Adesão ao regime medicamentoso dos adolescentes submetidos a transplante hepático: fatores motivacionais

O transplante hepático é uma condição crónica que implica a necessidade de aderir ao longo da vida a um regime medicamentoso pois, a imunossupressão é essencial para a sobrevida do enxerto e do recetor. O risco de não adesão à medicação pelo adolescente transplantado é potenciado pelas características da adolescência. Este estudo inclui-se na investigação quantitativa, descritiva-analítica, exploratória e correlacional e teve como objetivos caracterizar os adolescentes com transplante hepático; verificar a sua adesão ao regime medicamentoso; a sua motivação e se se julgam competentes para essa adesão, e verificar a relação entre estas variáveis. A colheita de dados foi realizada entre julho de 2015 e maio de 2016, utilizando como instrumentos a Medida de Adesão aos Tratamentos (MAT), os valores sanguíneos da imunossupressão, o Treatment Self-Regulation Questionnaire (TSRQ) e a Perceived Competence Scale (PCS), estes dois traduzidos para a língua portuguesa. A amostra é constituída por 32 adolescentes com transplante hepático seguidos no Hospital Pediátrico do Centro Hospitalar e Universitário de Coimbra, os quais tinham em média 14,44 anos, 56,3% eram do género masculino, 46,9% viviam em cidades e 37,5% frequentavam o segundo ciclo. Os adolescentes responderam ter um comportamento de maior adesão medicamentosa (100%) comparativamente à revelada pelos valores sanguíneos (66,7%). Apresentavam uma motivação predominantemente autónoma para cumprir a prescrição medicamentosa que assumiu um valor elevado. Os adolescentes mostraram sentirem-se confiantes e crentes na sua capacidade para cumprir o regime medicamentoso, dada a elevada competência percebida. Ao contrário do postulado pela Teoria da Autodeterminação (TAD) e de resultados de outras investigações, a motivação e a competência percebida não estavam relacionadas com a adesão ao regime medicamentoso neste estudo. A competência percebida parece ter influência na motivação autónoma dos adolescentes. A adolescência revela-se um período de elevado risco para a não adesão ao regime medicamentoso. Dada a importância atribuída ao regime imunossupressor e a relevância da motivação autónoma e da competência percebida para resultados de saúde positivos, os profissionais de saúde devem planear intervenções impulsionadoras da motivação autónoma e da competência percebida de modo a promover a adesão ao regime medicamentoso.

Adesão ao regime medicamentoso dos adolescentes submetidos a transplante hepático: fatores motivacionais.

Introduction: In liver transplantation the immunosuppression is essential for the survival of the graft and of the receiver. Although characteristics of adolescent development may influence medication non-adherence, the literature on the subject is scarce. The high prevalence and consequences of non-adherence makes it essential to identify the non-adherent adolescent with the intention of promoting medication adherence. Methods: The aim of this descriptive cross-sectional study is to characterize adolescents undergoing liver transplantation, and to determine the degree of medication non-adherence, using the Measure Treatment Adherence (MAT) scale and immunosuppression blood values. Moreover, the study seeks to explore the relationship between adherence and motivation - using the Treatment Self-Regulation Questionnaire (TSRQ), and adherence and competency - using Perceived Competence Scale (PCS). Results: The sample consisted of 32 adolescents (Age M=14,44 (SD=2,66); 56,3% (n=18) male) who underwent liver transplantation at a Portuguese pediatric hospital. Adolescents self-reported medication adherence scores in the MAT were significantly higher (100%) than what was expected based on the mean value of the three blood values of tacrolimus obtained within one year prior to completing the questionnaire (66,7%). As a subjective self-reported measure, the MAT is prone to bias and inflated self assessed adherence is commonly found in the literature. On the other hand, the mean value of the three blood levels of tacrolimus obtained widely and considered objective adherences measure, they may individually vary in terms of pharmacokinetic response and absorption. Adolescents showed a predominantly autonomous motivation to fulfill the medication prescription, being that motivation high (TSRQ autonomous motivation subscale presents an average value of 6.5, in a range of 1 to 7). They showed themselves confident and believing in their capacity to follow the medication regimen, due to the high perceived competence (PCS presents an average value of 6.65, in a range of 1 to 7). Opposed to what was postulated by the Self-determination Theory and other investigation's results, motivation and perceived competence are not related to adherence to the medication regimen in this study (rs=,119 p=,523; rs=,283 p=,123, respectively). Thus, perceived competence seems to have a positive influence on the autonomous motivation of these adolescents (rs=,482 p=,006). Conclusion: This study shows that medication adherence when evaluated subjectively scores higher compared to the blood values of immunosuppression. Also, Motivation and Perceived Competence do not seem to influence the adherence to the medication regimen. More multi-centre studies are needed, based on solid theory to examine adherence behaviour more.

Cognitive Assessment System (CAS): Psychometric studies with Portuguese children from 7 to 15 years.

The Cognitive Assessment System (CAS) is a new measure of cognitive abilities based on the Planning, Attention, Simultaneous and Successive (PASS) Theory. This theory is derived from research in neuropsychological and cognitive Psychology with particular emphasis on the work of Luria (1973). According to Naglieri (1999) and Naglieri and Das (1997), the PASS cognitive processes are the basic building blocks of human intellectual functioning. Planning processes provide cognitive control, utilization of processes and knowledge, intentionality, and self-regulation to achieve a desired goal; Attention processes provide focused, selective cognitive activity and resistance to distraction; and, Simultaneous and Successive processes are the two forms of operating on information. The PASS theory has had a strong empirical base prior to the publication of the CAS (see Das, Naglieri & Kirby, 1994), and its research foundation remains strong (see Naglieri, 1999; Naglieri & Das, 1997). The four basic psychological processes can be used to (1) gain an understanding of how well a child thinks; (2) discover the child’s strengths and needs, which can then be used for effective differential diagnosis; (3) conduct fair assessment; and (4) select or design appropriate interventions. Compared to the traditional intelligence tests, including IQ tests, the Cognitive Assessment System (CAS) has the great advantage of relying on a modern theory of cognitive functioning, linking theory with practice.

Internet share of advertising expenditure : growth drivers and inhibitors in the brazilian market

Os investimentos com publicidade na Internet como uma percentagem das despesas totais de publicidade variam significativamente de um país para outro. O número é tão baixo quanto 4,7% no mercado brasileiro e tão alto como 28,5% no mercado britânico (ZenithOptimedia, 2011b). Algumas razões explicam tal disparidade. No nível macro, a participação dos gastos com publicidade na Internet está fortemente ligada a variáveis como o produto interno bruto per capita e à penetração da Internet na população. No nível micro, uma pesquisa qualitativa foi feita para identificar os fatores que contribuem e inibem o crescimento da participação da publicidade online no mercado brasileiro. A vasta lista de inibidores parece ter profundo impacto sobre como os profissionais de mercado tomar decisões de alocação de investimento em publicidade por tipo de mídia. Devido à legislação, à auto-regulamentação e às dinâmicas da indústria, grande parte da tomada de decisão é realizada por agências de publicidade. Estas parecem ter fortes incentivos econômicos para selecionar outros tipos de mídia e não a Internet ao definir planos de mídia. Ao mesmo tempo, a legislação e a auto-regulamentação fornecem desincentivos para corretores de mídia a operar no mercado local. A falta de profissionais qualificados e a padronização limitada também desempenham papéis importante para inibir uma maior participação da Internet nos gastos com publicidade no Brasil. A convergência dos resultados quantitativos com os qualitativos indica possíveis motivos pelos quais a participação da publicidade online no Brasil é tão baixa. Em primeiro lugar, a participação é explicada pelo estágio de desenvolvimento dos países. Quanto mais rico e mais desenvolvido um país, maior a proporção de gastos com publicidade online tende a ser. Em segundo lugar, o estágio econômico emergente do Brasil potencialmente dá espaço para o aumento do ineficiências do mercado, tais como programas de descontos oferecidos de forma desproporcional para os principais decisores de alocação de investimentos de mídia. Este fato aparentemente produz um feedback negativo, contribuindo para manter a baixa participação da publicidade online no total dos investimentos publicitários.

Symmetry in biology: from genetic code to stochastic gene regulation

Mathematical models, as instruments for understanding the workings of nature, are a traditional tool of physics, but they also play an ever increasing role in biology - in the description of fundamental processes as well as that of complex systems. In this review, the authors discuss two examples of the application of group theoretical methods, which constitute the mathematical discipline for a quantitative description of the idea of symmetry, to genetics. The first one appears, in the form of a pseudo-orthogonal (Lorentz like) symmetry, in the stochastic modelling of what may be regarded as the simplest possible example of a genetic network and, hopefully, a building block for more complicated ones: a single self-interacting or externally regulated gene with only two possible states: ` on` and ` off`. The second is the algebraic approach to the evolution of the genetic code, according to which the current code results from a dynamical symmetry breaking process, starting out from an initial state of complete symmetry and ending in the presently observed final state of low symmetry. In both cases, symmetry plays a decisive role: in the first, it is a characteristic feature of the dynamics of the gene switch and its decay to equilibrium, whereas in the second, it provides the guidelines for the evolution of the coding rules.

Advertising to children in Brazilian families: a critical discourse analysis of reception

This article aims to contribute to the understanding of the reception of advertising to children in Brazilian families. The topic of children's advertising has gained importance in recent years because of the civil movements for regulation by-law of advertising to children in Brazil. In view of the various interests at stake, the matter has been the subject of discussion and controversy. Therefore the objective of this paper is to cooperate to the debate, in order to understand the reception of children's advertising in family dynamics. We chose here the focus in the perspective of mothers and fathers. Four semi-structured interviews for the mothers and fathers of children aged between six and 10 years, conducted in two schools in the Distrito Federal, were analyzed. The category ‘appraisal’ was considered for analysis of positions, behaviors and feelings present in the discourse of the parents. The reflections were guided on Critical Discourse Analysis and reveal that advertising to children has been responsible for a determinate disharmony in the family environment, while at the same time strengthen traditional roles of social actors.

From neural stem cells to precursors : Molecular regulation of self-renewal and differentiation

Stem cells are responsible for tissue turnover throughout lifespan. Only highly controlled specific environment, the stem cell niche , can sustain undifferentiated stem cell-pool. The balance between maintenance and differentiation is crucial for individual s health: uncontrolled stem cell self-renewal or proliferation can lead to hyperplasia and mutations that further provoke malignant transformation of the cells. On the other hand, uninhibited differentiation may result in diminished stem cell population, which is unable to maintain tissue turnover. The mechanisms that control the switch from maintenance to differentiation in stem cells are not well known. The same mechanisms that direct the self-renewal and proliferation in normal stem cells are likely to be also involved in maintenance of cancer stem cell . Cancer stem cells exhibit stem cell like properties such as self-renewal- and differentiation capacity and they can also regenerate the tumor tissue. In this thesis, I have investigated the effect of classical oncogenes E6/E7 and c-Myc, tumor suppressors p53 and retinoblastoma (pRb) family, and vascular endothelial growth factor (VEGF) subfamily and glial cell line-derived neurothropic factor (GDNF) family ligands on behavior of embryonic neural stem cells (NSCs) and progenitors. The study includes also the characterization of cytoskeletal tumor suppressor neurofibromatosis 2 (NF2) protein merlin and ezrin-radixin-moesin (ERM) protein ezrin expression in neural progenitors cells and their progeny. This study reveals some potential mechanisms regarding to NSCs maintenance. In summary, the studied molecules are able to shift the balance either towards stem cell maintenance or differentiation; tumor suppressor p53 represses whereas E6/E7 oncogenes and c-Myc increase the proportion of self-renewing and proliferating NSCs or progenitors. The data suggests that active MEK-ERK signaling is critical for self-renewal of normal and oncogene expressing NSCs. In addition, the results indicate that expression of cytoskeletal tumor suppressor merlin and ERM protein ezrin in central nervous system (CNS) tissue and progenitors indicates their role in cell differentiation. Furthermore, the data suggests that VEGF-C a factor involved in lymphatic system development, angiogenesis, neovascularization and metastasis but also in maintenance of some neural populations in brain is a novel thropic factor for progenitors in early sympathetic nervous system (SNS). It seems that VEGF-C dose dependently through ERK-pathway supports the proliferation and survival of early sympathetic progenitor cells, and the effect is comparable to that of GDNF family ligands.

Application of Decision-Making Theory to the Regulation of Muscular Work Rate During Self-Paced Competitive Endurance Activity.

Successful participation in competitive endurance activities requires continual regulation of muscular work rate in order to maximise physiological performance capacities, meaning that individuals must make numerous decisions with regards to the muscular work rate selected at any point in time. Decisions relating to the setting of appropriate goals and the overall strategic approach to be utilised are made prior to the commencement of an event, whereas tactical decisions are made during the event itself. This review examines current theories of decision-making in an attempt to explain the manner in which regulation of muscular work is achieved during athletic activity. We describe rational and heuristic theories, and relate these to current models of regulatory processes during self-paced exercise in an attempt to explain observations made in both laboratory and competitive environments. Additionally, we use rational and heuristic theories in an attempt to explain the influence of the presence of direct competitors on the quality of the decisions made during these activities. We hypothesise that although both rational and heuristic models can plausibly explain many observed behaviours in competitive endurance activities, the complexity of the environment in which such activities occur would imply that effective rational decision-making is unlikely. However, at present, many proposed models of the regulatory process share similarities with rational models. We suggest enhanced understanding of the decision-making process during self-paced activities is crucial in order to improve the ability to understand regulation of performance and performance outcomes during athletic activity.

Regulation of Nedd4-2 self-ubiquitination and stability by a PY motif located within its HECT-domain.

Ubiquitin ligases play a pivotal role in substrate recognition and ubiquitin transfer, yet little is known about the regulation of their catalytic activity. Nedd4 (neural-precursor-cell-expressed, developmentally down-regulated 4)-2 is an E3 ubiquitin ligase composed of a C2 domain, four WW domains (protein-protein interaction domains containing two conserved tryptophan residues) that bind PY motifs (L/PPXY) and a ubiquitin ligase HECT (homologous with E6-associated protein C-terminus) domain. In the present paper we show that the WW domains of Nedd4-2 bind (weakly) to a PY motif (LPXY) located within its own HECT domain and inhibit auto-ubiquitination. Pulse-chase experiments demonstrated that mutation of the HECT PY-motif decreases the stability of Nedd4-2, suggesting that it is involved in stabilization of this E3 ligase. Interestingly, the HECT PY-motif mutation does not affect ubiquitination or down-regulation of a known Nedd4-2 substrate, ENaC (epithelial sodium channel). ENaC ubiquitination, in turn, appears to promote Nedd4-2 self-ubiquitination. These results support a model in which the inter- or intra-molecular WW-domain-HECT PY-motif interaction stabilizes Nedd4-2 by preventing self-ubiquitination. Substrate binding disrupts this interaction, allowing self-ubiquitination of Nedd4-2 and subsequent degradation, resulting in down-regulation of Nedd4-2 once it has ubiquitinated its target. These findings also point to a novel mechanism employed by a ubiquitin ligase to regulate itself differentially compared with substrate ubiquitination and stability.

Advertising broadsheet for the book "Real Pen-Work Self-Instructor in Penmanship", [1881]

One advertising broadsheet titled Private Suggestions and Instructions-to-Agents how to sell the Real Pen-Work Self-Instructor in Penmanship and Patent Ink Capsules. There are sections on how to order, how agents sell the inks, how to send money, and more.

Coastal regulation zone rules in coastal panchayats (villages) of Kerala, India vis-a` -vis socio-economic impacts from the recently introduced peoples’ participatory program for local self-governance and sustainable development

Coastal Regulation Zone (CRZ) notification was issued by the Ministry of Environment and Forest of Government of India in February 1991 as a part of the Environmental Protection Act of 1986 to protect the coast from eroding and to preserve its natural resources. The initial notification did not distinguish the variability and diversity of various coastal states before enforcing it on the various states and Union Territories. Impact assessments were not carried out to assess its impact on socio-economic life of the coastal population. For the very same reason, it was unnoticed or rather ignored till 1994 when the Supreme Court of India made a land mark judgment on the fate of the coastal aquaculture which by then had established as an economically successful industry in many South Indian States. Coastal aquaculture in its modern form was a prohibited activity within CRZ. Lately, only various stakeholders of the coast realized the real impact of the CRZ rules on their property rights andbusiness. To overcome the initial drawbacks several amendments were made in the regulation to suit regional needs. In 1995, another great transformation took place in the State of Kerala as a part of the reorganization of the local self government institutions into a decentralized three tier system called ‘‘Panchayathi Raj System’’. In 1997, the state government also decided to transfer the power with the required budget outlay to the grass root level panchayats (villages) and municipalities to plan and implement the various projects in their localities with the full participation of the local people by constituting Grama Sabhas (Peoples’ Forum). It is called the ‘‘Peoples’ Planning Campaign’’(Peoples’ Participatory Programme—PPP for Local Level Self-Governance). The management of all the resources including the local natural resources was largely decentralized to the level of local communities and villages. Integrated, sustainable coastal zone management has become the concern of the local population. The paper assesses the socio-economic impact of the centrally enforced CRZ and the state sponsored PPP on the coastal community in Kerala and suggests measures to improve the system and living standards of the coastal people within the framework of CRZ.

New governance approaches to environmental regulation: an example of the Code for Sustainable Homes (CSH)

Environmental policy in the United Kingdom (UK) is witnessing a shift from command-and-control approaches towards more innovation-orientated environmental governance arrangements. These governance approaches are required which create institutions which support actors within a domain for learning not only about policy options, but also about their own interests and preferences. The need for construction actors to understand, engage and influence this process is critical to establishing policies which support innovation that satisfies each constituent’s needs. This capacity is particularly salient in an era where the expanding raft of environmental regulation is ushering in system-wide innovation in the construction sector. In this paper, the Code for Sustainable Homes (the Code) in the UK is used to demonstrate the emergence and operation of these new governance arrangements. The Code sets out a significant innovation challenge for the house-building sector with, for example, a requirement that all new houses must be zero-carbon by 2016. Drawing upon boundary organisation theory, the journey from the Code as a government aspiration, to the Code as a catalyst for the formation of the Zero Carbon Hub, a new institution, is traced and discussed. The case study reveals that the ZCH has demonstrated boundary organisation properties in its ability to be flexible to the needs and constraints of its constituent actors, yet robust enough to maintain and promote a common identity across regulation and industry boundaries.

The Lieber Code and the regulation of civil war in international law

In this paper, we consider one particularly interesting feature of the Lieber Code, which is the fact that it was drawn up by the U.S. Government to regulate the conduct of its armed forces in a civil war. In so doing, we hope to explore the extent to which there may be links between the Lieber Code and the contemporary regulation of non-international armed conflicts. In particular, we explore some similarities and contrasts between the views on the regulation of civil war that existed at the time of the drafting of the Lieber Code and the position that exists today.