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Este é um momento da relação de cuidado quando a técnica não mais representa sua função prioritária, é o fim da vida. Realizei uma revisão crítica da literatura concernente ao reconhecimento e ao respeito das expectativas, demandas e direitos das pessoas ao final da vida no espaço da conferência consensual sobre o acompanhamento das pessoas no fim da vida e de seus próximos. Apoiei-me sobre o método de ANAES, explorando as principais bases dos dados bibliográficos internacionais, notadamente: ‘Med Line’, ‘Embase’, Banco de dados em Saúde Pública, Cochrane e Pascal. A primeira etapa consistiu em selecionar, graças à leitura dos resumos, os artigos pertinentes a esta pesquisa. Consecutivamente, tínhamos analisado previamente os artigos a fim de apresentar seus resultados significativos para fundamentar os avanços da pesquisa sobre este tema. Neste meu artigo, proponho uma revisão mais “crítica” dos diferentes estudos.

Background The incidence of microscopic colitis (MC) is increasing, but its etiology remains unknown. Case reports and limited controlled data suggest that commonly prescribed drugs may be triggers. The aim of this study was to evaluate the prevalence of selected medication use [Proton pump inhibitors (PPIs), HMG-CoA reductase inhibitors (statins), and Selective serotonin reuptake inhibitors (SSRIs)] in patients with MC compared to ‘random controls’ and ‘diarrhea controls.' Methods All patients were selected from primary care practices of a university health system during 2002 to 2007. Patients with biopsy proven lymphocytic or collagenous colitis were identified as cases. Diarrhea controls consisted of a 10:1 random sample of patients with chronic diarrhea and normal colon biopsies. Ten random controls were matched to each case on sex and index date (date of biopsy proven diagnosis). Drugs prescribed within the year prior to the index date were collected from the electronic medical record system. Results 26 cases (median age 68.9 yrs), 259 random, and 259 diarrhea controls were identified. The adjusted ORs for PPI, SSRI, and statin prescription within 12 months of diagnosis of MC between cases and diarrhea controls were 0.28 (0.07-1.07), 0.87 (0.28-2.64), 1.12 (0.34-3.71) respectively. Use of PPI and statins was less common in MC patients than in random controls ( P < 0.05 for both comparisons). Conclusions While prior data suggest that PPIs, statins, and SSRIs may be etiologically related to MC, our study found no increased association with these drugs.

Abstract Background SOLAR II is the 2nd follow-up of a population-based cohort study that follows the participants of ISAAC Phase Two recruited in Munich and Dresden in 1995/6. A first follow-up study was conducted 2002 and 2003 (SOLAR I). The aims of SOLAR II were to investigate the course of atopic diseases over puberty taking environmental and occupational risk factors into account. This paper describes the methods of the 2nd follow-up carried out from 2007 to 2009 and the challenges we faced while studying a population-based cohort of young adults. Methods Wherever possible, the same questionnaire instruments were used throughout the studies. They included questions on respiratory and allergic diseases, domestic and occupational exposure and work related stress. Furthermore, clinical examinations including skin prick tests, spirometry and bronchial challenge with methacholine, exhaled nitric oxide (FeNO) and blood samples were employed at baseline and 2nd follow-up. As information from three studies was available, multiple imputation could be used to handle missing data. Results Of the 3053 SOLAR I study participants who had agreed to be contacted again, about 50% had moved in the meantime and had to be traced using phone directories and the German population registries. Overall, 2904 of these participants could be contacted on average five years after the first follow-up. From this group, 2051 subjects (71%) completed the questionnaire they received via mail. Of these, 57% participated at least in some parts of the clinical examinations. Challenges faced included the high mobility of this age group. Time constraints and limited interest in the study were substantial. Analysing the results, selection bias had to be considered as questionnaire responders (54%) and those participating in the clinical part of the study (63%) were more likely to have a high parental level of education compared to non-participants (42%). Similarly, a higher prevalence of parental atopy (e.g. allergic rhinitis) at baseline was found for participants in the questionnaire part (22%) and those participating in the clinical part of the study (27%) compared to non-participants (11%). Conclusions In conclusion, a 12-year follow-up from childhood to adulthood is feasible resulting in a response of 32% of the baseline population. However, our experience shows that researchers need to allocate more time to the field work when studying young adults compared to other populations.

Abstract Background There is currently much interest in pharmacogenetics: determining variation in genes that regulate drug effects, with a particular emphasis on improving drug safety and efficacy. The ability to determine such variation motivates the application of personalized drug therapies that utilize a patient's genetic makeup to determine a safe and effective drug at the correct dose. To ascertain whether a genotype-guided drug therapy improves patient care, a personalized medicine intervention may be evaluated within the framework of a randomized controlled trial. The statistical design of this type of personalized medicine intervention requires special considerations: the distribution of relevant allelic variants in the study population; and whether the pharmacogenetic intervention is equally effective across subpopulations defined by allelic variants. Methods The statistical design of the Clarification of Optimal Anticoagulation through Genetics (COAG) trial serves as an illustrative example of a personalized medicine intervention that uses each subject's genotype information. The COAG trial is a multicenter, double blind, randomized clinical trial that will compare two approaches to initiation of warfarin therapy: genotype-guided dosing, the initiation of warfarin therapy based on algorithms using clinical information and genotypes for polymorphisms in CYP2C9 and VKORC1; and clinical-guided dosing, the initiation of warfarin therapy based on algorithms using only clinical information. Results We determine an absolute minimum detectable difference of 5.49% based on an assumed 60% population prevalence of zero or multiple genetic variants in either CYP2C9 or VKORC1 and an assumed 15% relative effectiveness of genotype-guided warfarin initiation for those with zero or multiple genetic variants. Thus we calculate a sample size of 1238 to achieve a power level of 80% for the primary outcome. We show that reasonable departures from these assumptions may decrease statistical power to 65%. Conclusions In a personalized medicine intervention, the minimum detectable difference used in sample size calculations is not a known quantity, but rather an unknown quantity that depends on the genetic makeup of the subjects enrolled. Given the possible sensitivity of sample size and power calculations to these key assumptions, we recommend that they be monitored during the conduct of a personalized medicine intervention. Trial Registration clinicaltrials.gov: NCT00839657

Abstract There is increasing concern among many in the medical arena about the extent to which the effects of treatment, either good or bad, apply to specific subgroups of individuals. Women comprise one of the most frequently considered 'subgroups' of patients. In the 1980s, much political attention was focused on concerns about equity in the research enterprise. In this paper, we briefly describe the statutory approaches to achieving equity in research, beginning with The NIH Revitalization Act of 1993. We go on to describe clinical, methodological and political factors affecting these discussions. We conclude that the controversy over the inclusion of women in clinical trials probably stems, in part, from theoretical concerns about gender differences in treatment effects and, in part, by legitimate fears of exposing fetuses to investigational drugs. However, we believe that the broader issue centres on biological factors, possibly defined by genes or gene expression, that may directly or indirectly modify the effect of specific treatments on specific individuals. A growing concern of physicians, regulators, healthcare policy makers and patients is the extent to which the effects of treatment, both good and bad, apply to specific subgroups. Do results of clinical trials apply consistently and equally across all clinically meaningful subclasses of patients enrolled in the studies? Can the results of those studies be extrapolated to patients or types of patients who did not participate in the original research? Reliable data on these issues are rarely available at the time of drug approval and are more difficult to generate once the drug is on the market and readily available.

This article represents the largest ever primary data-based study of involuntary celibates (incels), previously studied nearly exclusively through analysis of online postings. The incel movement has been characterized by some as a radical ideology, with mass murderers such as Elliot Rodger, Alek Minassian, and Chris Harper Mercer being portrayed as prototypical of the movement. However, there is a dearth of research through direct questioning of incels and therefore very little nuanced understanding of the community, its shared grievances, and its opinions regarding violence in its name. The present study of over 250 self-identified incels demonstrates that although the majority of incels are non-violent and do not approve of violence, those who consider themselves to be staunch misogynists are likely to endorse a desire to commit violence and are also likely to become more misogynistic through participation on incel web forums, which validate their views. The study also finds that while many incels report experiencing a variety of psychological symptoms, they are loath to seek help from mental health professionals. This implies that the threat of violence from a subset of incels should not be ignored, but promotion of compassionate and understanding psychological may be more broadly beneficial to the community. [ABSTRACT FROM AUTHOR]

The article focuses on a study in which researchers aim to increase viewership of "Breaking the ISIS Brand" videos from the International Center for the Study of Violent Extremism among audiences in Europe. Facebook campaigns were run by the center in April 2020 targeting the main and vulnerable minority group languages in eight Europan Union countries. Data regarding viewership shows that one-minute videos were more effective in capturing viewers' attention.

Describes funding and communication strategies at six, nonprofit, nonsectarian, tuition-free preschools for mentally retarded and developmentally delayed children. Details marketing strategies; the role of multiple markets; the targeting of potential funders among local citizens, foundations, and corporations; and the creation of honorary trustees, annual giving, and special events. (RDN)

The use of corporal punishment in schools is cited as creating more problems than it solves. Educational and psychological perspectives for the elimination of physical discipline in schools is presented. (JMF)

In line with the seminal ideas on the "prejudice-prone personality" provided by Allport (1954) in the book The Nature of Prejudice , various studies have highlighted the association between individuals' high need for cognitive closure (NCC) and prejudice towards various outgroups. Nonetheless, evidence on the invariance of individuals' prejudice towards different outgroups is still missing. Study 1 and Study 2 aimed to provide evidence that individuals with high NCC display similar levels of prejudice towards different outgroups (i.e., people of a different race; people of a different religion; immigrants; people who speak a different language; people with a different sexual orientation), expressed in terms of desired social distance. Besides this, and based on the "group-centrism hypothesis" positing the role of groups as sources of epistemic certainty and stability of knowledge, Study 2 tackled the process underlying the relation between NCC and invariance of prejudice towards different outgroups by testing the mediational role of binding moral foundations. Evidence from both studies supported the hypothesis that individuals with high NCC display prejudice towards different outgroups to the same extent and that binding moral foundations mediate this relationship. Implications of these findings with reference to interventions aimed to hinder prejudice towards outgroups will be discussed. [ABSTRACT FROM AUTHOR]

Die Küsten des nördlichen Hokkaidos gehören zu den äquatornächsten Bereichen, die in saisonalem Wechsel einer wellen- und strömungsdominierten Sommerformung (8—10 Monate) und einer packeis- und frostinduzierten Winterformung (2—4 Monate) unterliegen. Es werden für diesen Raum die typischen Prozesse der Sommer- und Wintermonate beschrieben. Im Sommer werden die Küsten wesentlich stärker geformt als im Winter und die durch Eispressung entstandenen Formen an den Stränden und Dünen überdauern nur in Relikten. Dennoch kann die Zone der saisonal vereisten Küsten klimageomorphologisch von den Küsten wärmerer Breiten abgegrenzt werden, da nur hier ein derart großer Kontrast zwischen Sommer- und Winterformung existiert. Diese Grenze ist allerdings ein breiter Saum und kein schmaler Übergang, wie es für solche physisch geographischen Grenzen die Regel ist.

In Japan gibt es nur eine einzige Gebirgsregion, in der rezente Periglazialformen weitverbreitet auftreten. Es ist die Vulkan-Gruppe des Daisetsu San im zentralen Teil der Insel Hokkaido, der nördlichsten großen Insel Japans. Unter Mitverwendung der Beobachtungen Japanischer Autoren wird die Regelhaftigkeit des Auftretens von rezenten Periglazialformen und ihrer Vergesellschaftung in Tab. 1 aufgezeigt.

Im Relief der alpinen Stufe des Chirripó in Costa Rica sind über der heutigen Waldgrenze bei 3400 m Höhe drei Reliefgenerationen nachzuweisen. Die erste ist vorkaltzeitlich. In ihr wurden die Talzüge und der Verlauf der Wasserscheiden festgelegt. Die zweite ist kaltzeitlich. In ihr wurde das Relief am stärksten geprägt. Kargletscher mit Zungen in den Tälern vertieften und weiteten in allen Richtungen die Talschlüsse und Oberläufe der Täler. Einige während dieser Zeit entstandene Karlinge, Kare, Moränen und Rundhöcker wurden nach der Vereisung durch Periglazialprozesse in den Teilen überprägt, wo eine Schuttauflage vorhanden war. Die dritte Reliefgeneration wird durch das heutige Prozeßgefüge bestimmt. Es ist nur schwach entwickelt; die Formen verändern sich langsam. Lediglich leichte Nachtfröste, ausschließlich episodisch oberflächlich abfließendes Regenwasser und kleine Verwitterungsgeschwindigkeiten wirken nur langsam auf das Relief ein. Tiefer gelegene Bergstufen Costa Ricas sind geomorphologisch wesentlich aktiver. Die glazial entstandenen Formen blieben auch wesentlich besser erhalten als in höher aufragenden tropischen Gebirgen oder in den Hochgebirgsketten der gemäßigten Breiten. So hat sich hier eine vor allem kaltzeitlich gestaltete Bühne erhalten können — die einzige in Zentralamerika.

No abstract available.

Die südiberischen Küsten des Mittelmeeres haben ein Gepräge, das sich von dem des Atlantik stark unterscheidet. Sind auf der einen Seite nur kaum durch Tidenhub, Küstenströmung und Brandung geprägte Steilküsten mit Lösungskehlen, Schutthalden neben Flachküsten ohne starke Dynamik und episodisch bis periodisch grobe Sedimentschüttungen ins Meer führende Torrenten charakteristisch, so sind auf der anderen Seite stark von der Meeresseite her gestaltete Küsten kennzeichnend, die in den steilen Abschnitten viele aktive Kliffreihen, in den flachen breite dynamische Sandstrände mit Dünen zeigen und wo durch kontinuierlich mit Wasser gefüllte Flußbetten große Mengen feinkörnigen Materials dem Meer zugeführt werden. Der Übergang zwischen Mittelmeer und Atlantik vollzieht sich im Grenzsaum der Meerenge von Gibraltar. Bei einem Gang von Osten nach Westen auf der europäischen und afrikanischen Seite werden die einzelnen Stufen der Veränderungen auf die Küstenformen und die rezente Morphodynamik aufgezeigt. Einerseits ist die vorliegende Arbeit regional ausgerichtet. Andererseits will sie einen Beitrag zu einem in der Morphologie wenig beachteten Problemkreis liefern, nämlich zur Frage, wie ein Grenzsaum zwischen zwei geomorphologisch gänzlich unterschiedlichen Bereichen in seiner Differenzierung erkannt, erklärt und vereinfachend dargestellt werden kann.