Síndrome de desmoralización como alternativa diagnóstica al estado de ánimo deprimido en pacientes paliativos

The emotional state of palliative patients is one of the main aims in their professional attention. Several authors have approach this matter using depression definitions as defined for the general population. There are also many expert professional opinions and research data pointing to the need for adequate research at the patient’s end of life situation. Perhaps one of the most interesting ideas is that one initia­lly expressed by Frank and developed by Kis­sanne et al., suggesting differentiation between depression and demoralization. Following this line of thought, demoralization would more accurately reflect the situation observed in these patients, allows a better differential diagnosis and promotes more tailored inter­ventions. Demoralization syndrome would be defined as the presence of discouragement, despair, helplessness, loss of meaning in life and feelings of failure. That approach leaves aside somatic symptoms of depression scores. This work exposes a critical view and being thought-provoking about current interventions in palliative care. a definición, las intervenciones psicológicas tendrían unos objetivos operativos distintos al tratamiento de depresión, obteniéndose resul­tados en el bienestar del paciente paliativo. En este trabajo se realiza un planteamiento crítico y se invita a reflexionar sobre las intervencio­nes psicológicas que actualmente se llevan a cabo en pacientes paliativos.El estado de ánimo de los pacientes palia­tivos es uno de los objetivos fundamentales en la atención profesional a los mismos. Distintos autores han estudiado dicho estado de ánimo tomando como base definiciones de la depre­sión tal como se entiende en la población gene­ral. Son muchas las voces y los datos de investi­gación que apuntan a la necesidad de adecuar la investigación a la situación del paciente en final de vida. Quizá una de las ideas más inte­resantes es la planteada por Frank y desarrolla­da por Kissanne y colaboradores, proponiendo la diferenciación entre depresión y desmorali­zación. Siguiendo esta línea de pensamiento, la desmoralización reflejaría mejor la situación observada en estos pacientes, permitiendo un mejor diagnóstico diferencial y promoviendo un afinamiento mayor en las intervenciones. El síndrome de desmoralización vendría defini­do como la presencia de desánimo, desaliento, desamparo, pérdida de sentido de la vida y fracaso, sin que los síntomas somáticos propios de la conceptualización de la depresión ten­gan un peso importante. Teniendo en cuenta esta definición, las intervenciones psicológicas tendrían unos objetivos operativos distintos al tratamiento de depresión, obteniéndose resul­tados en el bienestar del paciente paliativo. En este trabajo se realiza un planteamiento crítico y se invita a reflexionar sobre las intervencio­nes psicológicas que actualmente se llevan a cabo en pacientes paliativos

Teoría y práctica de la dignidad en cuidados paliativos: una revisión

A review study on human dignity is performed in order to theoretically understand this concept in the framework of palliative care, and in which extent these ideas have been developed on a practical level. Specifically, a review of those texts focused on human dignity from philosophy, law, religion, bioethics, health care and palliative care was carried out. This review also tried to find and report some similarities and differences among different approaches. Those differences are the basis of current debate on palliative care. Authors conclude that any approach to human dignity should be closer to the clinical practice in palliative care.Se realiza un estudio de revisión sobre la dignidad humana, con el objetivo de entender este concepto a nivel teórico en los cuidados paliativos, y además, saber en qué medida estas ideas están desarrolladas a nivel práctico. Se realiza un estudio de textos centrados en revisiones de la dignidad humana desde diferentes disciplinas: filosofía, derecho, religión, bioética, atención sanitaria y cuidados paliativos. También se realiza un trabajo consistente en hallar coincidencias entre los diferentes puntos de vista, encontrando algunas semejanzas entre todas las disciplinas pero también diferencias que en Cuidados Paliativos generan el debate actual. Los autores consideran que es necesaria una revisión del tema de la dignidad humana más cercana a la práctica clínica en Cuidados Paliativos

The last Charrua Indian; (Uruguay): analysis of the remains of Chief Vaimaca Perú.

Uruguay is the only Latin American country that at present lacks Native populations and little is known about its prehistoric populations. In the construction of National identity, the unique reference to Natives is about Charra Indians, one of the most important ethnic groups that lived in the territory and exterminated in the 1830s. In 1833, four survivors were taken to be exhibited and studied in France, becoming martyrs and a symbol of their nation. The skeletal remains of Chief Perú were preserved and studied mainly by Rivet1; these are the only remains certainly identified as belonging to a Charrúa. In 2002, the French government returned the remains to Uruguay, where they were buried with honours at the National Pantheon. Before the burial, we performed morphological studies as well as extracted samples for DNA analysis. Peru's morphology is coherent with the one of a nomadic warrior: robust body with strong muscular insertions, wounds, and healthy diet based mainly on meat. Here we show that metric and morphological data as well as maternal inherited mitochondrial DNA (mtDNA) hypervariable region I (HVRI) and restriction fragment length polymorphisms (RFLPs), indicate a close relationship with Pampa-Patagonian Indians, and specially, with prehistoric Natives buried in mounds from eastern Uruguay. This last finding is particularly important to understand Uruguayan prehistory and history, raising the debate about who the mound builders were, and showing continuity between them, historic Charrúa Indians, and present populations

Domains and processes for institutionalizing evidence-informed health policy-making: a critical interpretive synthesis

BACKGROUND: While calls for institutionalization of evidence-informed policy-making (EIP) have become stronger in recent years, there is a paucity of methods that governments and organizational knowledge brokers can use to sustain and integrate EIP as part of mainstream health policy-making. The objective of this paper was to conduct a knowledge synthesis of the published and grey literatures to develop a theoretical framework with the key features of EIP institutionalization. METHODS: We applied a critical interpretive synthesis (CIS) that allowed for a systematic, yet iterative and dynamic analysis of heterogeneous bodies of literature to develop an explanatory framework for EIP institutionalization. We used a "compass" question to create a detailed search strategy and conducted electronic searches to identify papers based on their potential relevance to EIP institutionalization. Papers were screened and extracted independently and in duplicate. A constant comparative method was applied to develop a framework on EIP institutionalization. The CIS was triangulated with the findings of stakeholder dialogues that involved civil servants, policy-makers and researchers. RESULTS: We identified 3001 references, of which 88 papers met our eligibility criteria. This CIS resulted in a definition of EIP institutionalization as the "process and outcome of (re-)creating, maintaining and reinforcing norms, regulations, and standard practices that, based on collective meaning and values, actions as well as endowment of resources, allow evidence to become-over time-a legitimate and taken-for-granted part of health policy-making". The resulting theoretical framework comprised six key domains of EIP institutionalization that capture both structure and agency: (1) governance; (2) standards and routinized processes; (3) partnership, collective action and support; (4) leadership and commitment; (5) resources; and (6) culture. Furthermore, EIP institutionalization is being achieved through five overlapping stages: (i) precipitating events; (ii) de-institutionalization; (iii) semi-institutionalization (comprising theorization and diffusion); (iv) (re)-institutionalization; and (v) renewed de-institutionalization processes. CONCLUSIONS: This CIS advances the theoretical and conceptual discussions on EIP institutionalization, and provides new insights into an evidence-informed framework for initiating, strengthening and/or assessing efforts to institutionalize EIP

Demoralization syndrome as an alternative diagnostic to depressed mood in palliative patients

The emotional state of palliative patients is one of the main aims in their professional attention. Several authors have approach this matter using depression definitions as defined for the general population. There are also many expert professional opinions and research data pointing to the need for adequate research at the patient’s end of life situation. Perhaps one of the most interesting ideas is that one initia­lly expressed by Frank and developed by Kis­sanne et al., suggesting differentiation between depression and demoralization. Following this line of thought, demoralization would more accurately reflect the situation observed in these patients, allows a better differential diagnosis and promotes more tailored inter­ventions. Demoralization syndrome would be defined as the presence of discouragement, despair, helplessness, loss of meaning in life and feelings of failure. That approach leaves aside somatic symptoms of depression scores. This work exposes a critical view and being thought-provoking about current interventions in palliative care. a definición, las intervenciones psicológicas tendrían unos objetivos operativos distintos al tratamiento de depresión, obteniéndose resul­tados en el bienestar del paciente paliativo. En este trabajo se realiza un planteamiento crítico y se invita a reflexionar sobre las intervencio­nes psicológicas que actualmente se llevan a cabo en pacientes paliativos

Theory and praxis of dignity in palliative care: A review

A review study on human dignity is performed in order to theoretically understand this concept in the framework of palliative care, and in which extent these ideas have been developed on a practical level. Specifically, a review of those texts focused on human dignity from philosophy, law, religion, bioethics, health care and palliative care was carried out. This review also tried to find and report some similarities and differences among different approaches. Those differences are the basis of current debate on palliative care. Authors conclude that any approach to human dignity should be closer to the clinical practice in palliative care

Que sea ley: Análisis del debate parlamentario por la Ley de Interrupción Voluntaria del Embarazo en Argentina del día 13 de junio de 2018.

Trabajo Final para optar al grado académico de Licenciatura en Comunicación Social, Universidad Nacional de Córdoba (inédita). Calificación 8 (ocho)El presente trabajo es un estudio exploratorio de análisis de contenido interpretativo de discurso parlamentario en torno a la ley de Interrupción Voluntaria del Embarazo (IVE). Se enmarca en el área temática de la comunicación política, y analiza una muestra de los discursos parlamentarios de los diputados y las diputadas en la sesión del día 13 de junio en Argentina, a raíz del debate por la ley IVE. Para enmarcar el contexto, retoma el recorrido de la Campaña Nacional por el Derecho al Aborto Legal, Seguro y Gratuito, y los cambios en la legislación nacional en torno al aborto. A la vez, desarrolla un marco teórico basado en los dos temas fundamentales que atraviesan el trabajo: el discurso parlamentario y la cuestión de género. Se confeccionó un corpus de treinta discursos, utilizando como criterio de selección la jefatura de bloques. Para analizar el contenido de los mismos, se elaboraron categorías que ayudaron a identificar las nociones sobre las que basaron su voto los y las representantes, ya sea en apoyo o en rechazo al proyecto de ley; más específicamente, las nociones sobre la mujer, el aborto, el derecho a la vida y el rol del Estado presentes en el contenido de los discursos

Cross-cultural adaptation and assessment of reproducibility of the Duke Activity Status Index for COPD patients in Brazil

OBJECTIVE: To cross-culturally adapt the Duke Activity Status Index (DASI) for use in Brazil and evaluate the reproducibility of the new (Brazilian Portuguese-language) version. METHODS: We selected stable patients with clinical and spirometric diagnosis of COPD. Initially, the DASI was translated into Brazilian Portuguese, and the cross-cultural adaptation was performed by an expert committee. Subsequently, 12 patients completed the questionnaire, so that their questions and difficulties could be identified and adjustments could be made. An independent translator back-translated the final version into English, which was then submitted to and approved by the original author. The final Brazilian Portuguese-language version of the DASI was applied to 50 patients at three distinct times. For the assessment of interobserver reproducibility, it was applied twice within a 30-min interval by two different interviewers. For the assessment of intraobserver reproducibility, it was applied again 15 days later by one of the interviewers. RESULTS: The mean age of the patients was 62.3 ± 10.0 years, the mean FEV1 was 45.2 ± 14.7% of the predicted value, and the mean body mass index was 26.8 ± 5.8 kg/m². The intraclass correlation coefficients for intraobserver and interobserver reproducibility were 0.95 and 0.90, respectively. The correlations between the DASI and the Saint George's Respiratory Questionnaire (SGRQ) domains were all negative and statistically significant. The DASI correlated best with the SGRQ activity domain (r = -0.70), the total SGRQ score (r = -0.66), and the six-minute walk distance (r = 0.55). CONCLUSIONS: The Brazilian Portuguese-language version of the DASI is reproducible, fast, and simple, correlating well with the SGRQ.OBJETIVO: Adaptar culturalmente e avaliar a reprodutibilidade do Duke Activity Status Index (DASI) para o português do Brasil. MÉTODOS: Foram selecionados pacientes estáveis com diagnóstico clínico e espirométrico de DPOC. Inicialmente, o DASI foi traduzido para o português, e a adaptação cultural foi realizada por uma comissão de especialistas. Em seguida, o questionário foi aplicado em 12 pacientes para saber suas dúvidas e dificuldades, sendo realizadas as devidas adaptações. Um tradutor independente fez a tradução retrógrada, que foi submetida e aprovada pelo autor original. A versão final do DASI foi aplicada em 50 pacientes em dois momentos, com intervalo de 30 minutos (reprodutibilidade interobservador) e, num terceiro momento, após 15 dias (reprodutibilidade intraobservador). RESULTADOS: A média de idade dos pacientes foi de 62,3 ± 10,0 anos, a média do VEF1 foi de 45,2 ± 14,7% do valor previsto, e a do índice de massa corpórea foi de 26,8 ± 5,8 kg/m². Os coeficientes de correlação intraclasse intraobservador e interobservador foram de 0,95 e 0,90, respectivamente. As correlações do DASI com todos os domínios do Saint George's Respiratory Questionnaire (SGRQ) foram negativas e estatisticamente significantes. As melhores correlações ocorreram com o domínio atividade (r = -0,70) e a pontuação total do SGRQ (r = -0,66), assim como com a distância percorrida no teste de caminhada de seis minutos (r = 0,55). CONCLUSÕES: A versão em língua portuguesa do Brasil do DASI é reprodutível, de rápida e fácil aplicação e apresentou uma boa correlação com o SGRQ.Secretaria Estadual de Saúde Secretaria Municipal de SaúdeUniversidade Federal de Sergipe Hospital Universitário Serviço de PneumologiaUniversidade Federal de São Paulo (UNIFESP) Centro de Reabilitação PulmonarAssociação de Assistência à Criança DeficienteUniversidade Estadual de Ciências da Saúde de Alagoas Núcleo de Propedêutica e TerapêuticaStanford University School of MedicineUNIFESP, Centro de Reabilitação PulmonarSciEL

BETaaS: A Platform for Development and Execution of Machine-to-Machine Applications in the Internet of Things

The integration of everyday objects into the Internet represents the foundation of the forthcoming Internet of Things (IoT). Such “smart” objects will be the building blocks of the next generation of applications that will exploit interaction between machines to implement enhanced services with minimum or no human intervention in the loop. A crucial factor to enable Machine-to-Machine (M2M) applications is a horizontal service infrastructure that seamlessly integrates existing IoT heterogeneous systems. The authors present BETaaS, a framework that enables horizontal M2M deployments. BETaaS is based on a distributed service infrastructure built on top of an overlay network of gateways that allows seamless integration of existing IoT systems. The platform enables easy deployment of applications by exposing to developers a service oriented interface to access things (the Things-as-a-Service model) regardless of the technology and the physical infrastructure they belong

Actin stress fiber organization promotes cell stiffening and proliferation of pre-invasive breast cancer cells

This deposit is composed by the main article and supplementary files of the publication.Studies of the role of actin in tumour progression have highlighted its key contribution in cell softening associated with cell invasion. Here, using a human breast cell line with conditional Src induction, we demonstrate that cells undergo a stiffening state prior to acquiring malignant features. This state is characterized by the transient accumulation of stress fibres and upregulation of Ena/VASP-like (EVL). EVL, in turn, organizes stress fibres leading to transient cell stiffening, ERK-dependent cell proliferation, as well as enhancement of Src activation and progression towards a fully transformed state. Accordingly, EVL accumulates predominantly in premalignant breast lesions and is required for Src-induced epithelial overgrowth in Drosophila. While cell softening allows for cancer cell invasion, our work reveals that stress fibre-mediated cell stiffening could drive tumour growth during premalignant stages. A careful consideration of the mechanical properties of tumour cells could therefore offer new avenues of exploration when designing cancer-targeting therapies.Bloomington Drosophila Stock Centre; Vienna Drosophila Research Center (VDRC); Developmental Studies Hybridoma Bank (DSHB); Fundação para a Ciência e Tecnologia (FCT) grant: (IF/01031/2012); Laço Grant in breast cancer 2015; Alexander von Humboldt Foundation grant: (Alexander von Humboldt Professorship); Liga Portuguesa contra o Cancro/Pfizer.info:eu-repo/semantics/publishedVersio