Qualidade do ar e doença respiratória na Região Centro de Portugal: estudo exploratório

Com o crescimento exponencial da população e, consequentemente, da economia mundial, cada vez mais se torna fundamental perceber de que forma a poluição contribui para a diminuição da qualidade de vida dos cidadãos, nomeadamente no que diz respeito à saúde. De entre os principais poluentes atmosféricos, o ozono e as partículas são habitualmente considerados como os mais preocupantes em Portugal. O ozono afeta principalmente as zonas montanhosas do interior do país, enquanto as partículas afetam sobretudo as zonas urbanas, onde se concentra a maior parte da população. Desta forma, a presente dissertação tem como objetivo contribuir para uma melhor compreensão do impacto das concentrações de material particulado (PM10) nas doenças respiratórias na Região Centro de Portugal. Para tal, realizou-se primeiramente uma análise geral tanto à qualidade do ar como aos acessos aos Cuidados de Saúde Primários nesta Região, explorando distribuições quer a nível temporal, quer a nível espacial. Numa primeira instância e com os dados disponibilizados, analisou-se o comportamento espacial de determinadas patologias aquando dos Cuidados de Saúde Primários. De seguida, de uma forma mais detalhada, analisou-se a evolução temporal nos registos nos Cuidados de Saúde Primários e nas Urgências Hospitalares do Agrupamento de Centros de Saúde Baixo Vouga. Finalmente, focou-se a análise do binómio qualidade do ar/saúde num episódio crítico de poluição atmosférica, selecionado com base na identificação dos períodos de ultrapassagens aos valores limite definidos na legislação, para PM10, para proteção da saúde humana, e correspondente ao período dos incêndios ocorridos na Região Centro em outubro 2017. Os resultados obtidos mostram que a qualidade do ar na Região Centro é, no geral, boa, tendo vindo a melhorar ao longo dos últimos anos. É difícil estabelecer uma relação direta entre a qualidade do ar nesta Região e a saúde, dificuldade esta acrescida pelas limitações associadas aos dados existentes dos acessos aos Cuidados de Saúde.With the exponential growth of the population and, consequently, of the world economy, it is essential to understand how air pollution contributes to reduce the quality of life of citizens, particularly, regarding to health. Among the main air pollutants, ozone and particles are usually considered to be the most worrying in Portugal. Ozone mainly affects mountainous areas in the interior of the country, while particles affect mainly urban areas, where most of the population is concentrated. In this way, this thesis aims to contribute to better understand the impact of particulate matter (PM10) on respiratory diseases in the Central Region of Portugal. For this purpose, a general analysis of both air quality and access to Primary Health Care in this Region was carried out, exploring distributions both at a temporal and spatial level. At first and with the available data, the spatial behavior of certain pathologies during Primary Health Care was analyzed. Then, in more detail, the temporal evolution of records in Primary Health Care and Hospital Emergency Departments of the Baixo Vouga Health Centers Group was analyzed. Finally, an analysis of the binomial of air quality/health was focused on a critical episode of air pollution, selected based on the identification of periods of exceeding the limit values defined in the legislation, for PM10, for the protection of human health, and corresponding to the period of fires that occurred in the Center Region in October 2017. The results show that the air quality in the Center Region is, in general, good, having been improving over the last few years. It is difficult to establish a direct relationship between air quality in this Region and health, which was more difficult because of the limitations associated with existing data on access to Health CareMestrado em Engenharia do Ambient

Aspects of the unitarized soft multipomeron approach in DIS and diffraction

We studyin detail the main features of the unitarized Regge model (CFKS), recentlyprop osed to describe the small-Q2 domain. It takes into account a two-component description with two types of unitarized contributions: one is the multiple pomeron exchange contribution, interacting with the large dipole size configurations, and the other one consists of a unitarized dipole cross section, describing the interaction with the small size dipoles. We analyze the ratio between soft and hard pieces as a function of the virtuality, and also compare the resulting dipole cross section to that from the saturation model. Diffraction dissociation is also considered, showing the scaling violations in diffractive DIS and estimating the corresponding logarithmic slope

Altered T-cell subset distribution in the viral reservoir in HIV-1-infected individuals with extremely low proviral DNA (LoViReTs)

HIV cure strategies aim to eliminate viral reservoirs that persist despite successful antiretroviral therapy (ART). We have previously described that 9% of HIV-infected individuals who receive ART harbor low levels of provirus (LoViReTs). We selected 22 LoViReTs matched with 22 controls ART suppressed for more than 3 years with fewer than 100 and more than 100 HIV-DNA copies/10 6 CD4 + T cells, respectively. We measured HIV reservoirs in blood and host genetic factors. Fourteen LoViReTs underwent leukapheresis to analyze replication-competent virus, and HIV-DNA in CD4 + T-cell subpopulations. Additionally, we measured HIV-DNA in rectum and/or lymph node biopsies from nine of them. We found that LoViReTs harbored not only lower levels of total HIV-DNA, but also significantly lower intact HIV-DNA, cell-associated HIV-RNA, and ultrasensitive viral load than controls. The proportion of intact versus total proviruses was similar in both groups. We found no differences in the percentage of host factors. In peripheral blood, 71% of LoViReTs had undetectable replication-competent virus. Minimum levels of total HIV-DNA were found in rectal and lymph node biopsies compared with HIV-infected individuals receiving ART. The main contributors to the reservoir were short-lived transitional memory and effector memory T cells (47% and 29%, respectively), indicating an altered distribution of the HIV reservoir in the peripheral T-cell subpopulations of LoViReTs. In conclusion, LoViReTs are characterized by low levels of viral reservoir in peripheral blood and secondary lymphoid tissues, which might be explained by an altered distribution of the proviral HIV-DNA towards more short-lived memory T cells. LoViReTs can be considered exceptional candidates for future interventions aimed at curing HIV

Distribution and ecology of parent taxa of pollen lodged within the Latin American Pollen Database

The cornerstone of palaeoecological research, concerned with vegetation dynamics over the recent geological past, is a good understanding of the present-day ecology and distribution of the taxa. This is particularly necessary in areas of high floral diversity such as Latin America. Vegetation reconstructions, based on numerous pollen records, now exist with respect to all major vegetation associations from Latin America. With this ever-increasing number of sedimentary records becoming available, there is a need to collate this information and to provide information concerning ecology and distribution of the taxa concerned. The existing Latin American Pollen Database (LAPD) meets the first of these needs. Information concerning the ecology and distribution of the parent taxa responsible for producing the pollen, presently lodged within the LAPD, is the focus of this paper. The 'dictionary' describes the ecology and distribution of the parent taxa responsible for producing pollen identified within sedimentary records. These descriptions are based on a wide range of literature and extensive discussions with members of the palaeoecological community working in different parts of Latin America investigating a range of different vegetation types.Fil: Marchant, Robert. University of Amsterdam; Países BajosFil: Almeida, Lucía. Universidad Nacional Autónoma de México; MéxicoFil: Behling, Hermann. Center for Tropical Maritime Ecology; AlemaniaFil: Berrio, Juan Carlos. University of Amsterdam; Países BajosFil: Bush, Mark. West University Boulevard; Estados UnidosFil: Cleef, Antoine. University of Amsterdam; Países BajosFil: Duivenvoorden, Joost. University of Amsterdam; Países BajosFil: Kappelle, Maarten. Instituto Nacional de Biodiversidad (INBio); Costa RicaFil: De Oliveira, Paulo. Universidade de Sao Paulo; BrasilFil: de Oliveira, Ary Teixeira. Universidade Federal de Lavras; BrasilFil: Lozano García, Socorro. Universidad Nacional Autónoma de México; MéxicoFil: Hooghiemstra, Henry. University of Amsterdam; Países BajosFil: Ledru, Marie Pierre. Instituto de Geociencias; BrasilFil: Ludlow Wiechers, Beatriz. Universidad Nacional Autónoma de México; MéxicoFil: Markgraf, Vera. University of Colorado; Estados UnidosFil: Mancini, Maria Virginia. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Laboratorio de Paleoecología y Palinología; ArgentinaFil: Paez, Marta Mercedes. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Laboratorio de Paleoecología y Palinología; ArgentinaFil: Prieto, Aldo Raul. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; Argentina. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Laboratorio de Paleoecología y Palinología; ArgentinaFil: Rangel, Olando. Universidad Nacional de Colombia; ColombiaFil: Salgado Labouriau, Maria Lea. Universidade do Brasília; Brasi

Design and validation of an instrument about quality of the advance care planning for professionals

[ES] Objetivo: Diseñar y validar un cuestionario dirigido a profesionales para la medición de la calidad del proceso de planificación anticipada de decisiones y determinar sus propiedades psicométricas. Método: Estudio instrumental de validación de cuestionario. Emplazamiento: centros de atención pri maria y consultas externas de hospitales de Ferrol, Ourense, Monforte-Lugo y el Área Sanitaria V del Servicio de Salud de Asturias. Participantes: médico/as y enfermera/os. Fases: 1) diseño de la primera versión del cuestionario mediante técnica Delphi; 2) construcción de la segunda versión de 21 ítems, tras acuerdo de jueces y prueba W de Kendal; 3) pilotaje, análisis de consistencia interna mediante alfa de Cronbach y coeficiente omega,test-retest mediante coeficiente de correlación de Pearson; y 4) validación, test de esfericidad de Barlett y medida de Kaiser-Meyer-Olkin, análisis factorial exploratorio con rotación varimax y estudio de las dimensiones del cuestionario (número, coeficiente de correlación intraclase y correlación), consistencia interna mediante alfa de Cronbach. Resultados: Estudio piloto con 28 profesionales. Fiabilidad ɷ = 0.917, α = 0, 841 y coeficiente de correlación test-retest 0,785 (intervalo de confianza del 95%: 0,587-0,894; p < 0,001). Validación del cuestionario (21 ítems) en 204 profesionales. El análisis de los ítems y el factorial exploratorio (test de Barlett [χ2 = 1298,789] y KMO = 0,808; p < 0,001) arrojaron un modelo de cinco factores que explican el 64,377% de la varianza total, con 18 ítems agrupados en 5 dimensiones (información, preferencias, intención de conducta, capacitación y comunicación). El alfa de Cronbach del cuestionario global fue de 0,841. Conclusiones: El cuestionario ProPAD-pro ha demostrado ser un instrumento válido y fiable para evaluar la calidad del proceso de planificación anticipada de decisiones. [EN] Objective: To develop a questionnaire aimed to measure the quality of the advance care planning process in healthcare professionals and to assess its psychometric quality. Method: Instrumental questionnaire validation study. Scope: primary care centers and outpatients clinics from general hospitals in Ferrol, Ourense, Monforte-Lugo and Health Area V of the Health Service of Asturias. Participants: physicians and nurses. Phases: (1) design of the first version of the questionnaire using the Delphi technique; (2) construction of the second version of 21 items, after judges' agreement and Kendall's W test; (3) pilot study: internal consistency using Cronbach's alpha and omega coefficient, retest-test by Pearson's correlation coefficient; (4) validation: Barlett's spherity test and Kaiser-Meyer-Olkin measurement, exploratory factor analysis with varimax rotation and study of the dimensions of the questionnaire (number, CCI and correlation), internal consistency using Cronbach's alpha. Results: Pilot study with 28 professionals. Reliability ɷ=0.917, α=0.841, and test-retest correlation coefficient of 0.785 (95% confidence interval: 0.587-0.894; p<0.001). Validation of the questionnaire (21 items) in 204 professionals. Ítem analysis and exploratory factor analysis (Barlett's test [χ2=1298,789] and KMO=0.808; p<0.001) yielded a five-factor model explaining 64.377% of the total variance, with 18 items grouped into 5 dimensions (information, preferences, behavioral intention, training and communication). Cronbach's alpha of the global questionnaire was 0.841. Conclusions: The ProPAD-pro questionnaire has showed to be a valid and reliable instrument to assess the quality of the advance care planning process.Proyecto financiado por los Proyectos de Investigación en Salud (Modalidad Proyectos de Investigación) de la convocatoria 2016 de la Acción Estratégica en Salud 2013-2016, y cofinanciado por el Fondo Europeo de Desarrollo Regional (FEDER), Núm. exp. PI16/01686.S

Prevalência e fatores associados à fragilidade em idosos atendidos na Atenção Primária à Saúde

Objetivo: identificar a prevalência e os fatores associados à fragilidade em idosos atendidos na atenção primária à saúde. Método: estudo transversal e analítico, realizado entre março de 2018 e abril de 2019, com 184 idosos cadastrados em equipe de Estratégia Saúde da Família de uma cidade do norte de Minas Gerais. Foram coletadas variáveis sociodemográficas e clínicas, sendo a fragilidade identificada pelo Índice de Vulnerabilidade Clínico Funcional-20. Realizou-se estatística descritiva, análise bivariada e multivariada por meio da regressão logística com os respectivos intervalos de confiança de 95% e nível de significância de p?0,05. Resultado: entre os 184 idosos, a prevalência de fragilidade foi de 9,8%. As variáveis associadas ao desfecho foram: escolaridade (analfabeto) (p=0,007) e idade (?80 anos) (p=0,002). Conclusão: o estudo evidencia que a fragilidade é um achado comum entre idosos da atenção primária e medidas de promoção, proteção, prevenção e recuperação da saúde precisam ser implementadas

Novas perspectivas no tratamento farmacológico da doença de huntington / New perspectives in pharmacological treatment of huntington's disease

A doença de Huntington (DH) teve sua primeira publicação científica em abril de 1872, por George Huntington. Desde então, avanços científicos permitiram desvendar melhor essa moléstia que acomete 5 a cada 100.000 indivíduos e gera perdas neurológicas. O objetivo do atual estudo é elucidar a atualização no tratamento farmacológico dessa patologia

B-cell regeneration profile and minimal residual disease status in bone marrow of treated multiple myeloma patients

© 2021 by the authors.B-cell regeneration during therapy has been considered as a strong prognostic factor in multiple myeloma (MM). However, the effects of therapy and hemodilution in bone marrow (BM) B-cell recovery have not been systematically evaluated during follow-up. MM (n = 177) and adult (≥50y) healthy donor (HD; n = 14) BM samples were studied by next-generation flow (NGF) to simultaneously assess measurable residual disease (MRD) and residual normal B-cell populations. BM hemodilution was detected in 41 out of 177 (23%) patient samples, leading to lower total B-cell, B-cell precursor (BCP) and normal plasma cell (nPC) counts. Among MM BM, decreased percentages (vs. HD) of BCP, transitional/naïve B-cell (TBC/NBC) and nPC populations were observed at diagnosis. BM BCP increased after induction therapy, whereas TBC/NBC counts remained abnormally low. At day+100 postautologous stem cell transplantation, a greater increase in BCP with recovered TBC/NBC cell numbers but persistently low memory B-cell and nPC counts were found. At the end of therapy, complete response (CR) BM samples showed higher CD19− nPC counts vs. non-CR specimens. MRD positivity was associated with higher BCP and nPC percentages. Hemodilution showed a negative impact on BM B-cell distribution. Different BM B-cell regeneration profiles are present in MM at diagnosis and after therapy with no significant association with patient outcome.This work has been supported by the International Myeloma Foundation-Black Swan Research Initiative, the EuroFlow Consortium (grant LSHB-CT-2006-018708); Centro de Investigación Biomédica en Red de Cáncer (CIBER-ONC; Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain and FONDOS FEDER), numbers: CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480; grant from Bilateral Cooperation Program between Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-CAPES (Brasília/Brazil) and Dirección General de Políticas Universitárias (DGPU)-Ministério de Educación, Cultura y Deportes (Madrid/Spain) number DGPU 311/15; Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro of Brazil (FAPERJ) numbers: E26/110.105/2014 and E26/102.191/2013; grant from Conselho Nacional de Desenvolvimento Científico e Tecnológico of Brazil (CNPQ), number: 400194/2014-7. R.M.d.P. was supported by a grant from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/DGPU), number: 000281/2016-06 and CAPES/PROEX 641/2018, Brazil; Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro of Brazil (FAPERJ) number: E01/200/537/2018

Therapeutic vaccine in chronically Hiv-1-infected patients

Therapeutic vaccinations aim to re-educate human immunodeficiency virus (HIV)-1specific immune responses to achieve durable control of HIV-1 replication in virally suppressed infected individuals after antiretroviral therapy (ART) is interrupted. In a double blinded, placebocontrolled phase IIa multicenter study, we investigated the safety and immunogenicity of intranodal administration of the HIVACAT T cell Immunogen (HTI)-TriMix vaccine. It consists of naked mRNA based on cytotoxic T lymphocyte (CTL) targets of subdominant and conserved HIV-1 regions (HTI), in combination with mRNAs encoding constitutively active TLR4, the ligand for CD40 and CD70 as adjuvants (TriMix). We recruited HIV-1-infected individuals under stable ART. Study-arms HTI-TriMix, TriMix or Water for Injection were assigned in an 8:3:3 ratio. Participants received three vaccinations at weeks 0, 2, and 4 in an inguinal lymph node. Two weeks after the last vaccination, immunogenicity was evaluated using ELISpot assay. ART was interrupted at week 6 to study the effect of the vaccine on viral rebound. The vaccine was considered safe and well tolerated. Eighteen percent (n = 37) of the AEs were considered definitely related to the study product (grade 1 or 2). Three SAEs occurred: two were unrelated to the study product, and one was possibly related to ART interruption (ATI). ELISpot assays to detect T cell responses using peptides covering the HTI sequence showed no significant differences in immunogenicity between groups. There were no significant differences in viral load rebound dynamics after ATI between groups. The vaccine was safe and well tolerated. We were not able to demonstrate immunogenic effects of the vaccine

Desafíos de las metrópolis: Efectos ambientales y sociales. Tendencias geográficas II

El libro está conformado de estudios realizados por profesores-investigadores de la Universidad Autónoma del Estado de México, de la Universidad de Varsovia, así como de la Universidad Pedagógica Comisión de Educación Nacional de Cracovia. En esta obra se exponen algunas investigaciones sobre los cambios en los factores sociales, naturales, económicos y ambientales como principales desafios que presentan las zonas de México, Polonia y de contextos de Sudamérica, tales como Sao Paulo, Quito y Bogotá y ciudades medias y pequeñas.Universidad Autónoma del Estado de Méxic