Current trends in health care delivery and management such as predictive and personalized health care incorporating information and communication technologies, home-based care, health prevention and promotion through patients’ empowerment, care coordination, community health networks and governance represent exciting possibilities to dramatically improve health care. However, as a whole, current health care trends involve a fragmented and scattered array of practices and uncoordinated pilot projects. The present paper describes an innovative and integrated model incorporating and “assembling” best practices and projects of new innovations into an overarching health care system that can effectively address the multidimensional health care challenges related to aging patient especially with chronic health issues. The main goal of the proposed model is to address the emerging health care challenges of an aging population and stimulate improved cost-efficiency, effectiveness, and patients’ well-being. The proposed home-based and community-centered Integrated Healthcare Management System may facilitate reaching the persons in their natural context, improving early detection, and preventing illnesses. The system allows simplifying the health care institutional structures through interorganizational coordination, increasing inclusiveness and extensiveness of health care delivery. As a consequence of such coordination and integration, future merging efforts of current health care approaches may provide feasible solutions that result in improved cost-efficiency of health care services and simultaneously increase the quality of life, in particular, by switching the center of gravity of health delivery to a close relationship of individuals in their communities, making best use of their personal and social resources, especially effective in health delivery for aging persons with complex chronic illnesses.

ObjectiveThis study analyzed variability in cerebral blood flow velocity (CBFV) and its association with emotional, clinical and functional variables and medication use in fibromyalgia syndrome (FMS).MethodsUsing transcranial Doppler sonography, CBFV were bilaterally recorded in the anterior (ACA) and middle (MCA) cerebral arteries of 44 FMS patients and 31 healthy individuals during a 5-min resting period. Participants also completed questionnaires assessing pain, fatigue, insomnia, anxiety, depression and health-related quality of life (HRQoL).ResultsFast Fourier transformation revealed a spectral profile with four components: (1) a first very low frequency (VLF) component with the highest amplitude at 0.0024 Hz; (2) a second VLF component around 0.01-to-0.025 Hz; (3) a low frequency (LF) component from 0.075-to-0.11 Hz; and (4) a high frequency (HF) component with the lowest amplitude from 0.25-to-0.35 Hz. Compared to controls, FMS patients exhibited lower LF and HF CBFV variability in the MCAs (p < .005) and right ACA (p = .03), but higher variability at the first right MCA (p = .04) and left ACA (p = .005) VLF components. Emotional, clinical and functional variables were inversely related to LF and HF CBFV variability (r≥-.24, p≤.05). However, associations for the first VLF component were positive (r≥.28, p≤.05). While patients´ medication use was associated with lower CBFV variability, comorbid depression and anxiety disorders were unrelated to variability.ConclusionsLower CBFV variability in the LF and HF ranges were observed in FMS, suggesting impaired coordination of cerebral regulatory systems. CBFV variability was differentially associated with clinical variables as a function of time-scale, with short-term variability being related to better clinical outcomes. CBFV variability analysis may be a promising tool to characterize FMS pathology and it impact on facets of HRQoL.

ResumoA hipertensão arterial tem sido estudada sob vários enfoques. As pesquisas demonstram a conexão entre os determinantes sociais e as manifestações da doença. Este estudo trata dos estressores sociais de hipertensão na Vila Nossa Senhora de Fátima, Porto Alegre, Brasil. Relata e discute os resultados do trabalho realizado junto a esta população, no qual se examinam variáveis constitucionais, sociais e fisiológicas. O exame da literatura sobre o tema e a comparação com um grupo controle, advindo de estudo semelhante com população de outro contexto social, mostrou a influência dos estressores sociais no processo de desenvolvimento da hipertensão. As conclusões alcançadas permitem algumas recomendações de ação no sentido da construção da cidadania como instrumento de participação e promoção de saúde. Palavras-chave: Hipertensão; estressores sociais; classe social; qualidade de vida. Social Stressors of High Blood Pressure in Deprived Communities AbstractThe origins of systemic high blood pressure has been studied from a wide array of different approaches. Researches suggests a very close connection between social environment stressors and all the manifestations of the disease itself. The present study deals with relevant social stressors that might be related to the high rates of high blood pressure found among the inhabitants of Vila Nossa Senhora de Fátima, a poor neighborhood in Porto Alegre, Brasil. Results, when compared to those comming from samples from different contexts of the same city, suggest an important relationship between certain social circunstances and the evolution of the hypertension desease. The discussion points to the importance of building up ciitzenship as a tool for health participation and promotion.

PurposeThis work critiques the situation of the ecological and cultural heritage in many coastal territories and analyses how current land planning methodologies are responding to it. The study builds a new integrated approach founded on ecocultural values and local knowledge as resources for an effective territorial planning and sustainable development.Design/methodology/approachThe proposed framework was developed through: (1) analysing coastal planning needs and problems in European coastal areas; (2) identifying ecocultural values, including local knowledge, in such areas; (3) selecting best approaches and tools in spatial planning; (4) applying the selected planning approaches to use ecocultural values as resources for spatial planning and sustainable development; and (5) validating the final methodology.FindingsA dynamic approach for maritime-land planning was developed projecting coastal waters and river basins as strategic drivers for sustainable development, based on the natural capacity of water to shape and integrate the ecological and cultural territory. A participatory governance planning methodology supports the new articulations of space based on ecocultural value chains and networks as synergistic vectors, focusing on local knowledge as psychosocial capital for a collective mapping of cultural, historical, social, economic and ecological values into ecocultural littoral plans.Originality/valueThe results show the potentials of combining new approaches applying cultural and ecological heritage into an effective strategy of integration between society and territory as a powerful driver for effective sustainable planning and development.

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Esta investigación tiene como objetivo identificar los tipos de usuarios habituales de los entornos virtuales, de acuerdo a las dimensiones motivacionales, características conductuales y sus consecuencias. Para tal fin se administró un cuestionario a 332 usuarios de plataformas virtuales. Los datos se procesaron con técnicas de análisis factorial, ANOVAs, conglomerados y regresiones múltiples, donde se identificaron cinco tipos de motivaciones del uso de las plataformas virtuales: la estimulación intelectual, el poder, instrumental, el anonimato/libertad, el afecto, y la evasión. Atendiendo a estos factores surgen cinco tipos de usuarios: el lógico, el anónimo, el honesto, el interesado, el evasivo, y el poderoso. Todo ello sugiere la posibilidad de distinguir dos dimensiones principales que explican el comportamiento virtual: la más relevante caracterizada por la búsqueda positiva de estimulación intelectual, creatividad y conocimiento, y una segunda de carácter afectivo-emocional, más relacionada con factores de vulnerabilidad y riesgo.

This study analyzed the individual differences in hemodynamic time patterns and reactivity to cognitive and emotional tasks, and explored the diversity of psycho-physiological profiles that could be used for the personalized prediction of different diseases. An analysis of heart rate (HR)—blood pressure (BP) relationship patterns across time using cross-correlations (CCs) during a logical-mathematical task and a task recalling negative emotions (rumination) was carried out in a laboratory setting on 45 participants. The results showed maximum HR–BP CCs during the mathematical task significantly more positive than the maximum HR–BP CCs during the rumination task. Furthermore, our results showed a large variety of hemodynamic reactivity profiles across the participants, even when carrying out the same tasks. The most frequent type showed positive HR–BP CCs under cognitive activity, and several positive–negative HR–BP CCs cycles under negative emotional activity. In general terms, our results supported the main hypothesis. We observed some distinct time-based “coordination strategies” in the reactivity of the autonomic nervous system under emotional vs. cognitive loading. Overall, large individual, as well as situational, specificities in hemodynamic reactivity time patterns were seen. The possible relationships between this variety of profiles and different psychosocial characteristics, and the potential for integrative predictive health within the provision of highly personalized medicine, are discussed.

El presente estudiodescribe una metodología innovadora de planificación y desarrollo territorial ante los desafíos ecológicos, culturales y económicos derivados de la presión urbana, industrial y turística en las franjas costeras.El objetivo principal subraya el potencial de integración dinámica que poseen los territorios costeros, cuencas fluviales y espacios litorales para el logro de estrategias efectivas de desarrollo sostenible. El diseño de investigación y desarrollo metodológico estábasado en estudios participativospara el desarrollo territorialdesde enfoques psicosociales,y en el análisis de expertos en6 países, con el principal caso de estudio en el litoral de Cantabria (España). La metodología propuesta se centra en los valores ecoculturales y los conocimientos locales como vectores sinérgicos de desarrollo cultural y social, proyectándose como corredores estratégicos debido a su diversidad y capacidad natural para modelar paisaje y territorio. Se propone una ordenación territorial basadaen unagobernanza participativa donde el conocimiento local es transformado en un mapeo participativo y colectivo de los valores culturales, históricos, sociales, económicos y ecológicos de la población y sus instituciones. El resultado finales la implementación de una cartografía ecocultural que incorpora cadenas de valor territoriales y redes de integración socio-ecológica. El carácter dinámico de esta metodología permite su aplicación como base principal de un proceso de ordenación territorial o, de forma complementaria, para enriquecer los métodos clásicos de planificación y ordenación territorial