Molecular evidence of sporadic Coxiella burnetii excretion in sheep milk, central Portugal.

Coxiella burnetii is the etiologic agent of Q fever, a worldwide zoonosis. Cattle, sheep and goats are considered the main reservoirs of the disease. Transmission to humans occurs mainly through the inhalation of infectious aerosols from milk, faeces, urine, and birth products from infected ruminants. In this study, a 2-year longitudinal approach was performed to ascertain the excretion of C. burnetii in bulk tank milk samples of sheep from a mountain plateau in central Portugal, with sampling conducted during the years 2015 and 2016. From a total of 156 bulk tank milk samples tested by qPCR, only one showed to be positive for C. burnetii (1.28% [95%CI: 0.03-6.94]), from 2015, the first year of collection. Bidirectional sequencing and phylogenetic analysis of IS1111 transposase partial region confirmed the presence of C. burnetii DNA. The presence of C. burnetii in raw milk samples highlights the necessity for additional research to determine if raw milk is a potential source for human infection. Animal health surveillance and prevention measures against this zoonotic disease should be considered.

Molecular detection of Enterocytozoon bieneusi in bats from Portugal.

Enterocytozoon bieneusi is a microsporidia commonly found in the gastrointestinal tract of humans and a wide range of other animals, constituting a major cause of microsporidiosis in humans. Although E. bieneusi has been detected in humans, domestic, and wild animals in Portugal, and its presence in bats has been linked to zoonotic characteristics, its occurrence in bats within the country has not been reported. In this study, we investigated the presence of E. bieneusi in 380 bat fecal samples collected in mainland Portugal through a nested PCR assay targeting the internal transcribed spacer region and the flanking small and large subunits of the ribosomal RNA. Enterocytozoon bieneusi was detected in one bat sample (i.e., 0.26%; Pipistrellus pipistrellus). Additionally, another sample tested positive for Enterocytozoon sp. Phylogenetic analysis of the obtained ITS sequence of E. bieneusi revealed clustering within the potentially zoonotic Group 1. This study represents the first report of E. bieneusi in a bat from Europe. Findings presented here contribute to an enhanced understanding of E. bieneusi epidemiology.

Enterocytozoon bieneusi is the most frequent cause of microsporidiosis in humans. In this study, E. bieneusi, belonging to a potentially zoonotic Group, was detected in 0.26% bat samples from Portugal, highlighting bats' potential role in transmitting this microsporidia to humans and other animals.

[Use of Gadolinium in Follow-Up MRI of Multiple Sclerosis Patients: Current Recommendations]. / Utilização de Gadolínio nas Ressonâncias Magnéticas de Controlo em Doentes com Esclerose Múltipla: Recomendações Atuais.

Multiple sclerosis is the most frequent demyelinating disease of the central nervous system and is characterized by early onset and progressive disability. Magnetic resonance imaging, due to its high sensitivity and specificity in the detection of demyelinating lesions, is the most useful diagnostic test for this disease, with the administration of gadolinium-based contrast agents being an important contribution to imaging interpretation. Although contrast is essential for diagnostic purposes, its routine use in monitoring disease activity, response to treatment, and related complications is controversial. This article aims to collate current recommendations regarding the use of gadolinium in the imaging follow-up of multiple sclerosis and establish effective and safe guidelines for clinical practice. The literature review was conducted in PubMed, using the terms 'multiple sclerosis', 'magnetic resonance imaging' and 'gadolinium', or 'contrast media'. Articles published between January 2013 and January 2023 concerning the safety of gadolinium and the use of these contrast agents in follow-up scans of adult patients diagnosed with multiple sclerosis were selected. Although no biological or clinical consequences have been unequivocally attributed to the retention of gadolinium in the brain, which were mostly reported with linear agents, health authorities have been recommending the restriction of contrast to essential clinical circumstances. In multiple sclerosis, the detection of subclinical contrast-enhancing lesions with no corresponding new/ enlarging T2-WI lesions is rare and has a questionable impact on therapeutic decisions. On the other hand, gadolinium has a higher sensitivity in the differential diagnosis of relapses, in the detection of recent disease activity, before and after treatment initiation, and in patients with a large lesion burden or diffuse/confluent T2-WI lesions. Contrary to progressive multifocal leukoencephalopathy screening, monitoring of immune restitution inflammatory syndrome also benefits from the administration of gadolinium. It is feasible and safe to exclude gadolinium-based contrast agents from routine follow-up scans of multiple sclerosis, despite their additional contribution in specific clinical circumstances that should be acknowledged by the neurologist and neuroradiologist.

A esclerose múltipla é a doença desmielinizante do sistema nervoso central mais frequente, caracterizando-se pelo início precoce e incapacidade progressiva. A ressonância magnética, pela elevada sensibilidade e especificidade na deteção de lesões desmielinizantes, é o exame complementar mais útil nesta patologia, sendo a administração de meios de contraste com gadolínio um importante contributo na interpretação imagiológica. Embora o contraste seja imprescindível no âmbito do diagnóstico, a sua utilização por rotina na monitorização da atividade de doença, resposta ao tratamento e respetivas complicações é controversa. O objetivo deste artigo é reunir as recomendações atuais relativas à utilização do gadolínio no seguimento imagiológico da esclerose múltipla e definir um protocolo clínico efetivo e seguro. A revisão da literatura foi conduzida na PubMed, recorrendo aos termos 'esclerose múltipla', 'ressonância magnética' e 'gadolínio' ou 'meio de contraste'. Foram selecionados artigos publicados entre janeiro de 2013 e de 2023 relativos à segurança do gadolínio e à sua utilização na ressonância magnética de controlo dos doentes adultos com diagnóstico de esclerose múltipla. Apesar de nenhuma consequência biológica ou clínica ter sido inequivocamente atribuída à retenção cerebral do gadolínio, que foi reportada maioritariamente com agentes lineares, as autoridades de saúde têm vindo a recomendar a restrição do contraste a circunstâncias clínicas essenciais. Na esclerose múltipla, a deteção de lesões subclínicas com captação de gadolínio sem tradução em lesões novas/aumentadas nas sequências ponderadas em T2 ocorre raramente e com impacto na decisão terapêutica questionável. Por outro lado, o gadolínio assume uma sensibilidade superior no diagnóstico diferencial de surtos clínicos, na deteção de atividade inflamatória recente, antes e após o início de uma terapêutica e nos doentes com elevada carga lesional ou lesões difusas/confluentes nas sequências ponderadas em T2. Contrariamente ao rastreio da leucoencefalopatia multifocal progressiva, a monitorização da síndrome inflamatória de reconstituição imunológica beneficia também da inclusão do gadolínio. É exequível e segura a exclusão do gadolínio no seguimento imagiológico de rotina da esclerose múltipla, apesar do seu contributo adicional em circunstâncias clínicas específicas que devem ser do conhecimento articulado do neurologista e neurorradiologista.

A Thorny Tale of Parasites: Screening for Enteric Protozoan Parasites in Hedgehogs from Portugal.

Enteric protozoan parasites, such as Blastocystis sp., Balantioides coli, Cryptosporidium spp., and Giardia duodenalis, may have implications for both animal and human health.Transmitted through the fecal-oral route, these parasites cause symptoms such as diarrhea, abdominal pain, and weight loss. This study investigated the presence of these enteric protozoan parasites and genetically characterized them in hedgehogs from Portugal. A total of 110 hedgehog stool samples were collected. Molecular detection methods showed an overall occurrence of protozoa in 1.82% (2/110 95% CI: 0.22-6.41) of hedgehogs, with Blastocystis being found in one hedgehog and Cryptosporidium being found in another. No evidence for the presence of B. coli or G. duodenalis was found. This study suggests that there is a need to stay aware of hedgehogs as potential hosts of enteric protozoa. Ongoing research and surveillance efforts are recommended to explore practical prevention and control strategies. The results contribute to the limited knowledge of these parasites in Portuguese hedgehog populations and underscore their potential relevance to both veterinary and public health.

Avelumab as First-Line Maintenance Treatment in Locally Advanced or Metastatic Urothelial Carcinoma.

This work provides a summary of guideline recommendations and an expert position on the use of maintenance avelumab therapy based on a review of current international clinical practice guidelines for locally advanced or metastatic urothelial carcinoma (UC). A PubMed literature search was conducted in March 2022 (updated in July 2023) to identify guidelines for locally advanced or metastatic UC. An expert panel (four oncologists and one urologist) reviewed the guidelines and clinical evidence, and discussed practical questions regarding the use of avelumab maintenance therapy in this clinical setting. The National Comprehensive Cancer Network, European Association of Urology and European Society for Medical Oncology guidelines recommend first-line cisplatin-containing chemotherapy for cisplatin-eligible patients, carboplatin-gemcitabine for cisplatin-ineligible patients who are fit for carboplatin, or immunotherapy with programmed death ligand-1 (PD-L1) inhibitors (e.g. atezolizumab) in platinum-ineligible patients. Maintenance avelumab is recommended in patients with response/stable disease following chemotherapy (regardless of PD-L1 status). In patients who relapse after/during chemotherapy, options include immunotherapy, erdafitinib [in those with fibroblast growth factor receptor (FGFR) mutations], enfortumab vedotin or further chemotherapy. The expert panel provided the following practical guidance: (1) consider maintenance avelumab in all eligible patients; (2) continue avelumab until disease progression/unacceptable toxicity; (3) ideally, administer six cycles of platinum-based chemotherapy prior to maintenance avelumab; (4) perform radiological evaluation after four chemotherapy cycles and prior to maintenance avelumab; (5) carboplatin-gemcitabine followed by maintenance avelumab is preferred in cisplatin-ineligible patients (regardless of PD-L1 expression), but consider first-line immunotherapy in PD-L1-positive patients and platinum-ineligible patients (regardless of PD-L1 status); and (6) for patients who relapse on avelumab, second-line options include enfortumab vedotin, FGFR inhibitors (in those with FGFR mutations) or clinical trial inclusion. In conclusion, avelumab maintenance therapy is recommended following platinum-based chemotherapy in all eligible patients with locally advanced or metastatic UC, continued until disease progression or unacceptable toxicity.

Neoadjuvant Gastric Cancer Treatment and Associated Nutritional Critical Domains for the Optimization of Care Pathways: A Systematic Review.

(1) Background: Gastric cancer patients are known to be at a high risk of malnutrition, sarcopenia, and cachexia, and the latter impairs the patient's nutritional status during their clinical course and also treatment response. A clearer identification of nutrition-related critical points during neoadjuvant treatment for gastric cancer is relevant to managing patient care and predicting clinical outcomes. The aim of this systematic review was to identify and describe nutrition-related critical domains associated with clinical outcomes. (2) Methods: We performed a systematic review (PROSPERO ID:CRD42021266760); (3) Results: This review included 14 studies compiled into three critical domains: patient-related, clinical-related (disease and treatment), and healthcare-related. Body composition changes during neoadjuvant chemotherapy (NAC) accounted for the early termination of chemotherapy and reduced overall survival. Sarcopenia was confirmed to have an independent prognostic value. The role of nutritional interventions during NAC has not been fully explored. (4) Conclusions: Understanding critical domain exposures affecting nutritional status will enable better clinical approaches to optimize care plans. It may also provide an opportunity for the mitigation of poor nutritional status and sarcopenia and their deleterious clinical consequences.

Medication reconciliation in pediatrics: a validation of instruments to prevent medication errors.

OBJECTIVES: to develop and validate the content of two instruments for promoting medication reconciliation for the transition of care of hospitalized children. METHODS: methodological study, conducted in five stages: scope review for conceptual structure; elaboration of the initial version; content validation with five specialists using the Delphi technique; reassessment; and construction of the final version of the instruments. A content validity index of at least 0.80 was adopted. RESULTS: three rounds of evaluation were carried out to reach the validity index of the proposed contents, whereas a new analysis of 50% of the 20 items of the instrument aimed at families, and 28.5% of the 21 items aimed at professionals was necessary. The instrument aimed at families reached an index of 0.93, and the instrument for professionals, 0.90. CONCLUSIONS: the proposed instruments were validated. It is now possible to proceed with practical implementation studies to identify their influence on safety during medication reconciliation at transition of care.

Effect of the alveolate parasite Perkinsus olseni infection on sexual maturation and spawning efficiency of the clam Ruditapes decussatus.

The effect of Perkinsus olseni infection on the reproduction ability of clams has been underestimated so far. Although some studies found evidence of reduction of egg production and delay in gonad maturation after infection, the total effect of the infection is still unclear. In this study, Ruditapes decussatus clams from a naïve population were injected with two different doses of P. olseni parasites, a low dose leading to a light infection and a high dose leading to a heavy infection. Clams were maintained during 2 months for maturation, and at the end of the experiment, the spawning was induced, the number of larvae release and mortality were evaluated. During the maturation period, infection level, gonadal stage, condition index, gross biochemical composition and oxidative status of progenitors were evaluated at days 0, 30 and 60 post-injection. The effects of P. olseni infection on clams showed alterations on biochemical parameters, namely lipid peroxidation, a significant mortality and a delayed gonad maturation, with a greater effect in the highly infected individuals. The reproductive capacity of the clams was impaired in both infected groups showing a lower production and a higher mortality rate of larvae. Finally, this study indicates that the production of natural beds with a high prevalence of P. olseni could be compromised by a deregulation of the natural reproduction cycle and a decrease in larvae production by infected animals, probably due to a combination of lower egg production and lower lipid reserves in larvae from infected clams.

Search for new biomarkers of tolerance to Perkinsus olseni parasite infection in Ruditapes decussatus clams.

The grooved carpet shell (Ruditapes decussatus) is a clam species with high economic and social importance in several European and Mediterranean countries. Production of this species suffered a decline caused by biotic (parasite infection) and abiotic factors (environmental factors, stress, poor management methods and intensive culture of the introduced species Ruditapes philippinarum). The protozoan parasite Perkinsus olseni is also responsible for the decline of production, being nowadays one of the major issues for clam culture. Molecular biomarkers that might represent tolerance of R. decussatus to P. olseni have already been uncovered, shedding light in a possible production improvement by selecting those clams with a strongest immune response. In the present study, new tolerance biomarkers to P. olseni infection in R. decussatus were identified. The haemolymph proteomic profiles of naturally non/low-infected (tolerant) and highly-infected (susceptible) clams by the parasite across several heavy affected areas of Europe were characterized through a shotgun proteomics approach. Also, the mechanisms that might be involved in the responses against the disease in chronic infections were explored. Proteins related to energy restoration and balance, metabolic regulation, energy accumulation, ROS production, lysosomal activity, amino acid synthesis, proteolytic activity, iron regulation, iron withholding, and immune response modulation were significantly regulated in susceptible clams. In the tolerant group, proteins related to phagocytosis regulation, control of cell growth and proliferation, gonadal maturation, regulation of apoptosis, growth modulation, response to oxidative stress, iron regulation, shell development and metabolic regulation were significantly expressed. In summary, the protein expression profile of tolerant individuals suggests that an efficient pathogen elimination mechanism coupled to a better metabolic regulation leads to a tolerance to the parasite infection by limiting the spread through the tissues.

Medication reconciliation in pediatrics: a validation of instruments to prevent medication errors / Conciliación medicamentosa en pediatría: validación de instrumentos para la prevención de errores en la medicación / Reconciliação medicamentosa em pediatria: validação de instrumentos para a prevenção de erros na medicação

ABSTRACT Objectives: to develop and validate the content of two instruments for promoting medication reconciliation for the transition of care of hospitalized children. Methods: methodological study, conducted in five stages: scope review for conceptual structure; elaboration of the initial version; content validation with five specialists using the Delphi technique; reassessment; and construction of the final version of the instruments. A content validity index of at least 0.80 was adopted. Results: three rounds of evaluation were carried out to reach the validity index of the proposed contents, whereas a new analysis of 50% of the 20 items of the instrument aimed at families, and 28.5% of the 21 items aimed at professionals was necessary. The instrument aimed at families reached an index of 0.93, and the instrument for professionals, 0.90. Conclusions: the proposed instruments were validated. It is now possible to proceed with practical implementation studies to identify their influence on safety during medication reconciliation at transition of care.

RESUMEN Objetivos: elaborar y validar contenido de dos instrumentos para la promoción de conciliación medicamentosa en la transición de atención de niños hospitalizados. Métodos: estudio metodológico realizado en cinco etapas: revisión de ámbito para estructura conceptual; elaboración de versión inicial; validación del contenido con cinco especialistas utilizando la Técnica Delphi; re-evaluación; y construcción de versión final de los instrumentos. Adoptado índice de validez de contenido, como mínimo, 0.80. Resultados: fueron realizadas tres rondas de evaluación para alcance de índice de validez en los contenidos propuestos, siendo necesario nuevo análisis de 50% de los 20 ítems del instrumento destinado a familias, y 28,5% de los 21 ítems destinados a profesionales. Instrumento dirigido a familias alcanzó índice de 0,93; y el instrumento, a profesionales, 0,90. Conclusiones: instrumentos propuestos fueron validados, siendo posible proseguir con estudio de implementación práctica para identificar influencia en la seguridad durante la conciliación medicamentosa en la transición de atención.

RESUMO Objetivos: elaborar e validar o conteúdo de dois instrumentos para a promoção da reconciliação medicamentosa na transição dos cuidados de crianças hospitalizadas. Métodos: estudo metodológico realizado em cinco etapas: revisão de escopo para estrutura conceitual; elaboração da versão inicial; validação do conteúdo com cinco especialistas utilizando a Técnica Delphi; reavaliação; e construção da versão final dos instrumentos. Adotou-se o índice de validade de conteúdo de, no mínimo, 0.80. Resultados: foram realizadas três rodadas de avaliação para alcance de índice de validade nos conteúdos propostos, sendo necessária nova análise de 50% dos 20 itens do instrumento destinado às famílias, e 28,5% dos 21 itens destinados aos profissionais. O instrumento direcionado às famílias atingiu índice de 0,93; e o instrumento, aos profissionais, 0,90. Conclusões: os instrumentos propostos foram validados, sendo possível prosseguir com estudo de implementação prática para identificar influência na segurança durante a reconciliação medicamentosa na transição dos cuidados.

Evaluation of the Ruditapes decussatus immune response after differential injected doses of Perkinsus olseni.

Ruditapes decussatus is a highly appreciated clam species, with a high demand, especially in European countries. However, natural populations of this species have been affected by over-exploitation, abiotic factors and also by diseases mainly caused by bacteria, virus and protozoans. Within the latter group of pathogens, Perkinsus spp. has been attracting attention for causing relevant mortality rates on bivalves around the world. From all species of this genus, Perkinsus olseni is one of the most impactful for R. decussatus, as it may cause chronic infection with fatal consequences under adverse conditions. Therefore, in this study, naïve clams were injected with two doses of P. olseni in order to better understand the response of R. decussatus against this parasite. So, one of the main goals of this experiment was to evaluate the differential response of the clams at gene expression level after injection and also to monitor the possible mortalities related to parasite. Results indicated that the methods applied for injection and detection of parasite load are effective. Furthermore, altogether, R. decussatus gene expression studies indicate differences on expression of some of the addressed genes among distinct levels of infection over time, which require further studies to confirm if these genes could be used as molecular markers of P. olseni infection. According to the results obtained, Adiponectin-C1q seems to be a promising gene to be used as molecular marker of chronic infection in clams haemolymph.

The impact of the COVID-19 pandemic on young children and their caregivers.

BACKGROUND: The COVID-19 pandemic has adversely impacted child development and the well-being of caregivers, and such evidence ought to be used to inform public policy decisions. This study investigated the impact of COVID-19 on children's behaviours and their caregivers' needs. METHODS: A cross-sectional study was conducted with 153 caregivers of children (from 0 to 5 years old) from three public daycare centres in Brazil. The Nurturing Care Framework of the World Health Organization was used to guide the assessment of caregivers' needs. Online data collection using a questionnaire was conducted from June to July 2020. RESULTS: The COVID-19 pandemic increased stressors such as low family income, unemployment, sadness, depression and anxiety of caregivers. Their most commonly reported needs were related to offering age-appropriate playful activities (49.7%), organizing the care routine of children at home (41.8%) and educating children when they do something wrong (39.9%). Additionally, the results showed that misbehaviour, aggressiveness and agitation occurred more frequently among preschoolers than infants or toddlers (p ≤ 0.05). CONCLUSION: During the COVID-19 pandemic, public policies should provide mental health support to caregivers, as well as information about security, safety and early learning opportunities for childcare at home.

Antibiotic resistance and potential bacterial pathogens identified in red deer's faecal DNA.

In the last decades, the wildlife-human interface has been increasing due to several anthropogenic factors. Therefore, it is crucial to be aware of the impact of these new dynamics on the health of wild animals and their associated zoonotic disease risks. This study aimed to characterize the faecal microbiota of two populations of red deer (Cervus elaphus) by metabarcoding, with a particular focus on potential human and veterinary pathogens, and to perform an assessment of antibiotic resistance genes (ARGs) occurrence. The faecal microbiota of red deer was assessed by metabarcoding using the 16S rRNA marker, and OTUs of the genera Treponema, Yersinia, Clostridium, Mycobacterium, and Rickettsia were identified. Two of them affiliated with species more commonly regarded as pathogens (Clostridium piliforme and Yersinia enterocolitica). The quantification of ARGs was performed by quantitative real-time PCR, using a metagenomic approach, and the most abundant genes were found to be blaTEM , sul1, tetracycline resistance genes (tetW, tetO, and tetQ) and ermF. From these, tetO and tetW are rank II ARGs, which were recently considered future threats for human health. Our results suggest the need for screening programs for the occurrence of pathogens and ARGs in wildlife and particularly in-game species.

The complexity of having a child with a congenital heart defect in a developing country: A qualitative study of parental needs.

PURPOSE: To explore parental needs related to their experiences of living with a child with congenital heart defect (CHD) since the diagnosis. DESIGN AND METHODS: An interpretative qualitative study developed with nine parents of children between the ages of five months and 11 years diagnosed with CHD. Interviews were conducted at an ambulatory pediatric cardiology centre. Data were analyzed using inductive thematic analysis. The consolidated criteria for reporting qualitative research (COREQ) was followed for quality reporting. This research was approved by a research committee. RESULTS: One central theme emerged, namely 'A desire to feel safe in dealing with the demands of CHD,' along with two main themes. The first is 'Looking for effective relations with healthcare professionals and health care systems' which encompasses three types of need: (1) need for continuous, clear and accurate information; (2) need for resolution and the support of services such as the public health care system and social services; (3) need for trust in health care professionals. The second theme is 'Looking for balance in daily life' with two main needs: (1) maintain family functioning and (2) learn to deal with the child and CHD. CONCLUSION: The main parental needs are related to their interactions with healthcare professionals and healthcare systems, highlighted by a need for information and trust relationships to feel safe in their daily lives. PRACTICE IMPLICATIONS: Our results imply rethinking the nurse presence in ambulatory care, implementation of a family-centered care approach and addressing the diverse and multifaceted experiences and needs of parents and children with CHD in different health care contexts.

Genetic variability in Ruditapes decussatus clam combined with Perkinsus infection level to support founder population selection for a breeding program.

Clam farmers worldwide face several challenges, including irregular seed supply and high mortalities due to pathogenic organisms such as Perkinsus olseni. In Europe, there is a high unmet consumer demand for native clam species such as Ruditapes decussatus. The high market value of R. decussatus makes the culture of this species potentially more attractive than that culture of the alien species Ruditapes philippinarum. Thus, there is a market opportunity in breeding and producing R. decussatus at an industrial scale. A selective breeding program to improve R. decussatus performance will be carried out in Portugal; and the first critical step to develop such a breeding program is the establishment of a founder population. In this study, intra- and interpopulation genetic diversity was assessed using 13 microsatellite markers in eight natural beds located in Portugal, Spain and Italy. Also, allele and genotypic frequencies of each microsatellite locus were assessed discriminating between clams infected and non-infected by P. olseni. All locations showed similar values for several genetic diversity parameters. Analyses of population differentiation (F ST, Bayesian clustering and AMOVAs) revealed five genetically differentiated regions: Rías Altas and Rías Baixas (NW Spain), North/Central Coast of Portugal, Gulf of Cadiz and Adriatic Sea. Significant differences in the allelic and genotypic frequency distribution between infected clams and non-infected ones at four microsatellite loci are reported suggesting that resistance to the disease could have a genetic basis. Moreover, a positive or negative relationship between the frequency of certain alleles and the parasite infection was inferred. Further studies should confirm the potential use of those alleles as genetic markers for P. olseni infection. Integrating results of genetic diversity within and between populations and Perkinsus infection levels, a founder population for a R. decussatus breeding program is proposed, composed by individuals from Barallobre (Rías Altas), Pontevedra or Cangas (Rías Baixas), Óbidos (North/Central Coast of Portugal), Algarve (Gulf of Cadiz) and Venice (Adriatic Sea).

Patient-and Family-Centered Care and Patient Safety: reflections upon emerging proximity.

OBJECTIVE: To present reflections upon conceptual and pragmatic relationships between the Patient-and Family-Centered Care and patient safety. METHOD: A discussion about constructs related to the Patient-and Family-Centered Care and patient safety, which shows their interface with pragmatic issues of clinical nursing practice. RESULTS: Considering patients and families as partners and agents promoting safe care is mandatory for the safety culture. FINAL CONSIDERATIONS: Decreasing errors and adverse health care events can be accomplished by understanding manners to incorporate the principles of Patient-and Family-Centered Care into issues related to patient safety.

A 10-year review of primary major salivary gland cancers.

Primary salivary gland cancers comprise a heterogeneous group of histological entities and represent less than 5% of head and neck malignancies. Surgical resection is the main treatment, and adjuvant radiotherapy is performed in selected cases. Chemotherapy is an option in metastatic or recurrent disease, with poor evidence. We aimed to review a 10-year experience of a cancer centre on major salivary gland cancers, focusing on clinical, pathological, treatment and patients' outcomes data. A total of 93 patients were identified, median age at diagnosis was 64 years (IQR, 23), and 51.6% were male. The parotid gland was the site of origin in 76.3% of cases. The most frequent histological type was salivary duct carcinoma (21.5%). All patients were submitted to surgery and adjuvant radiotherapy was performed in 74.2%. From 26 patients diagnosed with metastatic disease, 9 were treated with systemic therapy. At 8 years, disease-free survival was 54.6% and overall survival was 48.4%. Male sex, salivary duct carcinoma, stage pT3-4, stage pN2-3, high histologic grade, lymphovascular invasion and perineural invasion were negative prognostic indicators for disease-free survival and overall survival. Extracapsular spread was a negative prognostic indicator for overall survival. In the multivariable analysis, histological type-salivary duct carcinoma-kept significant negative impact in disease-free survival and high histologic grade in overall survival. The most frequent histological type was salivary duct carcinoma, which is estimated to represent only 9% of salivary tumours. Patients with salivary duct carcinoma relapsed more than other histological types. High histologic grade was a negative prognostic indicator for overall survival.

Freezing Displayed by Others Is a Learned Cue of Danger Resulting from Co-experiencing Own Freezing and Shock.

Social cues of threat are widely reported [1-3], whether actively produced to trigger responses in others such as alarm calls or by-products of an encounter with a predator, like the defensive behaviors themselves such as escape flights [4-14]. Although the recognition of social alarm cues is often innate [15-17], in some instances it requires experience to trigger defensive responses [4, 7]. One mechanism proposed for how learning from self-experience contributes to social behavior is that of auto-conditioning, whereby subjects learn to associate their own behaviors with relevant trigger events. Through this process, the same behaviors, now displayed by others, gain meaning [18, 19] (but see [20]). Although it has been shown that only animals with prior experience with shock display observational freezing [21-25], suggesting that auto-conditioning could mediate this process, evidence for this hypothesis was lacking. Previously we found that, when a rat freezes, the silence that results from immobility triggers observational freezing in its cage-mate, provided the cage-mate had experienced shocks before [24]. Therefore, in our study, auto-conditioning would correspond to rats learning to associate shock with their own response to it-freezing. Using a combination of behavioral and optogenetic manipulations, here, we show that freezing becomes an alarm cue by a direct association with shock. Our work shows that auto-conditioning can indeed modulate social interactions, expanding the repertoire of cues mediating social information exchange, providing a framework to study how the neural circuits involved in the self-experience of defensive behaviors overlap with the ones involved in socially triggered defensive behaviors.

Patient-and Family-Centered Care and Patient Safety: reflections upon emerging proximity / Atención centrada en el paciente y la familia y la Seguridad del Paciente: reflexiones sobre una proximidad emergente / Cuidado Centrado no Paciente e Família e Segurança do Paciente: reflexões sobre uma proximidade emergente

ABSTRACT Objective: To present reflections upon conceptual and pragmatic relationships between the Patient-and Family-Centered Care and patient safety. Method: A discussion about constructs related to the Patient-and Family-Centered Care and patient safety, which shows their interface with pragmatic issues of clinical nursing practice. Results: Considering patients and families as partners and agents promoting safe care is mandatory for the safety culture. Final considerations: Decreasing errors and adverse health care events can be accomplished by understanding manners to incorporate the principles of Patient-and Family-Centered Care into issues related to patient safety.

RESUMEN Objetivo: Exponer reflexiones sobre las relaciones conceptuales y pragmáticas acerca del Atención centrada en el paciente y la familia y la Seguridad del Paciente. Método: Discusión acerca de construcciones relacionadas con Atención centrada en el paciente y la familia y la Seguridad del Paciente; presentando la interfaz de estos, con problemas pragmáticos de la práctica clínica de enfermería. Resultados: Se enfatiza ser imperativo a la cultura de seguridad, considerar pacientes y familias como colaboradores y agentes promotores de un cuidado seguro. Consideraciones finales: Comprender formas de incorporar los principios del Atención centrada en el paciente y la familia, a los problemas relacionados con la seguridad del paciente, puede contribuir para mitigar errores y eventos adversos en salud.

RESUMO Objetivo: Apresentar reflexões sobre as relações conceituais e pragmáticas acerca do Modelo Cuidado Centrado no Paciente e na Família e da Segurança do Paciente. Método: Discussão acerca de construtos relacionados ao Modelo de Cuidado Centrado no Paciente e na Família e Segurança do Paciente apresentando a interface desses com questões pragmáticas da prática clínica de enfermagem. Resultados: Enfatiza-se ser imperativo à cultura de segurança considerar pacientes e famílias como parceiros e agentes promotores de um cuidado seguro. Considerações finais: Compreender formas de incorporar os princípios do Cuidado Centrado no Paciente e Família às questões relacionadas à segurança do paciente pode contribuir para mitigar erros e eventos adversos em saúde.