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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