Palacete Mendonça: ecletismo, internacionalismo e progresso

Construído entre 1900 e 1909, o palacete Mendonça é um projeto de Miguel Ventura Terra para a habitação de Henrique José Monteiro de Mendonça, roceiro e grande capitalista da Lisboa do final do século XIX e início de XX. Situado no alto do parque Eduardo VII, é mais um pedaço de uma paisagem urbana fragmentária, feita de projetos de cidade avulsos e inacabados. Refletir sobre a ideia de cidade e sobre o projeto doméstico que informam o desenho desta casa e deste troço de cidade é o propósito deste texto. Para tal, propõe-se uma hipótese de leitura que ponha em evidência a relação entre o arquiteto, o lugar e o proprietário, procurando perceber de que modo, estes dois atores, por si e na interação de ambos com o lugar, partilham uma certa ideia de internacionalismo e progresso que encontra no ecletismo o lugar da sua expressão e dá corpo a este fragmento de cidade, na Lisboa do virar de século

Costo económico del tratamiento de las úlceras por presión : una aproximación teórica

O presente artigo consiste numa abordagem teórica sobre a problemática dos custos económicos das úlceras por pressão. Parte-se do conhecimento do problema, numa perspetiva conceptual, para, de seguida, apresentar resultados de estudos de prevalência, a partir dos quais foram delineados estudos de impacto económico. O objectivo deste artigo é o de reflectir sobre os custos económicos associados às úlceras por pressão, quer numa perspetiva global, considerando a repercussão financeira, quer numa vertente personalista, atendendo aos custos intangíveis. Relativamente ao impacto económico das úlceras por pressão, foi efectuada uma estimativa ao nível da Região Autónoma dos Açores do custo total do tratamento por ambiente de cuidados. Nos cuidados domiciliários o custo com o tratamento de todas as categorias é calculado em 7.086.415 euros; nos cuidados hospitalares, em 1.723.509 euros, e nos cuidados prestados em lares de idosos, em 1.002.562 euros. Nos Açores, a estimativa do custo total do tratamento das úlceras por pressão, considerando todas as suas categorias, ronda os 9.812.486 euros. Quanto ao impacto emocional associado, este tem elevados custos para pessoa e para os familiares, nomeadamente pelo sofrimento gerado. De facto, as úlceras por pressão acarretam elevados custos económicos associados ao tratamento, bem como custos intangíveis pelo sofrimento vivenciado por pessoas e cuidadores.RESUMEN: El presente artículo consiste en una reflexión teórica sobre el problema de los costos económicos de las úlceras por presión. Se empieza por el conocimiento del problema, desde una perspectiva conceptual, y, a continuación, se presentan los resultados de estudios de prevalencia, a partir de los cuales se diseñaron estudios de impacto económico. El objetivo del artículo es reflexionar sobre los costos económicos asociados a las úlceras por presión tanto en una perspectiva global, considerando la repercusión financiera, como en una vertiente personalista, de acuerdo a los costos intangibles. En cuanto al impacto económico de las úlceras por presión, se realizó una estimación de la Región Autónoma de Açores del costo total del tratamiento por ámbito de atención. En la atención domiciliaria el costo con el tratamiento de todas las categorías se estima en € 7.086.415, en la atención hospitalaria, se estima € 1.723.509 y en la atención en los asilos se estima en €1.002.562. En Açores, el costo total estimado del tratamiento de las úlceras por presión en todas las categorías, es de alrededor de € 9.812.486. En cuanto al impacto emocional asociado, éste tiene elevados costos para la persona y para los familiares, principalmente, por el sufrimiento causado. De hecho, las úlceras por presión implican altos costos económicos asociados con el tratamiento, así como, costos intangibles generados por el sufrimiento experimentado por los individuos y los cuidadores.ABSTRACT: The present study consisted of a theoretical approach to the problem posed by the economic costs associated with pressure ulcers (PUs). The initial aim was to assess the target problem from a conceptual perspective and then to report the results of prevalence studies that formed the basis for investigations of the disease’s economic impact. The purpose of the present article is to discuss the economic costs associated with PUs from both the global point of view (appraising their financial repercussion) and the individual point of view (addressing the intangible costs). Regarding the economic impact of the costs associated with PUs, the total cost of treatment per healthcare setting was estimated relative to the Autonomous Community of Azores. The total cost of all the PU categories was EUR 7,086,415 in the homecare setting, EUR 1,723,509 in the hospital setting, and EUR 1,002,562 in older people’s homes. Therefore, the estimated total treatment cost of all the PU categories was approximately EUR 9,812,486 in Azores. However, the emotional impact of this disease imposes high costs on patients and their relatives as a function of the resultant suffering. Indeed, PUs impose high costs not only related to the treatment but also related to the intangible costs of the suffering caused to patients and their caregivers.Project ICE 2 – Investigação Científica em Enfermagem – Estudo do “Custo Económico das Úlceras por Pressão na Macaronésia” (MAC/1/A029) de Iniciativa Comunitária – Programa de Cooperação Transnacional Madeira-Açores-Canárias 2007-2013info:eu-repo/semantics/publishedVersio

Maternal HIV infection is an important health determinant in non-HIV-infected infants

OBJECTIVE: To assess morbidity and mortality in HIV-exposed uninfected (HEU) children to help guiding appropriate clinical care and effective preventive interventions. DESIGN: This is a longitudinal study comparing two cohorts of children; one born to HIV-infected women and the other born to HIV-uninfected women. METHODS: We have analyzed prospectively obtained information on nutritional status, morbidity and mortality from 966 HEU and 909 HIV-unexposed infants followed up until their first 18 months of life at a referral health facility in southern Mozambique. Determinants for adverse health outcomes in HEU children were also assessed using multivariate logistic regression. RESULTS: Increased incidence of hospital admissions (P = 0.0015), shorter survival in the first 18 months of life (P = 0.0510) and moderate and severe malnutrition (P = 0.0006 and 0.0014, respectively) were observed among HEU children compared with HIV-unexposed children. Incidence of outpatient attendance in HEU children was associated with being men, older age and the mother being on antiretroviral treatment. Among HEU children, those who were never breastfed, or who were weaned or were partially breastfed, had an increased incidence of hospital admissions compared with children who were exclusively breastfed. CONCLUSION: Maternal HIV infection has important health consequences in non-HIV-infected children. As the prevalence of HIV-infected pregnant women is maintained and the proportion of HIV-infected children declines because of the scale-up of antiretroviral treatment during pregnancy and breastfeeding, more focus should be given to the health needs of HEU children to ensure that the post-2015 sustainable development goals are met

A gene expression assay based on chronic lymphocytic leukemia activation in the microenvironment to predict progression

Gene expression; Chronic lymphocytic leukemiaExpresión génica; Leucemia linfocítica crónicaExpressió gènica; Leucèmia limfocítica crònicaSeveral gene expression profiles with a strong correlation with patient outcomes have been previously described in chronic lymphocytic leukemia (CLL), although their applicability as biomarkers in clinical practice has been particularly limited. Here we describe the training and validation of a gene expression signature for predicting early progression in patients with CLL based on the analysis of 200 genes related to microenvironment signaling on the NanoString platform. In the training cohort (n = 154), the CLL15 assay containing a 15-gene signature was associated with the time to first treatment (TtFT) (hazard ratio [HR], 2.83; 95% CI, 2.17-3.68; P < .001). The prognostic value of the CLL15 score (HR, 1.71; 95% CI, 1.15-2.52; P = .007) was further confirmed in an external independent validation cohort (n = 112). Notably, the CLL15 score improved the prognostic capacity over IGHV mutational status and the International Prognostic Score for asymptomatic early-stage (IPS-E) CLL. In multivariate analysis, the CLL15 score (HR, 1.83; 95% CI, 1.32-2.56; P < .001) and the IPS-E CLL (HR, 2.23; 95% CI, 1.59-3.12; P < .001) were independently associated with TtFT. The newly developed and validated CLL15 assay successfully translated previous gene signatures such as the microenvironment signaling into a new gene expression–based assay with prognostic implications in CLL.This work was supported by research funding from the Asociación Española Contra el Cáncer grant [5U01CA157581-05, ECRIN-M3 - A29370] and in part by the Instituto de Salud Carlos III, Fondo de Investigaciones Sanitarias [PI17/00950, M.C., PI17/00943, F.B, PI18/01392, P.A.], and the Spanish Ministry of Economy and Competitiveness [CIBERONC-CB16/12/00233], the Education Council or Health Council of the Junta de Castilla y León [GRS 2036/A/19], and Gilead Sciences [GLD15/00348]. This work was supported by research funding from the Asociación Española Contra el Cáncer grant [5U01CA157581-05, ECRIN-M3 - A29370] and in part by the Instituto de Salud Carlos III, Fondo de Investigaciones Sanitarias [PI17/00950, M.C., PI17/00943, F.B, PI18/01392, P.A.], and the Spanish Ministry of Economy and Competitiveness [CIBERONC-CB16/12/00233], the Education Council or Health Council of the Junta de Castilla y León [GRS 2036/A/19], Gilead Sciences [GLD15/00348] and Gilead Fellowships [GLD16/00144, GLD18/00047, F.B.], and Fundació la Marató de TV3 [201905-30-31 F.B]. All Spanish funding was cosponsored by the European Union FEDER program “Una manera de hacer Europa”. M.C. holds a contract from Ministerio de Ciencia, Innovación y Universidades [RYC-2012-2018]

Immunological and genetic kinetics from diagnosis to clinical progression in chronic lymphocytic leukemia

Progressió clínica; Evasió immuneProgresión clínica; Evasión inmuneClinical progression; Immune evasionBackground Mechanisms driving the progression of chronic lymphocytic leukemia (CLL) from its early stages are not fully understood. The acquisition of molecular changes at the time of progression has been observed in a small fraction of patients, suggesting that CLL progression is not mainly driven by dynamic clonal evolution. In order to shed light on mechanisms that lead to CLL progression, we investigated longitudinal changes in both the genetic and immunological scenarios. Methods We performed genetic and immunological longitudinal analysis using paired primary samples from untreated CLL patients that underwent clinical progression (sampling at diagnosis and progression) and from patients with stable disease (sampling at diagnosis and at long-term asymptomatic follow-up). Results Molecular analysis showed limited and non-recurrent molecular changes at progression, indicating that clonal evolution is not the main driver of clinical progression. Our analysis of the immune kinetics found an increasingly dysfunctional CD8+ T cell compartment in progressing patients that was not observed in those patients that remained asymptomatic. Specifically, terminally exhausted effector CD8+ T cells (T-betdim/−EomeshiPD1hi) accumulated, while the the co-expression of inhibitory receptors (PD1, CD244 and CD160) increased, along with an altered gene expression profile in T cells only in those patients that progressed. In addition, malignant cells from patients at clinical progression showed enhanced capacity to induce exhaustion-related markers in CD8+ T cells ex vivo mainly through a mechanism dependent on soluble factors including IL-10. Conclusions Altogether, we demonstrate that the interaction with the immune microenvironment plays a key role in clinical progression in CLL, thereby providing a rationale for the use of early immunotherapeutic intervention.This work was supported by the Instituto de Salud Carlos III, Fondo de Investigaciones Sanitarias (PI17/00950, M.C., PI18/01392, P.A. and PI17/00943, F.B.) and co-financed by the European Regional Development Fund (ERDF) and Fundación Asociación Española Contra el Cáncer (M.C. and P.A.), Gilead Fellowships (GLD16/00144, GLD18/00047, F.B.) and Fundació la Marató de TV3 (201905–30-31 F.B). S.B. is the recipient of a postdoctoral fellowship from Fundación Alfonso Martin Escudero. R.V-M. is supported by a Torres Quevedo fellowship from the Spanish Ministry of Science and Innovation (PTQ-16-08623). A.E-C. is funded by ISCIII/MINECO (PT17/0009/0019) which is co-funded by FEDER. M.C. holds a contract from Ministerio de Ciencia, Innovación y Universidades (RYC-2012-2018)

Identificação do perfil consumidor de carne suína dos estudantes da área da Saúde de uma Universidade do Município de Joinville, SC / Identification of the pork consumer profile of Health Students from a University in the City of Joinville, SC

O objetivo desse estudo foi identificar o comportamento do consumidor de carne suína.  Foram entrevistados 192 estudantes da área da saúde da Universidade da Região de Joinville, no munícipio de Joinville-SC através da aplicação de um questionário com 11 perguntas objetivas que levantaram questões sobre o conhecimento dos entrevistados a respeito da carne suína e suas preferências, definindo seu perfil. Do total de entrevistados, o gênero feminino (83,8%) e a faixa etária de 20 a 30 anos (59,2%) foram predominantes. A carne suína ocupou o quarto lugar de preferência do consumidor. Dos consumidores ativos de carne suína (79,3%), a maioria demonstra ter preferência pelo consumo na forma industrializada. A falta de hábito foi apontada como o principal motivo para não aumentar o consumo. No presente estudo, 73,2% entrevistados relacionaram o consumo de carne suína com a cisticercose. A maioria dos entrevistados (82,1%) não tiveram acesso a campanhas de incentivo ao consumo da carne suína. Faz-se necessário o investimento em campanhas de marketing, para divulgar os benefícios da carne suína, além da ênfase nas disciplinas de saúde pública dentro dos respectivos cursos da área da saúde

Cell free circulating tumor DNA in cerebrospinal fluid detects and monitors central nervous system involvement of B-cell lymphomas

Limfoma no Hodgkin agressiu; Limfoma del SNCLinfoma no Hodgkin agresivo; Linfoma del SNCAggressive Non-Hodgkin's Lymphoma; CNS lymphomaThe levels of cell free circulating tumor DNA (ctDNA) in plasma correlated with treatment response and outcome in systemic lymphomas. Notably, in brain tumors, the levels of ctDNA in the cerebrospinal fluid (CSF) are higher than in plasma. Nevertheless, their role in central nervous system (CNS) lymphomas remains elusive. We evaluated the CSF and plasma from 19 patients: 6 restricted CNS lymphomas, 1 systemic and CNS lymphoma, and 12 systemic lymphomas. We performed whole exome sequencing or targeted sequencing to identify somatic mutations of the primary tumor, then variant-specific droplet digital PCR was designed for each mutation. At time of enrolment, we found ctDNA in the CSF of all patients with restricted CNS lymphoma but not in patients with systemic lymphoma without CNS involvement. Conversely, plasma ctDNA was detected in only 2/6 patients with restricted CNS lymphoma with lower variant allele frequencies than CSF ctDNA. Moreover, we detected CSF ctDNA in 1 patient with CNS lymphoma in complete remission and in 1 patient with systemic lymphoma, 3 and 8 months before CNS relapse was confirmed; indicating CSF ctDNA might detect CNS relapse earlier than conventional methods. Finally, in 2 cases with CNS lymphoma, CSF ctDNA was still detected after treatment even though a complete decrease in CSF tumor cells was observed by flow cytometry (FC), indicating CSF ctDNA better detected residual disease than FC. In conclusion, CSF ctDNA can better detect CNS lesions than plasma ctDNA and FC. In addition, CSF ctDNA predicted CNS relapse in CNS and systemic lymphomas.This work was supported by research funding from Fundación Asociación Española contra el Cáncer (AECC) (to JS, MC and PA); FERO (to JS), laCaixa (to JS), BBVA (CAIMI) (to JS), the Instituto de Salud Carlos III, Fondo de Investigaciones Sanitarias (PI16/01278 to JS; PI17/00950 to MC; PI17/00943 to FB) cofinanced by the European Regional Development Fund (ERDF) and Gilead Fellowships (GLD16/00144, GLD18/00047, to FB). MC holds a contract from Ministerio de Ciencia, Innovación y Universidades (RYC-2012-12018). SB received funding from Fundación Alfonso Martin Escudero. LE received funding from the Juan de la Cierva fellowship. We thank CERCA Programme / Generalitat de Catalunya for institutional support

Manual de boas práticas e sustentabilidade no turismo

info:eu-repo/semantics/publishedVersio

Perspectivas em Psicologia Institucional: investigação/intervenção em escolas públicas da Maré

Este texto pretende apresentar os resultados da investigação realizada em escolas públicas da Maré/RJ. O objetivo da pesquisa era tornar visíveis os efeitos das ações de um programa social que se desenvolvia nas escolas, buscando a construção de um instrumento de avaliação de projetos sociais assentada na perspectiva de participação e coletivização. A metodologia adotada é denominada de investigação/intervenção, tendo como base ferramentas da Análise Institucional. Foi possível apreender a dinâmica das relações sociais produzidas a partir da inserção de novos atores sociais no cotidiano escolar, ganhando visibilidade as práticas instituídas e os limites das forças que se pretendem instituintes