O Projeto CuiDando: a qualificação de um projeto de intervenção comunitária / The CuiDando Project: the qualification of a community intervention project

Reconhecida a sua importância no bem-estar e saúde global das pessoas, bem como o seu impacto transversal na sociedade, a evolução das respostas e serviços na área da saúde mental não tem acompanhado o progresso das políticas públicas neste âmbito, persistindo importantes barreiras ao acesso equitativo a respostas adequadas e de qualidade. Importa, assim, o desenvolvimento de projetos comunitários, voltados para as pessoas com doença mental e para as suas reais necessidades e das suas famílias e cuidadores, capazes de os reconhecer como os agentes principais da sua recuperação e integração social. Neste desígnio, assumiu-se como objetivo principal deste Trabalho de Projeto qualificar, numa lógica participada e colaborativa, uma resposta comunitária de intervenção em saúde mental existente no território de Barcelos o Projeto CuiDando. O Projeto CuiDando é um projeto de intervenção comunitária em saúde mental desenvolvido pela Casa de Saúde S. João de Deus em Barcelos que, com dez anos de trabalho desenvolvido com e para as pessoas com doença mental, e sólidos ganhos em saúde demonstrados ao longo do seu percurso, se apresenta hoje muito orientado para a sua operacionalização no imediato, urgindo criar uma visão estratégia que potencie a sua efetividade e impacto e coloque definitivamente os cidadãos no centro dos seus cuidados, potenciando o seu empowerment e recovery, na prossecução da sua verdadeira integração comunitária. Considerando o planeamento em saúde baseado em metodologias participativas estruturante do desenvolvimento de respostas mais integradas e efetivas em saúde pública, assumiu-se este como pressuposto central do projeto. Assim, centrada nas pessoas com doença mental, seus familiares e cuidadores, a qualificação do Projeto Cuidando pretende contribuir para a valorização da multiplicidade de perspetivas e para a participação ativa e efetiva de todos os envolvidos nos processos de diagnóstico, planeamento, ação e avaliação, rumo à real transformação social. Mais, assume-se neste trabalho o planeamento e pensamento estratégicos como base para uma ação estratégica, capaz de considerar a globalidade da cadeia de causas e consequências, ao longo do tempo, do problema social que o projeto CuiDando se propõe resolver, e por isso contribuir para um processo partilhado, dinâmico e interativo e para uma tomada de decisão verdadeiramente intencional, informada e plural. O presente Relatório, em que culmina o percurso desenvolvido para a obtenção do grau de Mestre e Especialista em Enfermagem Comunitária, espelha, assim, o resultado de um plano de ação e intervenção que seguiu os pressupostos da Metodologia do Planeamento em Saúde, com recurso à revisão bibliográfica, análise de orientações estratégicas e de políticas públicas e institucionais e à facilitação de sessões de trabalho com a equipa do projeto, os seus beneficiários e respetivos familiares e parceiros comunitários, na elaboração, participada e colaborativa, de um Documento de Consenso do Projeto CuiDando, consubstanciado pela co-construção do Plano Estratégico que o norteia. A partir da elaboração participada deste Plano, o CuiDando desenvolveu e concretizou de uma forma mais estruturada e precisa o seu modelo de criação de valor, objetivos, metodologias de atuação e resultados esperados, otimizando-os e reformulando-os, e definiu, assim, uma estratégia de consolidação e crescimento a longo prazo, de comunicação e avaliação de impacto, que permitirá potenciar a sua sustentabilidade e impacto social e económico. Paralelamente, crê-se que o desenvolvimento deste Trabalho contribuirá, também, para o reconhecimento e valorização do desenvolvimento profissional dos Enfermeiros, designadamente dos Enfermeiros habilitados com o Mestrado de Enfermagem Comunitária, no seio das organizações da sociedade civil e da economia social, como parte ativa na construção de soluções colaborativas e sustentadas para desafios sociais e globais na área da saúde.

Recognized its importance in the well-being and global health of population, as well as its transversal impact on society, the evolution of responses and services in the mental health field of intervention has not kept pace with the progress of public policies in this field, , there are still important barriers to access to an equitable response to adequate and quality responses. Therefor, it is important to develop community projects, aimed at people with mental disorders and their real needs and that of their families and caregivers, capable of recognizing them as the main agents of their recovery and social integration processes. In this context, the main objective of this Project was to qualify, in a participatory and collaborative logic, a community mental health service established in the territory of Barcelos - the CuiDando Project. Saúde S. João de Deus, in Barcelos, which, with ten years of intervention with and for people with mental illness, has shown solid health gains. However, its path, today, is too oriented towards its immediate operationalization, requiring the creation of a strategic vision that enhances its effectiveness and impact and definitively puts the citizen at the center of its intervention, enhancing their empowerment and recovery, in the pursuit of their real community integration. Considering that health planning based on participatory methodologies structures the development of more integrated and effective responses in public health, this was assumed as the central assumption of the project. Thus, centered on people with mental illness, their families and caregivers, the qualification of the Project "CuiDando" aims to contribute to the consideration of the multiplicity of perspectives and to the active and effective participation of all those involved in the processes of diagnosis, planning, action and evaluation, towards real social transformation. Furthermore, this Project assumes strategic planning and startegic thinking as the basis for strategic action, capable of considering the global chain of causes and consequences, over time, of the social problem that Project CuiDando aims to solve, contributing for a shared, dynamic and interactive process and for a intendend, informed and plural decision process. This Report, which represents the culmination of the path developed to obtain the degree of Master and Specialist in Community Nursing, concretizes the result of an action and intervention plan that obeyed the assumptions of the Health Planning Methodology, using bibliographic review, analysis of public guidelines, institutional policies and policies and facilitation of working sessions with the project team, its beneficiaries, their families -construction of the Strategic Plan that guides it.. Based on the participatory elaboration of this Plan, CuiDando developed and defined its model of value proposal, its objectives, operating methodologies and expected results in a more structured, concrete and precise way, optimizing and reformulating them, defining a long-term consolidation and growth strategy, a communication strategy and an impact assessment methodology, which will enhance its sustainability and social and economic impact. At the same time, it is believed that the development of this Project will also contribute to the recognition and appreciation of professional nursing development, namely of qualified nurses with a Master's Degree in Community Nursing, within the scope of civil society and social economy organisations, as an active part in the construction of collaborative and sustained solutions to social and global health challenges.

Risk Variants in Three Alzheimer's Disease Genes Show Association with EEG Endophenotypes.

BACKGROUND: Dementia due to Alzheimer's disease (AD) is a complex neurodegenerative disorder, which much of heritability remains unexplained. At the clinical level, one of the most common physiological alterations is the slowing of oscillatory brain activity, measurable by electroencephalography (EEG). Relative power (RP) at the conventional frequency bands (i.e., delta, theta, alpha, beta-1, and beta-2) can be considered as AD endophenotypes. OBJECTIVE: The aim of this work is to analyze the association between sixteen genes previously related with AD: APOE, PICALM, CLU, BCHE, CETP, CR1, SLC6A3, GRIN2 ß, SORL1, TOMM40, GSK3 ß, UNC5C, OPRD1, NAV2, HOMER2, and IL1RAP, and the slowing of the brain activity, assessed by means of RP at the aforementioned frequency bands. METHODS: An Iberian cohort of 45 elderly controls, 45 individuals with mild cognitive impairment, and 109 AD patients in the three stages of the disease was considered. Genomic information and brain activity of each subject were analyzed. RESULTS: The slowing of brain activity was observed in carriers of risk alleles in IL1RAP (rs10212109, rs9823517, rs4687150), UNC5C (rs17024131), and NAV2 (rs1425227, rs862785) genes, regardless of the disease status and situation towards the strongest risk factors: age, sex, and APOE ɛ4 presence. CONCLUSION: Endophenotypes reduce the complexity of the general phenotype and genetic variants with a major effect on those specific traits may be then identified. The found associations in this work are novel and may contribute to the comprehension of AD pathogenesis, each with a different biological role, and influencing multiple factors involved in brain physiology.

APOE Variants in an Iberian Alzheimer Cohort Detected through an Optimized Sanger Sequencing Protocol.

The primary genetic risk factor for late onset Alzheimer's disease (LOAD) is the APOE4 allele of Apolipoprotein E (APOE) gene. The three most common variants of APOE are determined by single nucleotide polymorphisms (SNPs) rs429358 and rs7412. Our aim was to estimate allele and genotype frequencies of APOE variants in an Iberian cohort, thus helping to understand differences in APOE-related LOAD risk observed across populations. We analyzed saliva or buccal swab samples from 229 LOAD patients and 89 healthy elderly controls (≥68 years old) from Northern Portugal and Castile and León region, Spain. The genotyping was performed by Sanger sequencing, optimized to overcome GC content drawbacks. Results obtained in our Iberian LOAD and control cohorts are in line with previous large meta-analyses on APOE frequencies in Caucasian populations; however, we found differences in allele frequencies between our Portuguese and Spanish subgroups of AD patients. Moreover, when comparing studies from Iberian and other Caucasian cohorts, differences in APOE2 and APOE4 frequencies and subsequent different APOE-related LOAD risks must be clarified. These results show the importance of studying genetic variation at the APOE gene in different populations (including analyses at a regional level) to increase our knowledge about its clinical significance.

Genome-Wide Scan for Five Brain Oscillatory Phenotypes Identifies a New QTL Associated with Theta EEG Band.

Brain waves, measured by electroencephalography (EEG), are a powerful tool in the investigation of neurophysiological traits and a noninvasive and cost-effective alternative in the diagnostic of some neurological diseases. In order to identify novel Quantitative Trait Loci (QTLs) for brain wave relative power (RP), we collected resting state EEG data in five frequency bands (δ, θ, α, ß1, and ß2) and genome-wide data in a cohort of 105 patients with late onset Alzheimer's disease (LOAD), 41 individuals with mild cognitive impairment and 45 controls from Iberia, correcting for disease status. One novel association was found with an interesting candidate for a role in brain wave biology, CLEC16A (C-type lectin domain family 16), with a variant at this locus passing the adjusted genome-wide significance threshold after Bonferroni correction. This finding reinforces the importance of immune regulation in brain function. Additionally, at a significance cutoff value of 5 × 10-6, 18 independent association signals were detected. These signals comprise brain expression Quantitative Loci (eQTLs) in caudate basal ganglia, spinal cord, anterior cingulate cortex and hypothalamus, as well as chromatin interactions in adult and fetal cortex, neural progenitor cells and hippocampus. Moreover, in the set of genes showing signals of association with brain wave RP in our dataset, there is an overrepresentation of loci previously associated with neurological traits and pathologies, evidencing the pleiotropy of the genetic variation modulating brain function.