Inclusion and accessibility: contribution to Sustainable Schools National Pro gram

[Resumo] O presente artigo busca fazer uma breve reflexão sobre o Programa Nacional Escolas Sustentáveis (PNES), proposto pelo governo brasileiro através do Ministério da Educação (MEC) e buscar elementos de conexão entre os conceitos de sustentabilidade, acessibilidade e direitos humanos, com enfoque na garantia de direitos das pessoas com deficiência. Para isso, serão abordadas questões históricas e também destacados alguns eventos que buscam esta aproximação, remetendo a desafios aos processos educativos na construção de uma educação ambiental que dialogue com a diversidade. É possível assim, oferecer algumas pistas para pensar sociedades sustentá veis em uma perspectiva inclusiva e na direção da universalização de direitos a todas as pessoas[Abstract] This article offers a brief reflection about National Program for Sustainable Schools (NHSP), proposed by the Australian Government through the Ministry of Education (MEC) and seek connecting factors between the concepts of sustainability, accessibility and human rights, with a focus on ensuring rights of people with disabilities. Therefore, historical issues will be addressed and also some events will be highlighted in search of this approach, referring to challenges to educational processes in the construction of environmental education that dialogues with a diversidade. This may, offer some clues to think sustainable societies in an inclusive perspective and towards the universal rights of all people

Política da pessoa com deficiência no Brasil : percorrendo o labirinto

As pessoas com deficiência, conforme dados da ONU, representam 10% da população mundial, em torno de 650 milhões de pessoas. No Brasil, são 23,7% da população, o que corresponde a 45 milhões de pessoas. Ao longo das últimas décadas, o conceito de “deficiência” tem passado por transformações importantes mediadas pela participação da sociedade civil, ação dos governos e debates internacionais. Os dados e indicadores apontam para a fragilidade substancial desses sujeitos no acesso às políticas públicas em diferentes níveis. Nesse sentido, a presente tese busca refletir sobre os processos de formação da agenda política da pessoa com deficiência no Brasil, considerando diferentes aspectos, como o protagonismo, a transversalidade das políticas públicas e sua evolução, o papel dos indicadores, as relações de embate e diálogo entre governo e sociedade civil e os processos formativos instituídos, até mesmo na busca pela legitimidade desses conceitos no cenário local e internacional. O caráter polissêmico das políticas públicas para pessoas com deficiência fica evidente com a presença nas quatro arenas de poder, nas quais terão maior ou menor rejeição, envolvendo discussão entre os partidos políticos (governo x oposição) e a barganha entre os grupos de interesse. Diante da multiplicidade do movimento das pessoas com deficiência, há, em cada tipo de política pública, uma diversidade nos atores que compõem os grupos de interesse. A gestão da política da pessoa com deficiência no Brasil passou por diferentes modificações, nos últimos anos, em uma disputa entre o campo da assistência social e dos direitos humanos. Números, dados, leis, enfim, o que importa mais? Qual será a Evidence-based que determinará o maior o menor grau de uma política pública para pessoas com deficiência no Brasil? Acreditamos que essa resposta não seja especificamente o objeto dessa tese, mas conhecermos as possibilidades a que podemos recorrer neste labirinto que estamos estudando poderá ajudar nas reflexões. Se, do ponto de vista teórico, é possível defender um estado ideal, onde os direitos dos sujeitos são universalizados, do ponto de vista prático, surgem algumas questões. Qual o limite entre proteger e incluir? É possível universalizar sempre? Talvez o que devamos discutir é uma transição paradigmática, onde podemos aprender com as diferentes experiências vigentes em todo país, sobretudo nos estados, Distrito Federal e municípios.People with disabilities, according to UN data, represent 10% of the world's population, around 650 million people. In Brazil, there are 23.7% of the population, corresponding to 45 million people. Over the last few decades, the concept of "disability" has undergone major transformations mediated by civil society participation, government action and international debates. The data and indicators point to the substantial fragility of these subjects in access to public policies at different levels. In this sense, the present thesis seeks to reflect on the processes of formation of the political agenda of people with disabilities in Brazil, considering different aspects, such as the protagonism, the transversality of public policies and their evolution, the role of indicators, dialogue between government and civil society and the formative processes instituted, even in the search for the legitimacy of these concepts in the local and international scenario. The polysemic character of public policies for people with disabilities is evident with the presence in the four arenas of power, in which they will have more or less rejection, involving discussion between political parties (government and opposition) and bargaining among interest groups. Given the multiplicity of the movement of people with disabilities, there is a diversity in each type of public policy in the actors that make up the interest groups. The management of disability policy in Brazil has undergone different modifications in recent years in a dispute between the field of social assistance and human rights. Numbers, data, laws, anyway, what matters most? What will be the Evidence-based that will determine the highest degree of a public policy for people with disabilities in Brazil? We believe that this answer is not specifically the object of this thesis, but knowing the possibilities that we can use in this labyrinth we are studying may help in the reflections. If, from the theoretical point of view, it is possible to defend an ideal state, where the subjects' rights are universalized, from the practical point of view, some questions arise. What is the limit between protecting and including? Is it possible to universalize always? Perhaps what we should discuss is a paradigmatic transition, where we can learn from the different experiences in force in every country, especially in the states, Federal District and municipalities

Política da pessoa com deficiência no Brasil: percorrendo o labirinto

As pessoas com deficiência, conforme dados da ONU, representam 10% da população mundial, em torno de 650 milhões de pessoas. No Brasil, são 23,7% da população, o que corresponde a 45 milhões de pessoas. Ao longo das últimas décadas, o conceito de “deficiência” tem passado por transformações importantes mediadas pela participação da sociedade civil, ação dos governos e debates internacionais. Os dados e indicadores apontam para a fragilidade substancial desses sujeitos no acesso às políticas públicas em diferentes níveis. Nesse sentido, a presente tese busca refletir sobre os processos de formação da agenda política da pessoa com deficiência no Brasil, considerando diferentes aspectos, como o protagonismo, a transversalidade das políticas públicas e sua evolução, o papel dos indicadores, as relações de embate e diálogo entre governo e sociedade civil e os processos formativos instituídos, até mesmo na busca pela legitimidade desses conceitos no cenário local e internacional. O caráter polissêmico das políticas públicas para pessoas com deficiência fica evidente com a presença nas quatro arenas de poder, nas quais terão maior ou menor rejeição, envolvendo discussão entre os partidos políticos (governo x oposição) e a barganha entre os grupos de interesse. Diante da multiplicidade do movimento das pessoas com deficiência, há, em cada tipo de política pública, uma diversidade nos atores que compõem os grupos de interesse. A gestão da política da pessoa com deficiência no Brasil passou por diferentes modificações, nos últimos anos, em uma disputa entre o campo da assistência social e dos direitos humanos. Números, dados, leis, enfim, o que importa mais? Qual será a Evidence-based que determinará o maior o menor grau de uma política pública para pessoas com deficiência no Brasil? Acreditamos que essa resposta não seja especificamente o objeto dessa tese, mas conhecermos as possibilidades a que podemos recorrer neste labirinto que estamos estudando poderá ajudar nas reflexões. Se, do ponto de vista teórico, é possível defender um estado ideal, onde os direitos dos sujeitos são universalizados, do ponto de vista prático, surgem algumas questões. Qual o limite entre proteger e incluir? É possível universalizar sempre? Talvez o que devamos discutir é uma transição paradigmática, onde podemos aprender com as diferentes experiências vigentes em todo país, sobretudo nos estados, Distrito Federal e municípios

AUDIODESCRIÇÃO E EDUCAÇÃO AMBIENTAL: DIÁLOGOS POLÍTICOS E PEDAGÓGICOS

A sociedade moderna passa por muitas transformações, as quais afetam diretamente nosso modo de ver e agir no mundo. Ao longo da história, extermínio, exclusão, segregação, integração foram conceitos que fazem parte da vida das pessoas com deficiência. O presente trabalho busca identificar a construção das políticas públicas de acessibilidade e inclusão, suas transformações conceituais e como a audiodescrição se estabelece neste contexto, ou seja, como se afirma teórica e politicamente. Como utilizar a audiodescrição como uma ferramenta pedagógica nos processos de educação ambiental? A ideia de acessibilidade e sustentabilidade é trabalhada para pensar novas concepções pedagógicas que conectem saberes individuais e coletivos a partir da compreensão de que o meio ambiente é um direito de todos, inclusive das pessoas com deficiência. São apresentadas as principais normas no âmbito do Brasil e como as mesmas são influenciadas por documentos internacionais e quais são os atores envolvidos nestes processos. Por fim, há uma tentativa de conectar estas questões como dimensões de uma política pública de educação para todas as pessoas, oferecendo sugestões de acessibilidade a projetos e programas de educação ambiental no âmbito federal. 

O estado da arte sobre políticas públicas para pessoas com deficiência no Brasil: dialogando sobre transversalidade e educação

Este artigo pretende apresentar um panorama das políticas para as pessoas com deficiência no Brasil, abordando sua estrutura organizacional e propondo um diálogo com a educação, visando conectar, assim, os diferentes saberes da escola, que são reprodução social, para procurar pistas sobre as políticas transversais, que talvez sejam o maior desafio de uma democracia em evolução. Além de tentar compreender como essas políticas se organizam, e em que espaços sociais se materializam, buscamos pensar, a partir das teorias educacionais, a defesa do argumento de que a transversalidade pode contribuir para um processo de diálogo entre a sociedade civil e os órgãos governamentais, exigindo uma pedagogia da participação social, assim como novas formas de fazer e compreender a política e, mais do que isso, exercitar diferentes práticas para um mundo mais inclusivo.Revista do Serviço Público - RSP, v. 67, n. 4, p. 555 - 574Políticas Públicas e SociaisISSN eletrônico: 2357-8017ISSN impresso: 0034-924

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt