Continuidades y rupturas en el proceso de centralización de la administración sanitaria argentina (1880-1945)

El objetivo del trabajo es presentar el proceso de centralización administrativa de la repartición sanitaria nacional. Para ello se analizan, en primer lugar y con la intención de situar el problema en un plazo más largo, los límites que debió afrontar el Departamento Nacional de Higiene desde el momento de su creación, en 1880, para avanzar en sus intenciones centralizadoras. Entre ellos se encuentran su escasa autonomía administrativa, las superposiciones jurisdiccionales con otras dependencias del Estado, las indefiniciones respecto de su supremacía jerárquica, la resistencia de las provincias, los municipios fuertes y las asociaciones benéficas y los conflictos de proyectos al interior mismo de la repartición. En segundo lugar se muestra cómo los sucesivos presidentes del Departamento Nacional de Higiene asumieron ese límite para su gestión y apostaron a la organización interna de la repartición antes que al desafío de la centralización de la asistencia sanitaria. Su estrategia fue el fortalecimiento de nuevas áreas de incumbencia que constituyeron una agenda que sirvió como base de la definitiva centralización de la administración sanitaria. En esta tarea contaron con el apoyo parlamentario, fundamentalmente de la bancada socialista, que logró convertir en ley durante los años 30 a una serie de nuevas atribuciones del Departamento en aspectos que ligaban la salud con la asistencia social. Por último se analiza un momento clave de este proceso, el primer ensayo de centralización sanitaria a través de la creación, en 1943, de la Dirección Nacional de Salud Pública y Asistencia Social.

The importance of patient involvement in stroke rehabilitation

OBJECTIVE: To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. METHOD: Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment. RESULTS: The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading. CONCLUSIONS: The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs.

Brooke-Spiegler Syndrome - an underrecognized cause of multiple familial scalp tumors: report of a new germline mutation

BACKGROUND: Brooke-Spiegler syndrome (BSS) is probably an underdiagnosed genodermatosis that predisposes for the development of cylindromas, spiradenomas and trichoepitheliomas mainly of the head and neck. Wide phenotypic variability regarding the number and type of lesions can be observed within a family. Mutations of the CYLD gene are identified in the vast majority of cases and play a key role in BSS pathogenesis. MAIN OBSERVATIONS: Two first degree relatives with numerous erythematous telangiectatic nodules of the scalp present for decades, with recurring tendency regardless the multiple previous excisions. Histopathological review of the lesions revealed predominantly "spiradenocylindromas" in the proband and cylindromas in her sister. The suspicion of BSS was confirmed after detection of a new nonsense germline mutation of CYLD (c.1783C>T pGln 595*) in the proband. CONCLUSIONS: BSS diagnosis can be challenging and is based on clinical-pathological correlation, positive familial association and identification of CYLD mutations. CYLD exerts antineoplastic effects by downregulating intracellular NF-κB signalling pathways. The reported mutation affecting the ubiquitin-specific protease domain leads to a truncated and catalytically inactive enzyme. Despite the expanding list of CYLD mutations no firm genotype-phenotype correlation is known so far. Early recognition and treatment of BSS avoid disfiguring changes like "turban tumor".

Information Pertaining to the Public Hearing, 1986

On August 12, 1986, a public hearing was held in the Henry A. Wallace Building Auditorium, 900 East Grand Avenue, Des Moines, Iowa, for the purpose of receiving comments and statements from individuals, groups, and associations that have an interest in the limits of financial responsibility for intrastate passenger motor carriers.

Redes interorganizacionais e inovação: o caso do pólo joalheiro de Belém

This work is a case study based on Belém Jewelry Pole, whose main issue is to understand how the social network (which the Pole is inserted) influences on innovation process on this area. The main objective is to analyze how interorganizational networks impacted/impact on the potential for innovation, creating both limits and opportunities for the companies development. The adopted method analyzed the historical jewelry industry trajectory since the beginning of mineral extraction in the city of Itaituba (in the Pará State) until nowadays. Primary and secondary data were used allowing the view of the dynamics of the network during transformation periods of the main involved actors in the process. The prospect of embeddedness structural as analysis technique allowed verifying the quality of interactors ties, as well as the visualization of their structures. During the jewelry industry trajectory was verified a change in the quality of social relations, modifying the information flow, trust and associations of various links in the production chain. Both direct and indirect ties facilitated the access to remote networks entering new information related to new products, processes and market aspects. This interaction has led to raising the innovation potential causing a qualitative and quantitative improvement in competitiveness of organizations. Some embedded ties allowed the formation of partnerships bringing various economic earnings for those involved in the relationship. Thus, it is understood how aspects related to the position, architecture and quality of ties in a wide social network influenced on the innovation process and eventual jewelry industry trajectory

Os forrós da Serra da Gameleira (São Tomé/RN) : etnicidade, festa e sociabilidade

This work intends to describe and analyze the parties of forró that happen in Serra da Gameleira, in São Tomé/RN. Serra is a divided social space: groups of different ethnic origins live together in Gameleira de Baixo, Salgadinho (or Gameleira de Cima) and Chaves Belas. They are approximately two hundred families that live exclusively from agriculture. We try to understand how the parties inform about the social organization, the ethnic composition of the families that live there and the past of Serra, through the genealogy offorró players. In the discussion, we identify the festive places: in the total, we have Five houses of forró that function regularly one of them has been described. The private and public spaces inside them are intimate related, with no clear limits between the house of forró and the residence. Each house of forró has an owner, that regularly makes the parties, mobilizing a big part of the inhabitants, and provoking the straitening of the social relations. Observing the festive sociability between different social segments, the forró appears like na element that minimizes social conflicts, providing news ways of association and cooperation in the space of Serra da Gameleira. For the collection of facts, we used the ethnographic method, through the direct observation, interviewing and documentary research. The local history is recounted following the routes of oral memory and historical documents analysis. In the end of the analysis, we concluded that music and party are elements that aggregate the different groups that live in the location and determine forms of expression of what is seen as a traditional culture

Embolada e outras coisas do folclore tulusano: a experiência da Associação Escambiar em Toulouse - França

Since the middle 80 s from the 20th century, some musical genres associated to the Brazilian Northeastern region notably the forró, coco de embolada and repente de viola have been gradually incorporated to the musical production of south France linked to the occitanista trend, currently linking many musicians and groups from those regions in both countries. This paper is engaged in reflecting on the particular experience of the groups formed by the Escambiar Association, located on the city of Toulouse, and specially the duet Fabulous Trobadors, whose compositions are mostly made in the coco de embolada form. Watching the motivations and the processes that led to the creation of the groups from this association and it s current operation, this study investigates the transcultural phenomenon, that allow to cross two symbolic universes through rationalizing speeches about music, considering the locality s production in the midst of a political debate that involve questions about cultural identity and tradition

O médico na indústria farmacêutica: contributo para o enquadramento da atividade

Ao longo desta dissertação de mestrado pretendemos analisar e discutir o papel do Médico na Indústria Farmacêutica, contribuindo para um melhor enquadramento de uma atividade ainda não muito conhecida. A partir da análise da implementação da Indústria Farmacêutica em Portugal, descrevemos o seu contributo para a Sociedade aliado ao valor do medicamento. Descrevemos a Medicina Farmacêutica, o treino da atividade e alguns dos órgãos relevantes nesta área, como a Competência em Medicina Farmacêutica da Ordem dos Médicos e a Associação dos Médicos Portugueses da Indústria Farmacêutica. De uma forma detalhada caraterizamos as atividades e competências do Médico nesta indústria que reforçamos com uma análise de um questionário efetuado com as opiniões de colegas Portugueses e estrangeiros com experiência nesta área do conhecimento. Concluímos, reconhecendo a importância da atividade, da sua caraterização e dos seus desafios futuros.

Brooke-Spiegler Syndrome - an underrecognized cause of multiple familial scalp tumors: report of a new germline mutation

BACKGROUND: Brooke-Spiegler syndrome (BSS) is probably an underdiagnosed genodermatosis that predisposes for the development of cylindromas, spiradenomas and trichoepitheliomas mainly of the head and neck. Wide phenotypic variability regarding the number and type of lesions can be observed within a family. Mutations of the CYLD gene are identified in the vast majority of cases and play a key role in BSS pathogenesis. MAIN OBSERVATIONS: Two first degree relatives with numerous erythematous telangiectatic nodules of the scalp present for decades, with recurring tendency regardless the multiple previous excisions. Histopathological review of the lesions revealed predominantly "spiradenocylindromas" in the proband and cylindromas in her sister. The suspicion of BSS was confirmed after detection of a new nonsense germline mutation of CYLD (c.1783C>T pGln 595*) in the proband. CONCLUSIONS: BSS diagnosis can be challenging and is based on clinical-pathological correlation, positive familial association and identification of CYLD mutations. CYLD exerts antineoplastic effects by downregulating intracellular NF-κB signalling pathways. The reported mutation affecting the ubiquitin-specific protease domain leads to a truncated and catalytically inactive enzyme. Despite the expanding list of CYLD mutations no firm genotype-phenotype correlation is known so far. Early recognition and treatment of BSS avoid disfiguring changes like "turban tumor".

Fetal-maternal interface impedance parallels local NADPH oxidase related superoxide production

Blood flow assessment employing Doppler techniques is a useful procedure in pregnancy evaluation, as it may predict pregnancy disorders coursing with increased uterine vascular impedance, as pre-eclampsia. While the local causes are unknown, emphasis has been put on reactive oxygen species (ROS) excessive production. As NADPH oxidase (NOX) is a ROS generator, it is hypothesized that combining Doppler assessment with NOX activity might provide useful knowledge on placental bed disorders underlying mechanisms. A prospective longitudinal study was performed in 19 normal course, singleton pregnancies. Fetal aortic isthmus (AoI) and maternal uterine arteries (UtA) pulsatility index (PI) were recorded at two time points: 20-22 and 40-41 weeks, just before elective Cesarean section. In addition, placenta and placental bed biopsies were performed immediately after fetal extraction. NOX activity was evaluated using a dihydroethidium-based fluorescence method and associations to PI values were studied with Spearman correlations. A clustering of pregnancies coursing with higher and lower PI values was shown, which correlated strongly with placental bed NOX activity, but less consistently with placental tissue. The study provides evidence favoring that placental bed NOX activity parallels UtA PI enhancement and suggests that an excess in oxidation underlies the development of pregnancy disorders coursing with enhanced UtA impedance.