Cuidados paliativos

RESUMO Reconhecido como uma forma inovadora de assistência à saúde, o Cuidado Paliativo vem ganhando espaço no Brasil, especialmente na última década. Diferencia-se fundamentalmente da medicina curativa por focar no cuidado integral, através da prevenção e do controle de sintomas, para todos os pacientes que enfrentem doenças graves, ameaçadoras da vida - conceito que também se aplica a familiares, cuidadores e equipe de saúde e seu entorno, que adoece e sofre junto. Neste artigo, recuperamos o histórico do movimento dos Cuidados Paliativos no mundo, apresentamos seus conceitos e princípios e apontamos o estado da arte da prática no Brasil, especialmente da organização dos serviços e das recentes regulamentações a que estão submetidos profissionais, pacientes e instituições públicas e privadas que nela orbitam

The European Reference Genome Atlas: piloting a decentralised approach to equitable biodiversity genomics.

ABSTRACT: A global genome database of all of Earth’s species diversity could be a treasure trove of scientific discoveries. However, regardless of the major advances in genome sequencing technologies, only a tiny fraction of species have genomic information available. To contribute to a more complete planetary genomic database, scientists and institutions across the world have united under the Earth BioGenome Project (EBP), which plans to sequence and assemble high-quality reference genomes for all ∼1.5 million recognized eukaryotic species through a stepwise phased approach. As the initiative transitions into Phase II, where 150,000 species are to be sequenced in just four years, worldwide participation in the project will be fundamental to success. As the European node of the EBP, the European Reference Genome Atlas (ERGA) seeks to implement a new decentralised, accessible, equitable and inclusive model for producing high-quality reference genomes, which will inform EBP as it scales. To embark on this mission, ERGA launched a Pilot Project to establish a network across Europe to develop and test the first infrastructure of its kind for the coordinated and distributed reference genome production on 98 European eukaryotic species from sample providers across 33 European countries. Here we outline the process and challenges faced during the development of a pilot infrastructure for the production of reference genome resources, and explore the effectiveness of this approach in terms of high-quality reference genome production, considering also equity and inclusion. The outcomes and lessons learned during this pilot provide a solid foundation for ERGA while offering key learnings to other transnational and national genomic resource projects.info:eu-repo/semantics/publishedVersio

Lipid profile and cardiovascular risk in two Amazonian populations Perfil lipídico e risco cardiovascular em amazônidas

OBJECTIVE: To compare the lipid profiles and coronary heart disease risks of 2 Brazilian Amazonian populations as follows: a riverside population (village of Vigia) and an urban population (city of Belém in the state of Pará). METHODS: Fifty individuals controlled for age and sex were assessed in each region, and the major risk factors for coronary heart disease were analyzed. RESULTS: According to the National Cholesterol Education Program (NCEP III) and using the Framingham score, both populations had the same absolute risk of events (Vigia = 5.4 ± 1 vs Belém = 5.7 ± 1), although the population of Vigia had a lower consumption of saturated fat (P<0.0001), a greater consumption of mono- and polyunsaturated fat (P<0.03), in addition to lower values for body mass index (25.4± 0.6 vs 27.6 ± 0.7 kg/m², P<0.02), of biceps skin fold (18.6 ± 1.1 vs 27.5 ± 1.3 mm, P<0.0001), of triceps skin fold (28.7 ± 1.2 vs 37.3 ± 1.7 mm, P<0.002), and of total cholesterol (205 ± 5 vs 223 ± 6 mg/dL, P< 0.03) and triglycerides (119 ± 9 vs 177 ± 18 mg/dL, P<0.005). Both populations did not differ in regard to HDL-C (46 ± 1 vs 46 ± 1 mg/dL), LDL-C (135 ± 4 vs 144 ± 5 mg/dL) and blood pressure (SBP 124 ± 3 vs 128 ± 3 mmHg; DBP 80 ± 2 vs 82 ± 2 mmHg). CONCLUSION: The riverside and urban populations of Amazonia had similar cardiovascular risks. However, the marked difference in the variables studied suggests that different strategies of prevention should be applied.<br>OBJETIVO: Comparar o perfil lipídico e risco coronariano de uma população ribeirinha (Vigia) ao de uma população urbana (Belém). MÉTODOS: Foram avaliados 50 indivíduos de cada região, controlados por idade e sexo, examinando-se os principais fatores de risco para a doença coronariana. RESULTADOS: Segundo o Programa Nacional de Educação sobre o Colesterol (NCEP III) e determinando-se o escore de Framingham, ambas as populações expressaram o mesmo risco absoluto de eventos (Vigia 5,4 ± 1 vs. Belém 5,7 ± 1), a despeito da população de Vigia apresentar menor consumo de gordura saturada (p<0,0001), maior de mono e poliinsaturada (p<0,03), além de menores valores do índice de massa corpórea (25,4±0,6 vs. 27,6±0,7kg/m², p<0,02), da prega biceptal (18,6±1,1 vs. 27,5±1,3mm, p<0,0001) e triceptal (28,7±1,2 vs. 37,3±1,7mm, p<0,002), de colesterol total (205±5 vs. 223±6mg/dL, p< 0,03) e triglicérides (119 ± 9 vs. 177±18mg/dL, p<0,005), não diferindo no HDL-c (46±1 vs. 46±1mg/dL), LDL-c (135 ± 4 vs. 144 ± 5mg/dL) e pressão arterial (PAS 124 ± 3 vs. 128 ± 3mmHg; PAD 80 ± 2 vs. 82 ± 2mmHg). CONCLUSÃO: A população ribeirinha e urbana da Amazônia apresentaram risco cardiovascular semelhante. Entretanto, a marcante diferença entre as variáveis estudadas sugere que devam ser aplicadas diferentes estratégias de prevenção

Formação profissional ética: um compromisso a partir das diretrizes curriculares? Ethical professional education: a commitment based on the curricular guidelines?

Esta reflexão problematiza o discurso e a prática que se estabelecem em torno do tema da formação ética dos profissionais da saúde e, mais particularmente, do cirurgião-dentista, situando o atual momento de implantação das Diretrizes Curriculares Nacionais no ensino superior brasileiro. Procura-se, desta forma, indicar alguns limites e possibilidades para uma formação ética condizente com o novo perfil profissional almejado.<br>This reflection questions the discourse and practice surrounding the ethical education of health professionals and, more particularly, of dentists, situating the current state of deployment of the National Curriculum Guidelines in Brazilian Higher Education. The goal is to point to a few limits and possibilities for an ethical education in line with the new professional profile that is sought

Internal Control Quality as an Explanatory Factor of Tax Avoidance

Internal control disclosures mandated by section 404 of the Sarbanes-Oxley Act (SOX) are designed to provide information about a firm’s financial reporting quality and in doing so may offer information on firm-specific tax planning activities. Internal control weaknesses disclosed under SOX are frequently related to a firm’s tax function (Ge and McVay, 2005; Gleason, Pincus and Rego, 2010) and thus raise the question of whether or not these frequent problems affect corporate tax avoidance. In this thesis, I test hypotheses that tax-related disclosures, particularly those that contain company-level internal control weaknesses (ICWs), provide information with respect to long-run tax avoidance. Furthermore, I test hypotheses that the combination of internal control quality and aggressive tax avoidance aid in assessing shareholder returns. To conduct these tests, I collect and construct firm-level SOX disclosure data from 2004 to 2006 across 1,286 publicly-owned corporations. I begin with an empirical analysis of the association between tax avoidance and firm-level ICWs and generally find that the presence of tax ICWs and company-level tax ICWs constrain long-run tax avoidance. For firms with low cash constraints however, company-level tax ICWs appear to lead to an increase in tax avoidance. Nevertheless, subsequent analysis of monthly abnormal returns implies that the stock market reacts negatively to the disclosure of company-level tax ICWs, regardless of whether or not tax aggressiveness is also present. This thesis contributes to the literature by documenting the first evidence that internal control disclosures provide information regarding firm-level tax planning. Although the number of internal control weakness disclosures is decreasing over time, the availability of these SOX disclosures represents a previously unavailable opportunity to examine and further understand internal governance mechanisms within the firm and their influence on tax planning. In addition, this thesis further corroborates prior literature that argues for the importance of the pervasiveness of internal control weaknesses by showing that the pervasive, company-level tax internal control weaknesses are associated with tax avoidance and lower shareholder returns. Finally, my dissertation implies that the presence of tax internal control weaknesses constrains tax avoidance and thus a focus on improving internal controls could help improve the tax planning function. However, my firm-level analysis also implies that effective tax planning is a sustainable process and thus a firm and its stakeholders may require several periods before the full benefits of these improvements are realized