Fragilidade e qualidade de vida de idosos com doença renal crônica

Introdução: A expectativa de vida dos brasileiros cresce a cada ano; com isso, os idosos vivem mais, e fatores como, Hipertensão Arterial Sistêmica, Diabetes mellitus e o próprio processo de envelhecimento os tornam suscetíveis à doença renal crônica (DRC). Com a DRC, esses idosos têm maiores chances de desenvolverem a fragilidade e terem consequências desfavoráveis na Qualidade de Vida (QV). Objetivo geral: Analisar a relação entre as variáveis independentes (fragilidade, características sociodemográficas e clínicas) e a variável desfecho (QV) de idosos com DRC em tratamento conservador, hemodiálise (HD) e diálise peritoneal (DP). Material e método: Trata-se de uma pesquisa quantitativa, descritiva e transversal. Participaram idosos com 60 anos ou mais, com DRC em tratamento conservador, HD ou DP, que estavam, no mínimo, há seis meses em tratamento e em acompanhamento em um hospital público de Ribeirão Preto-SP. A coleta de dados ocorreu de outubro/14 a março/15, utilizando-se os seguintes instrumentos: de caracterização sociodemográfica, econômica e clínica adaptado; para avaliar a fragilidade, a Edmonton Frail Scale (EFS); para avaliar a QV, o WHOQOL-BREF e WHOQOL-OLD; para avaliar a cognição, o Mini-Exame do Estado Mental (MEEM). Foram realizadas análises estatísticas descritivas, teste de correlação de Spearman e análise de variância multivariada (MANOVA) para as variáveis de interesse. O nível de significância adotado foi de 5%. O projeto foi aprovado por um Comitê de Ética em Pesquisa com seres humanos com CAAE número 34923214.0.0000.5393; seguiu-se as recomendações da Resolução CNS 466/2012. Resultados: Participaram 77 idosos, sendo 35 em tratamento conservador, 14 em DP e 28 em HD. A maioria era homem (41; 53,2%) e tinha companheiro(a) (51; 66,2%). A média dos escores de fragilidade entre os tratamentos foi: tratamento conservador (7,71±3,10); DP (6,79±2,72) e HD (7,36±2,92). No WHOQOL-BREF, os domínios relações sociais e físico obtiveram maior e menor escores médios, respectivamente, (68,93±17,48) e (55,44±14,11). O WHOQOL-OLD apresentou a maior média na faceta Intimidade (68,67±16,45) e menor média na faceta Morte e morrer (37,66±22,76). Foram encontradas correlações inversas entre a idade e o escore do MEEM (p=0,001) e entre anos de estudo e fragilidade (p=0,016); por outro lado, houve correlações positivas entre os escores do MEEM e anos de estudo (p<0,001), entre número de complicações da DRC e fragilidade (p<0,001) e número de comorbidades e fragilidade (p<0,001). Em relação à QV, houve correlação positiva entre o escore global do WHOQOL-BREF e o escore da faceta global do WHOQOL-OLD, bem como correlação inversa entre os escores globais desses instrumentos com os escores de fragilidade (p<0,00; p=0,023). Na MANOVA, o tipo de tratamento e o número de complicações não influenciaram a QV, porém a fragilidade apresentou relação com o constructo, sendo que, para o aumento de um ponto na escala da fragilidade, a QV apresentou redução média de 1,38 no escore global do WHOQOL-BREF e 0,82 no escore global do WHOQOL-OLD, considerando pertencer ao mesmo tipo de tratamento. Conclusão: os pacientes com DRC apresentaram piores escores médios de QV mediante a maiores escores de fragilidade, independentemente do tipo de tratamento e considerando-se a mesma média de complicações

Capitalismo e direitos humanos de solidariedade: elementos para uma crítica

Nosso estudo busca identificar a conexão material entre o capitalismo e os direitos humanos de solidariedade. Esses direitos, segundo a teoria jurídica e as declarações internacionais, ao contemplarem toda a humanidade, ao conceberem o gênero humano como sujeito de direito, são a mais elevada expressão do progresso da consciência humana no que concerne a dignidade do homem e as ameaças contra a vida coletiva na Terra. Nós propomos, ao contrário, que os direitos humanos de terceira geração exprimem as formas mais abstratas do capitalismo depois da Segunda Guerra Mundial, especialmente aquelas que correspondem à finança e à mundialização do capital. A sociedade burguesa internacionalizada tornou-se ela mesma, em suas categorias fundamentais, mais abstrata, e as categorias jurídicas seguiram este mesmo movimento. E de modo similar ao que sucede com os direitos humanos de primeira geração e de segunda geração, as palavras charmosas apresentadas pelo humanismo jurídico portam, discretamente, a exploração capitalista. Os direitos ao patrimônio comum da humanidade, ao meio ambiente sadio, ao desenvolvimento e mesmo o direito à paz, cada um deles reproduz os meios de apropriação e organização capitalista do imperialismo os mesmos meios que dão suporte aos lucros privados sobre os bens coletivos, que mantêm a dominação imperialista e que preparam as guerras no interior do sistema de Estados. O idealismo e a visão romântica sobre os direitos humanos escondem esta contradição, e é preciso expô-la, é preciso superar a ideologia jurídica. Nossa crítica marxista, realizada pela crítica do capital e de sua forma jurídica em escala internacional, é um esforço nesta direção.

Providing Bereavement Counseling to Chinese Americans: A Cultural Adaptation of a Western Grief Counseling Model.

The aim of this paper is to extend the existing literature and propose an alternative perspective on bereavement counseling with Chinese Americans. This aim is achieved by integrating William Worden's (2009) grief counseling model with several cultural components that are relevant to counseling with Chinese Americans, including: (a) the barriers to seeking counseling, (b) the clinical presentations of Asian Americans, (c) the common coping styles among Asian Americans, (d) the major Chinese religions and philosophies, and (e) the bereavement-related cultural practices. The corresponding treatment recommendations will be explored following the discussion of each cultural element. Finally, a culturally responsive grief counseling model for Chinese Americans will be proposed in the last section, along with a discussion of important caveats.

Mortalidad evitable y políticas en salud: Colombia, 1985-2002

Introducción: La confianza en la capacidad de evitar algunas muertes o diferir su aparición es el fundamento de toda política de salud, uno de cuyos principales resultados debe ser reducir las muertes evitables, y controlar las condiciones que aumentan el riesgo de morir. Objetivos: Establecer variaciones en la tendencia de la mortalidad evitable (ME) registrada en Colombia entre 1985 y 2002, como indicadoras del impacto efectivo que las reformas en la política sanitaria pudieran haber tenido sobre sus determinantes. Métodos: Estudio de la ME con base en los registros oficiales de defunción y en las proyecciones censales de Colombia entre 1985-2002. Para determinar la evitabilidad, se aplicó un inventario de causas de ME (ICME) ajustado a las condiciones epidemiológicas del país durante el período que se analiza. Resultados: De las muertes registradas, 75.3% se clasificaron como evitables. Se identificaron siete patrones de tendencia que reflejan, de manera particular, los efectos de las políticas públicas sobre los determinantes de la mortalidad. Conclusiones: En general, la ME viene disminuyendo en Colombia desde 1985 en la población general y entre los hombres, sin variaciones significativas durante el período. Las variaciones en la tendencia de las tasas ajustadas de varios grupos de causas hacen pensar en un deterioro en el control de sus determinantes, especialmente desde 1990. Los cambios aplicados en las políticas públicas durante los últimos años no se reflejaron en un mejor control de las muertes evitables, aunque el gasto en salud aumentó de modo muy notable en el país.

Cancer mortality inequalities in urban areas: a Bayesian small area analysis in Spanish cities

Background: Intra-urban inequalities in mortality have been infrequently analysed in European contexts. The aim of the present study was to analyse patterns of cancer mortality and their relationship with socioeconomic deprivation in small areas in 11 Spanish cities. Methods: It is a cross-sectional ecological design using mortality data (years 1996-2003). Units of analysis were the census tracts. A deprivation index was calculated for each census tract. In order to control the variability in estimating the risk of dying we used Bayesian models. We present the RR of the census tract with the highest deprivation vs. the census tract with the lowest deprivation. Results: In the case of men, socioeconomic inequalities are observed in total cancer mortality in all cities, except in Castellon, Cordoba and Vigo, while Barcelona (RR = 1.53 95%CI 1.42-1.67), Madrid (RR = 1.57 95%CI 1.49-1.65) and Seville (RR = 1.53 95%CI 1.36-1.74) present the greatest inequalities. In general Barcelona and Madrid, present inequalities for most types of cancer. Among women for total cancer mortality, inequalities have only been found in Barcelona and Zaragoza. The excess number of cancer deaths due to socioeconomic deprivation was 16,413 for men and 1,142 for women. Conclusion: This study has analysed inequalities in cancer mortality in small areas of cities in Spain, not only relating this mortality with socioeconomic deprivation, but also calculating the excess mortality which may be attributed to such deprivation. This knowledge is particularly useful to determine which geographical areas in each city need intersectorial policies in order to promote a healthy environment.

[Notes on Christianity], 1803-1804

Three pieces of paper consisting of a one-leaf handwritten summary of unidentified lectures about the divinity of Christ titled "lect. 62 to 66, page 51, March 22, 1803," and two slips of paper with handwritten copies of two declarations about the Christian trinity and divine nature. The copied declarations are in two different hands, and one copy is dated "Cambridge Novr 14th 1804."

Collection of humorous verses and sketches relating to Harvard College, 1769

Manuscript volume in various hands containing three general sections: satirical poems about Harvard tutors, a section of "last words & dying" speeches of Harvard tutors, and a copy of the Book of Harvard."

Commonplace book of Benjamin Penhallow, 1721-1724

This leather-bound volume contains excerpts copied by Benjamin Penhallow from books he read while he was a student at Harvard in the 1720s. The volume contains extracts from two texts: Johanis Henrici Alstedii's (John Henry Alsted / Johann Heinrich Alsted) Geometria Domini, and the anonymous text "The Legacy of a dying Father; bequeath'd to his Beloved Children, or Sundry Directions in Order unto a well Regulated Conversation," from 1724 (originally published in 1693-4). The last page of text in the volume contains the hymn "The Sacred Content of Praise" first published in 1734, and added after Penhallow's death.

Ukraine: Can meaningful reform come out of conflict? Bruegel Policy Contribution 2014/08, August 2014

Apart from threats to its national security and territorial integrity, Ukraine faces serious economic challenges. These result from the slow pace of economic and institutional reform in the previous two decades, the populist policies of the Yanukovych era and the consequences of the conflict with Russia. The new Ukrainian authorities have made pro-reform declarations, but these do not seem to be supported sufficiently by concrete policy measures, especially in the critical areas of fiscal, balance-of-payment and structural adjustment. Also, the international financial aid package granted to Ukraine has not been accompanied by sufficiently strong policy conditionality. Ukraine urgently needs a complex programme of far-reaching economic and institutional reform, which will include both short-term fiscal and macroeconomic adjustment measures and medium- to long-term structural and institutional changes. Energy subsidies and the low retirement age are the two critical policy areas that require adjustment to avoid sovereign default and a balance-of-payments crisis.

The G20 financial reform agenda. Bruegel Policy Contribution Issue 2014/11, September 2014

Five years ago, the declarations of the G20 in landmark leaders’ summits in London and Pittsburgh listed specific commitments on financial regulatory reform. When measured against these declarations, as opposed to the surrounding rhetorical hype, most (though not all) commitments have been met to a substantial degree. However, the effectiveness of these reforms in making global finance more stable is not so far proven. This uncertainty on impact mirrors the absence of an analytical consensus on the 2007-08 financial crisis itself. In addition, unintended consequences of the reforms are appearing gradually, even as their initial implementation is still unfinished. At a broader level, the G20 has established neither an adequate institutional infrastructure nor a consistent policy vision for a globally integrated financial system. This shortcoming justifies increasing concerns about economically harmful market fragmentation. One key aim should be to make international regulatory bodies more representative of the rapidly-changing geography of global finance, not only in terms of their membership but also of their leadership and location.

Does ASEM work? CEPS Policy Brief No. 321, 14 October 2014

This CEPS Policy Brief is based on a larger study for the EEAS and European Commission, written by the same authors in the run-up of the Milan ASEM summit of 16-17 October 2014. The main idea of the study is to assess whether ASEM works and how, by verifying the factual evidence in detail. After all, ASEM has no institutions, no budget and no treaty, whilst dialogues and a loose improvement over time in Asia-Europe relations refer to process much more than genuine ‘results’. The stocktaking covers all ASEM activities since the 2006 Helsinki summit. Summit and foreign ministers’ declarations and ASEM calendar of activities (and interviews) are used to trace ASEM activities in the three ASEM pillars (political, economic, and peoples-to-peoples/cultural). All the ‘regular’ ASEM meetings at ministerial and other levels (many of which are only known to relatively few) have been mapped. Also the ASEM working methods, based on the 2000 AECF framework and many subsequent initiatives, have been scrutinised, including whether they are actually implemented or not or partially. Such methods refer to how to work together in areas of cooperation (beyond the typical ASEM dialogue), organisation, coordination and ASEM visibility. The main conclusion is that ASEM works reasonably well, once one accepts the ASEM of today, although some inefficiencies still characterise the ‘system’. There is a host of secondary conclusions on the three pillars, the foreign ministers, the strong government-to-government nature of ASEM and the working methods. We recommend that today’s ASEM needs no reform and that not having ASEM would entail political and diplomatic costs. We emphasise that ASEM is well placed to stimulate exchange of information between the mega-FTAs such as TPP, RCEP and TTIP. However, the ASEM of tomorrow might be different, given the great changes in geo-political and economic conditions since ASEM began in the mid-1990s. Moreover, the size of ASEM has become such that classical ways of operating with (after Milano) 53 countries (including the EU and ASEAN) cannot possibly be effective all the time. We suggest that, in the run-up to the 20th ASEM birthday (2016), EU and Asian independent think-tanks get together to write an ‘options report’ reconsidering options for a new ASEM, as the basis for a profound and wide debate how to get more value-added out of ASEM.

Rosja wobec Unii Europejskiej: kryzys „strategicznego partnerstwa.” Prace OSW 22/2006. = Russia vs. the European Union: a “strategic partnership” crisis. OSW Study 22/2006

Contrary to both parties' declarations on the development of their "strategic partnership", relations between Russia and the European Union have over recent years been in a state which could be called one of crisis. However, this does not mean that there have been no achievements in EU-Russian relations. The key problem is that Russia and the European Union have essentially different perceptions, aspirations and interests, which causes mistrust and disillusionment. This crisis is manifested in mutual criticism by the two sides, regularly recurring tensions and cooling of relations ("minicrises"), and especially by the "virtualisation of co-operation", i.e. concealing a lack of substantive content in many key areas under increasingly rich layers of dialogue and co-operation.

Counter-reforms in times of prosperity. OSW Point of View, September 2006

In 2000, Vladimir Putin came to power after nearly a decade of the rule of the first Russian president, Boris Yeltsin. As prime minister, and later as a candidate for president, Putin announced that he would reform the state. The main assumptions of this reform were presented during a congress of the pro-Kremlin Unity movement, in Putin's address entitled 'Russia at the turn of the millennium' which was delivered on 29 December 1999, and later in a open letter to voters published on 25 February 2000. Both declarations were rather general, but they gave a clear picture of the principal directions of and priority areas for the future president's efforts: they outlined Russia's development path as pro-market and democratic. Nearly seven years have passed since Vladimir Putin came to power, a time for a summary of his achievements. In a way, Vladimir Putin has partially delivered on his initial declarations; indeed, Russia has undergone a deep transformation. However, when seen in the light of the president’s initial promises, the changes appear to be no more than 'counter-reforms', because instead of putting into practice the policy he outlined seven years ago, they have largely followed a different, if not entirely opposite direction.

Chechnya: Between a Caucasian Jihad and ‘hidden’ separatism. OSW Point of View, January 2007

1. Even though Chechnya remains the most unstable republic in the Russian North Caucasus, the open armed conflict known as the Second Chechen War, which broke out in the autumn of 1999, is gradually dying down. 2. Several years ago, the conflict in Chechnya could have been characterised as a war between Chechen separatists and the government of the Russian Federation. However, the nature of the conflict has changed significantly over the last four or five years. 3. Even though the intensity of fighting in Chechnya has abated in recent years, the conflict has spilt over to the other Caucasus republics such as Ingushetia, Dagestan and Kabardino-Balkaria. As a result, this is presently not so much a Chechen conflict as a regional clash between the authorities and the Caucasian (including Chechen) Islamists. 4. The Chechen militants are weaker now, and the conflict has changed from a struggle for national liberation into a fight for the Islamic cause; but this does not mean that Russia has ultimately solved the problem of Chechen separatism.

The Iasi-Ungheni pipeline: a means of achieving energy independence from Russia? Moldova's attempts at gas supply diversification. OSW Commentary No. 118, 2013-10-08

Since taking power in 2009, the Alliance for European Integration (AIE) has been trying to end Moldova’s dependence on Russian gas. Currently, natural gas accounts for about 50% of the country’s energy balance (excluding Transnistria), and Gazprom has a monopoly on the supply of gas to the republic. The key element of Chișinău’s diversification project is the construction of the Iasi-Ungheni pipeline, which is designed to link the Moldovan and Romanian gas transmission networks, and consequently make it possible for Moldova to purchase gas from countries other than Russia. Despite significant delays, construction work on the interconnector began in August 2013. The Moldovan government sees ensuring energy independence from Russia as its top priority. The significance and urgency of the project reflect Chișinău’s frustration at Moscow’s continued attempts to use its monopoly of Moldova’s energy sector to exert political pressure on the republic. Nonetheless, despite numerous declarations by Moldovan and Romanian politicians, the Iasi- -Ungheni pipeline will not end Moldova’s dependence on Russian gas before the end of the current decade. This timeframe is unrealistic for two reasons: first, because an additional gas pipeline from Ungheni to Chisinau and a compression station must be constructed, which will take at least five years and will require significant investment; and second, because of the unrelenting opposition to the project coming from Gazprom, which currently controls Moldova’s pipelines and will likely try to torpedo any energy diversification attempts. Independence from Russian gas will only be possible after the the Gazprom-controlled Moldova-GAZ, the operator of the Moldovan transmission network and the country’s importer of natural gas, is divided. The division of the company has in fact been envisaged in the EU’s Third Energy Package, which is meant to be implemented by Moldova in 2020.