Community-Based Rehabilitation a burden or an opportunity?: the case of Mongolia inclusion of children with cognitive disabilities

Dissertação apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Acção Humanitária, Cooperação e DesenvolvimentoA tese de mestrado Community-Based Rehabilitation (CBR) - a burden or an opportunity? The case of Mongolia inclusion of children with cognitive disabilities, estuda a forma como a CBR se constituí como um instrumento de afirmação da cidadania e coesão social. No plano teórico estabelece o quadro conceptual da CBR e da cidadania, no plano metodológico fundamenta as escolhas do estudo de caso, dando especial atenção ao caso da “grey literature”, validação e generalização dos resultados. Da análise do caso CBR Mongólia, foi possível encontrar evidência importante do impacto nas áreas: da governação, produção de legislação, “accountability”, influência das partes interessadas na implementação de programas de acção; na educação, além de promover a educação inclusiva, foram também identificadas influências na definição dos curricula universitários e na formação profissional dos técnicos de saúde e de educação; já no que respeita à formação da opinião, foram identificadas importantes acções junto dos jovens, nos media e na organização das partes interessadas sob a forma de organizações; foi também possível constactar a importância do CBR na coesão territorial, que se reveste de grande importância para um dos países com menor densidade populacional, em todas estas vertentes foi também possível verificar a importância das ONG’s como veículo de promoção do CBR e da cidadania de diversa forma, definição de políticas, planeamento e implementação de programas, suporte técnico, formação, etc.The master thesis Community-Based Rehabilitation (CBR) - a burden or an opportunity? The case of Mongolia inclusion of children with cognitive disabilities, studies how CBR is constituted as an instrument for the affirmation of citizenship and social cohesion. At the theoretical level defines the conceptual framework of CBR and citizenship, in regards to the methodology it substantiates the choices underlying the case study, giving special attention to the case of "gray literature", validation and generalization of the findings. The analysis of the case CBR Mongolia, enabled to find significant evidence of the impact on the following areas: governance, production of legislation, accountability, the influence of stakeholders in the implementation of action programs; in education in addition to promote inclusive education, were also identified influences within the definition of university curricula and the vocational training of health workers and education; regarding to the formation of opinion, important actions were identified among young people, in the media and organization of stakeholders in the form of organizations; it was also possible to observe the importance of CBR on territorial cohesion, which is of great importance to a country with one of lowest population densities, in all these aspects it was also possible to confirm the importance of NGOs as a vehicle to promote CBR and citizenship on different ways, policy, planning and program implementation, technical support, training, etc.Олон нийтийн оролцоонд түшиглэсэн сэргээн засал – дарамт уу эсвэл боломж уу? сэдэвт магистрын ажил нь Монгол улсын оюуны хөгжлийн бэрхшээлтэй хүүхдийн нийгэм дэх оролцоонд олон нийтэд түшиглэсэн сэргээн засалтын иргэний эрх болон нийгмийн харилцан шүтэлцээний уялдааг гаргаж ирэх гол арга хэрэгслийг хэрхэн бүрдүүлдэг талаар судалсан. Судалгааны арга зүйн хувьд авч үзэхэд олон нийтэд түшиглэсэн сэргээн засалт ба иргэний эрхийн үзэл баримтлалын хүрээ нь онолын түвшиндээ кейс судалгааны үр дүнг “албан бус судалгаа”-г ашиглан нотлоход чиглэгдсэн. Монгол улсын олон нийтэд түшиглэсэн сэргээн засалтын талаар судлах явцад дараах чухал үр дүнгүүд гарч ирлээ. Үүнд: засаглал, хууль тогтоомжийн боловсруулалт, хариуцлага, үйл ажиллагааны үндсэн хөтөлбөрүүдийг хэрэгжүүлэхэд хамтрагч байгууллагуудын нөлөөлөл, ялангуяа боловсролын хүрээнд авч үзэхэд боловсролд тэгш хамруулахыг дэмжих, их дээд сургуулийн сургалтын хөтөлбөр, эрүүл мэнд болон нийгмийн ажилтнуудын мэргэжлийн сургалтуудын хөтөлбөрүүдийн тодорхойлолт, түүнчлэн залуучуудын бодол, ойлголт чухал нөлөөтэй болох нь нотлогдсон. Мөн хэвлэл мэдээллийн байгууллага, хүн амын нягтшил багатай газар олон нийтэд түшиглэсэн сэргээн засалт илүү чухал болох нь ажиглагдаж байна. Үүнээс харахад төрийн бус байгууллагууд нь олон нийтэд түшиглэсэн сэргээн засалт болон тэдний эрхийг бодлого, төлөвлөлт, хөтөлбөр хэрэгжүүлэх, техникийн туслалцаа үзүүлэх, сургалт хийх гэх мэт олон замаар дэмжихэд гол хөдөлгөгч хүч болж чадах нь батлагдаж байна

Modelação do impacto da circulação rodoviária da N1 na qualidade do ar em Leiria

Atualmente o setor dos transportes é responsável por uma emissão significativa de poluentes para a atmosfera originando consequências graves ao nível da degradação da qualidade do ar e na saúde pública, com maior intensidade em meios urbanos onde o tráfego automóvel é maior. Nesse sentido é importante determinar as emissões que resultam dos transportes rodoviários para auxiliar nas medidas que visem a redução dos impactes resultantes dessas emissões. Neste trabalho foi determinada a contribuição das emissões provenientes dos transportes rodoviários resultantes da estrada nacional N1 para a qualidade do ar em Leiria. Esta estimativa teve como base dados reais do tráfego automóvel registado num local de estudo situado na N1. O tráfego rodoviário do local de estudo foi caracterizado em termos de volume, cilindrada, tipo de combustível, ano de fabrico e categoria (ligeiro, pesado, mercadorias, motociclo, etc…), culminando na modelação da emissão de poluentes e gases com efeito de estufa (GEE), com recurso a um software de emissões, o copert, da Agência Europeia do Ambiente. Com base nos dados de emissão foram estimadas as concentrações dos poluentes em estudo, nomeadamente o NO2, PM10 e CO, em vários recetores localizados em Leiria, usando o software de dispersão caline. Para avaliar o impacto das emissões na qualidade do ar do local de estudo foram efetuados vários cenários possíveis, caracterizados por diferentes condições atmosféricas. Com o objetivo de validar os resultados obtidos no modelo de dispersão caline, foram efetuadas medições dos poluentes no local para estudo, aferindo assim os resultados da modelação da dispersão. Foram ainda efetuadas medições meteorológicas que serviram como dados de input para os cálculos. Os resultados permitiram verificar que as contribuições das emissões obtidas nos vários cenários simulados provenientes da estrada nacional N1 são pouco significativas para a qualidade do ar em Leiria

Community-based rehabilitation a burden or an opportunity?: the case of Mongolia inclusion of children with cognitive disabilities

Dissertação apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Acção Humanitária, Cooperação e DesenvolvimentoA tese de mestrado Community-Based Rehabilitation (CBR) - a burden or an opportunity? The case of Mongolia inclusion of children with cognitive disabilities, estuda a forma como a CBR se constituí como um instrumento de afirmação da cidadania e coesão social. No plano teórico estabelece o quadro conceptual da CBR e da cidadania, no plano metodológico fundamenta as escolhas do estudo de caso, dando especial atenção ao caso da “grey literature”, validação e generalização dos resultados. Da análise do caso CBR Mongólia, foi possível encontrar evidência importante do impacto nas áreas: da governação, produção de legislação, “accountability”, influência das partes interessadas na implementação de programas de acção; na educação, além de promover a educação inclusiva, foram também identificadas influências na definição dos curricula universitários e na formação profissional dos técnicos de saúde e de educação; já no que respeita à formação da opinião, foram identificadas importantes acções junto dos jovens, nos media e na organização das partes interessadas sob a forma de organizações; foi também possível constactar a importância do CBR na coesão territorial, que se reveste de grande importância para um dos países com menor densidade populacional, em todas estas vertentes foi também possível verificar a importância das ONG’s como veículo de promoção do CBR e da cidadania de diversa forma, definição de políticas, planeamento e implementação de programas, suporte técnico, formação, etc.The master thesis Community-Based Rehabilitation (CBR) - a burden or an opportunity? The case of Mongolia inclusion of children with cognitive disabilities, studies how CBR is constituted as an instrument for the affirmation of citizenship and social cohesion. At the theoretical level defines the conceptual framework of CBR and citizenship, in regards to the methodology it substantiates the choices underlying the case study, giving special attention to the case of "gray literature", validation and generalization of the findings. The analysis of the case CBR Mongolia, enabled to find significant evidence of the impact on the following areas: governance, production of legislation, accountability, the influence of stakeholders in the implementation of action programs; in education in addition to promote inclusive education, were also identified influences within the definition of university curricula and the vocational training of health workers and education; regarding to the formation of opinion, important actions were identified among young people, in the media and organization of stakeholders in the form of organizations; it was also possible to observe the importance of CBR on territorial cohesion, which is of great importance to a country with one of lowest population densities, in all these aspects it was also possible to confirm the importance of NGOs as a vehicle to promote CBR and citizenship on different ways, policy, planning and program implementation, technical support, training, etc.Олон нийтийн оролцоонд түшиглэсэн сэргээн засал – дарамт уу эсвэл боломж уу? сэдэвт магистрын ажил нь Монгол улсын оюуны хөгжлийн бэрхшээлтэй хүүхдийн нийгэм дэх оролцоонд олон нийтэд түшиглэсэн сэргээн засалтын иргэний эрх болон нийгмийн харилцан шүтэлцээний уялдааг гаргаж ирэх гол арга хэрэгслийг хэрхэн бүрдүүлдэг талаар судалсан. Судалгааны арга зүйн хувьд авч үзэхэд олон нийтэд түшиглэсэн сэргээн засалт ба иргэний эрхийн үзэл баримтлалын хүрээ нь онолын түвшиндээ кейс судалгааны үр дүнг “албан бус судалгаа”-г ашиглан нотлоход чиглэгдсэн. Монгол улсын олон нийтэд түшиглэсэн сэргээн засалтын талаар судлах явцад дараах чухал үр дүнгүүд гарч ирлээ. Үүнд: засаглал, хууль тогтоомжийн боловсруулалт, хариуцлага, үйл ажиллагааны үндсэн хөтөлбөрүүдийг хэрэгжүүлэхэд хамтрагч байгууллагуудын нөлөөлөл, ялангуяа боловсролын хүрээнд авч үзэхэд боловсролд тэгш хамруулахыг дэмжих, их дээд сургуулийн сургалтын хөтөлбөр, эрүүл мэнд болон нийгмийн ажилтнуудын мэргэжлийн сургалтуудын хөтөлбөрүүдийн тодорхойлолт, түүнчлэн залуучуудын бодол, ойлголт чухал нөлөөтэй болох нь нотлогдсон. Мөн хэвлэл мэдээллийн байгууллага, хүн амын нягтшил багатай газар олон нийтэд түшиглэсэн сэргээн засалт илүү чухал болох нь ажиглагдаж байна. Үүнээс харахад төрийн бус байгууллагууд нь олон нийтэд түшиглэсэн сэргээн засалт болон тэдний эрхийг бодлого, төлөвлөлт, хөтөлбөр хэрэгжүүлэх, техникийн туслалцаа үзүүлэх, сургалт хийх гэх мэт олон замаар дэмжихэд гол хөдөлгөгч хүч болж чадах нь батлагдаж байна

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Em busca da identidade dos instrumentos musicais no Brasil: um estudo exploratório da literatura de cordel

Based on a collection of 2340 poems, the present article aims to explore the identity of musical instruments considered most popular by the printed Literatura de Cordel (Cordel Literature) in the countryside of Northeastern and Northern regions of Brazil, from the end of the 19th Century to present days. The Cordel Literature is known for representing the views of the social group from which it is originated rather than the creative work of its poets/writers. In search of musical instruments mentioned in the text, some of them were selected due to frequency and relevance of the context found: e.g. the Brazilian viola (a five course guitar), the violão (the six string guitar), the violin, the mandolin, the rabeca (Brazilian fiddle), the electric guitar and the piano. The violão and the Brazilian viola, which are similar in shape, are seen by that population in quite different ways. The fiddle is a popular instrument, but had only a few mentions. Other instruments like the violin, the mandolin, the piano and the electric guitar are described as urban instruments, thus less known in that context.O presente trabalho procura, em consulta a uma coleção de 2340 obras da Literatura de Cordel, explorar identidades culturais presentes nos instrumentos musicais aparentemente mais populares junto à população cultora de tal forma literária - sertão nordestino e parte da Região Norte do Brasil - desde o final do século XIX até o presente. Há no trabalho o pressuposto de que a Literatura de Cordel representa, muito mais que o trabalho criativo dos seus autores, as práticas vigentes no grupo social que a origina. Assim, à procura de menções a instrumentos musicais, este estudo detém-se em alguns deles, pela frequência e relevância da sua caracterização: viola caipira, violão, violino, bandolim, rabeca, guitarra elétrica e piano. Instrumentos aparentemente próximos como a viola e o violão são vistos de formas muito distintas pela população considerada. A rabeca, instrumento popular, poucas vezes é citada. Outros instrumentos, como violino, bandolim, piano e guitarra elétrica, são retratados como instrumentos urbanos e menos conhecidos

Educomunicação e suas áreas de intervenção: Novos paradigmas para o diálogo intercultural

oai:omp.abpeducom.org.br:publicationFormat/1O material aqui divulgado representa, em essência, a contribuição do VII Encontro Brasileiro de Educomunicação ao V Global MIL Week, da UNESCO, ocorrido na ECA/USP, entre 3&nbsp;e 5 de novembro de 2016. Estamos diante de um conjunto de 104 papers executivos, com uma média de entre 7 e 10 páginas, cada um. Com este rico e abundante material, chegamos ao sétimo e-book publicado pela ABPEducom, em seus seis primeiros anos de existência. A especificidade desta obra é a de trazer as “Áreas de Intervenção” do campo da Educomunicação, colocando-as a serviço de uma meta essencial ao agir educomunicativo: o diálogo intercultural, trabalhado na linha do tema geral do evento internacional: Media and Information Literacy: New Paradigms for Intercultural Dialogue

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years