Percepção do estado de saúde de doentes com anticoagulação oral

RESUMO - O aumento da incidência das doenças crónicas representa um desafio enorme para todos os Sistemas de Saúde, pelo que a assistência de Saúde a doentes crónicos se tornou num problema das sociedades ocidentais. Os países mais pobres são os que mais sofrem, embora nos países desenvolvidos também se verifique um aumento notável das doenças crónicas. Estima-se que estas representem mais de 60% do total das doenças mundiais no ano 2020 (WHO, 2001). A adaptação dos actuais modelos de saúde aos doentes crónicos não atingiu os objectivos, o que conduziu a que, de há alguns anos a esta parte, se procure alternativas mais eficazes e eficientes. Uma das pressões do mercado que se fazem sentir será caracterizada por uma maior aposta na Promoção da Saúde e Prevenção da doença. O conceito de “Saúde” migrou de “não existência de doença” para “Bem-estar Físico e Psicológico”. Desta forma, o foco dos cuidados de saúde teve que ser adaptado, o que conduziu a uma situação em que o âmbito da prestação de cuidados de saúde é um contínuo de serviços que vai desde a promoção da saúde, medicina preventiva e medicina curativa aos cuidados continuados e cuidados paliativos. As tecnologias de informação e comunicação desempenharão um importante papel nesta tendência, permitindo estabelecer ligações contínuas entre os consumidores e prestadores de cuidados de saúde. Por outro lado, as potencialidades da Internet, das comunicações móveis, dispositivos portáteis e do instrumental electrónico, tornam-se evidentes no desenvolvimento de serviços de e-Saúde: para monitorização, seguimento e controlo dos doentes extra hospitalar - serviços estes centrados no doente. O objectivo geral do presente estudo consiste no desenho de um projecto de investigação para posterior avaliação da percepção do estado de saúde dos doentes seguidos na consulta de hipocoagulação do Hospital de Santa Marta. Devido à escassez de investigação na temática deste trabalho em Portugal, procedeu-se a um trabalho exploratório, descritivo, de carácter comparativo e enquadrado na abordagem quantitativa. O campo de análise consiste em comparar doentes que fazem anticoagulação oral, seguidos na consulta de cardiologia (consulta convencional), com os doentes seguidos no programa Airmed (através das comunicações móveis). 4 Para avaliação da percepção do estado de saúde foi utilizado o questionário SF-36.----ABSTRACT - The increasing incidence of chronic diseases represents an enormous challenge to the Health Systems and on cause of that, the Health Assistance to chronic patients became a concern of the Occidental society. The Countries with lower economical resources are the ones that suffers the most, but also the Developed countries have a noticeable increase of chronic diseases. It is estimated these will represent over 60% of total diseases world wide in 2020 (WHO,2001). The adaptation of the actual Health Models to chronic patients did not achieved it’s goals, what leaded to look for more effective and efficient alternatives. One of the more sensitive market pressure factor is to look for a better Health Promotion and Disease Prevention. The concept of “Health” merged from “Disease absence” to “Physic and Psychic Wellness”. In this way the Health Care focus had to be adapted, what drove to a status where the scope of the Health care is a continuum of services that goes from the Health Promotion, Preventive and Curative to Continued and Palliative Medical Care. The Information and Communication Technologies will play a crucial role in this trend, allowing to establish continued connections between patients and Health Care providers. In parallel the potential of the Internet, mobile communications, portable devices and electronic instruments became evident to deploy e-Health services: to monitor, follow-up and control of patients outside the Hospital. The overall objective of the present study is an Investigation Project Design to further evaluate the health status perception of the patients followed in the consultation for Hypocoagulation in the “Hospital de Santa Marta”. Due to lack of investigation in this thematic, in Portugal, this study is developed in an exploratory way, descriptive, comparative, within a scope of a quantified approach. The analysis field consists on comparing patients prescribed with oral anticoagulants and followed-up at the

Organização e disposição dos armazéns

Relatório de Estágio Curricular apresentado ao Instituto Superior de Contabilidade e Administração do Porto para obtenção do Grau de Mestre em Logística Orientado pelo Doutor Júlio Faceira Guedes Coorientado pelo Engenheiro Ricardo Costa Moreira

Importance of hand germ contamination in health-care workers as possible carriers of nosocomial infections

The importance of hands in the transmission of nosocomial infection has been world wide admitted. However, it is difficult to induce this behavior in health-care workers. The aim of the present work was to point out the importance of hand bacteria colonization, the influence of hand washing and of patient physical examination. One hundred health-care workers were randomly divided in two groups: Group A without hand washing previous to patient physical examination or handling (PPE); group B with hand washing previous to PPE. Direct fingerprint samples in Columbia agar before and after PPE were obtained. The colonies were counted and identified by conventional techniques, and antibiograms according to NCCLS were performed. Before PPE group A participants showed a high number of bacteria regarding group B participants (73.9 Vs 20.7; p < 0.001); 44 out of 50 participants were carriers of potentially pathogen bacteria. No group B participants were carriers of potential pathogen bacteria before PPE. The latter group showed an increase in number of bacteria after PPE (20.7 CFU (before) Vs 115.9 CFU (after); p < 0.001). Sixteen group B participants were contaminated after PPE with potential pathogens such as S. aureus (50% of them meticillin resistant); Escherichia coli, Pseudomonas aeruginosa and Enterococcus faecalis, half of them multiresistant. We can conclude on the importance of these results to implement educational programs and to provide the health-care workers with the proper commodities to fulfill this practice.

An immunofluorescence test for diagnosis of ophthalmic herpes in a mouse corneal model

Herpes simplex virus type 1 (HSV-1) ophthalmic disease is the most common cause of corneal blindness in humans world-wide. Current culture techniques for HSV take several days and commercially available HSV laboratory based diagnostic techniques vary in sensitivity. Our study was conducted to evaluate the use of a quicker and simpler method to herpes ophthalmic diagnosis. Corneal smears were made by firm imprints of infected mouse eyes to glass slides, after smears were fixated with cold acetone, and an indirect immunofluorescence (IIF) method was performed using monoclonal antibodies in a murine model of ophthalmic herpes. Eye swabs from infected mice were inoculated in Vero cells for virus isolation. Cytology and histology of the eye were also performed, using hematoxylin-eosin routine. Mouse eyes were examined by slit-lamp biomicroscopy for evidence of herpetic disease at various times postinoculation. We made a comparative evaluation of sensitivity, specificity and speed of methods for laboratory detection of HSV. Our results indicate that this IIF method is quick, sensitive, specific and can be useful in the diagnosis of ophthalmic herpes as demonstrated in an animal model.

Anti-apolipoprotein A-I antibodies in the pathogenesis of Alzheimer disease : project plan

RESUMO: A doença de Alzheimer (AD) é a forma mais comum de demência em todo o mundo e sua prevalência deverá duplicar até 2050. Os mecanismos precisos responsáveis pela AD são desconhecidas mas as características histopatológicas estão bem caracterizadas. A hipótese mais importante para a perda neuronal e declínio cognitivo na AD é a cascata amilóide que indica que AD é o resultado da sobreprodução de beta amilóide (Aβ) e / ou remoção ineficaz; a acumulação do BA no cérebro seria o passo crítico na patogénese da AD. Actualmente, a identificação de proteínas que se ligam ao Aβ e modulam a sua agregação e neurotoxicidade pode proporcionar a base para novas abordagens terapêuticas. A apolipoproteína AI (ApoA-I), o principal componente das HDL humanas, interage com o domínio extracelular da proteína precursora de amilóide (APP), bem como com o Aβ. Estudos epidemiológicos têm mostrado uma diminuição acentuada da ApoA-I plasmática em doentes com AD, com uma correlação inversa entre o nível de ApoA-I e o risco de AD. Este trabalho pretende apresentar um projecto que tem como objectivo investigar se os anticorpos anti-apo AI podem impedir a formação de complexos Aβ / ApoA-I, bloqueando o efeito protector da ApoA-I. A hipótese baseia-se na possibilidade dos doentes com AD terem anticorpos anti-ApoA-I plasmáticos e de estes poderem interferir com a formação do complexo no LCR.------- ABSTRACT:Alzheimer’s disease (AD) is the most common form of dementia world-wide and its prevalence is expected to double by the year 2050. The precise mechanisms responsible for AD are unknown but the histopathologic features are well-characterised. The most compelling hypothesis for neuronal loss and cognitive decline in AD is the amyloid cascade hypothesis which states that AD is the result of amyloid beta (Aβ) overproduction and/or ineffective clearance and its accumulation in the brain would be the critical step in AD pathogenesis. Currently, identification of proteins that bind Aβ and modulate its aggregation and neurotoxicity could provide the basis for novel treatment approaches. Apolipoprotein A-I (ApoA-I), the main constituent of human HDL, ApoA-I interacts with the extracellular domain of amyloid precursor protein (APP), as well as with Aβ itself. Epidemiological studies have shown a marked decrease of plasma ApoA-I levels in AD patients, with an inverse correlation between the ApoA-I level and the risk of AD. This work intends to present a project that aims to investigate if anti-ApoA-I antibodies may prevent the formation of the Aβ /ApoA-I complex and by doing so blocking the protective effect of ApoA-I in AD. We base the hypothesis on the possibility that patients with AD might have anti-ApoA-I antibodies in plasma and that these can interfere with the complex formation in the cerebrospinal fluid (CSF).

Tropical lowland mosses disjunct between Africa and the Americas, including Calyptothecium planifrons (Ren. & Par.) Argent, new to the Western Hemisphere

Calyptothecium planifrons (Ren. & Par.) Argent is reported new to the Western Hemisphere based on two recent collections from Brazilian Amazonia, in Pará and Rondônia; C. planifrons was originally described from Madagascar. Forteen Other species of mosses with apparently disjunct distributions between tropical Africa and tropical America are also discussed. It is likely that mos or all of this species discussed will prove to have wider distributions in the tropics when world-wide revisions are carried out.

RECERCAT. El Dipòsit de la Recerca de Catalunya

Seguint la tendència mundial de crear dipòsits institucionals d'accés lliure per recopilar i preservar els documents d'investigació generats en les institucions acadèmiques, el CESCA i el CBUC han posat en funcionament RECERCAT. RECERCAT és un dipòsit cooperatiu de documents digitals que inclou la literatura de recerca de les universitats i dels centres d'investigació de Catalunya, com ara articles encara no publicats (preprints), comunicacions a congressos, informes de recerca, working papers, projectes de final de carrera, memòries tècniques, etc. La comunicació pretén explicar els processos que s'han seguit per posar en marxa aquest projecte: des de la selecció i adaptació del programari amb el que funciona (DSpace), fins als treballs duts a terme per establir les polítiques d'accés, d’introducció de dades, de metadades Dublin Core necessàries per descriure els documents, el tipus de llicència de les Creative Commons sota la qual es troben subjectes els documents, etc.

The ‘Global Dimension’ of Contemporary Politics. An Argument for Taking ‘Global’ Seriously

Recent years have seen a striking proliferation of the term ‘global’ in public and political discourse. The popularity of the term is a manifestation of the fact that there is a widespread notion that contemporary social reality is ‘global’. The acknowledgment of this notion has important political implications and raises questions about the role played by the idea of the ‘global’ in policy making. These questions, in turn, expose even more fundamental issues about whether the term ‘global’ indicates a difference in kind, even an ontological shift, and, if so, how to approach it. This paper argues that the notion of ‘global’, in other words the ‘global dimension’, is a significant aspect of contemporary politics that needs to be investigated. The paper argues that in the globalization discourse of International Studies ‘global’ is ‘naturalized’, which means that it is taken for granted and assumed to be self-evident. The term ‘global’ is used mainly in a descriptive way and subsumed under the rubric of ‘globalization’. ‘Global’ tends to be equated with transnational and/or world-wide; hence, it addresses quantitative differences in degree but not (alleged) differences in kind. In order to advance our understanding of contemporary politics, ‘global’ needs to be taken seriously. This means, firstly, to understand and to conceptualize ‘global’ as a social category; and, secondly, to uncover ‘global’ as a ‘naturalized’ concept in the Political and International Studies strand of the globalization discourse in order to rescue it for innovative new approaches in the investigation of contemporary politics. In order to do so, the paper suggests adopting a strong linguistic approach starting with the analysis of the word ‘global’. Based on insights from post-structuralism as well as cognitive and general constructivist perspectives it argues that a frame-based corpus linguistic analysis offers the possibility of investigating the collective/social meaning(s) of global in order to operationalize them for the analysis of the ‘global dimension’ of contemporary politics.

Un diàleg de sords: intentant donar sentit al debat sobre la publicació electrònica

Aquest article se centra en les implicacions de la difusió electrònica per al sistema de publicació de revistes basat en la revisió per parells [peer-reviewed]. Per donar sentit a un assumpte tan complex, és de molt ajut mirar-s'ho des de la perspectiva dels orígens del sistema i de les seves tres funcions nuclears: el rànquing en la recerca, facilitar la comunicació interactiva entre els estudiosos i crear un arxiu global del coneixement científic. Cadascuna d’aquestes funcions principals té requeriments diferents que, en certa mesura, se sobreposen però que també entren, d'alguna manera, en conflicte. Internet obre la possibilitat de desenvolupar una varietat de models distints de comunicació científica modulant la intensitat de cadascun d'aquests tres rols que les revistes en paper han desenvolupat i, possiblement, d'altres funcions que no eren ni tan sols imaginables abans del desenvolupament de les xarxes electròniques d'abast planetari. Les implicacions de la distribució electrònica per a la propietat i accés a la literatura científica són profundes i tendeixen a agreujar la ja seriosa crisi dels preus de les revistes que està frenant l'accés a la informació científica. La comunitat d'estudiosos, que és autora del material que aquestes publicacions contenen i, al mateix temps, n'és el principal consumidor, està en possessió de la clau per a solucionar aquesta crisi tot permetent a Internet ser un vehicle que faciliti la difusió d’una recerca finançada des del sector públic en comptes de crear una situació de propietat privada d'aquesta recerca.

Els agrocombustibles a Catalunya : mecanismes i efectes de l'europeïtzació en la política pública

En els darrers temps els agrocombustibles s’han promocionat com una alternativa als combustibles fòssils,adquirint un pes important en les agendes polítiques internacionals. Les dues grans potències econòmiques mundials, els Estats Units i la Unió Europea, han impulsat els agrocombustibles a través de diferents estratègies; plans, legislació, però també amb excempcions fiscals i obligacions de barreja amb combustibles fòssils. En aquest marc, Catalunya va ser de les comunitats autònomes de l’Estat espanyol pioneres en la potenciació d’experiències de producció i consum d’agrocombustibles. A partir de l’anàlisi de la política i el debat a Catalunya es pot destacar la gran influència de l’esfera europea a través de diversos mecanismes en el procés, el que s’ha anomenat en la literatura com europeïtzació. Darrerament Europa s’ha convertit en un important centre de producció de polítiques públiques, especialment en polítiques ambientals i agrícoles a partir dels anys 80. És per aquest motiu que resulta rellevant conèixer les dinàmiques europees en una política complexa com la dels agrocombustibles a Catalunya, que presenta components energètics, però també amb altres aspectes relacionats amb el món agràri i el medi ambient.

Stock market integration between new EU member states and the Euro-zone

This paper measures the degree in stock market integration between five Eastern European countries and the Euro-zone. A potentially gradual transition in correlations is accommodated by smooth transition conditional correlation models. We find that the correlation between stock markets has increased from 2001 to 2007. In particular, the Czech and Polish markets show a higher correlation to the Euro-zone. However, this is not a broad-based phenomenon across Eastern Europe. We also find that the increase in correlations is not a reflection of a world-wide phenomenon of financial integration but appears to be specific to the European market. JEL classifications: C32; C51; F36; G15 Keywords: Multivariate GARCH; Smooth Transition Conditional Correlation; Stock Return Comovement; New EU Members.

The Global Dimension to Fiscal Sustainability

This paper examines the issue of fiscal sustainability in emerging market countries and industrial countries. We highlight the importance of the time series properties of the primary surplus and debt, and find evidence of a positive long run relationship. Consequently we emphasise, that especially for emerging markets, it is important to recognise the implications of global capital market shocks for fiscal sustainability, a relationship which has hitherto been ignored in the empirical literature. Using a factor model we demonstrate that the relationship between deficit and debt is conditional upon a global factor and we suggest that this global factor is related to world-wide liquidity. We also demonstrate that this acts as a constraint on emerging market economies’ fiscal policy.

Caught Between Theory and Practice: Government, Market, and Regulatory Failure in Electricity Sector Reforms

The world-wide electricity sector reforms of the early 1990s have revealed the considerable complexities of making market driven reforms in network and infrastructure industries. This paper reflects on the experiences to date with the process and outcomes of marketbased electricity reforms across less-developed, transition and developed economies. The reforms outcomes suggest similar problems facing the electricity sector of these countries though their contexts vary significantly. Many developing and developed economies continue to have investment inadequacy concerns and the need to balance economy efficiency, sustainability and social equity after more than two decades of experience with reforms. We also use a case study of selected countries that in many respects represent the current state of the reform though they are rarely examined. Nepal, Belarus and Ireland are chosen as country-specific case studies for this purpose. We conclude that the changing dynamics of the electricity supply industry (ESI) and policy objectives imply that analysing the success and failure of reforms will indeed remain a complex process.

Molecular analysis of yellow fever virus 17DD vaccine strain

The Oswaldo Cruz Foundation produces most of the yellow fever (YF) vaccine prepared world wide. As part of a broader approach to determine the genetic variability in YF l7D seeds and vaccines and its relevance to viral attenuation the 17DD virus was purifed directly from chick embryo homogenates which is the source of virus used for vaccination of millions of people in Brazil and other countries for half a century. Neutralization and hemagglutination tests showed that the purified virus is similar to the original stock. Furthermore, radioimmune precipitation of 35S-methionine-labeled viral proteins using mouse hyperimmune ascitic fluid revealed identical patterns for the purified 17DD virus and the YF l7D-204 strain except for the 17DD E protein which migrated slower on SDS-PAGE. This difference is likely to be due to N-linked glycosylation. Finally, comparison by northern blot nybridization of virion RNAs of purified 17DD with two other strains of YF virus only fenome-sized molecules for all three viruses. These observations suggest that vaccine phenotype is primarily associated with the accumulation of mutations.

Human polymeric IgA is superior to IgG and single-chain Fv of the same monoclonal specificity to inhibit urease activity associated with Helicobacter pylori.

Helicobacter-induced gastritis is considered nowadays an epidemic, the prevalence of which is one of the highest world-wide (70%), with as much as 40% of the population in industrialized countries. Helicobacter pylori (H. pylori) antigens (Ag) capable to elicit a protective immune response in animal models have been identified, but these antigens have not been shown to be strongly immunogenic when administered to humans. Due to their stability in the gastric environment and avidity, passive administration of secretory immunoglobulin A (SIgA) antibodies (Ab) targeting protective Ag might be particularly relevant as a substitute or complement to current therapies. To this aim, we have designed expression vectors to convert a scFv polypeptide specific for H. pylori urease subunit A into human IgG, polymeric IgA (IgAp/d) and SIgA. Purified proteins show proper binding characteristics toward both the native and denatured forms of H. pylori urease. The direct comparison between different isotype and molecular forms, but of unique specificity, demonstrates that SIgA and IgAp/d are more efficient in blocking free and H. pylori-associated urease than IgG and scFv. We conclude that the expression system reported herein will represent a valuable tool to produce human SIgA Ab of multiple specificities against H. pylori antigens involved in colonization and persistence.