OTALEXC - 15 anos de cooperação transfronteiriça em Território e SIG

As matérias relacionadas com o Território, a análise das suas características, potencialidades, valores e debilidades é uma das preocupações de todas a entidades que tem de tomar decisões sobre o ordenamento e gestão territoriais. Os Sistemas de Informação Geográfica aliadas a sistemas periciais, redes neuronais e análise multicritério são as ferramentas essenciais para as tarefas relacionadas com a caracterização e análise territorial e ambiental. No âmbito da cooperação transfronteiriça juntaram-se diversas entidades, ao nível local (Diputações e Associações de Municípios – atuais Comunidades Intermunicipais- CIMs), regional (Comissão de Coordenação e Desenvolvimento Regional do Alentejo – CCDRA e Junta da Extremadura – JE), e nacional (Institutos geográficos Português e Espanhol – IGP e IGN) com responsabilidades na gestão e planeamento territorial. Estas entidades começaram por colaborar na área da compatibilização de SIG e cartografia, e tem atualmente em produção a primeira infraestrutura de dados espaciais transfronteiriça – www.ideotalex.eu, onde se encontra compatibilizada informação geográfica de ambos os lados da fronteira e informação temática de indicadores sociais, económicos, territoriais e ambientais do Alentejo e Extremadura estando em curso a integração da informação da região Centro. Os princípios inspiradores que norteiam esta cooperação são: promover o desenvolvimento económico e social dando especial relevância aos valores ambientais,contribuir para o efetivo desenvolvimento sustentável e melhoria da qualidade de vida das populações. Este artigo dá conta dos projetos em que as diversas entidades de ambos os lados da fronteira têm cooperado, ao longo de já 15 anos e dos resultados e prémios alcançados em cada um deles assim como dos efeitos colaterais positivos que essa colaboração tem induzido

Costumbres privadas e interés público: la lactancia materna en la literatura médica de divulgación. Barcelona, 1880-1890

A partir de las últimas décadas del siglo XIX, las formas de vida de las clases populares se vieron amenazadas por la homogeneización que la cultura burguesa introdujo en las sociedades industriales. Una forma de incidir en las pautas de conducta fue la transmisión de nuevos valores a través de los mecanismos de comunicación con los que se contaba. La alimentación y la higiene se convirtieron en cuestiones fundamentales dentro de un cambio cultural que fue potenciado desde la vida política, y apoyado por instituciones y grupos sociales influyentes, que jugaron además un papel de intermediarios en los conflictos de clase. La lactancia materna es uno de los temas claves de la literatura de divulgación higiénica de final de siglo y representa un intento de paliar el problema de la mortalidad infantil, de modelar la conducta de las mujeres y consolidar un tipo de familia en un contexto que demandaba estabilidad, ahorro y trabajo, frente a los peligros que suponía la miseria y la falta de vínculos de la gran masa obrera que llegaba a la ciudad industrial

La formación en étíca profesional: reflexión y diálogo. Relato de una experiencia compartida.

Sin resume

Pathophysiology of Bradykinin-Mediated Angioedema: The Role of the Complement System

The “complement system” is one of the effector pathways of the immune system against microorganisms and tumor cells. The complement system can be activated through three major pathways: classical, lectin, and alternative. The sequential activation through the generation of complex enzymes from inactive zymogens produces a cascade in which a capable enzyme generates a large number of active downstream molecules

Short‐Term Prophylaxis in Odontostomatological, Maxillofacial and ENT Procedures in Patients with Hereditary Angioedema Due to C1‐Inhibitor Deficiency

Oestrogens, trauma, infections or stress has been described as triggers for angioedema (AE) attacks in patients with hereditary angioedema due to C1-inhibitor deficiency (C1-INH-HAE). Microtrauma can precipitate the onset of acute AE attacks, and thus, dental-oral procedures carry a high risk of triggering them and also an increased risk of death from asphyxiation due to the AE location. In the past, without proper specific treatment, the overall mortality after dental surgery in patients with C1-INH-HAE was up to 30–40%. Some dental-oral, medical and/or surgical procedures are susceptible to receive “short-term prophylaxis” (STP) in order to reduce the risk of AE. We describe the published case reports of dental-oral, maxillofacial and ear, nose and throat (ENT) procedures in patients with C1-INH-HAE. Different consensus algorithms and clinical guidelines have been published for managing dental-oral, maxillofacial and otolaryngological procedures (DOMFOPs) and will be reviewed below. Based on the clinical experience of the Department of Allergology of the University Hospital La Paz (Madrid) and the University General Hospital Nuestra Señora del Prado (Talavera de la Reina), these algorithms have been updated and modified. We advise to classify procedures according to the risk of producing AE as minor, intermediate and major risks

Classification and Treatment of Angioedema without Wheals: A Spanish Delphi Consensus

Angioedema; Delphi ConsensusAngioedema; Consenso DelphiAngioedema; Consens DelphiIntroduction Problems in the definition and classification of angioedema, leading to difficulties in its diagnosis and treatment, have been identified; therefore, an improvement in the current classification of angioedema is required. Objective The aim of this study was to propose a practical classification of angioedema without wheals that helps to establish a differential diagnosis and take appropriate therapeutic decisions. Methods An initial proposal of classification of angioedema without wheals was agreed by a scientific committee of experts and was subsequently validated by a panel of experts by means of consensus based on the Delphi methodology. Forty-five items on the classification, diagnosis, and treatment of angioedema without wheals were proposed for the survey. Results Most items (93.8%) were agreed after two rounds. All panelists agreed with the proposed classification, as well as with most of the clinical and treatment characteristics. The angioedema without wheals classification established three groups: histamine-mediated, bradykinin-mediated, and unknown mechanism angioedema. The clinical characteristics of the proposed types of angioedema were also agreed, except for the allergic histamine-mediated and unknown mechanism angioedema, which generated debate. Regarding treatments, although there was broad agreement with the proposed items, a lack of knowledge about some treatments in this pathology was observed. Conclusion The proposed classification of angioedema without wheals was accepted with a high degree of agreement; however, knowledge of available treatments needs to be increased and the definition of angioedema of unknown mechanism needs to be improved.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature

Fortalecimiento de capacidades de los actores locales para una gestión del desarrollo local desde la cultura

Aim: Despite current advances, there is still a lack of understanding of culture as a valuable resource for local development management in Cuba. Therefore, strengthening local actor capacities is a strategic axis. Fundamental elements regarding capacity strengthening within the Local Development Program are explained from a cultural perspective. Methods: This study was based on the methodology of generalization of experiences to collect data, as well as questionnaires, and document review. Main results: Guidelines are suggested for future initiatives, in order to reinforce local actor capacities to design and implement strategies and projects with a multisector perspective, which integrates transforming actions of the local reality, creating a greater impact on the quality of life of the population, to be considered in their cultural context. Conclusions: The need to tackle local actor training to achieve local development from a cultural standpoint, is corroborated.Objetivo: Pese a los avances, aún persisten manifestaciones de incomprensión de la cultura como un recurso valioso en la gestión del desarrollo local hoy en Cuba; por esta razón, el fortalecimiento de capacidades en actores locales constituye un eje estratégico. Se exponen elementos sustantivos acerca del fortalecimiento de capacidades en el marco del Programa de Desarrollo Local desde la Cultura en Camagüey. Métodos: El estudio se apoyó en la metodología de la sistematización de experiencias para la obtención de datos, junto al empleo de cuestionarios y análisis de documentos. Principales resultados: Se ofrecen pautas a tener en cuenta en iniciativas futuras, para fortalecer las capacidades de los actores locales en el diseño y ejecución de estrategias y proyectos con una visión multisectorial, que integre acciones transformadoras de la realidad del territorio, con mayor impacto en la calidad de vida de la población al tener en cuenta su contexto cultural. Conclusiones: Se reafirma la necesidad de atender a la preparación de los actores locales, con vista a los procesos de desarrollo local desde la cultura

IDE-OTALEX. The first crossborder SDI between Portugal and Spain

IDE-OTALEX is the first crossborder spatial data infrastructure between contiguous Portuguese (Alentejo and Centro) and Spanish (Extremadura) regions. IDE-OTALEX was implemented to share official geographic information, from Alentejo and Extremadura, and now Centro region, with everyone. This is the most effective way to have a distributed and flexible system to be used as a territorial observatory for sustainable development and environment protection in these rural and low populated regions. It also contributes to territorial cohesion, one of the tree main pillars of European Cohesion Policy. It’s characterized for being a distributed, decentralized, modular and collaborative system, based on standards (OGC, W3C, ISO) and open source technology, developed to guarantee interoperability between the different GIS provided by each project partner. The geoportal is multilingual (Portuguese, Spanish and English) and integrates a Map viewer, Metadata Catalogue and Gazetteer. It consists in central and local nodes which communicate through WMS (Web Map Services), CSW (Catalog Service Web) and WFS (Web Feature Services). It is now implementing SOS (sensor observation services) and WPS (web map processing). The geographic information on it available results of an extensive work of data harmonisation adapted to INSPIRE Directive (D 2007/2/EC, of the European Parliament and Council, of March 14, 2007). It integrates basic cartography, socio-economic and environmental indicators

The hereditary angioedema burden of illness study in Europe (HAE-BOIS-Europe) : background and methodology

Background: Hereditary angioedema (HAE) is a rare but serious disease marked by swelling attacks in the extremities, face, trunk, airway, or abdominal areas that can be spontaneous or the result of trauma and other triggers. It can be life-threatening due to the risk of asphyxiation. While there have been major advancements in our understanding of the immunogenetics of HAE, there are significant gaps in the literature regarding understanding of the humanistic and economic impact of the disease, particularly in Europe. The purpose of the HAE Burden of Illness Study-Europe (HAE-BOIS-Europe), the development and methodology of which is described here, is to better understand the management and impact of HAE from the patient perspective in Europe. Methods/Design: This is a cross-sectional study in which retrospective data were also collected being conducted in Denmark, Germany and Spain. The study is open to patients ages 12 and older with a diagnosis of HAE-I or HAE-II. Data collection includes: (i) a survey on individuals’ health care resource use, direct and indirect medical costs, impact on work and school, treatment satisfaction, and emotional functioning (via the Hospital Anxiety and Depression Scale); and (ii) one-on-one interviews to collect detailed descriptive data and patient testimonials on the impact of HAE on patients’ health-related quality of life. Discussion: The present manuscript describes the development and plans for implementing a multi-country European study with the aim of characterizing the humanistic and economic burden of HAE from the patient perspective. This study will help raise awareness of HAE as a rare but debilitating condition with wide-ranging impacts

Social costs of icatibant self-administration vs. health professional-administration in the treatment of hereditary angioedema in Spain

Background: Icatibant is the only subcutaneous treatment for acute Type I and Type II hereditary angioedema with C1-esterase inhibitor deficiency (HAE-C1-INH) licensed for self-administration in Europe. Aim: To compare the economic impact of two icatibant administration strategies: health professional-administration only (strategy 1) versus including the patient self-administration option (strategy 2). Methods:Economic evaluation model based on the building of a decision tree. Both strategies are assumed to have equivalent effectiveness. The payer (Spanish National Health System) and the social perspectives were considered. All relevant cost-generating factors were taken into account. The time horizon was one year. Sources of information included scientific evidence, official data and experts' opinion. A deterministic sensitivity analysis was carried out to quantify the underlying uncertainty in the model. Results: From the social perspective, which considers both direct (health care costs) and indirect costs (productivity losses), strategy 2 would result into average savings of 121.30 per acute attack compared to strategy 1. For Spain, this would achieve in an annual savings of 551,371. The reduction in direct costs accounts for 74% of the savings and lower indirect costs account for the remaining 26%. Savings per acute attack may range from 79.50 to 169.80; accordingly, the annual savings in Spain may vary between 90,319 and 2,315,360. Conclusion: Costs related to the management of acute HAE attacks with C1 inhibitor deficiency may be substantially reduced through interventions targeting home treatment by training patients to self-administer icatibant