Palliative care in the treatment of women with breast cancer: A scoping review.

OBJECTIVES: Recent studies on the quality of life in women with breast cancer show a high prevalence of signs and symptoms that should be the focus of palliative care (PC), leading us to question the current role they play in addressing breast cancer. Therefore, the objective of this review is to map the scope of available literature on the role of PC in the treatment of women with breast cancer. METHODS: This is a methodologically guided scoping review by the Joanna Briggs Institute and adapted to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist for report writing. Systematic searches were conducted in 8 databases, an electronic repository, and gray literature. The searches were conducted with the support of a librarian. The study selection was managed through the RAYYAN software in a blind and independent manner by 2 reviewers. The extracted data were analyzed using the qualitative thematic analysis technique and discussed through textual categories. RESULTS: A total of 9,812 studies were identified, of which only 136 articles and 3 sources of gray literature are included in this review. In terms of general characteristics, the majority were published in the USA (35.7%), had a cross-sectional design (44.8%), and were abstracts presented at scientific events (19.6%). The majority of interventions focused on palliative radiotherapy (13.6%). Thematic analysis identified 14 themes and 12 subthemes. SIGNIFICANCE OF RESULTS: Our findings offer a comprehensive view of the evidence on PC in the treatment of breast cancer. Although a methodological quality assessment was not conducted, these results could guide professionals interested in the topic to position themselves in the current context. Additionally, a quick synthesis of recommendations on different palliative therapies is provided, which should be critically observed. Finally, multiple knowledge gaps are highlighted, which could be used for the development of future studies in this field.

Long range gene flow beyond predictions from oceanographic transport in a tropical marine foundation species.

The transport of passively dispersed organisms across tropical margins remains poorly understood. Hypotheses of oceanographic transportation potential lack testing with large scale empirical data. To address this gap, we used the seagrass species, Halodule wrightii, which is unique in spanning the entire tropical Atlantic. We tested the hypothesis that genetic differentiation estimated across its large-scale biogeographic range can be predicted by simulated oceanographic transport. The alternative hypothesis posits that dispersal is independent of ocean currents, such as transport by grazers. We compared empirical genetic estimates and modelled predictions of dispersal along the distribution of H. wrightii. We genotyped eight microsatellite loci on 19 populations distributed across Atlantic Africa, Gulf of Mexico, Caribbean, Brazil and developed a biophysical model with high-resolution ocean currents. Genetic data revealed low gene flow and highest differentiation between (1) the Gulf of Mexico and two other regions: (2) Caribbean-Brazil and (3) Atlantic Africa. These two were more genetically similar despite separation by an ocean. The biophysical model indicated low or no probability of passive dispersal among populations and did not match the empirical genetic data. The results support the alternative hypothesis of a role for active dispersal vectors like grazers.

Palliative care in the treatment of women with breast cancer: a scoping review protocol.

INTRODUCTION: Currently, breast cancer ranks first among female malignancies; hence, there are strong recommendations for the early inclusion of these patients in palliative care. Palliative care aims to alleviate symptoms improving the quality of life of dying patients, an essential component of breast cancer care. This study aimed to map and synthesise the available evidence on palliative care for women with breast cancer and to discuss the review results with stakeholders. METHODS: A scoping review protocol is presented in this article, consisting of two phases. In the first phase, a scoping review study will be conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and guided by the Joanna Briggs Institute Manual for Evidence Synthesis. Nine databases, an electronic repository, a trial register website, grey literature and additional sources will be searched. A focus group discussion with six stakeholders will occur in the second phase. The analysis will be performed through inductive and manifest content analysis using the IRaMuTeQ V.0.7 alpha software. ETHICS AND DISSEMINATION: The scoping review protocol did not require ethical approval. However, the study's second phase has been approved by the institutional review board of Maternidade Escola Assis Chateaubriand/MEAC/UFC. The findings will be disseminated through professional networks, conference presentations and publications.

Palliative Care in Breast Cancer During the COVID-19 Pandemic: A Scoping Review.

BACKGROUND: The COVID-19 pandemic has harmed the provision of palliative care (PC) services for women with breast cancer due to all the restrictions that came along with the virus. OBJECTIVE: To map the available evidence on the situation of PC in breast cancer during the COVID-19 pandemic. METHODS: A scoping review was carried out based on the methodology proposed by the Joanna Briggs Institute. The search was conducted in nine databases, one electronic repository, and one library, using controlled vocabularies. RESULTS: Twenty-nine articles and seven documents were included. The majority (11.4% each) were published in the United Kingdom, Italy, and the United States, 38.9% addressed palliative radiotherapy (RT), and 47.2% consisted of recommendations. From the content analysis, five categories were obtained focused on the recommendations on changes in palliative treatment guidelines and the response of PC teams to the evolving crisis. CONCLUSIONS: The evidence pointed to the management of general PC, palliative RT, palliative chemotherapy, management of metastatic breast cancer, and use of technologies in palliative care. No recommendations were found to manage frequent symptoms in PC, indicating the need to develop primary studies that investigate these aspects in detail in this vulnerable group. IMPLICATIONS: The results contained in this document can provide professionals working in this field of care with a global view of how other teams have dealt with the pandemic, thereby identifying the best guidelines to apply in their reality, taking into account the clinical and social situation of each patient.

Telenursing in the sexual function of women with breast cancer: A study protocol.

INTRODUCTION: Most women with breast cancer have sexual function problems related to cancer diagnosis and treatment. These problems harm the quality of life and relationships. However, most patients do not receive care or guidance regarding sexuality from healthcare providers. This study aimed to test the effect of telenursing counseling on sexual functioning in women undergoing breast cancer treatment. METHODS: This randomized clinical trial was conducted at 2 reference hospitals for cancer treatment. One hundred eight women with stage I-IV breast cancer undergoing treatment (surgery, chemotherapy, radiotherapy or hormone therapy) with a partner will be included in this study. The study was authorized by the Ethics Committee of the Federal University of Ceará (Opinion number: 46,13,609) and the Maternity School Assis Chateaubriand (Opinion number: 47,42,687). Patients will be allocated to the following groups: the control group, which will not receive an active intervention, and the intervention group, which will receive 3 telenursing counseling sessions for 6 weeks. The levels of sexual function in these patients before the intervention, soon after the intervention and at 12 weeks were compared and analyzed. All data will be collected and analyzed by the JASP program. RESULTS: Differences in levels of sexual function among women allocated to the control and intervention groups in the analyzed periods. CONCLUSION: This evidence-based nursing care strategy can be used to improve the sexual function of breast cancer patients and consequently their quality of life and marital relationship.

Satellite tracking reveals sex-specific migration distance in green turtles (Chelonia mydas).

Satellite tracking is a key tool for studying sea turtles in the wild. Most tracking has been performed on adult females however, leaving knowledge gaps regarding other population segments, such as adult males. By satellite tracking 12 male green turtles (Chelonia mydas) at a breeding site in West Africa, we describe their movements from the breeding to the foraging grounds and compare migrations with those of 13 females tracked in the same season. During the mating period, some males remained near the focal nesting site, while others performed exploratory movements, apparently to visit other nearby rookeries. Males migrated on average shorter distances to foraging grounds (377 km, range 50-1081, n = 9) compared to females (1038 km, range 957-1850, n = 11]). Importantly, male foraging areas overlapped with previously described areas for females, suggesting sex-specific migration distances are not derived from differences in habitat selection. Strong support for differential migration by sex in sea turtles has hitherto been found in just one other species, but indications are that it may be a general feature in this group. These findings have important implications for our understanding of the interplay between reproductive roles and movement ecology of these emblematic animals.

Fibropapillomatosis and the Chelonid Alphaherpesvirus 5 in Green Turtles from West Africa.

Fibropapillomatosis (FP) is a tumorigenic panzootic disease of sea turtles, most common in green turtles (Chelonia mydas). FP is linked to the chelonid alphaherpesvirus 5 (ChAHV5) and to degraded habitats and, though benign, large tumours can hinder vital functions, causing death. We analyse 108 green turtles, captured in 2018 and 2019, at key foraging grounds in Guinea-Bissau and Mauritania, West Africa, for the presence of FP, and use real-time PCR to detect ChAHV5 DNA, in 76 individuals. The prevalence of FP was moderate; 33% in Guinea-Bissau (n = 36) and 28% in Mauritania (n = 72), and most turtles were mildly affected, possibly due to low human impact at study locations. Juveniles had higher FP prevalence (35%, n = 82) compared to subadults (5%, n = 21), probably because individuals acquire resistance over time. ChAHV5 DNA was detected in 83% (n = 24) of the tumour biopsies, consistent with its role as aetiological agent of FP and in 26% (n = 27) of the 'normal' skin (not showing lesions) from FP turtles. Notably, 45% of the asymptomatic turtles were positive for ChAHV5, supporting multifactorial disease expression. We report the first baselines of FP and ChAHV5 prevalence for West Africa green turtles, essential to assess evolution of disease and future impacts of anthropogenic activities.

Lower urinary tract symptoms in female prison inmates: prevalence and impact on quality of life.

INTRODUCTION AND HYPOTHESIS: The objective was to estimate the prevalence and assess the impact of lower urinary tract symptoms (LUTS) on the quality of life of incarcerated women. METHODS: Cross-sectional study conducted with 307 incarcerated women from the state of Ceará, Brazil, from June to September 2018. To identify the prevalence of symptoms, an instrument was developed according to the recommendations of the International Continence Society. To assess the frequency, intensity, and impact of the identified symptoms on quality of life, the International Consultation on Incontinence Questionnaire-Short Form and King's Health Questionnaire were applied. RESULTS: The profile of the inmates was mostly young women (mean = 32.9 ± 11.8 years), Black, who had been in prison for a mean of 17.3 ± 12.0 months. Approximately half (n = 152, 49.5%) presented with storage complaints, with emphasis on urinary incontinence (n = 61, 19.9%), nocturia (n = 55, 17.9%), and urinary urgency (n = 45, 14.7%). Among the voiding symptoms (n = 71, 23.1%), dysuria (n = 39, 12.7%), and recurrent UTI (n = 44, 14.3%) were the most frequent. The complaint of incomplete bladder emptying (19.5%) was mentioned by 60 of the inmates. Sociodemographic data and environmental conditions were mainly associated with storage symptoms (p = 0.019). Women from prisons 2 and 3 presented with a greater impact on the quality of life. CONCLUSIONS: The high prevalence of LUTS in female inmates, together with unhealthy toileting behaviors within the prison units, indicate that incarceration might play a role in the occurrence of these symptoms, while also affecting quality of life. The acknowledgement and investigation of these symptoms is important for improving health care in prisons.

Climate change resilience of a globally important sea turtle nesting population.

Few studies have looked into climate change resilience of populations of wild animals. We use a model higher vertebrate, the green sea turtle, as its life history is fundamentally affected by climatic conditions, including temperature-dependent sex determination and obligate use of beaches subject to sea level rise (SLR). We use empirical data from a globally important population in West Africa to assess resistance to climate change within a quantitative framework. We project 200 years of primary sex ratios (1900-2100) and create a digital elevation model of the nesting beach to estimate impacts of projected SLR. Primary sex ratio is currently almost balanced, with 52% of hatchlings produced being female. Under IPCC models, we predict: (a) an increase in the proportion of females by 2100 to 76%-93%, but cooler temperatures, both at the end of the nesting season and in shaded areas, will guarantee male hatchling production; (b) IPCC SLR scenarios will lead to 33.4%-43.0% loss of the current nesting area; (c) climate change will contribute to population growth through population feminization, with 32%-64% more nesting females expected by 2120; (d) as incubation temperatures approach lethal levels, however, the population will cease growing and start to decline. Taken together with other factors (degree of foraging plasticity, rookery size and trajectory, and prevailing threats), this nesting population should resist climate change until 2100, and the availability of spatial and temporal microrefugia indicates potential for resilience to predicted impacts, through the evolution of nest site selection or changes in nesting phenology. This represents the most comprehensive assessment to date of climate change resilience of a marine reptile using the most up-to-date IPCC models, appraising the impacts of temperature and SLR, integrated with additional ecological and demographic parameters. We suggest this as a framework for other populations, species and taxa.

Major, minor, trace and rare earth elements in sediments of the Bijagós archipelago, Guinea-Bissau.

Sixty sediment samples from four sites in the Bijagós archipelago were characterized for fine fraction, loss on ignition, major, minor and trace elemental composition (Al, Fe, Ca, Mg, Ti, P, Zr, Mn, Cr, Sr, Ba, B, V, Li, Zn, Ni, Pb, As, Co, U, Cu, Cs and Cd), and the elements of the La-Lu series. Element concentrations were largely explained by the Al content and the proportion of fine fraction content, with the exception of Ca and Sr. Sediments showed enhanced Ti, U, Cr, As and Cd concentrations with respect to estimated upper crust values, most likely mirroring a regional signature. Rare earth elements were in deficit relatively to the North American Shale Composite (NASC), mainly in coarser material. No pronounced Ce-anomaly was observed, while Eu-anomalies were positive in most analyzed sediments.