Herlyn-Werner-Wunderlinch: An unusual presentation in a patient with Prader-Willi syndrome.

Herlyn-Werner-Wunderlich syndrome is an uncommon urogenital anomaly defined by uterus didelphys, obstructed hemi-vagina and unilateral renal anomalies. The most common clinical presentation is dysmenorrhoea following menarche, but it can also present as pain and an abdominal mass. Prader-Willi syndrome is a rare neuroendocrine genetic syndrome. Hypothalamic dysfunction is common and pituitary hormone deficiencies including hypogonadism are prevalent. We report the case of a 33-year-old female with Prader-Willi syndrome who was referred to the Gynaecology clinic due to vaginal bleeding and abdominal pain. Abdominal ultrasound revealed a haematometra and haematocolpos and computed tomography showed a uterus malformation and a right uterine cavity occupation (hematometra) as well as right kidney agenesis. Vaginoscopy and hysteroscopy were performed under general anaesthesia, finding a right bulging vaginal septum and a normal left cervix and hemiuterus. Septotomy was performed with complete haematometrocolpos drainage. The association of the two syndromes remains unclear.

Anxiolytic effect of alamandine in male transgenic rats with low brain angiotensinogen is dependent on activation of MrgD receptors.

Alamandine is a peptide hormone belonging to the renin-angiotensin system (RAS). It acts through the Mas-related G-protein coupled receptor type D, MrgD, which is expressed in different tissues, including the brain. In the present study, we hypothesize that a lack of alamandine, through MrgD, could cause the anxiety-like behavior in transgenic rats with low brain angiotensinogen [TGR(ASrAOGEN)680]. Adult male transgenic rats exhibited a significant increase in the latency to feeding time in the novelty suppressed feeding test and a decrease in the percentage of time and entries in the open arms in the elevated plus maze. These effects were reversed by intracerebroventricular infusion of alamandine. Pretreatment with D-Pro7-Ang-(1-7), a Mas and MrgD receptor antagonist, prevented the anxiolytic effects induced by this peptide. However, its effects were not altered by the selective Mas receptor antagonist, A779. In conclusion, our data indicates that alamandine, through MrgD, attenuates anxiety-like behavior in male TGR(ASrAOGEN)680, which reinforces the importance of the counter-regulatory RAS axis as promising target for the treatment of neuropsychiatric disorders.

Hours of sleep and associated factors in college students during the COVID-19 pandemic.

BACKGROUND: Sleep alterations are common in college students, particularly during the COVID-19 pandemic. Sociodemographic factors may predict these alterations in this population. OBJECTIVE: To identify the sociodemographic factors and health characteristics associated with the number of hours of sleep of college students during the COVID-19 pandemic. METHODS: This was a cross-sectional study carried out with 244 university students from a multicampi public university in the State of Bahia, Northeast Brazil. Data collection was performed online and participants answered a specific questionnaire to assess sleep hours, sociodemographic and health variables. RESULTS: Significant associations were observed between hours of sleep and older students (odds ratio adjusted -ORaj: 3.75; 95% Confidence Interval -CI: 1.81-7.75; p <  0.01), attending the final semesters (ORaj: 1.85; 95% CI: 1.05-3.25; p <  0.03), and who reported having some disease (ORaj: 2.18; 95% CI: 1.05-4.50; p <  0.03) with greater chances of getting less sleep. However, those who used tobacco (ORaj: 0.08; 95% CI: 0.01-0.45; p <  0.001) were likely to have more hours of sleep per night. CONCLUSION: Sleep restriction was common among participating college students, which has likely intensified due to the COVID-19 pandemic and its restrictions. This encourages specific public health actions, contemplating the health and hours of sleep of this population.

Critically ill patients with high predicted mortality: Incidence and outcome.

OBJECTIVE: As calculated by the severity scores, an unknown number of patients are admitted to the Intensive Care Unit (ICU) with a very high risk of death. Clinical studies have poorly addressed this population, and their prognosis is largely unknown. DESIGN: Post hoc analysis of a multicenter, cohort, longitudinal, observational, retrospective study (CIMbA). SETTING: Sixteen Portuguese multipurpose ICUs. PATIENTS: Patients with a Simplified Acute Physiology Score II (SAPS II) predicted hospital mortality above 80% on admission to the ICU (high-risk group); A comparison with the remaining patients was obtained. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Hospital, 30 days, 1 year mortality. RESULTS: We identified 4546 patients (59.9% male), 12.2% of the whole population. Their SAPS II predicted hospital mortality was 89.0±5.8%, whilst the observed mortality was lower, 61.0%. This group had higher mortality, both during the first 30 days (aHR 3.52 [95% CI 3.34-3.71]) and from day 31 to day 365 after ICU admission (aHR 1.14 [95%CI 1.04-1.26]), respectively. However, their hospital standardized mortality ratio was similar to the other patients (0.69 vs. 0.69, P=.92). At one year of follow-up, 30% of patients in the high-risk group were alive. CONCLUSIONS: Roughly 12% of patients admitted to the ICU for more than 24h had a SAPS II score predicted mortality above 80%. Their hospital standardized mortality was similar to the less severe population and 30% were alive after one year of follow-up.

Chemical conjugation of aptamer-sphingomyelin nanosystems and their potential as inhibitors of tumour cell proliferation in breast cancer cells.

Breast cancer is a complex and heterogeneous disease with a high mortality rate due to non-specific cytotoxicity, low intratumoral accumulation and drug resistance associated with the ineffectiveness of chemotherapy. In recent years, all efforts have been focused on finding new markers and therapeutic targets, protein kinase MNK1b being a promising candidate. Recently, an aptamer known as apMNK2F showed a highly specific interaction with this protein kinase, leading to a significant reduction in tumour cell proliferation, migration and colony formation. However, as aptamers are unable to penetrate the cell membrane and reach the target, these small biomolecules need to be conjugated to suitable vectors that can transport and protect them inside the cells. In this work, covalent conjugation between biocompatible and non-harmful nanoemulsions of vitamin E and sphingomyelin and the aptamer was performed to facilitate intracellular delivery of the therapeutic aptamer apMNK2F. All strategies employed were based on 2-step bioconjugation and optimized to get the simplest and most reproducible vehicle with the highest association efficiency (about 70% in all cases). The ability of the nanosystems to successfully deliver the conjugated therapeutic aptamer was demonstrated and compared to other commercial transfection agents such as Lipofectamine 2000, leading to an effective decrease of breast cancer cell proliferation in the MDA-MB-231 cell line. The proliferation inhibition of the aptamer nanoconjugates compared to the non-conjugated aptamer provides evidence that the antitumoral capacity derived from kinase interaction is improved in a dose-dependent manner. Furthermore, various experiments including cell migration and colony formation assays, along with apoptosis induction experiments, emphasize the significant antitumoral potential. Overall, the obtained results indicate that the developed formulation could be a promising therapy for the treatment of breast cancer.

Polymyoclonus, ventricular fibrillation and Takotsubo after accidental spinal injection of tranexamic acid.

Several factors have been identified as contributing to medication administration errors, including look-alike, sound-alike (LASA) errors. LASA errors are important causes of serious adverse events arising from spinal injection of tranexamic acid, which can be confused with ampoules of local anaesthesia.We present a case of accidental injection of 250 mg of tranexamic acid rather than prilocaine during spinal anaesthesia. The patient developed lower extremities myoclonus, followed by generalised convulsions and ventricular fibrillation, that was reverted within 6 min. Severe cardiogenic shock requiring both inotropic and vasopressor therapy followed, along with a classic apical ballooning pattern on echocardiography and elevated myocardial injury markers, indicating Takotsubo cardiomyopathy. The patient's condition progressively improved to full recovery, and she was discharged from hospital after 1 month with no neurological deficit or cardiac dysfunction.To our knowledge, this is the 28th reported case of accidental spinal injection of tranexamic acid. We present a brief review of previously published cases.

An Algorithm to Predict the Lack of Pregnancy after Intrauterine Insemination in Infertile Patients.

Increasing intrauterine insemination (IUI) success rates is essential to improve the quality of care for infertile couples. Additionally, straight referral of couples with less probability of achieving a pregnancy through IUI to more complex methods such as in vitro fertilization is important to reduce costs and the time to pregnancy. The aim of the present study is to prospectively evaluate the threshold values for different parameters related to success in intrauterine insemination in order to provide better reproductive counseling to infertile couples, moreover, to generate an algorithm based on male and female parameters to predict whether the couple is suitable for achieving pregnancy using IUI. For that, one hundred ninety-seven infertile couples undergoing 409 consecutive cycles of intrauterine insemination during a two-year period were included. The first year served as a definition of the parameters and thresholds related to pregnancy achievement, while the second year was used to validate the consistency of these parameters. Subsequently, those parameters that remained consistent throughout two years were included in a generalized estimating equation model (GEE) to determine their significance in predicting pregnancy achievement. Parameters significantly associated with the lack of pregnancy through IUI and included in the GEE were (p < 0.05): (i) male age > 41 years; (ii) ejaculate sperm count < 51.79 x 106 sperm; (iii) swim-up alkaline Comet > 59%; (iv) female body mass index > 45 kg/m2; (v) duration of infertility (>84 months), and (vi) basal LH levels > 27.28 mUI/mL. The application of these limits could provide a pregnancy prognosis to couples before undergoing intrauterine insemination, therefore avoiding it in couples with low chances of success. The retrospective application of these parameters to the same cohort of patients would have increased the pregnancy rate by up to 30%.

Factors Associated with the Lifestyle of Pediatric Healthcare Professionals during the COVID-19 Pandemic.

The objective of this study was to analyze the association between sociodemographic and occupational variables with the lifestyle of health professionals in pediatric units during the COVID-19 pandemic. A cross-sectional study was conducted with 407 health professionals working in four pediatric health units in the State of Bahia, northeast Brazil. The Fantastic Lifestyle Questionnaire and a questionnaire with sociodemographic and employment variables self-applied via Google Forms were used. The final binary logistic regression models revealed significant associations between those who received 3 to 5 minimum wages, without a marital relationship and with more than one employment relationship. Data suggest that these sociodemographic and occupational profiles are more exposed to risky lifestyle behaviors. The findings of this study demonstrated the need for greater attention to the health of health professionals in the pediatric field, as well as the promotion of initiatives that seek to value the work of these professionals and reduce the damage caused to their lifestyle, especially in a pandemic scenario.

Conhecimento de estudantes do ensino médio sobre métodos contraceptivos: pesquisa-ação em escolas da rede privada / Knowledge of high school students about contraceptive methods: action research in private schools / Conocimientos de estudiantes de secundaria sobre métodos anticonceptivos: investigación-acción en escuelas privadas

OBJETIVO: Identificar o conhecimento de estudantes sobre os métodos contraceptivos, antes e após a realização de oficinas sobre a temática. MÉTODOS: Pesquisa-ação, realizada com 38 estudantes do ensino médio. Foram realizadas oficinas com discussão da temática (audiogravadas) e aplicação de pré e pós-teste em outubro de 2022. Utilizou-se a análise de conteúdo temática para as narrativas e cálculo da frequência relativa para as questões fechadas do questionário. RESULTADOS: As narrativas se diferenciam entre as escolas. Os estudantes acreditam que o dispositivo intrauterino é abortivo; conhecem pouco sobre dupla proteção; e associam a pílula anticoncepcional aos benefícios à estética. Após as oficinas houve ampliação dos acertos e incorporação de novos conhecimentos mensurados pelo pós-teste nas duas escolas. CONCLUSÃO: É importante realizar oficinas no ambiente escolar a fim de reduzir danos à saúde e o Programa Saúde na Escola pode ser um facilitador para o acesso às temáticas da sexualidade e saúde reprodutiva.

OBJECTIVE: To identify students' knowledge about contraceptive methods, before and after workshops on the topic. METHODS: Action research, carried out with 38 high school students. Workshops were held with discussion of the topic (audiorecorded) and application of pre- and post-tests in October 2022. Thematic content analysis was used for the narratives and calculation of the relative frequency for the closed questions of the questionnaire. RESULTS: The narratives differ between schools. Students believe that the intrauterine device is abortifacient; they know little about double protection; and they associate the contraceptive pill with aesthetic benefits. After the workshops, there was an increase in correct answers and the incorporation of new knowledge measured by the post-test in both schools. CONCLUSION: It is important to hold workshops in the school environment in order to reduce harm to health and the School Health Program can be a facilitator for access to sexuality and reproductive health topics.

OBJETIVO: Identificar los conocimientos de los estudiantes sobre métodos anticonceptivos, antes y después de los talleres sobre el tema. MÉTODOS: Investigación acción, realizada con 38 estudiantes de secundaria. Se realizaron talleres con discusión del tema (audiograbados) y aplicación de pre y post pruebas en octubre de 2022. Para las narrativas se utilizó análisis de contenido temático y cálculo de la frecuencia relativa para las preguntas cerradas del cuestionario. RESULTADOS: Las narrativas difieren entre escuelas. Los estudiantes creen que el dispositivo intrauterino es abortivo; saben poco sobre la doble protección; y asocian la píldora anticonceptiva con beneficios estéticos. Luego de los talleres, hubo un aumento en las respuestas correctas y la incorporación de nuevos conocimientos medidos por el post-test en ambas escuelas. CONCLUSIÓN: Es importante realizar talleres en el ámbito escolar para reducir los daños a la salud y el Programa de Salud Escolar puede ser un facilitador para el acceso a temas de sexualidad y salud reproductiva.

Locomotor adaptations in the Early Miocene species Diamantomys luederitzi (Rodentia, Mammalia) from Uganda (Napak).

The study of morphological adaptations to different ecological parameters among fossil vertebrates has been an important challenge in recent decades. In this paper, we focus on the link between morphological traits and locomotor behavior such as terrestriality, fossoriality and arboreality (including gliding). One of the most diverse groups in which various locomotor habits are represented is rodents, occupying a wide range of ecological niches. This work highlights morphological variations in skulls and humerus in extant rodents with varying locomotion, to predict this parameter in the extinct species Diamantomys luederitzi (Early Miocene, Napak, Uganda). Linear discriminant analysis and phylogenetic flexible discriminant analysis are used to analyze datasets obtained via traditional morphometry (measurements) and geometric morphometrics (landmarks). The results show good discrimination between locomotor groups for both structures in extant species: the skull has a wider and longer rostrum in terrestrial and fossorial taxa compared to arboreal rodents, is also higher and posteriorly wider in fossorial taxa; the distal humerus shows elongation of the trochlea and capitulum and a higher trochlea in fossorial and terrestrial species, allowing an increase of stability instead of mobility, which is more important in arboreal taxa for movement in trees. In D. luederitzi, all skull analyses except one predicted it as a terrestrial species, the other prediction as a glider was possibly linked to the diet. For the distal humerus, this species has been predicted as a terrestrial, fossorial and arboreal taxon in differing analyses, reflected by morphological traits represented in these different locomotor categories. These varying predictions could highlight the intraspecific variation in this fossil species as well as its locomotor repertoire, raising a discussion about the use of different methods in such analyses. In addition to these predictions, several issues are discussed, such as the presence of locomotor signal in the skull and its validity in locomotor studies, as well as the relevance of the use of fragmentary material in such analyses. The results obtained in this work highlight the importance of the locomotor signal in these structures, as well as the possibility of taking into account poorly preserved material, in particular the distal humerus.

Reproducibility and validity of the Toronto-modified Harvard food frequency questionnaire in a multi-ethnic sample of young adults.

BACKGROUND/OBJECTIVES: To assess the reproducibility and validity of a Toronto-modified Harvard food frequency questionnaire (FFQ) among a multi-ethnic sample of young adults. SUBJECTS/METHODS: A total of 150 participants recruited from the Toronto Nutrigenomics and Health Study cohort who had existing dietary intakes assessed by FFQ (FFQ1) and reassessment one year later (FFQ2). Of these, 100 participants also completed a three-day food record to evaluate the validity of the FFQ for 38 nutrients (energy, 14 macronutrients, 22 micronutrients, and 1 bioactive). Analyses were also stratified between the two major ethnic groups (Caucasian and East Asian). RESULTS: Among the full sample, mean intakes of most nutrients (27/38) did not differ significantly between estimates derived from FFQ2 compared to the three-day food record. Energy, sex, and ethnicity adjusted deattenuated Pearson correlation coefficients ranged from 0.20 to 0.92 (mean r = 0.52 ± 0.15), and 34/38 validity coefficients were r ≥ 0.32. Gross misclassification of intakes between FFQ2 and the three-day food record was low (<6%), but energy, polyunsaturated fatty acids (PUFA), and sodium were underestimated by FFQ2. Mean intakes between FFQ1 and FFQ2 did not differ significantly for any nutrient. Between the two major ethnic groups, mean validity coefficients were similar, but varied for individual nutrients with saturated fat, PUFA, and omega 3 being among the most discrepant. CONCLUSIONS: Compared to a three-day food record, the Toronto-modified Harvard FFQ is a reproducible and valid tool to estimate dietary intake among a multi-ethnic sample of young adults. However, incorporation of protocols to improve the assessment of culturally diverse diets should be considered.

Cuidar de pessoas em paliação: o olhar do familiar cuidador / Caring for people undergoing palliation: the look of the family caregiver / Cuidar a personas en paliación: la mirada del cuidador familiar

Objetivo: Compreender a visão do familiar ao assumir o papel de cuidador de um ente em paliação. Método: Estudo exploratório e descritivo de abordagem qualitativa, realizado com 27 familiares cuidadores de pacientes com diagnóstico oncológico acompanhados num ambulatório de uma cidade de grande porte no estado de Pernambuco. Os dados foram coletados usando a entrevista semiestruturada e organizados no Software IRaMuTeQ®, considerando a Técnica de Análise de Conteúdo de Bardin, possibilitando assim a sua análise e discussão à luz da Teoria de Enfermagem Humanística. Resultados: Foi possível inferir que os familiares têm conhecimento sobre o diagnóstico de câncer; conhecem os riscos da doença e tratamento e, demonstram resiliência e altruísmo ao prestar os cuidados com amor e afeto. Reconhecem que para uma boa adesão ao tratamento, paciente e família precisam se sentirem acolhidos por toda equipe, com ênfase na equipe de enfermagem. Considerações finais: Possibilita refletir sobre a importância do familiar no processo de tratamento, e aponta para a necessidade de que a equipe esclareça sobre as mudanças que este familiar enfrentará no processo de cuidar, assim como de que seja dada visibilidade ao que são os cuidados paliativos, de modo a proporcional alívio ao sofrimento do paciente e família.

Objective: To understand the view of the family member when assuming the role of caregiver of a person undergoing palliation. Method: Exploratory and descriptive study with a qualitative approach, carried out with 27 family caregivers of patients with an oncological diagnosis followed at an outpatient clinic in a large city in the state of Pernambuco. Data were collected using semistructured interviews and organized in the IRaMuTeQ® Software, considering Bardin's Content Analysis Technique, thus enabling its analysis and discussion in the light of the Humanistic Nursing Theory. Results: It was possible to infer that family members are aware of the cancer diagnosis; they know the risks of the disease and treatment and demonstrate resilience and altruism when providing care with love and affection. They recognize that for good adherence to treatment, the patient and family need to feel welcomed by the entire team, with an emphasis on the nursing team. Final considerations: It makes it possible to reflect on the importance of the family member in the treatment process, and points to the need for the team to clarify the changes that this family member will face in the care process, as well as to give visibility to what palliative care is, in order to provide relief in the suffering of the patient and family.

Objetivo Comprender la mirada del familiar al asumir el rol de cuidador de una persona en paliación. Método: Estudio exploratorio y descriptivo con enfoque cualitativo, realizado con 27 cuidadores familiares de pacientes con diagnóstico oncológico seguidos en un ambulatorio de una gran ciudad del estado de Pernambuco. Los datos fueron recolectados mediante entrevista semiestructurada y organizados en el Software IRaMuTeQ®, considerando la Técnica de Análisis de Contenido de Bardin, posibilitando así su análisis y discusión a la luz de la Teoría Humanística de Enfermería. Resultados: Se pudo inferir que los familiares conocen el diagnóstico de cáncer; conocen los riesgos de la enfermedad y el tratamiento y demuestran resiliencia y altruismo al brindar atención con amor y afecto. Reconocen que para una buena adherencia al tratamiento, el paciente y la familia necesitan sentirse acogidos por todo el equipo, con énfasis en el equipo de enfermería. Consideraciones finales: Permite reflexionar sobre la importancia del familiar en el proceso de tratamiento, y apunta la necesidad de que el equipo aclare los cambios que este familiar enfrentará en el proceso de cuidado, así como dar visibilidad a lo que son los cuidados paliativos, con el fin de brindar alivio en el sufrimiento del paciente y su familia.

Clinical Characteristics and Mortality-Associated Factors in COVID-19 Critical Patients in a Portuguese ICU.

INTRODUCTION: Severe COVID-19 is associated with serious complications and poor outcomes. Older age and underlying comorbidities are known risk factors for severe COVID-19, but a better understanding of baseline characteristics and outcomes of patients with severe COVID-19 is urgently needed. METHODS: This study was a retrospective case series of 227 consecutive patients with laboratory-confirmed COVID-19 admitted to the intensive care unit (ICU) at our institution between March 2020 and December 2021. Demographic and clinical data were collected. RESULTS: The median age of patients was 65 years, and 180 (79.3%) were male. Cardiovascular comorbidities were frequent and included hypertension (n=148; 65.2%), dyslipidemia (n=116; 51.1%), obesity (n=114; 50.2%), and diabetes mellitus (n=80; 35.2%). About 20% of the patients had the chronic respiratory disease, with sleep apnea being the most common. Immunosuppression was identified in 13% of the patients, with autoimmunity, post-transplantation, and neoplasms being the most represented causes. Most patients were admitted to the ICU at six to 15 days after symptom onset, corresponding to stages IIb (pulmonary involvement/hypoxia) and III (hyperinflammatory). All patients received systemic steroids, with an average treatment duration of 22 days. Several ventilatory support strategies were used; 80 patients were supported entirely noninvasively with high flow nasal oxygenation and noninvasive ventilation, while 164 patients were invasively ventilated. Most intubations (65%) occurred in the first 24 hours after admission, and the mean duration of mechanical ventilation was 14 days. The reintubation rate was 10%, occurring on average two to three days after planned extubation. Thirty-two tracheostomies were performed. Bacterial co-infection was treated in 75% of patients, and Aspergillus co-infection complicating COVID-19 pneumonia was diagnosed in eight patients. Median ICU and hospital stays were 15 and 25 days, respectively, and the 28-day mortality rate was 38%. Patients over 75 years experienced a higher mortality rate (56%). Increased age and multimorbidity, particularly comprising cardiovascular disease and associated risk factors, were significantly more common in patients who died within 28 days after ICU admission. CONCLUSIONS: A large proportion of critically ill COVID-19 patients required prolonged mechanical ventilation. ICU/hospital stay and mortality were particularly elevated in older patients and patients with cardiovascular risk factors. Considerable discrepancy existed between the proportion of patients with microbiological documentation of bacterial infections and those receiving antimicrobials. Improved methods for adequate microbiological diagnosis are needed and stewardship programs should be reinforced.

Differential Performance and Lung Deposition of Levofloxacin with Different Nebulisers Used in Cystic Fibrosis.

We compared the performance and levofloxacin (Quinsair) lung deposition of three nebulisers commonly used in CF (I-Neb Advance, eFlow rapid, and LC Plus) with the approved nebuliser Zirela. The delivered dose, delivery rate, and aerosol particle size distribution (APSD) for each device were determined using the methods described in the Pharmacopeia. High-resolution computed tomography scans obtained from seven adult patients with mild CF were used to generate computer-aided, three-dimensional models of their airway tree to assess lung deposition using functional respiratory imaging (FRI). The eFlow rapid and the LC Plus showed poor delivery efficiencies due to their high residual volumes. The I-Neb, which only delivers aerosols during the inspiratory phase, achieved the highest aerosol delivery efficiency. However, the I-Neb showed the largest particle size and lowest delivery rate (2.9 mg/min), which were respectively associated with a high extrathoracic deposition and extremely long nebulisation times (>20 min). Zirela showed the best performance considering delivery efficiency (159.6 mg out of a nominal dose of 240 mg), delivery rate (43.5 mg/min), and lung deposition (20% of the nominal dose), requiring less than 5 min to deliver a full dose of levofloxacin. The present study supports the use of drug-specific nebulisers and discourages the off-label use of general-purpose devices with the present levofloxacin formulation since subtherapeutic lung doses and long nebulisation times may compromise treatment efficacy and adherence.

Nursing interventions for people in palliative care, based on the Dignity Model.

BACKGROUND: The use of the standardised nursing language aims to accurately represent clinical practice, contributing to proper documentation and the creation of evidence-based practice. AIMS: To validate nursing interventions (NI) for patients in palliative care, structuring these using the Dignity-Conserving Care Model. METHODS: A methodological study was conducted, developed according to the recommendations of the International Council of Nurses (ICN) and anchored in the Dignity-Conserving Care Model. The NI were developed in four stages: 1) construction of NI, based in the International Standards Organisation's standard (18.104:2014); 2) content validation by 26 expert nurses; 3) cross-mapping with the NIs contained in the International Classification for Nursing Practice (ICNP®) catalogue, Palliative Care for Dignified Dying, to identify those already existing in the catalogue; and 4) structuring the NI based on the concepts of the Dignity-Conserving Care Model. FINDINGS: 209 NI were validated and grouped into categories, namely: illness-related concerns; dignity-conservation repertoire; social dignity inventory. Of these, 183 were new and 26 already existed in the ICNP® Catalogue. CONCLUSION: The study presents new insights into palliative care in Brazil and presents 183 new NI in addition to those already published by the ICN.

Development and validation of children's stories as a health education strategy in speech, language, and hearing sciences. / Elaboração e validação de histórias infantis como estratégia de educação em saúde na fonoaudiologia.

PURPOSE: Developing and validating children's stories focused on health education in Speech, Language, and Hearing Sciences. METHODS: Cross-sectional, descriptive, quali-quantitative two-step study. 1st) elaboration of 10 children's stories, guiding questions, explanatory notes, and illustrations. 2nd) validation by judges (speech therapists, educators, and familiar) in two phases. In the first, the sample consisted of 42 judges and in the second, 28. To access the materials and the validation questionnaire, a website was made available. The questionnaire investigated the judges' personal data and the judges' perceptions regarding the contents, vocabulary, illustrations, structure, and motivation of the materials. A five-point Likert scale of the agreement was used, with spaces for suggestions in each question. The quantitative analysis was done using the Content Validity Index and the Content Validity Coefficient. The qualitative analysis was based on the comments of the judges. The minimum rate of agreement among the judges on the decision to change or not change the materials was 80%. RESULTS: The first phase pointed out the need for modifications in three titles and two vocabularies (bullying and dyke), and the need for increasing to five years of age the minimum age for access to the materials. The second phase revealed good acceptability in all changes made. CONCLUSION: The materials developed were validated and can be used as health education tools by speech therapists and educators, as well as parents.

OBJETIVO: Desenvolver e validar histórias infantis voltadas para a educação em saúde na Fonoaudiologia. MÉTODO: Estudo transversal, descritivo, quali-quantitativo de duas etapas. 1ª) elaboração de 10 histórias infantis, questões norteadoras, notas explicativas e ilustrações. 2ª) validação por juízes (fonoaudiólogos, educadores e familiares) em duas fases. Na primeira, a amostra foi composta por 42 juízes e na segunda por 28. Para acessar os materiais e o questionário de validação, foi disponibilizado um website. O questionário investigava os dados pessoais dos juízes e a percepção dos juízes em relação ao conteúdo, ao vocabulário, às ilustrações, à estrutura e à motivação dos materiais. Utilizou-se escala Likert de concordância de cinco pontos, com espaços para sugestões em cada questão. A análise quantitativa ocorreu por meio do Índice de Validade do Conteúdo e do Coeficiente de Validade de Conteúdo. A análise qualitativa ocorreu a partir dos comentários feitos pelos juízes. O índice mínimo de concordância entre os juízes sobre a decisão de alterar ou não os materiais foi de 80%. RESULTADOS: A primeira fase apontou necessidade de modificar três títulos e dois vocabulários (bullying e dique), e de aumentar a idade mínima sugerida para acesso aos materiais para cinco anos de idade. A segunda fase revelou boa aceitabilidade em todas as mudanças realizadas. CONCLUSÃO: Os materiais elaborados foram validados e podem ser usados como ferramentas de educação em saúde por fonoaudiólogos e educadores, e também pelos familiares.

Fonoaudiologia na comunidade em período de pandemia: relato de experiências de estudantes de graduação / Speech Language Therapy in the community during pandemic: report of experiences of undergraduate students / Terapia del lenguaje en la comunidad en periodo de pandemia: informe de experiencias de estudiantes de pregrado

Introdução: A pandemia de Covid-19 tem exigido adaptações e planejamentos constantes das instituições de ensino para a manutenção das atividades acadêmicas. Houve a substituição das disciplinas presenciais por remotas, através das Tecnologias de Informação e Comunicação (TICs). Como as atividades de cunho prático (como estágios acadêmicos) são fundamentais para os estudantes da Saúde, elas também migraram para a forma remota. Diante disso, modelos assíncronos de fornecimento de serviço foram sugeridos e regulamentados nesse período pandêmico. Objetivo: Relatar a experiência de estagiários do curso de Fonoaudiologia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo na aplicação de atividades remotas direcionadas a escolares e idosos usuários de serviços de Atenção Primária à Saúde, durante a pandemia. Métodos: Trata-se de um estudo descritivo, do tipo relato de experiência. Resultados: Foram elaboradas ações passíveis de realização no ambiente domiciliar, segmentadas em atividades físicas, de linguagem e de memória, todas com abordagem lúdica, fornecendo oportunidades de interação e estimulação/aprimoramento dessas habilidades. Para os estudantes, as experiências foram fundamentais para o desenvolvimento dessa nova metodologia, estimulando sua criatividade. Conclusão:As atividades remotas dirigidas às crianças e idosos permitiram que essas populações fossem amparadas durante a restrição social. O estabelecimento de contato com o público-alvo e a possibilidade de interação com a comunidade foi muito importante para os estudantes. É possível a replicação das ações propostas a qualquer grupo, desde que sejam adequadas à faixa etária.

Introduction: Covid-19 pandemic has required constant adaptations and planning by educational institutions to preserve academic activities. In-person classes were replaced by remote courses through Information and Communication Technologies (ICTs). Since practical activities (such as academic internships) are essential for students in the Health Areas, they also migrated to remote classes. Thus, asynchronous models of service provision were suggested and regulated during this pandemic period. Objective: reporting the experience of interns at the Speech Language and Audiology Course at the Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo during the development of remote activities aimed at students and elderly users of Primary Health Care services during the pandemic. Methods: This is a descriptive study of the experience report type. Results: Actions that could be performed at home were created, divided into physical, speech and memory activities, all with a playful approach, providing opportunities for interaction and stimulation/improvement of the aforementioned skills. For these students, these experiences were fundamental to the development of this new methodology, stimulating their creativity. Conclusion: Remote activities aimed at children and elderly allowed these populations to be supported during social restriction. The opportunity to establish contact with the target audience and the possibility of keeping up interaction with the community was extremelly important for the students. There is a chance of spreading these actions to any group, if they are adapted according to the group age.

Introducción: La pandemia de Covid-19 ha requerido constantes adaptaciones y planificación de las instituciones educativas para mantener las actividades académicas. Se sustituyeron los cursos presenciales por los remotos, mediante las Tecnologías de la Información y las Comunicaciones (TIC). Como las actividades prácticas (como las prácticas académicas) son fundamentales para los estudiantes de Salud, también ellas han migrado a la forma remota. Por lo tanto, se sugirieron y reglamentaron modelos de prestación de servicios asincrónicos en este período pandémico. Objetivo: Informar la experiencia de los pasantes del Curso de Terapia del Lenguaje de la Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo en la aplicación de actividades a distancia dirigidas a estudiantes y usuarios ancianos de los servicios de Atención Primaria durante la pandemia. Métodos: este es un estudio descriptivo, del tipo relato de experiencia. Resultados: Se desarrollaron acciones que se pueden realizar en el ámbito del hogar, segmentadas en actividades físicas, de lenguaje y de memoria, todas con un enfoque lúdico, brindando oportunidades de interacción y estimulación/mejora de las habilidades mencionadas. Para los pasantes, las experiencias fueron fundamentales para el desarrollo de esta nueva metodología, estimulando su creatividad. Conclusión: Las actividades remotas dirigidas a niños y ancianos permitieron apoyar a estas poblaciones durante la restricción social. Establecer contacto con el público objetivo y la posibilidad de interacción con la comunidad fue muy importante para los estudiantes. Es posible replicar las acciones propuestas a cualquier grupo, siempre que sean adaptadas para el grupo de edad.