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Summary: Despite extensive global research into genetic predisposition for severe COVID-19, knowledge on the role of rare host genetic variants and their relation to other risk factors remains limited. Here, 52 genes with prior etiological evidence were sequenced in 1,772 severe COVID-19 cases and 5,347 population-based controls from Spain/Italy. Rare deleterious TLR7 variants were present in 2.4% of young (

Abstract Background Low back pain (LBP) is a common health condition and the leading cause of years lived with disability worldwide. Most LBP episodes have a favourable prognosis, but recurrences within a year are common. Despite the individual and societal impact related to LBP recurrences, there is limited evidence on effective strategies for secondary prevention of LBP and successful implementation of intervention programmes in a real-world context. The aim of this study is to analyse the effectiveness of a tailored exercise and behavioural change programme (MyBack programme) in the secondary prevention of LBP; and evaluate acceptability, feasibility and determinants of implementation by the different stakeholders, as well as the implementation strategy of the MyBack programme in real context. Methods This protocol describes a hybrid type I, randomized controlled trial to evaluate the effectiveness and implementation of MyBack programme in the context of primary health care. The Behaviour Change Wheel framework and FITT-VP principles will inform the development of the behaviour change and exercise component of MyBack programme, respectively. Patients who have recently recovered from an episode of non-specific LBP will be randomly assigned to MyBack and usual care group or usual care group. The primary outcome will be the risk of LBP recurrence. The secondary outcomes will include disability, pain intensity, musculoskeletal health, and health-related quality of life. Participants will be followed monthly for 1 year. Costs data related to health care use and the MyBack programme will be also collected. Implementation outcomes will be assessed in parallel with the effectiveness study using qualitative methods (focus groups with participants and health providers) and quantitative data (study enrolment and participation data; participants adherence). Discussion To our knowledge, this is the first study assessing the effectiveness and implementation of a tailored exercise and behaviour change programme for prevention of LBP recurrences. Despite challenges related to hybrid design, it is expected that data on the effectiveness, cost-effectiveness, and implementation of the MyBack programme may contribute to improve health care in patients at risk of LBP recurrences, contributing to direct and indirect costs reduction for patients and the health system. Trial registration number NCT05841732.

Abstract This study aimed to characterize the antimicrobial resistance (AMR) and virulence profiles of 67 Escherichia coli isolates obtained from faecal samples of 77 wild mammals from 19 different species, admitted in two rescue and rehabilitation centers in Costa Rica. It was possible to classify 48% (n = 32) of the isolates as multidrug-resistant, and while the highest resistance levels were found towards commonly prescribed antimicrobials, resistance to fluoroquinolones and third generation cephalosporins were also observed. Isolates obtained from samples of rehabilitated animals or animals treated with antibiotics were found to have significantly higher AMR levels, with the former also having a significant association with a multidrug-resistance profile. Additionally, the isolates displayed the capacity to produce α-haemolysins (n = 64, 96%), biofilms (n = 51, 76%) and protease (n = 21, 31%). Our results showed that AMR might be a widespread phenomenon within Costa Rican wildlife and that both free-ranging and rehabilitated wild mammals are potential carriers of bacteria with important resistance and virulence profiles. These results highlight the need to study potential sources of resistance determinants to wildlife, and to determine if wild animals can disseminate resistant bacteria in the environment, potentially posing a significant threat to public health and hindering the implementation of a “One Health” approach.

Abstract Background Recurrences of low back pain (LBP) are frequent and associated with high levels of disability and medical costs. Regular exercise practice may be an effective strategy to prevent recurrences of LBP, however, the promotion of this behaviour by physiotherapists seems to be challenging. This study aims to explore physiotherapists’ perceived barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice by patients at risk of recurrence of low back pain. Methods Two focus groups with primary healthcare physiotherapists were conducted, based on a semi-structured interview schedule informed by the Behaviour Change Wheel, including the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). All focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis, using a coding matrix based on the COM-B and TDF, was performed by two independent researchers. A third researcher was approached to settle disagreements. Results In total, 14 physiotherapists participated in the focus groups. The analysis revealed a total of 13 barriers (4 COM-B components and 7 TDF domains) and 23 facilitators (5 COM-B and 13 TDF) to physiotherapists’ implementation of a behaviour change-informed exercise intervention. The most common barriers were the lack of skills and confidence to implement the proposed intervention. These were explained by the fact that it differs from the usual practice of most participants and requires the learning of new skills applied to their contexts. However, for those who had already implemented other similar interventions or whose rationale is aligned with the new intervention, there seemed to exist more positive determinants, such as potential benefits for physiotherapists and the profession, improvement of quality of care and willingness to change clinical practice. For others who did not previously succeed in implementing these types of interventions, more context-related barriers were mentioned, such as lack of time to implement the intervention, schedule incompatibilities and lack of material and human resources. Conclusions This study identified modifiable barriers and facilitators to physiotherapists’ implementation of a behaviour change-informed exercise intervention for patients at risk of recurrence of LBP in primary healthcare. The findings of this study will allow the systematic and theory-based development of a behaviour change-informed training programme, aimed at physiotherapists and supporting the successful implementation of the exercise intervention.

Introdução: Para o Enfermeiro Especialista em Saúde Infantil e Pediátrica (EESIP) prestar cuidados culturalmente competentes, a famílias que estejam a vivenciar transições, necessita de compreender os fenómenos socioculturais e religiosos que as influenciam. A população Muçulmana em Portugal reflete o mesmo crescimento que esta tem mundialmente. Para os muçulmanos a família é a base da sociedade, regulada por normas religiosas e tradicionais relacionadas com a saúde, a alimentação, a higiene pessoal, a conduta e interação social, o casamento, gravidez, o nascimento, a parentalidade, bem como, os rituais neles expressos, como a circuncisão. Objetivos: Compreender como as diferenças culturais influenciam a prestação de cuidados do Enfermeiro Especialista em Saúde Infantil e Pediátrica, bem como, identificar estratégias para uma prestação de cuidados culturalmente competentes. Métodos: Revisão narrativa da literatura nas seguintes bases de dados: PubMed, RCAAP e CINAHL. Resultados: A sociedade e leis islâmicas baseiam-se no Alcorão e na Sunnah. A parentalidade organiza-se segundo um modelo matrilinear com assunção de novos papéis na dinâmica familiar alargada. Sendo a circuncisão (Kitan) prática comum e percecionada como importante na identidade cultural e religiosa, identifica quem segue e obedece a Allah. No entanto, essa prática, usualmente no período neonatal, apresenta aumento de complicações imediatas e tardias se realizada de forma tradicional (fora do ambiente hospitalar). Ao compreender o ato cultural associado ao ritual da circuncisão o EESIP desenvolve as competências interculturais ao considerar e conceber intervenções de enfermagem para garantir a saúde da criança e família no seu contexto social e cultural. Conclusões: Tendo como base o Modelo do Sol Nascente de Leininger e sabendo que a realização da circuncisão é uma questão cultural, o EESIP, pode atuar através da Acomodação/Negociação do Cuidado Cultural.

Introdução: A adolescência é uma fase de mudanças importantes no processo de desenvolvimento biopsicossocial, apresentando-se com particular vulnerabilidade pelo processo de transição acometido. O diagnóstico de uma doença oncológica na fase da adolescência é perspetivado como contraditório e inesperado, num período de construção do futuro, agravado pelo sentimento de vulnerabilidade caraterístico desta etapa, para o qual o Enfermeiro Especialista em Saúde Infantil e Pediátrica (EESIP) deve focar a sua intervenção. Objetivos: Identificar intervenções de Enfermagem promotoras de esperança numa adolescente com doença oncológica. Material e Métodos: Realizado um estudo de caso orientado nas guidelines Case Reports como desenho de estudo estruturado (Gagnier et al., 2013), com pesquisa de evidência em diversas fontes científicas: SciELO, CINAHL e Pubmed. O estudo aborda uma adolescente diagnosticada com leucemia linfoblástica aguda num serviço de Pediatria Oncológica. Perante um caso clínico na área de Enfermagem, e adaptando as diretrizes anteriormente referidas, foi realizada uma análise reflexiva e investigativa, baseada no raciocínio clínico do processo de Enfermagem, enaltecendo a importância deste tipo de estudos na construção de novas práticas cada vez mais complexas e avançadas na intervenção do Enfermeiro, reconhecendo que mais estudos devem ser realizados para aumentar o grau de evidência que os casos clínicos comportam entre si (Yang et al., 2019). Resultados: Numa visão holística, através da avaliação de Enfermagem, a esperança surge como um dos focos de atenção, com orientação de intervenções do EESIP como promotoras de esperança na adolescente, por enfrentar diversos processos de transição complexos, com necessidades de intervenção particulares e especiais, visto ser necessário suporte emocional e mecanismos de coping para enfrentar uma doença oncológica (Saraiva & Sousa, 2022; Paramos et al., 2023). Dentro da sua capacidade de adaptação de intervenção do EESIP ajustada ao processo de transição da adolescente (Souza et al., 2022), este promove fatores facilitadores que influenciam a esperança dentro do seu caráter dinâmico (Santos et al., 2020), numa visão holística e humanista da adolescente. Conclusões: A intervenção do EESIP perante uma adolescente em processo de doença oncológica, é de extrema importância, no seu ajuste a cada momento de transição, com intervenções facilitadoras de esperança, promoção da adoção de estratégias de empoderamento, num sentido de maximização de todo o potencial da adolescente, orientando-a numa transição saudável, com perspetiva num futuro próximo e na manutenção dos seus sonhos e objetivos para a vida.

Background: Although surgical treatments for breast cancer have exhibited advanced interventions, axillary lymph node dissection can limit functionality and compromise women’s self-care. This study aims to assess the effectiveness of a rehabilitation nursing program in improving self-care performance in women undergoing breast surgery with axillary lymph node dissection. Methods: This quantitative, quasi-experimental study involved 48 women recruited from a main hospital between 2018 and 2019. The participants completed a three-month rehabilitation program at home. The evaluation instrument used was the DASH questionnaire. This study was not registered. Results: The functionality of the upper limb ipsilateral to the surgery improved significantly (p < 0.001) after the implementation of the program, influencing the participants’ capacity for self-care, including washing/drying their hair, washing their back, and wearing a shirt. The average DASH total score increased from 54.4 to 8.1 after the program. Conclusions: The rehabilitation nursing program positively influenced the participants’ self-care ability. Incorporating rehabilitation nursing programs into breast cancer treatment can improve self-care performance and the overall quality of patients’ lives. This study was not registered.

Abstract Ribosome biogenesis is a key process in all eukaryotic cells that requires hundreds of ribosome biogenesis factors (RBFs), which are essential to build the mature ribosomes consisting of proteins and rRNAs. The processing of the required rRNAs has been studied extensively in yeast and mammals, but in plants much is still unknown. In this study, we focused on a RBF from A. thaliana that we named NUCLEOLAR RNA CHAPERONE-LIKE 1 (NURC1). NURC1 was localized in the nucleolus of plant cell nuclei, and other plant RBF candidates shared the same localization. SEC-SAXS experiments revealed that NURC1 has an elongated and flexible structure. In addition, SEC-MALLS experiments confirmed that NURC1 was present in its monomeric form with a molecular weight of around 28 kDa. RNA binding was assessed by performing microscale thermophoresis with the Arabidopsis internal transcribed spacer 2 (ITS2) of the polycistronic pre-rRNA precursor, which contains the 5.8S, 18S, and 25S rRNA. NURC1 showed binding activity to the ITS2 with a dissociation constant of 228 nM and exhibited RNA chaperone-like activity. Our data suggested that NURC1 may have a function in pre-rRNA processing and thus ribosome biogenesis.

The success of the intracellular parasite Toxoplasma gondii in invading host cells relies on the apical complex, a specialized microtubule cytoskeleton structure associated with secretory organelles. The T. gondii genome encodes three isoforms of both α- and β-tubulin, which undergo specific post-translational modifications (PTMs), altering the biochemical and biophysical proprieties of microtubules and modulating their interaction with associated proteins. Tubulin PTMs represent a powerful and evolutionarily conserved mechanism for generating tubulin diversity, forming a biochemical ‘tubulin code’ interpretable by microtubule-interacting factors. T. gondii exhibits various tubulin PTMs, including α-tubulin acetylation, α-tubulin detyrosination, Δ5α-tubulin, Δ2α-tubulin, α- and β-tubulin polyglutamylation, and α- and β-tubulin methylation. Tubulin glutamylation emerges as a key player in microtubule remodeling in Toxoplasma, regulating stability, dynamics, interaction with motor proteins, and severing enzymes. The balance of tubulin glutamylation is maintained through the coordinated action of polyglutamylases and deglutamylating enzymes. This work reviews and discusses current knowledge on T. gondii tubulin glutamylation. Through in silico identification of protein orthologs, we update the recognition of putative proteins related to glutamylation, contributing to a deeper understanding of its role in T. gondii biology.

El presente estudio tiene como objetivo comprender las concepciones de los maestros de primaria sobre el aprendizaje socioemocional y la forma en que incluyen e implementan las actividades de aprendizaje socioemocional en sus prácticas diarias. Se trata de un estudio exploratorio, de carácter cualitativo, en el que participaron 31 maestros pertenecientes a las escuelas públicas y privadas de Portugal. Los resultados obtenidos corroboran, en general, las representaciones teóricas y los resultados empíricos presentados en la literatura de la especialidad. Los maestros expresan la importancia del aprendizaje socioemocional, pero sus prácticas en el aula varían según los intereses individuales de cada maestro, manifestando que, en su realidad escolar, a pesar de la valoración implícita sobre el aprendizaje socioemocional, la ausencia de una regulación curricular específica a nivel nacional sobre el desarrollo socioemocional de los alumnos hace que la implicación de la escuela dependa de la motivación individual de cada maestro.

Introdução: As lesões pigmentadas da mucosa oral podem corresponder a alterações locais ou a manifestações de doença sistémica. Importa conhecer as principais etiologias destas lesões para assim identificar aquelas com necessidade de intervenção e tratamento atempado específico. Descrição do caso: Relata-se o caso de uma mulher de 89 anos que, numa consulta de vigilância de diabetes, refere lesões pigmentadas na língua, com meses de evolução, sem dor ou outra sintomatologia associada. Foi referenciada a consulta de dermatologia para estudo, onde foi realizada biópsia de uma das lesões, cujo resultado foi compatível com mácula melanótica. Perante o quadro clínico e os achados anatomopatológicos foi considerado o diagnóstico de síndroma de Laugier-Hunziker (SLH). A utente foi informada da benignidade do quadro e da ausência de necessidade de tratamento. Comentário: A SLH é uma doença mucocutânea, benigna, de caráter adquirido, que se caracteriza por múltiplas máculas hiperpigmentadas, mais frequentemente presentes na mucosa oral ou lábios e configura um diagnóstico de exclusão. O artigo pretende relatar uma síndroma rara, com manifestação dermatológica, e abordar o diagnóstico diferencial de lesões hiperpigmentadas da mucosa oral.

Gait symmetry is commonly used as an informal measure to assess functional gait recovery. As other outcome measures used for the evaluation of clinical change over time, gait symmetry indices must be reliable. However, studies assessing the reliability of symmetry indices are scarce and focused on discrete and local indices (i.e., peak joint angle, step length), which fail to assess overall gait symmetry. On the other hand, the repeatability of global symmetry indices (using multiple continuous waveforms) based on joint angles may be hampered by the sensitivity of these variables to marker placement imprecision. The aim of this study is to evaluate the test–retest intra-rater reliability and measurement error of an alternative global symmetry index. Two 3D gait analyses were performed on separate days (a week interval) on twenty-three healthy adults. Reliability and measurement error were assessed by calculating the intraclass correlation coefficient and the 95% limits of agreement, standard error of measurement and smallest detectable change, respectively. The new symmetry index presented acceptable results in terms of reliability (ICC = 0.71, 95% CI 0.33–0.88) and measurement error (95% LOA between −30.2% and 29.1%, SEM = 10.7% and SDC = 29.7%), thus being a more promising tool to assess overall gait symmetry.

Collagen is a ubiquitous protein present in the extracellular matrix of all major metazoan animals, with approximately 28 different human collagen types described in the literature, each with unique physicochemical properties. Collagens found broad application in the cosmeceutical, pharmaceutical, and biomedical fields and can be isolated from environmentally sustainable sources such as marine byproducts, which are abundant in the fish processing industry and are highly appealing low-cost sources. In this study, marine collagen was isolated from the skins of Greenland halibut (Reinhardtius hippoglossoides), an unexplored byproduct from fish processing plants, using three different collagen extraction methods, due to the use of distinct salting-out methods using a solution of 2.6 M NaCl + 0.05 M Tris-HCl pH = 7.5, (method I); a combination of 0.7 M NaCl followed by a solution of 2.3 M NaCl + 0.05 M Tris-HCl pH = 7.5 (method II); and one method using only 0.9 M NaCl (method III), yielding COLRp_I, COLRp_II, and COLRp_III collagens. These extracted type I collagens were produced with a yield of around 2 and 4% and characterized regarding the physicochemical properties, considering possible biotechnological applications. This work evidenced that the typical triple helix structure conformation was preserved in all extraction methods, but influenced the thermal behavior, intrinsic morphology, and moisture capacity of the collagens, with interest for biotechnological application, as the incorporation as an ingredient in cosmetic formulation. Furthermore, the use of collagen isolated from skin byproducts represents a high economic value with decreasing collagen cost for industrial purposes and is also an environmentally sustainable source for industrial uses.

Kikuchi-Fujimoto disease (KFD) is a rare, benign and usually self-limiting disorder that more often affects young women, which is characterized by cervical lymphadenopathy and fever. Clinical presentation may be indistinguishable from other diseases, and its inclusion in the differential diagnosis of lymphoproliferative, infective and autoimmune diseases is essential. An association with systemic lupus erythematosus is acknowledged. We present 2 different cases of 2 young women with KFD; the first case highlights the classic diagnostic features of this rare entity, and the second, the findings when KFD occurs in association with systemic lupus erythematosus.

BackgroundNon-specific low back pain (NSLBP) is the most prevalent musculoskeletal condition in western countries and is associated with persistent disability and high consumption of health care resources. NSLBP patients first seek primary health care services but the outcomes are often uncertain. This study aimed to examine the clinical course of the outcomes and to identify prognostic indicators for poor outcomes in NSLBP patients who consulted primary care.MethodsA prospective cohort study of 115 patients seeking treatment for NSLBP in primary care was conducted. Participants were consecutively recruited by their General Practitioners (GPs) and then assessed at baseline and 2 and 6 months later. Baseline assessment included socio-demographic and clinical data, psychosocial factors, pain, disability, and health related quality of life (HRQoL). Pain, disability, HRQoL and global perception of change were also assessed at 2 and 6-months' follow-up. In addition, information regarding the GP' practice was collected. Poor outcomes were determined according to the cut-off point used to define a persistent disabling condition and the minimal important change established for disability, pain and for global perception of change. The relationship between variables on baseline and poor outcomes was modulated through binary logistic regression analysis. The significance of associations was evaluated at ≤ 0.05 p-value with 95% confidence intervals (CI) and adjusted odds ratios (AOR).Results110 (94.8%) and 104 (89.7%) participants completed the follow-up assessment at 2 and 6 months, respectively. The mean age (±SD) was 48.06 ± 11.41, with 53.9%, (N = 62) reporting an acute presentation of NSLBP. Six months after GP consultation, 53.8% (N = 56) of the participants reported a persistent disabling condition. An "LBP episode of less than 12 weeks" [AOR: 0.26; 95% CI (0.10, 0.65); AOR: 0.34; 95% CI (0.14, 0.81); AOR: 0.21; 95% CI (0.09, 0.53)],"maladaptive psychosocial factors" [AOR: 2.06; 95% CI (1.40, 3.04); AOR: 1.82; 95% CI (1.27, 2.59); AOR: 1.72; 95% CI (1.20, 2.47)] were significantly associated with poor outcomes on disability, pain and global perception of change, respectively. Besides these factors, being employed reduces the chances of poor outcomes on disability [AOR 0.31; 95% CI (0.11, 0.92)].ConclusionsA large proportion of LBP patients seeking primary health care reported poor outcomes 6 months after GP consultation. Patients who report chronic LBP, maladaptive psychosocial factors and are unemployed have a significant increase in the risk of poor outcome. These findings suggest the need of implementing effective models of care able to provide early screening and appropriate treatment to those at greatest risk of a poor outcome.Trial registrationCurrent Controlled Trials NCT04046874 (August 6, 2019). Retrospectively registered.

Cystic mesotheliomas (also called mesothelial inclusion cysts) are rare benign neoplasms that occur more often in young women. Symptoms are usually non-specific, demanding a thorough work-up. We report a case of a 40-year-old female patient with 2 prior caesarean sections presenting with a 3-month history of abdominal pain. Laboratory tests revealed microcytic hypochromic anaemia and an elevated tumour marker CA-125. An investigation identified a large cystic abdominal mass, mostly in the left side of the abdomen. A laparotomy was performed with total resection of the lesion. Histological assessment resulted in a diagnosis of a mesothelial inclusion cyst. The patient had no recurrence after 3 years.

Objetivo: conocer las identidades profesionales de enfermeros portugueses y los sentidos de las transiciones en curso, para proporcionar el apoyo necesario a los desafíos de identidad profesional.Materiales y método: investigación de enfoque mixto realizada entre 2016 y 2017. Se utilizó el Inventario de Identidad Psicosocial de Zavalloni y Louis-Guérin como herramienta de recolección de datos, junto a una muestra de 102 enfermeros, de los cuales 19 fueron entrevistados posteriormente. Se analizaron datos que correspondían a los posibles selves, a la identificación del núcleo central, a los elementos periféricos de identidad profesional y las condiciones profesionales.Resultados: se verificó la existencia de un grupo dominante de enfermeros en una dualidad de identidad entre el enfoque en los cuidados y la autonomía profesional y el enfoque en las exigencias institucionales, con temor a la externalización del cuidado. Se identificó otro grupo profesional, más relacionado con el cuidado, que no presenta evidencias de institucionalización, sino que persigue un mayor desarrollo de las relaciones humanas y del conocimiento científico.Conclusiones: las posibles transiciones de identidad reconocidas pueden ocurrir según refuerzos y reconocimientos ofrecidos, que correspondan a factores de mercado y consecuente despersonalización del cuidado, o con la conquista de la autonomía y el rescate del cuidado, basado en la cientificidad profesional.

Background and objectiveThe SPLIT project aims to introduce an interdisciplinary stratified model of care for patients with low back pain. This study aimed to explore the acceptability and identify potential barriers and facilitators regarding the upcoming implementation of this project, based on the general practitioners' and physiotherapists' perceptions.MethodsA qualitative study was carried out supported by two focus groups, which were conducted by two researchers. A focus group was carried out with each professional group. One focus group included six general practitioners and the other included six physiotherapists. The focus groups were based on a semi-structured interview schedule, audio-recorded and transcribed verbatim. A thematic analysis was conducted.ResultsThe participants explored aspects related to the acceptability of the SPLIT project, emphasising the satisfactory amount of effort that is expected to be required for its implementation. Potential facilitators to the implementation of the model were identified, such as the participants`motivation. Potential barriers were also explored, with particular emphasis on the challenges related to the change of routine care. Lastly, the need for particular adjustments in the health services was also highlighted.ConclusionsThis study`s participants highlighted the feasibility and acceptability of the SPLIT project. The identification of potential barriers and facilitators to its implementation also attained major relevance to better prepare the upcoming implementation of this project. The generalizability of findings to the larger population of relevant practitioners is limited, since only two focus groups were carried out. Therefore, this study`s findings should be considered in terms of transferability to contexts that may have some similarities to the context where the study was carried out.

As alterações na sociedade refletem-se na formação, na profissão e no trabalho dos enfermeiros, originando novas profissionalidades. Neste estudo, de paradigma qualitativo, pretendeu-se conhecer as implicações da formação nas transições no mundo de trabalho, na identidade e no desenvolvimento profissional dos enfermeiros. Aplicou-se o Inventário de Identidade Psicossocial. A valorização da formação formal e informal nas transições laborais, permite a (re)construção de identidades baseadas na praticidade científica, na evolução dos saberes, integrada nos projetos profissionais, na partilha de conhecimentos e experiências entre pares e interprofissionais e no estabelecimento de referências para o desenvolvimento e aperfeiçoamento dos cuidados de enfermagem.

Mediante análise de 18 colunas dos ombudsman Carlos Eduardo Lins da Silva (Folha de S. Paulo) e Rita Célia Faheina (O Povo), investigamos como o gênero ombudsman se constitui em meio à mobilização de diferentes vozes. Nosso suporte teórico é a Análise Crítica do Discurso e, mais especificamente, o modelo de análise de Fairclough (1989). Esse autor sugere que os dados sejam investigados por meio de três dimensões: como texto, como prática discursiva e como prática social. Para contemplar essas dimensões do enunciado, analisamos: a) na dimensão do texto, os participantes dos processos verbais expressos por verbos dicendi; b) na dimensão da prática discursiva, as estratégias de construção simbólica mobilizadas no texto; c) na dimensão da prática social, as relações sociais estabelecidas entre o ombudsman e seu público, a identidade social que o ombudsman constrói para si e os modos de operação da ideologia para manutenção da hegemonia do jornal. Os resultam sugerem que o gênero ombudsman pode compreender formas bastante diversas de interação. Silva cria a identidade de um ombudsman que trata de questões mais gerais do jornalismo, servindo como “consciência” do jornal. Já Faheina constitui-se como representante do leitor. Esses dois modos de operação do gênero podem estar relacionados ao leitor visado de cada jornal. Lins parece supor um leitor mais intelectualizado, enquanto Faheina parece prever leitores mais preocupados com questões cotidianas. As colunas têm em comum o fato de constituírem espaços para leitores exporem suas críticas, criando a impressão de que o monologismo e autoritarismo, inerentes ao jornalismo, estão relativizados. No entanto, a crítica possível não atinge o cerne do fazer jornalístico. Assim, pode ser largamente ilusória a pluralidade de vozes no espaço discursivo gerado pela coluna.

Os quistos ósseos aneurismáticos são lesões expansivas osteolíticas benignas de etiologia controversa, ocorrendo preferencialmente nas metáfises dos ossos longos e no ráquis. Classificam-se como lesões primárias ou secundárias dependendo da presença ou ausência de patologia óssea precursora. As lesões fibro-ósseas benignas constituem um dos sub-tipos lesionais que podem ocorrer em associação com os quistos ósseos aneurismáticos. Contudo, na região craniofacial, a ocorrência simultânea desta patologia dupla é rara. O autores apresentam dois casos incomuns comprovados histologicamente de sobreposição de quistos ósseos aneurismáticos em sub-tipos diferentes de lesões fibro-ósseas benignas (displasia fibrosa e fibroma ossificante juvenil psamomatóide) em topografia craniofacial, colocando especial ênfase nas características imagiológicas destas entidades.

O objetivo deste artigo é apresentar parte de uma pesquisa em que analisamos a contribuição da teoria de gêneros do discurso de Bakhtin (2003) para o desenvolvimento de competências em leitura e escrita. Para tanto, elaboramos uma abordagem terapêutica e a aplicamos em uma situação de terapia em grupo. Neste trabalho apresentamos parte da interlocução com um dos sujeitos do grupo, em processo de escrita em um dos gêneros selecionados para o processo terapêutico: o gênero peça de teatro.

Neurofibromatosis type 1 (NF1) is one of the most common neurocutaneous disorders. It is an autosomal dominant hereditary condition, although an half of all cases are related with spontaneous mutations. Mutations within NF1 gene (c17q11.2) result in loss of function of the protein neurofibromin leading to increase cell proliferation and tumorigenesis. NF1 is a variable condition concerning its clinical manifestations. It may also present different complications through life--a capital issue to pediatric management.Descriptive, retrospective, study based on clinical notes of patients with NF1 referred to Unidade de Neuropediatria e Desenvolvimento--Hospital Garcia de Orta, between 1992 and June of 2005. Diagnostic criteria were those of National Institute of Health Consensus Development Conference.Thirty-five patients were included (20 male,15 female). Age distribution: 6-year-old--28. NF1 diagnosis was proposed at the mean age of 4,7 year-old. Patients were referred for assessment mainly for "café-aulait" spots. Other motives included: first-degree relative with NF1, cutaneous neurofibroma, plexiform neurofibroma, tibia's pseudarthrosis, headaches, seizures, failure to thrive and learning disabilities. Diagnostic criteria included: café-au-lait spots (35/35), first degree relative with NF1 (22/35), axillary or inguinal freckling (9/35), neurofibromas (5/35), iris Lisch nodules (4/35), optic glioma (3/35), dysplastic bony lesions (3/35), plexiform neurofibroma (2/35). Three patients presented short stature and 11/35 macrocephaly. MR imaging revealed unidentified bright signals (UBO's) in 12 cases. Cognitive and psychological evaluation was performed in 12 cases. Mean IQ was 87. Attention-deficit-hyperactivity disorder was present in 40% (14/35) of all cases. Learning disabilities were identified in 48% of cases however only nine children had specifically educational programming. Visuospatial deficits were present in 5/35 children, reading deficits in 4/35, graphomotor deficits in 4/35, language deficits in 3/12 and dyscalculia in 3/12 cases. Three children presented emotional disturbance and other three children social skills deficits.Management of children with NF1 should focus on complications related with its multiple clinical manifestations, some of them age-dependent. It should also involve careful neuropsychological evaluation and observe the development of social skills. A high suspicion and an early intervention are essential to prevent a poor social functioning and outcome.

Person‐centred planning includes the active social participation of individuals with intellectual and developmental disabilities (IDD) and is the fairest path towards assuring human rights and citizenship among people with IDD. Semi‐structured interviews were undertaken with four technicians from centres of activities in Portugal, four family members, and four adults with IDD to observe the best practices that facilitate/hinder the implementation of person‐centred interventions. Several discrepancies were identified regarding inclusive practices in centres of activities and capacity building, associated with the sense of mission, vision and perspective of technical structures, the bureaucratic weight that conditions the transition between intervention models, the participation and positioning of families regarding their representation of the centres, as well as the investment these centres make concerning effective and fair inclusion in surrounding communities. Still far from successful implementation, a person‐centred approach must be considered and include all participants’ perspectives to build robust and integral life projects. [ABSTRACT FROM AUTHOR]