Repercussões da recepção-escuta no atendimento da porta dos serviços de saúde mental coletiva e em seus projetos terapêuticos

Pós-graduação em Psicologia - FCLAS

Encontros e desencontros: a estratégia de saúde da família em sua relação com a rede de serviços e dispositivos submetidos em saúde mental

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise das práticas discursivas no CAPS II - Frutal (MG): sobre a reforma psiquiátrica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Suplementos múltiplos para novilhas de corte a pasto no período seco: características nutricionais

The objective was to evaluate levels of multiple supplements supplied to beef heifers in low supply of pasture on intake and nutrients digestibility, pH and concentration of ruminal ammonia nitrogen, nitrogen balance, synthesis and microbial efficiency. Five Nellore heifers with initial body weight of 344.00 +/- 21.10 kg and average initial age of 22 months were used. The following supplements were evaluated as fed to the animals: control (mineral supplement) and supplementation levels of 2, 4, 6 and 8 kg/animal/day, composing the following percentages of body weight (BW): 0.55, 1.11, 1.66 and 2.22%, respectively. The experimental design was a Latin square with five replications and five supplements. Intakes of total dry matter, crude protein (CP) and total digestible nutrients, and total apparent digestibility of dry matter, crude protein, total carbohydrates and no fiber carbohydrates increased linearly (P <0.0001) and dry matter intake of forage decreased (P <0.0001) with supplementation levels. Supplementation strategies promoted reduction on ruminal pH (P = 0.0343) and increased concentration of ruminal ammonia nitrogen (NH3-N) (P = 0.0004) before the supply of supplements, and after, this NH3-N presented quadratic behavior (P = 0.0023). Nitrogen intake, excretion of urea in urine and nitrogen excretion in feces increased linearly (P <0.0001) according to supplementation levels. The supply of high levels of multiple supplements reduces forage intake and presents itself as an alternative to cattle maintained in a systems with low supply of pasture in the dry season.

Significados de atividade na terapia ocupacional na área de saúde mental: um olhar sobre a prática da atividade

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Significados de atividade na terapia ocupacional na área de saúde mental: um olhar sobre a prática da atividade

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The revision of the Brazilian Forest Act: increased deforestation or a historic step towards balancing agricultural development and nature conservation?

Almost two-thirds of the Brazilian territory still has prevalence of natural vegetation. Although not all pristine, much of these areas have high conservation value. 170 million hectare (Mha) of the natural vegetation is located within Federal and State protected areas. Most of the remaining 367 Mha is on private agriculture lands, where the Forest Act is the most important legal framework for conservation. In July 2010, the Brazilian parliament began the analysis of a substitutive legislation for the Forest Act. The main motivations for the revision is that, on the one hand, it has been found ineffective in protecting natural vegetation, and on the other hand, it is perceived as a barrier against development in the agriculture sector. The substitutive Forest Act, as it presently stands, does not represent a balance between existing standpoints and objectives; it may drive development towards either more private protection through market-driven compensation actions, or increased deforestation and less nature protection/restoration. This article uses outcomes from modeling analyses to discuss weaknesses of the substitutive Forest Act and to suggest possible improvements. (C) 2011 Elsevier Ltd. All rights reserved.

Il craniofaringioma nel bambino e nell'adolescente. Luci ed ombre durante il follow-up

Introduction. Craniopharyngioma (CF) is a malformation of the hypothalamicpituitary region and it is the most common nonglial cerebral tumor in children with an high overall survival rate. In some case severe endocrinologic and metabolic sequelae may occur during follow up. 50% of patients (pts), in particular those with radical removal of suprasellar lesions, develop intractable hyperphagia and morbid obesity, with dyslypidemia and high cardiovascular risk. We studied the auxological and metabolic features of a series of 29 patients (18 males) treated at a mean age of 7,6 years, followed up in our Centre from 1973 to 2008 with a mean follow up of 8,3 years. Patients features at the onset. 62% of pts showed as first symptoms of disease visual impairment and neurological disturbancies (headache); 34% growth arrest; 24% signs of raised intracranial pressure and 7% diabetes insipidus. Diagnosis. Diagnosis of CF was reached finally by TC or MRI scans which showed endo-suprasellar lesion in 23 cases and endosellar tumour in 6 cases. Treatment and outcome. 25/29 pts underwent surgical removal of CF (19 by transcranial approach and 6 by endoscopic surgery); 4 pts underwent stereotactic surgery as first line therapy. 3 pts underwent local irradiation with yttrium-90, 5 pts post surgery radiotherapy. 45% of pts needed more than one treatment procedure. Results. After CF treatment all patients suffered from 3 or more pituitary hormone deficiencies and diabetes insipidus. They underwent promptly substitutive therapy with corticosteroids, l-thyroxine and desmopressin. In 28/29 pts we found growth hormone (GH) deficiency. 20/28 pts started GH substitutive therapy and 15 pts reached final height(FH) near target height(TH). 8 pts were not GH treated for good growth velocity, even without GH, or for tumour residual. They reached in 2 cases FH over TH showing the already known phenomenon of growth without GH. 38% of patients showed BMI SDS >2 SDS at last assessment, in particular pts not GH treated (BMI 2,5 SDS) are more obese than GH treated (BMI 1,2 SDS). Lipid panel of 16 examined pts showed significative differencies among GH treated (9 pts) and not treated (7 pts) with better profile in GH treated ones for Total Cholesterol/C-HDL and C-LDL/C-HDL. We examined intima media thickness of common carotid arteries in 11 pts. 3/4 not GH treated pts showed ultrasonographic abnormalities: calcifications in 2 and plaque in 1 case. Of them 1 pt was only 12,6 years old and already showed hypothalamic obesity with hyperphagia, high HOMA index and dyslipidemia. In the GH treated group (7) we found calcifications in 1 case and a plaque in another one. GH therapy was started in the young pt with carotid calcifications, with good improvement within 6 months of treatment. 5/29 pts showed hypothalamic obesity, related to hypothalamic damage (type of surgical treatment, endo-suprasellar primitive lesion, recurrences). 48% of patients recurred during follow up ( mean time from treatment: 3 years) and underwent, in some cases up to 4 transcranial surgical treatments. GH seems not to increase recurrence rate since 40% of GH treated recurred vs 66,6% of not GH treated pts. Discussion. Our data show the extereme difficulties that occur during follow up of craniopharyngioma treated patients. GH therapy should be offered to all patients even with good growth velocity after CF treatment, to avoid dislypidemia and reduce cardiovascular risk. The optimal therapy is not completely understood and whether gross tumor removal or partial surgery is the best option remains to be decided only on one patient tumour features and hypothalamic involvement. In conclusion the gold standard treatment of CF remains complete tumour removal, when feasible, or partial resection to preserve hypothalamic function in endosuprasellar large neoplasms.

Design methods and geometric modelling of scaffolds for bone tissue engineering

Every year, thousand of surgical treatments are performed in order to fix up or completely substitute, where possible, organs or tissues affected by degenerative diseases. Patients with these kind of illnesses stay long times waiting for a donor that could replace, in a short time, the damaged organ or the tissue. The lack of biological alternates, related to conventional surgical treatments as autografts, allografts, e xenografts, led the researchers belonging to different areas to collaborate to find out innovative solutions. This research brought to a new discipline able to merge molecular biology, biomaterial, engineering, biomechanics and, recently, design and architecture knowledges. This discipline is named Tissue Engineering (TE) and it represents a step forward towards the substitutive or regenerative medicine. One of the major challenge of the TE is to design and develop, using a biomimetic approach, an artificial 3D anatomy scaffold, suitable for cells adhesion that are able to proliferate and differentiate themselves as consequence of the biological and biophysical stimulus offered by the specific tissue to be replaced. Nowadays, powerful instruments allow to perform analysis day by day more accurateand defined on patients that need more precise diagnosis and treatments.Starting from patient specific information provided by TC (Computed Tomography) microCT and MRI(Magnetic Resonance Imaging), an image-based approach can be performed in order to reconstruct the site to be replaced. With the aid of the recent Additive Manufacturing techniques that allow to print tridimensional objects with sub millimetric precision, it is now possible to practice an almost complete control of the parametrical characteristics of the scaffold: this is the way to achieve a correct cellular regeneration. In this work, we focalize the attention on a branch of TE known as Bone TE, whose the bone is main subject. Bone TE combines osteoconductive and morphological aspects of the scaffold, whose main properties are pore diameter, structure porosity and interconnectivity. The realization of the ideal values of these parameters represents the main goal of this work: here we'll a create simple and interactive biomimetic design process based on 3D CAD modeling and generative algorithmsthat provide a way to control the main properties and to create a structure morphologically similar to the cancellous bone. Two different typologies of scaffold will be compared: the first is based on Triply Periodic MinimalSurface (T.P.M.S.) whose basic crystalline geometries are nowadays used for Bone TE scaffolding; the second is based on using Voronoi's diagrams and they are more often used in the design of decorations and jewellery for their capacity to decompose and tasselate a volumetric space using an heterogeneous spatial distribution (often frequent in nature). In this work, we will show how to manipulate the main properties (pore diameter, structure porosity and interconnectivity) of the design TE oriented scaffolding using the implementation of generative algorithms: "bringing back the nature to the nature".

Benefaction proper and surrogation

The semantic role of beneficiary is usually conceptualized in very general terms, typically without an intensive definition of what can constitute a benefit in the particular construction under study. Among those accounts that have proposed to discuss benefaction as related to the notion(s) of surrogation, substituting, and/or deputing, Kittilä (2005) proposes a distinction between recipients, beneficiaries, and recipient-beneficiaries based on the binary features [reception] and [substitutive benefaction]; the recipient includes only reception (and the beneficiary only substitutive benefaction), whereas both features are relevant with recipient-beneficiaries. This paper proposes an alternative account (i) by defining benefaction proper in terms of a prototype related to possession (and thereby to reception) and a periphery, and (ii) by defining surrogation as a separate notion that can, but need not, coalesce with benefaction proper. Thus, the beneficiaries’ condition improves because they are relieved from having to carry out a given action themselves.

Caracterización probabilística de vidrio mediante diferentes tipos de ensayos

El vidrio no puede ser tratado como un material estructural convencional desde el punto de vista de la resistencia mecánica. Su naturaleza, como material frágil, junto con la inevitable presencia de microfisuras en su superficie y las consecuencias de accidentes por posibles fallos, exigen métodos rigurosos que garanticen un cálculo seguro de los elementos estructurales de vidrio, cuya resistencia a rotura depende en gran medida del tamaño del elemento y del tipo de carga a la que está sometido. Por lo tanto, su cálculo debe basarse en conceptos probabilísticos y en criterios de mecánica de la fractura, en sustitución de un cálculo convencional de vidrio según tablas deducidas de programas experimentales y posterior aplicación del concepto de tensiones admisibles. Con el fin de analizar y comparar las características mecánicas de vidrios templados, termoendurecidos y recocidos, se realizó un amplio programa experimental de ensayos de flexión a cuatro puntos y de anillos concéntricos de pequeña superficie, seguido de un ajuste de los resultados mediante una función de distribución triparamétrica de Weibull. Glass cannot be handled as a conventional structural material from the point of view of the mechanical strength. Its nature as brittle material, together with the inevitable presence of micro-cracks on its surface and the consequences of eventual failures, demand rigorous methods to achieve a safe design for glass elements, whose stress resistance is very much dependent on the integrity of its surface, element size and loading pattern. Thus, its design must rely on probabilistic concepts and fracture mechanics criteria, substitutive of the conventional glass design based on charts derived from experimental programs and subsequent application of the admissible stress concept. In order to analyze and compare the strength characteristics of tempered, heat-strengthened and annealed glass, a large experimental programme based on four-point bending and coaxial double ring tests was performed and the results were fitted using a three-parameter Weibull cumulative distribution function.

Interregional trade changes in Spain caused by the introduction of a road fee charge for heavy goods vehicles

The introduction of a homogeneous road charging system according to the Directive 2011/76/EU for the use of roads is still under development in most European Union (EU) member states. Spain, like other EU members, has been encouraged to introduce a charging system for Heavy Goods Vehicles (HGVs) throughout the country. This nationwide charge has been postponed because there are serious concerns about their advantages from an economic point of view. Within this context, this paper applies an integrated modeling approach to shape elastic trade coefficients among regions by using a random utility based multiregional Input- Output (RUBMRIO) approach and a road transport network model in order to determine regional distributive and substitutive economic effects by simulating the introduction of a distance-based charge (?/km) considering 7,053.8 kilometers of free highways linking the capitals of the Spanish regions. In addition, an in-depth analysis of interregional trade changes is developed to evaluate and characterize the role of the road charging approach in trade relations among regions and across freight intensive economic sectors. For this purpose, differences in trade relations are described and assessed between a base-case or ?do nothing? scenario and a road fee-charge setting scenario. The results show that the specific amount of the charge set for HGVs affect each region differently and to a different extent because in some regions the price of commodities and the Generalized Transport Cost will decrease its competiveness within the country.

Hashimoto’s thyroiditis follow up along 10 years

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Exports and Capacity Constraints: A smooth transition regression model for six euro-area countries. CEPS Working Document No. 395/May 2014

The significant gains in export market shares made in a number of vulnerable euro-area crisis countries have not been accompanied by an appropriate improvement in price competitiveness. This paper argues that, under certain conditions, firms consider export activity as a substitute for serving domestic demand. The strength of the link between domestic demand and exports is dependent on capacity constraints. Our econometric model for six euro-area countries suggests domestic demand pressure and capacity-constraint restrictions as additional variables of a properly specified export equation. As an innovation to the literature, we assess the empirical significance through the logistic and the exponential variant of the non-linear smooth transition regression model. We find that domestic demand developments are relevant for the short-run dynamics of exports in particular during more extreme stages of the business cycle. A strong substitutive relationship between domestic and foreign sales can most clearly be found for Spain, Portugal and Italy, providing evidence of the importance of sunk costs and hysteresis in international trade.

The finance-welfare state nexus. ACES Cases No. 2013.1

At the height of the financial crisis, the Western welfare state prevented a repeat of the Great Depression. But there were also suggestions that social policy had contributed to the crisis, particularly by promoting households’ access to credit in pursuit of welfare goals. Others claim that it was the withdrawal of state welfare that led to the disaster. Against this background that motivated our interest, we propose a systematic way of assessing the relationship between financial market and public welfare provisions. We use structural vector auto-regression to establish the causal link and its direction. Two hypotheses about this relationship can be inferred from the literature. First, the notion that welfare states ‘decommodify’ livelihoods or that there is an equity-efficiency tradeoff would suggest that welfare states substitute to varying degrees for financial market offers of insurance and savings. By contrast, welfare states may support private interests selectively and/or help markets for households to function better; thus the nexus would be one of complementarity. Our empirical strategy is to spell out the causal mechanisms that can account for a substitutive or complementary relationship and then to see whether advanced econometric techniques find evidence for the existence of either of these mechanisms in six OECD countries. We find complementarity between public welfare (spending and tax subsidies) and life insurance markets for four out of our six countries, notably even for the United States. Substitution between welfare and finance is the more plausible interpretation for France and the Netherlands, which is surprising. Data availability constrains us from testing the implications for the welfare state contribution to the crisis directly but our findings suggest that the welfare state cannot generally be blamed for the financial crisis.