89; 95% confidence interval =-1.21 to -0.56) and medical-school related (beta=-0.85; 95% CI=-1.25 to -0.45) QoL scores, environment (beta=-6.48; 95% CI=-10.01 to -2.95), psychological (beta=-22.89; 95% CI=-25.70 to -20.07), social relationships (beta=-14.28; 95% CI=-19.07 to -9.49), and physical health (beta=-10.74; 95% CI=-14.07 to -7.42) WHOQOL-BREF domain scores. They also had a worse educational environment perception, measured by global DREEM score (beta=-31.42; 95% CI=-37.86 to -24.98), learning (beta=-7.32; 95% CI=-9.23 to -5.41), teachers (beta=-5.37; 95% CI=-7.16 to -3.58), academic self-perception (beta=-7.33; 95% CI=-8.53 to -6.12), atmosphere (beta=-8.29; 95% CI=-10.13 to -6.44) and social self-perception (beta=-3.12; 95% CI=-4.11 to -2.12) DREEM domain scores. We also observed a dose-response pattern across resilience level groups for most measurements. Medical students with higher resilience levels had a better quality of life and a better perception of educational environment. Developing resilience may become an important strategy to minimize emotional distress and enhance medical training106CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPE