Hand arthritis in systemic lupus erythematosus: an ultrasound pictorial essay.

A small minority of systemic lupus erythematosus (SLE) patients may develop a deforming arthritis, typically with a non-erosive (Jaccoud's) pattern, although erosive features indistinguishable from rheumatoid arthritis may also occur. High-resolution ultrasonography (HRUS) allows detailed 'real time' imaging of joint and tendon morphostructural changes involving the hand in patients with several rheumatic diseases. The main aim of this pictorial essay is to provide the first descriptive HRUS and power Doppler (PD) findings of joint and tendon involvement of the hand and wrist in patients with SLE arthritis. Seventeen patients with SLE and hand involvement were examined. HRUS of the wrist, 2nd and 3rd MCP joints, 3rd PIP joint and 2nd, 3rd and 4th finger flexor tendons were studied in the dominant hand for each patient. Sixteen (94%) patients had joint effusion or synovial hypertrophy in the wrist. Twelve (71%) patients had joint effusion or synovial hypertrophy in 2nd or 3rd MCPJs. Eight (47%) patients had erosion at 2nd or 3rd MCPJs. In three cases erosions were not present radiologically. Eleven (65%) patients had evidence of tenosynovitis. In SLE, HRUS with PD detects a high prevalence of inflammatory pathology in the tendons and synovium of the hand and wrist, and a high prevalence of MCP joint erosions. HRUS offers a sensitive, real-time and readily repeatable assessment of soft-tissue, inflammatory and bony changes in SLE hands.

A helminth cathelicidin-like protein suppresses antigen processing and presentation in macrophages via inhibition of lysosomal vATPase

We previously reported the identification of a novel family of immunomodulatory proteins, termed helminth defense molecules (HDMs), that are secreted by medically important trematode parasites. Since HDMs share biochemical, structural, and functional characteristics with mammalian cathelicidin-like host defense peptides (HDPs), we proposed that HDMs modulate the immune response via molecular mimicry of host molecules. In the present study, we report the mechanism by which HDMs influence the function of macrophages. We show that the HDM secreted by Fasciola hepatica (FhHDM-1) binds to macrophage plasma membrane lipid rafts via selective interaction with phospholipids and/or cholesterol before being internalized by endocytosis. Following internalization, FhHDM-1 is rapidly processed by lysosomal cathepsin L to release a short C-terminal peptide (containing a conserved amphipathic helix that is a key to HDM function), which then prevents the acidification of the endolysosomal compartments by inhibiting vacuolar ATPase activity. The resulting endolysosomal alkalization impedes macrophage antigen processing and prevents the transport of peptides to the cell surface in conjunction with MHC class II for presentation to CD4(+) T cells. Thus, we have elucidated a novel mechanism by which helminth pathogens alter innate immune cell function to assist their survival in the host.-Robinson, M. W., Alvarado, R., To, J., Hutchinson, A. T., Dowdell, S. N., Lund, M., Turnbull, L., Whitchurch, C. B., O'Brien, B. A., Dalton, J. P., Donnelly, S. A helminth cathelicidin-like protein suppresses antigen processing and presentation in macrophages via inhibition of lysosomal vATPase.

Interculturalidade : caminhos para a transformação

Relatório de estágio de mestrado, Ciências da Educação (Educação Intercultural), Universidade de Lisboa, Instituto de Educação, 2013

Use of Distress and Depression Thermometers to Measure Psychosocial Morbidity Among Southern European Cancer Patients

GOALS OF WORK: Recent literature has indicated the need for rapid evaluation of psychosocial issues secondary to cancer. Because of the problems of routine use of psychometric instruments, short instruments such as visual analogue scales or one-item 0-10 scales have been developed as valid assessment alternatives. PATIENTS AND METHODS: A study was conducted to examine the role of two 0-10 scales in measuring emotional stress (distress thermometer, DT) and depressed mood (mood thermometer, MT), respectively, in a multicenter study carried out in southern European countries (Italy, Portugal, Spain, and Switzerland). A convenience sample of 312 cancer outpatients completed the DT and MT and the Hospital Anxiety Depression Scale (HADS). MAIN RESULTS: DT was more significantly associated HADS anxiety than HADS depression while MT was related both to HADS anxiety and depression. The correlation of MT with HADS was higher than DT. A cutoff point >4 on the DT maximized sensitivity (65%) and specificity (79%) for general psychosocial morbidity while a cutoff >5 identified more severe "caseness" (sensitivity=70%; specificity=73%). On the MT, sensitivity and specificity for general psychosocial morbidity were 85% and 72% by using the cutoff score >3. A score >4 on the MT was associated with a sensitivity of 78% and a specificity of 77% in detecting more severe caseness. CONCLUSIONS: Two simple instruments, the DT and the MT, were found to have acceptable levels of sensitivity and specificity in detecting psychosocial morbidity. Compared to the HADS, however, the mood MT performed better than the DT.

Do Spirituality and Faith Make a Difference? Report from the Southern European Psycho-Oncology Study Group

OBJECTIVE: In the last decade, some attention has been given to spirituality and faith and their role in cancer patients' coping. Few data are available about spirituality among cancer patients in Southern European countries, which have a big tradition of spirituality, namely, the Catholic religion. As part of a more general investigation (Southern European Psycho-Oncology Study--SEPOS), the aim of this study was to examine the effect of spirituality in molding psychosocial implications in Southern European cancer patients. METHOD: A convenience sample of 323 outpatients with a diagnosis of cancer between 6 to 18 months, a good performance status (Karnofsky Performance Status > 80), and no cognitive deficits or central nervous system (CNS) involvement by disease were approached in university and affiliated cancer centers in Italy, Spain, Portugal, and Switzerland (Italian speaking area). Each patient was evaluated for spirituality (Visual Analog Scale 0-10), psychological morbidity (Hospital Anxiety and Depression Scale--HADS), coping strategies (Mini-Mental Adjustment to Cancer--Mini-MAC) and concerns about illness (Cancer Worries Inventory--CWI). RESULTS. The majority of patients (79.3%) referred to being supported by their spirituality/faith throughout their illness. Significant differences were found between the spirituality and non-spirituality groups (p ≤ 0.01) in terms of education, coping styles, and psychological morbidity. Spirituality was significantly correlated with fighting spirit (r = -0.27), fatalism (r = 0.50), and avoidance (r = 0.23) coping styles and negatively correlated with education (r = -0.25), depression (r = -0.22) and HAD total (r = -0.17). SIGNIFICANCE OF RESULTS: Spirituality is frequent among Southern European cancer patients with lower education and seems to play some protective role towards psychological morbidity, specifically depression. Further studies should examine this trend in Southern European cancer patients.

Hopelessness and Related Variables among Cancer Patients in the Southern European Psycho-Oncology Study (SEPOS).

BACKGROUND: Although hopelessness has been studied in cancer, no data are available in non-English-speaking countries. OBJECTIVE: The authors sought to amass data from Southern European countries (Italy, Portugal, Spain, and Switzerland) in order to fill this void. METHOD: A group of 312 cancer patients completed the Mini-MAC Hopelessness subscale, the Hospital Anxiety and Depression Scale (HADS), the Cancer Worry Inventory (CWI), and a six-item Visual Analog scale (VAS) to measure intensity of physical symptoms, general well-being, difficulty in coping with cancer, intensity of social support from close relationships, leisure activity, and support from religious beliefs. RESULTS: Regression analysis indicated that HADS-Depression, VAS Maladaptive Coping and Well-Being, and the CWI explained 42% of the variance. CONCLUSION: Hopelessness in cancer patients seems not exclusively to correspond to depression, but is related to various other psychosocial factors, such as maladaptive coping, as well.

A Communication Intervention for Training Southern European Oncologists to Recognize Psychosocial Morbidity in Cancer. I - Development of the Model and Preliminary Results on Physicians' Satisfaction

BACKGROUND: The detection of psychosocial distress is a significant communication problem in Southern Europe and other countries. Work in this area is hampered by a lack of data. Because not much is known about training aimed at improving the recognition of psychosocial disorders in cancer patients, we developed a basic course model for medical oncology professionals. METHODS: A specific educational and experiential model (12 hours divided into 2 modules) involving formal teaching (ie, journal articles, large-group presentations), practice in small groups (ie, small-group exercises and role playing), and discussion in large groups was developed with the aim of improving the ability of oncologists to detect emotional disturbances in cancer patients (ie, depression, anxiety, and adjustment disorders). RESULTS: A total of 30 oncologists from 3 Southern European countries (Italy, Portugal, and Spain) participated in the workshop. The training course was well accepted by most participants who expressed general satisfaction and a positive subjective perception of the utility of the course for clinical practice. Of the total participants, 28 physicians (93.3%) thought that had they been exposed to this material sooner, they would have incorporated the techniques received in the workshop into their practices; 2 participants stated they would likely have done so. Half of the doctors (n = 15) believed that their clinical communication techniques were improved by participating in the workshop, and the remaining half thought that their abilities to communicate with cancer patients had improved. CONCLUSIONS: This model is a feasible approach for oncologists and is easily applicable to various oncology settings. Further studies will demonstrate the effectiveness of this method for improving oncologists skills in recognizing emotional disorders in their patients with cancer.

Blood pressure and LDL-cholesterol targets for prevention of recurrent strokes and cognitive decline in the hypertensive patient: design of the European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment randomized trial.

BACKGROUND AND OBJECTIVES: The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design. PROTOCOL DESIGN: The European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment trial is a prospective multinational, randomized trial with a 3 × 2 factorial design comparing: three different SBP targets (1, <145-135; 2, <135-125; 3, <125 mmHg); two different LDL-C targets (target A, 2.8-1.8; target B, <1.8 mmol/l). The trial is to be conducted on 7500 patients aged at least 65 years (2500 in Europe, 5000 in China) with hypertension and a stroke or transient ischaemic attack 1-6 months before randomization. Antihypertensive and statin treatments will be initiated or modified using suitable registered agents chosen by the investigators, in order to maintain patients within the randomized SBP and LDL-C windows. All patients will be followed up every 3 months for BP and every 6 months for LDL-C. Ambulatory BP will be measured yearly. OUTCOMES: Primary outcome is time to stroke (fatal and non-fatal). Important secondary outcomes are: time to first major cardiovascular event; cognitive decline (Montreal Cognitive Assessment) and dementia. All major outcomes will be adjudicated by committees blind to randomized allocation. A Data and Safety Monitoring Board has open access to data and can recommend trial interruption for safety. SAMPLE SIZE CALCULATION: It has been calculated that 925 patients would reach the primary outcome after a mean 4-year follow-up, and this should provide at least 80% power to detect a 25% stroke difference between SBP targets and a 20% difference between LDL-C targets.

La toma de decisiones de la pareja en el programa de planificación familiar : estudio de campo realizado en la colonia Lázaro Cárdenas,Cadereyta Jiménez, N.L.

Tesis (Maestría en Enfermería con Esp. en Salud Comunitaria) UANL

Uncover the Concealed Link: Gender & Ethnicity-Divided Local Knowledge on the Agro-Ecosystem of a Forest Margin

This research is a study about knowledge interface that aims to analyse knowledge discontinuities, the dynamic and emergent characters of struggles and interactions within gender system and ethnicity differences. The cacao boom phenomenon in Central Sulawesi is the main context for a changing of social relations of production, especially when the mode of production has shifted or is still underway from subsistence to petty commodity production. This agrarian change is not only about a change of relationship and practice, but, as my previous research has shown, also about the shift of knowledge domination, because knowledge construes social practice in a dialectical process. Agroecological knowledge is accumulated through interaction, practice and experience. At the same time the knowledge gained from new practices and experiences changes mode of interaction, so such processes provide the arena where an interface of knowledge is manifested. In the process of agro-ecological knowledge interface, gender and ethnic group interactions materialise in the decision-making of production and resource allocation at the household and community level. At this point, power/knowledge is interplayed to gain authority in decision-making. When authority dominates, power encounters resistance, whereas the dominant power and its resistance are aimed to ensure socio-economic security. Eventually, the process of struggle can be identified through the pattern of resource utilisation as a realisation of production decision-making. Such processes are varied from one community to another, and therefore, it shows uniqueness and commonalities, especially when it is placed in a context of shifting mode of production. The focus is placed on actors: men and women in their institutional and cultural setting, including the role of development agents. The inquiry is informed by 4 major questions: 1) How do women and men acquire, disseminate, and utilise their agro ecological knowledge, specifically in rice farming as a subsistence commodity, as well as in cacao farming as a petty commodity? How and why do such mechanisms construct different knowledge domains between two genders? How does the knowledge mechanism apply in different ethnics? What are the implications for gender and ethnicity based relation of production? ; 2) Using the concept of valued knowledge in a shifting mode of production context: is there any knowledge that dominates others? How does the process of domination occur and why? Is there any form of struggle, strategies, negotiation, and compromise over this domination? How do these processes take place at a household as well as community level? How does it relate to production decision-making? ; 3) Putting the previous questions in two communities with a different point of arrival on a path of agricultural commercialisation, how do the processes of struggle vary? What are the bases of the commonalities and peculiarities in both communities?; 4) How the decisions of production affect rice field - cacao plantation - forest utilisation in the two villages? How does that triangle of resource use reflect the constellation of local knowledge in those two communities? What is the implication of this knowledge constellation for the cacao-rice-forest agroecosystem in the forest margin area? Employing a qualitative approach as the main method of inquiry, indepth and dialogic interviews, participant observer role, and document review are used to gather information. A small survey and children’s writing competition are supplementary to this data collection method. The later two methods are aimed to give wider information on household decision making and perception toward the forest. It was found that local knowledge, particularly knowledge pertaining to rice-forest-cacao agroecology is divided according to gender and ethnicity. This constellation places a process of decision-making as ‘the arena of interface’ between feminine and masculine knowledge, as well as between dominant and less dominant ethnic groups. Transition from subsistence to a commercial mode of production is a context that frames a process where knowledge about cacao commodity is valued higher than rice. Market mechanism, as an external power, defines valued knowledge. Valued knowledge defines the dominant knowledge holder, and decision. Therefore, cacao cultivation becomes a dominant practice. Its existence sacrifices the presence of rice field and the forest. Knowledge about rice production and forest ecosystem exist, but is less valued. So it is unable to challenge the domination of cacao. Various forms of struggles - within gender an ethnicity context - to resist cacao domination are an expression of unequal knowledge possession. Knowledge inequality implies to unequal access to withdraw benefit from market valued crop. When unequal knowledge fails to construct a negotiated field or struggles fail to reveal ‘marginal’ decision, e.g. intensification instead of cacao expansion to the forest, interface only produces divergence. Gender and ethnicity divided knowledge is unabridged, since negotiation is unable to produce new knowledge that accommodates both interests. Rice is loaded by ecological interest to conserve the forest, while cacao is driven by economic interest to increase welfare status. The implication of this unmediated dominant knowledge of cacao production is the construction of access; access to the forest, mainly to withdraw its economic benefit by eliminating its ecological benefit. Then, access to cacao as the social relationship of production to acquire cacao knowledge; lastly, access to defend sustainable benefit from cacao by expansion. ‘Socio-economic Security’ is defined by Access. The convergence of rice and cacao knowledge, however, should be made possible across gender and ethnicity, not only for the sake of forest conservation as the insurance of ecological security, but also for community’s socio-economic security. The convergence might be found in a range of alternative ways to conduct cacao sustainable production, from agroforestry system to intensification.

Anorí, lo dulce y amargo de la sustitución de cultivos

Anorí es un pueblo pujante de Antioquia que sustituye su forma de vida; intenta pasar de lo ilegal a lo legal, de la violencia a la paz y de la coca al cacao. Sustituir para la construcción de conciencias es la esencia del programa de la Gobernación de Antioquia y de la Oficina de Naciones Unidas contra la Droga y el Delito. Este proyecto empezó en el 2006 e involucró a 100 familias y, aunque la idea era sumar experiencias, sucedió lo contrario. Hoy, solo 56 grupos son beneficiarios de la iniciativa. Sin embargo, ya está a la venta la chocolatina Anorí, producto de los nuevos cultivos de cacao, capaces de devolverle la sonrisa a la población de este municipio, que tantas veces ha sido censurada por el miedo.

Diagnósticos de las apuestas productivas para seis productos del sector agrícola en Colombia

El documento “Diagnósticos de las apuestas productivas para seis productos del sector agrícola en Colombia”, pretende proporcionar herramientas para el incremento productivo de seis productos agrícolas con un alto potencial en el país, mediante la identificación de mercados internacionales factibles, el análisis de sus procesos de producción y la comparación de eficiencia en costos del transporte de mercancía a nivel nacional; buscando el aumento de la participación del PIB agrícola en el PIB nacional. Los productos seleccionados son el Aguacate, el Ají, el Algodón, la Uchuva, la Pitahaya y el Tomate de árbol.

Rehabilitation of executive functions: Implications and strategies

Executive Functions (EF) concern a range of abilitiesincluding problem-solving, planning, initiation, selfmonitoring,conscious attention, cope with new situationsand the ability to modify plans if necessary. It’s ahigh cognitive function that is crucial for a person to getengaged and maintain daily activities whilst keeping agood quality of life. Problems in the EF were formerlyknown as Dysexecutive Syndrome (DS). There are manymodels concerning DS, although the literature on thesubject still remains unclear. Several works appoint theeffects brought by elderly life, as well as abuse of drugsand some psychopathologies. These factors are knownto increase the distress of the frontal circuits and thatcould be associated to executive deficits. The effects ofDS would compromise individuals in day-to-day routine,academic, social and labor fields. There is a growingbody of studies trying to determine the causes, implications,associations and the best way to take care of theseeffects. This work intends to review DS, focusing on themost important fields related to this area, such as psychopathologyassociations, cognitive reserve, assessmentand cognitive rehabilitation programs.