Progetto per un complesso parrocchiale Santa Teresa di Gesù Bambino con la nuova chiesa dedicata ai Santi Louis e Zelie Martin a Cannavà di Rizziconi

La nuova Chiesa dedicata ai Santi Louis e Zelie Martin riprende la tipologia del manufatto rurale investendone le forme e i materiali tradizionali di un nuovo significato, formando con l'edificio esistente un sistema a doppia corte ricalcando l'impianto morfologico del borgo, riuscendo a conferire a entrambe le piazze una qualità spaziale di tipo collettivo oltre che porle come soglia tra il sacro e il profano. La Parrocchia di Santa Teresa di Gesù Bambino, insiste su un territorio diocesano che dall'Aspromonte muove verso la piana di Gioia Tauro, distribuendosi con morfologia policentrica articolata in diversi nuclei abitati, a vocazione agricola. In questa realtà frammentaria il nuovo complesso parrocchiale assume il ruolo di connettore geografico e sociale, diventando luogo preferenziale di aggregazione e riconoscimento per gli abitanti che hanno scelto di vivere in contatto con le proprie radici storiche e culturali. Per questo motivo si è deciso di reinterpretare tipi, forme e volumetrie delle architetture tradizionali del borgo per creare una nuova costruzione capace di inserirsi nell'immaginario collettivo caro ai residenti, dando vita a un nuovo luogo nel quale la comunità possa riconoscersi. L'identità della nuova Chiesa è garantita dalla presenza di segni chiari come la grande croce intagliata nel muro absidale, i volumi organici delle cappelle e dal campanile che si erge come un totem sacro all'ingresso della piazza laterale. Iil sito si apre sulla strada pubblica con il sagrato-piazza che conduce direttamente all'ingresso principale; sulla strada privata, in continuità con la corte adiacente segnalata dal campanile, si apre la piazza della Via Crucis da cui si accede all'ala degli uffici e della sagrestia, al verde attrezzato, ai locali dell'oratorio. In particolare, per il preesistente edificio delle opere pastorali, è stato proposto un sistema a recinto che circonda l'edificio e lo caratterizza in modo nuovo per relazionarlo più efficacemente alla Chiesa. Schermi leggeri e permeabili lo circondano e lo proteggono senza chiuderlo rispetto all'ambiente, creando al contempo un giardino concluso per stare e per giocare, un luogo di sosta e aggregazione intergenerazionale. La Chiesa è composta oltre che dall'aula liturgica anche da un volume ortogonale dove la sagrestia è direttamente collegata all'altare e all'ufficio. Per quanto riguarda l'accesso alle macchine e quindi la presenza di aree a parcheggio, si è pensato di organizzare una fascia buffer-zone attorno al lotto, lasciando intatta e pedonale tutta la superficie interna a uso della Chiesa e delle opere parrocchiali. Il volume della Chiesa è ad aula unica e riprende la forma e il significato delle prime ecclesie, rimandando al significato profondo e arcaico di assemblea e ad alcune simbologie come l'orientamento, la frontalità, l'andare verso, il riunire, l'altro e l'altrove. L'impianto longitudinale associa al percorso lineare un andamento ascensionale, iniziando dal sagrato che forma un grande piano inclinato tra la quota del terreno e l'imposta della chiesa leggermente sollevata. L'ingresso principale è allineato con la mensa posizionata su un presbiterio alto due gradini nel quale si innesta, da un lato un ambone “abitabile” e dall'altro la cappella con la custodia eucaristica. Di seguito, le cappelle laterali che accolgono il fonte battesimale, la penitenzieria, la cappella devozionale creano degli ambiti protetti e intimi senza separarli dall'aula centrale e dal rito collettivo. La copertura a falda asimmetrica reinventa la tipologia dei tetti in legno grazie a un sistema di controsoffitti a vela che creano uno spazio interno avvolgente tagliato da fasci luminosi di luce naturale, provenienti da fenditure sommitali. Le pareti della Chiesa sono diverse tra loro. La parete delle cappelle utilizza una trama alternata tra pieni e vuoti (gelosie) che ricamano lo spazio con luci e ombre cangianti con il movimento del sole, fornendo all'interno della chiesa colori e sfumature diverse in ogni momento della giornata per ogni giorno dell'anno. La parete opposta (est), a trama compatta, è rivestita al suo interno da un grande bassorilievo sul ciclo narrativo della vita di Santa Teresa e dei suoi genitori Louis e Zelie Martin. Le opere d'arte sono state pensate in stretta connessione con l'architettura del complesso. Il tema centrale del ciclo narrativo è la simbologia della novena delle rose a lei rivolta, i cui atti si dividono in due momenti, uno esterno, dove la Santa è rappresentata già in cielo da cui dispensa le sue grazie; uno interno, in cui la stessa è raffigurata in atteggiamento di preghiera. Gli arredi liturgici sono concepiti come geometrie assolute e materiali puri per sottomettere la forma alla parola senza annullarne il ruolo solenne e solido all'interno della liturgia.Culmine della prospettiva centrale è il Cristo Glorioso interpretato nella sequenza di luci incastonate nel metallo della croce absidale incisa nella parete di fondo. Le stazioni della via Crucis, incise su stele metalliche, sono interpretate nella loro sequenza temporale di un universo rotante di legami di reciprocità. Sui quattordici lati si muove la croce, luminosa perché incisa a taglio passante nella stele di metallo, che afferma il suo ruolo iconico nel tempo e nei luoghi degli spostamenti del percorso di Cristo. Dal punto di vista della sostenibilità e dell'efficientamento energetico, il progetto è stato pensato per minimizzare l'utilizzo di sistemi meccanici di climatizzazione privilegiando le buone pratiche del costruire utilizzate nell'edilizia ecclesiastica come le strutture massive per ridurre le escursioni termiche; la ventilazione naturale; il suolo utilizzato come bacino di energia geotermica; uso di alberature per l'ombreggiamento degli spazi esterni e per la protezione dai venti freddi; recupero delle acque piovane per usi idonei e utilizzo di materiali locali durevoli e a bassa manutenzione

Sun exposure habits, sun protection practices, knowledge and attitudes of andalusian teenagers

La historia de quemaduras solares y la exposición solar acumulativa durante la infancia y la adolescencia son los factores de riesgo más importantes para el desarrollo de cáncer de piel. Se conoce que el 85% de esta neoplasia podría evitarse reduciendo la exposición solar, especialmente durante la adolescencia. En este grupo de edad se han intensificado las prácticas de riesgo relacionadas con la exposición solar, motivadas por el deseo del bronceado, el tiempo que pasan al aire libre, la baja percepción del riesgo a desarrollar cáncer de piel y la falta de control paterno. Las campañas de prevención de cáncer de piel tienen como objetivo mejorar los hábitos de exposición solar, reducir las quemaduras solares y la incidencia de cáncer de piel. Los adolescentes son un grupo prioritario al que debe ir dirigidas estas campañas. En el presente trabajo se realiza un recorrido por los hallazgos más significativos sobre los hábitos de exposición solar, las prácticas de protección solar, las actitudes y comportamientos de riesgo de los adolescentes, de las intervenciones educativas que se han llevado a cabo en Andalucía y las perspectivas futuras.A history of sunburn and cumulative sun exposure during childhood and adolescence are the most important risk factors for the development of skin cancer. Nevertheless, 85% of the cases of skin cancer could be prevented by reducing sun exposure, particularly during adolescence. In fact, persons in this age group have now increased their sun exposure practices, motivated by the desire for a suntan, and the fact that they spend more time outdoors, have a poor perception of the risk of developing skin cancer, and the lack of parental control. Skin cancer prevention campaigns aim to improve sun protection habits, and reduce sunburns and incidence of skin cancer. In this work, we do a summary about the most significant findings on the sun exposure habits, sun protection practices, attitudes and risk behaviors of adolescents, as well as, educational interventions that have been carried out in Andalusia and the future prospects.Los autores agradecen el apoyo del equipo de investigación del Hospital Costa del Sol y al Programa del Doctorado de Medicina Clínica y Salud Pública de la Universidad de Granad

Sensitivity to change of the Beach Questionnaire to behaviour, attitudes and knowledge related to sun exposure: quasi-experimental before-after study

Background: Health questionnaires must present accredited measurement properties such as validity, reliability and sensitivity to change, the latter being essential for interventions to be planned and for evaluating their effectiveness. The aim of this study was to evaluate the sensitivity to change of a Beach Questionnaire.Methods: Quasi-experimental before-after study carried out in 2011, for a study population of adolescents attending schools in the Costa del Sol. First, the questionnaire was administered to the adolescents, after which a multicomponent educational intervention was carried out; finally, three months later, the same questionnaire was re-administered to the same adolescents. Changes were assessed in the categories of each item, using the McNemar test, and the changes in the scores, standardised to a range of 0–100, using the Student t test for paired samples, and including the mean of the differences and the 95% confidence interval. The level of statistical significance was set at p < 0.05.Results: 228 adolescents, aged 14–17 years, and 55.3% were girls. Statistically significant changes were observed in sunburn experiences, exposure to the sun at mid-day and attitudes to sun exposure and suncreams. For the seven items related to knowledge about sun exposure, a higher rate of correct answers was observed. The analysis of changes, within the standardised range, revealed a significant improvement in the scores for sun exposure habits (MD 4.33; CI 95% 2.2-6.5), attitudes to sun exposure (MD 2.22; CI 95% 1.2-3.2) and knowledge (MD 9.10; CI 95% 7.1-11.1), but not in those for sun-protection practices (MD 0.23; CI 95% -1.2-1.7).Conclusions: The Beach Questionnaire on behaviour, attitudes and knowledge related to sun exposure is the first such instrument in Spanish language to provide sufficient sensitivity to change. It constitutes a useful tool for epidemiologic research into photoprotection and for skin cancer prevention programmes.The authors would like to acknowledge support from the Research Department of the Costa del Sol Hospital

factors underlying the development of chronic temporal lobe epilepsy in autoimmune encephalitis

Abstract Purpose Limbic encephalitis (LE) is an autoimmune condition characterized by amnestic syndrome, psychiatric features and seizures. Early diagnosis and prompt treatment are crucial to avoid long-term sequelae, including psycho-cognitive deficits and persisting seizures. The aim of our study was to analyze the characteristics of 33 LE patients in order to identify possible prognostic factors associated with the development of chronic epilepsy. Methods This is a retrospective cohort study including adult patients diagnosed with LE in the period 2010–2017 and followed up for ≥12 months. Demographics, seizure semiology, EEG pattern, MRI features, CSF/serum findings were reviewed. Results All 33 LE patients (19 M/14F, mean age 61.2 years) presented seizures. Thirty subjects had memory deficits; 22 presented behavioural/mood disorders. Serum and/or CSF auto-antibodies were detected in 12 patients. In 31 subjects brain MRI at onset showed typical alterations involving temporal lobes. All patients received immunotherapy. At follow-up, 13/33 had developed chronic epilepsy; predisposing factors included delay in diagnosis (p = .009), low seizure frequency at onset (p = .02), absence of amnestic syndrome (p = .02) and absence/rarity of inter-ictal epileptic discharges on EEG (p = .06). Conclusions LE with paucisymptomatic electro-clinical presentation seemed to be associated to chronic epilepsy more than LE presenting with definite and severe "limbic syndrome"

Adrenal Modulation & Perceived Distress of BC Survivors

Background: Distress and adrenal balance of breast cancer survivors (BCS) are key elements of their psychophysical health, and increasing evidence has shown both physical exercise and the natural environment are effective for their modulation. The aim of the study was to evaluate the acute effects of the environment and type of light intensity workouts, on distress, salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S) in BCS.Methods: Twenty-four BCS participated in six different workouts, each with the same duration and intensity. Three of them were conducted in natural environments – walking (Wnature), canoeing with assistance (Cnature) and a mix of myofascial and yoga exercises (MYnature). The others were conducted in an urban environment, namely walking (Wurban), or an indoor environment, namely mobilisation and light upper body exercises (MCgym) and a mix of myofascial and yoga exercises (MYgym). Before and after each workout, the Distress Thermometer was completed and saliva was collected.Results: Workouts practised in natural environments elicited a higher reduction in cortisol and the cortisol to DHEA-S ratio and a greater DHEA-S increase compared with workouts practised in urban and indoor environments. Overall, Cnature and MYnature were the best activities; among those practised in urban and indoor environments, MYgym elicited the best results. Distress was not acutely reduced after Wurban and MCgym. Conclusion: Natural environments seem to provide the best management of distress, cortisol, DHEA-S and their balance when working out at light intensities. The simultaneous presence of forests and rivers seems to be the key element of the observed results

An ontology-based approach supporting holistic structural design with the consideration of safety, environmental impact and cost

Early stage decision-making for structural design critically influences the overall cost and environmental performance of buildings and infrastructure. However, the current approach often fails to consider the multi-perspectives of structural design, such as safety, environmental issues and cost in a comprehensive way. This paper presents a holistic approach based on knowledge processing (ontology) to facilitate a smarter decision-making process for early design stage by informing designers of the environmental impact and cost along with safety considerations. The approach can give a reasoning based quantitative understanding of how the design alternatives using different concrete materials can affect the ultimate overall performance. Embodied CO2 and cost are both considered along with safety criteria as indicative multi-perspectives to demonstrate the novelty of the approach. A case study of a concrete structural frame is used to explain how the proposed method can be used by structural designers when taking multi performance criteria into account. The major contribution of the paper lies on the creation of a holistic knowledge base which links through different knowledge across sectors to enable the structural engineer to come up with much more comprehensive decisions instead of individual single objective targeted delivery

Regional differences in the quality of maternal and neonatal care during the COVID-19 pandemic in Portugal: results from the IMAgiNE EURO study

Objective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. Results: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). Conclusion: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.info:eu-repo/semantics/publishedVersio

Quality of health care around the time of childbirth during the COVID-19 pandemic: Results from the IMAgiNE EURO study in Norway and trends over time

Objective: To describe maternal perception of the quality of maternal and newborn care (QMNC) in facilities in Norway during the first year of COVID-19 pandemic. Methods: Women who gave birth in a Norwegian facility from March 1, 2020, to October 28, 2021, filled out a structured online questionnaire based on 40 WHO standards-based quality measures. Quantile regression analysis was performed to assess changes in QMNC index over time. Results: Among 3326 women included, 3085 experienced labor. Of those, 1799 (58.3%) reported that their partner could not be present as much as needed, 918 (29.8%) noted inadequate staff numbers, 183 (43.6%) lacked a consent request for instrumental vaginal birth (IVB), 1067 (34.6%) reported inadequate communication from staff, 78 (18.6%) reported fundal pressure during IVB, 670 (21.7%) reported that they were not treated with dignity, and 249 (8.1%) reported experiencing abuse. The QMNC index increased gradually over time (3.68 points per month, 95% CI, 2.83– 4.53 for the median), with the domains of COVID-19 reorganizational changes and experience of care displaying the greatest increases, while provision of care was stable over time. Conclusion: Although several measures showed high QMNC in Norway during the first year of the COVID-19 pandemic, and a gradual improvement over time, several findings suggest that gaps in QMNC exist. These gaps should be addressed and monitored

Effectiveness, safety/tolerability of OBV/PTV/r ± DSV in patients with HCV genotype 1 or 4 with/without HIV-1 co-infection, chronic kidney disease (CKD) stage IIIb-V and dialysis in Spanish clinical practice - Vie-KinD study

Limited data are available on the effectiveness and tolerability of direct-acting antivirals (DAAs) therapies in the real world for HCV-infected patients with comorbidities. This study aimed to describe the effectiveness of OBV/PTV/r ± DSV (3D/2D regimen) with or without ribavirin (RBV) in HCV or HCV/HIV co-infected patients with GT1/GT4 and CKD (IIIb-V stages), including those under hemodialysis and peritoneal dialysis in routine clinical practice in Spain in 2015.Non-interventional, retrospective, multicenter data collection study in 31 Spanish sites. Socio-demographic, clinical variables, study treatment characteristics, effectiveness and tolerability data were collected from medical records.Data from 135 patients with a mean age (SD) of 58.3 (11.4) years were analyzed: 92.6% GT1 (81.6% GT1b and 17.6% GT1a) and 7.4% GT4, 14 (10.4%) HIV/HCV co-infected, 19.0% with fibrosis F3 and 28.1% F4 by FibroScan®, 52.6% were previously treated with pegIFN and RBV. 11.1%, 14.8% and 74.1% of patients had CKD stage IIIb, IV and V respectively. 68.9% of patients were on hemodialysis; 8.9% on peritoneal dialysis and 38.5% had history of renal transplant. A total of 125 (96.2%) of 135 patients were treated with 3D, 10 (7.4%) with 2D and 30.4% received RBV. The overall intention-to-treat (ITT) sustained virologic response at week 12 (SVR12) was 92.6% (125/135) and the overall modified-ITT (mITT) SVR12 was 99.2% (125/126). The SVR12 rates (ITT) per sub-groups were: HCV mono-infected (91.7%), HCV/HIV co-infected (100%), GT1 (92.0%), GT4 (100%), CKD stage IIIb (86.7%), stage IV (95%) and stage V (93%). Among the 10 non-SVR there was only 1 virologic failure (0.7%); 4 patients had missing data due lost to follow up (3.0%) and 5 patients discontinued 3D/2D regimen (3.7%): 4 due to severe adverse events (including 3 deaths) and 1 patient´s decision.These results have shown that 3D/2D regimens are effective and tolerable in patients with advanced CKD including those in dialysis with GT 1 or 4 chronic HCV mono-infection and HIV/HCV coinfection in a real-life cohort. The overall SVR12 rates were 92.6% (ITT) and 99.2% (mITT) without clinically relevant changes in eGFR until 12 weeks post-treatment. These results are consistent with those reported in clinical trials