Patients' views and experiences on the supported self-management/patient-initiated follow up pathway for breast cancer.

PURPOSE: To explore patients' expectations and experience of Supportive Self-Management (SSM)/ Patient Initiated Follow Up (PIFU) following breast cancer treatments over a 12-month period. METHODS: In total, 32/110 (29%) patient participants in the PRAGMATIC (Patients' experiences of a suppoRted self-manAGeMent pAThway In breast Cancer) study were interviewed at baseline, 3, 6, 9 and 12 months. Interviews in this sub-study used a mix-methods approach to explore understanding of the pathway, confidence in self-management, triggers to seek help and/or re-engage with the clinical breast team and impact of the COVID-19 pandemic. Responses to pre-assigned categories were summarised as counts/ percentages and collated in tabular or graphic format. Free responses were recorded verbatim and reviewed using framework analysis. RESULTS: Participants regarded the SSM/PIFU pathway as a way to save time and money for them and the National Health Service (NHS) (14/32; 44%) and as a means of assuming responsibility for their own follow-up (18/32; 56%). Most maintained (very/somewhat) confidence in managing their BC follow-up care (baseline 31/32, 97%; 12 months 29/31, 93%). During the year, 19% (5/26) stopped endocrine therapy altogether because of side effects. Qualitative analysis revealed general satisfaction with SSM/PIFU and described the breast care nurses as reassuring and empathic. However, there was a lingering anxiety about identifying signs and symptoms correctly, particularly for those with screen-detected cancers. There was also uncertainty about who to contact for psychological support. The COVID-19 pandemic discouraged some participants from contacting the helpline as they did not want to overburden the NHS. CONCLUSIONS: The results show that during the first year on the SSM/PIFU pathway, most patients felt confident managing their own care. Clinical teams should benefit from understanding patients' expectations and experiences and potentially modify the service for men with BC and/or those with screen-detected breast cancers.

The use of biofeedback intervention in the improvement of depression levels: a randomised trial.

OBJECTIVE: To evaluate the use of biofeedback intervention in the levels of depression. The main hypothesis tested if the use of biofeedback improves depression levels compared to the control group. METHODS: A randomised clinical trial. The final sample was composed of 36 participants (18 in the experimental group, receiving 6 training, once a week, with biofeedback; and 18 in the control group, who received conventional treatment in the service).Outcome measures were assessed in two stages: pre-test and post-test. The research used the following instruments: demographic survey data, Mini International Neuropsychiatric Interview 5.0.0 and Beck Depression Inventory (BDI). The factors and variables were presented in terms of descriptive and inferential statistics. Fisher's exact test (p < 0.05) was used to verify the existence of an association between the counting variables. The multinomial logistic regression model was adopted, and the Logit link function was used, as the software RStudio version 3.6.2. RESULTS: The factors that remained in the final model were group, sex, partner, atypical antidepressant, benzodiazepines, mood stabiliser, antiepileptic and antihistamine, according to the levels of depression based on the BDI. The group that did not receive biofeedback intervention had 16 times more chances of increasing the depression levels compared to participants in the experimental group. CONCLUSION: The use of biofeedback reduces depression, thus, representing a complementary alternative for the treatment of moderate and severe depression, and dysthymia.

Complaints filed against nursing professionals.

BACKGROUND: In their daily practice, Brazilian nurses have been met with complaints from co-workers and patients, as well as bioethical dilemmas intrinsic to the profession, particularly in the context of care delivery. Complaints against nursing professionals have been in the media spotlight. OBJECTIVE: To examine complaints filed with the Regional Board of Nursing of Mato Grosso do Sul (COREN-MS) in Midwest Brazil. METHOD: Retrospective, analytical desk research of 111 complaints received by COREN-MS in 2003-2013 was carried out. Characterizations of complainant, professionals investigated, and complaints were the variables investigated. Ethical consideration: The project was approved by the Research Ethics Committee of the Federal University of Mato Grosso do Sul. To ensure confidentiality and anonymity, all documents retrieved were examined in situ and subjects were assigned numbered codes. RESULTS: Most complainants were nursing professionals (40). Most causes of complaint originated in the hospital setting (65). Most allegations were made against nursing technicians and licensed practical nurses (82). Complaints involving interprofessional relationships (85), iatrogenic events (36), and professional liability (20) predominated. DISCUSSION: Bioethical principles were breached, translating to poor-quality nursing care, detrimental to the professional image of nurses among users and nursing professionals alike. CONCLUSION: The findings can serve as input to guide nursing schools and boards of nursing in developing policies to raise awareness among nursing professionals, sensitizing them to the responsible provision of care in the light of bioethical and legal principles.

A framework model to integrate sources and pathways in the assessment of river water pollution.

Metal and nutrient pollution, soil erosion, and alterations in climate and hydrology are prevalent issues that impact the water quality of riverine systems. However, integrated approaches to assess and isolate causes and paths of river water pollution are scarce, especially in the case of watersheds impacted by multiple hazardous activities. Therefore, a framework model for investigating the multiple sources of river water pollution was developed. The chosen study area was the Paraopeba River basin located in the Minas Gerais, Brazil. Besides multiple agriculture, industrial, and urban pollution sources, this region was profoundly affected by the rupture of the B1 tailings dam (in January 2019) at the Córrego do Feijão mine, resulting in the release of metal-rich waste. Considering this situation, thirty-nine physicochemical and hydromorphological parameters were examined in the Paraopeba River basin, in the 2019-2023 period. The analysis involved various statistical techniques, including bivariate and multivariate methods such as correlation analysis, principal component analysis, and clustering. The Paraopeba River was mainly impacted by metal contamination resulting from the dam collapse, whereas nutrient contamination, mainly from urban and industrial discharges, predominantly affected its tributaries. Additionally, the elevated concentrations of aluminum, iron, nitrate, and sulfate in both main river and tributaries can be attributed to diffuse and point source pollution. In terms of hydromorphology and soil type, the interaction between woody vegetation and erosion-resistant soils, especially latosols, contributes to the stability of riverbanks in the main river. Meanwhile, in the tributaries, the presence of neosols and sparse vegetation in urbanized areas promoted riverbank erosion potentially amplifying pollution. While the study was conducted in a particular watershed, the findings are based on a methodology that can be applied universally. Hence, the insights on surface water quality from this research can be a valuable resource for researchers studying watersheds with diverse pollution sources.

Epigenetic and immune function profiles associated with posttraumatic stress disorder.

The biologic underpinnings of posttraumatic stress disorder (PTSD) have not been fully elucidated. Previous work suggests that alterations in the immune system are characteristic of the disorder. Identifying the biologic mechanisms by which such alterations occur could provide fundamental insights into the etiology and treatment of PTSD. Here we identify specific epigenetic profiles underlying immune system changes associated with PTSD. Using blood samples (n = 100) obtained from an ongoing, prospective epidemiologic study in Detroit, the Detroit Neighborhood Health Study, we applied methylation microarrays to assay CpG sites from more than 14,000 genes among 23 PTSD-affected and 77 PTSD-unaffected individuals. We show that immune system functions are significantly overrepresented among the annotations associated with genes uniquely unmethylated among those with PTSD. We further demonstrate that genes whose methylation levels are significantly and negatively correlated with traumatic burden show a similar strong signal of immune function among the PTSD affected. The observed epigenetic variability in immune function by PTSD is corroborated using an independent biologic marker of immune response to infection, CMV-a typically latent herpesvirus whose activity was significantly higher among those with PTSD. This report of peripheral epigenomic and CMV profiles associated with mental illness suggests a biologic model of PTSD etiology in which an externally experienced traumatic event induces downstream alterations in immune function by reducing methylation levels of immune-related genes.

N-(2-Nitro-phen-yl)furan-2-carboxamide.

In the title furan-carboxamide derivative, C11H8N2O4, the benzene and furan rings are rotated from the mean plane of the central fragment by 2.68 (5) and 7.03 (4)°, respectively. The nitro group forms a dihedral angle of 10.15 (5)° with the adjacent benzene ring. In the crystal, mol-ecules are linked by weak C-H⋯O inter-actions, forming helical chains running along [010].

Exercise of professional autonomy of intensive care nurses in the pandemic scenario.

OBJECTIVE: To analyze the exercise of professional autonomy of intensive care nurses during times of the new coronavirus pandemic. METHOD: A descriptive, qualitative study, conducted with 19 nurses from Intensive Care Units of two public hospitals and one private hospital. The information was produced from October 2020 to January 2021, through semi-structured interviews, using content analysis in thematic modality, guided by Eliot Freidson's Sociology of Professions. RESULTS: Nursesargued that it was difficult, amidst the pandemic, to act with all the prerogatives assigned to them by their social mandate, for various reasons, such as limited knowledge about the disease, fragile teamwork communication, and scarcity of material and human resources. CONCLUSION: The exercise of professional autonomy is shaped by the confrontation of multiple factors that impact the performance of intensive care nurses, especially in a context of pandemic crisis.

Factors associated with the permission for child vaccination in the context of the COVID-19 pandemic.

OBJECTIVE: To identify factors associated with permission for child vaccination in the context of the COVID-19 pandemic. METHOD: Cross-sectional study, with parents/guardians of children aged up to 1 year, 11 months and 29 days, aged 18 years or older, with internet access and residents of the state of Alagoas. The collection was conducted between June 2021 and April 2022, using a structured instrument via Google forms®. Fisher's Exact and Pearson's chi-square statistical tests were used. RESULTS: A total of 94 parents/guardians participated. There was an association between permission for child vaccination during the COVID-19 pandemic and higher education level of parents/guardians, with the lack of an educational bond with the child, and between parents/guardians who would allow the application of the COVID-19 vaccine. CONCLUSION: Permission for child vaccination in the context of the COVID-19 pandemic was associated with higher education level of parents/guardians and the absence of educational bond of the child.

Urea as a source of nitrogen and carbon leads to increased photosynthesis rates in Chlamydomonas reinhardtii under mixotrophy.

Microalgae is a potential source of bioproducts, including feedstock to biofuels. Urea has been pointed as potential N source for microalgae growth. Considering that urea metabolism releases HCO3- to the medium, we tested the hypothesis that this carbon source could improve photosynthesis and consequently growth rates of Chlamydomonas reinhardtii. In this sense, the metabolic responses of C. reinhardtii grown with ammonium and urea as nitrogen sources under mixotrophic and autotrophic conditions were investigated. Overall, the mixotrophy led to increased cell growth as well as to a higher accumulation of lipids independent of N source, followed by a decrease in photosynthesis over the growth phases. In mixotrophy, urea stimulates growth in terms of cell number and dry weight. Furthermore, higher photosynthesis was verified in late logarithmic phase compared to ammonium. Under autotrophy conditions, although cell number and biomass were reduced, there was higher production of starch independent of N source. Nonetheless, urea-based autotrophic treatments stimulated biomass production compared to ammonium-based treatment. Under mixotrophy higher input of carbon into the cell from acetate and urea optimized photosynthesis and consequently promoted cell growth. Together, these results suggest urea as alternative source of carbon, improving photosynthesis and cell growth in C. reinhardtii.

Understanding the Elevated Lethality of COVID-19 in Liver Transplant Recipients: Does Immunosuppression Management Matter? Results from a Brazilian Multicentric Historical Cohort.

BACKGROUND: Infections by SARS-CoV-2 in liver transplant recipients (LT) patients are of particular concern, notably due to perceived added risks related to immunosuppression and comorbidity burden. Current literature on this topic often relies on small, non-standardized, and geographically limited studies. This manuscript describes COVID-19 presentations and causes for elevated mortality in a large cohort of LT recipients. METHODS: This study was designed as a multicentric historical cohort, including LT recipient patients with COVID-19 in 25 study centers, with the primary endpoint being COVID-related death. We also collected demographic, clinical, and laboratory data regarding presentation and disease progression. RESULTS: Two hundred and thirty-four cases were included. The study population was predominantly male and White and had a median age of 60 years. The median time from transplantation was 2.6 years (IQR 1-6). Most patients had at least one comorbidity (189, 80.8%). Patient age (P = .04), dyspnea (P < .001), intensive care unit admission (P < .001), and mechanical ventilation (P < .001) were associated with increased mortality. Modifications of immunosuppressive therapy (P < .001), specifically the suspension of tacrolimus, maintained significance in multivariable analysis. CONCLUSIONS: Attention to risk factors and the individualization of patient care, especially regarding immunosuppression management, is crucial for delivering more precise interventions to these individuals.

2,4,6-Trinitro-phenyl benzoate.

In the title mol-ecule, C13H7N3O8, the phenyl and benzene rings are rotated from the mean plane of the central ester group by 18.41 (9) and 81.80 (5)°, respectively. The dihedral angle between the rings is 80.12 (14)°. In the crystal, mol-ecules are linked by weak C-H⋯O inter-actions, forming helical chains along [010].

[Neuropsychological side effects of combined hormonal contraceptives for the treatment of mild symptoms. Bioethical assessment of its adequacy]. / Efectos secundarios neuropsicológicos de los anticonceptivos hormonales combinados para el tratamiento de síntomas leves. Valoración bioética de su adecuación.

Since the beginning of the commercialization, in 1960, of combined estrogen-progestin hormonal contraceptives (CHCs), their use has become widespread for other non-contraceptive indications: dysmenorrhea, irregular cycle length, hypermenorrhea and acne, among others (Lete, 2009; Barranco, 2016). In all cases, these are mild pathologies or minor symptoms for which there are effective therapeutic alternatives. Millions of women in the world receive this treatment, which acts by inhibiting the hypothalamic-pituitary-ovarian hormonal axis (HHO Axis), the central axis and regulator of the entire sexual and reproductive physiology of women. Despite the existence of an enormous number of women subjected to this inhibition (ACHs are currently used by some 214 million women around the world, with an annual market of close to 18 billion dollars), very little research has been done on the consequences of suppressing the HHO axis. Only in recent years, and in parallel to the demonstration of the existence of functional receptors for gonadotropins at different levels in the central and peripheral nervous systems, have publications on the neuropsychological effects of HCAs begun to appear. It is also striking that, despite being the most widely used drugs and for the longest time for the treatment of functional gynecological disorders, their use is outside the technical data sheet (i.e., they are used for purposes other than those listed in the official indication approved in their technical data sheet and which appear in the package insert). Although the use of these hormonal products causes a wide variety of side effects, which have been widely studied in the medical literature, the present study proposes, after an exposition of the different aspects of the use of HCAs, a detailed review of the available literature on the neuropsychological effects due to the annulment of the HHO axis. This in order to, after a biological analysis, subsequently establish whether there is an ethical appropriateness in the use that concerns us.

Suicidal overdoses of psychotropic drugs by elderly in New York City: comparison with younger adults.

We compared New York City suicide victims aged 18-59 with those 60+ according to rates by which psychotropic/analgesic drugs and ethanol contributed to death. Barbiturates were more frequent in the elderly, while antidepressants were more frequent in younger adults. Addressing the potential for overdose with barbiturates may aid suicide prevention in the elderly.

Redetermination of 3-methyl-benzoic acid.

The asymmetric unit of the title compound, C(8)H(8)O(2), contains two crystallographically independent mol-ecules, which form dimers linked by O⋯H-O hydrogen bonds. The benzene rings in the dimers are inclined at a dihedral angle of 7.30 (8)° and both methyl groups display rotational disorder. This redetermination results in a crystal structure with significantly higher precision than the original determination [Ellas & García-Blanco (1963 ▶). Acta Cryst. 16, 434], in which the authors reported only the unit-cell parameters and space group, without any detailed information on the atomic arrangement. In the crystal, dimers are connected by weak C-H⋯O inter-actions, forming R(2) (2)(10) and R(4) (4)(18) rings along [110] and an infinite zigzag chain of dimers along the [001] direction also occurs.

2-Bromo-2-methyl-N-p-tolyl-propanamide.

In the title mol-ecule, C(11)H(14)BrNO, there is twist between the mean plane of the amide group and the benzene ring [C(=O)-N-C C torsion angle = -31.2 (5)°]. In the crystal, inter-molecular N-H⋯O and weak C-H⋯O hydrogen bonds link mol-ecules into chains along [100]. The methyl group H atoms are disordered over two sets of sites with equal occupancy.

2-Bromo-N-(4-chloro-phen-yl)-2-methyl-propanamide.

In the title mol-ecule, C(10)H(11)BrClNO, there is a twist between the mean plane of the amide group and the benzene ring [C(=O)-N-C-C torsion angle = -27.1 (3)°]. In the crystal, inter-molecular N-H⋯O and weak C-H⋯O hydrogen bonds link the mol-ecules into chains along [010].

The professional autonomy of nursing in pandemic times.

OBJECTIVE: To reflect on the exercise of Nursing's professional autonomy in times of pandemic. METHOD: Theoretical reflection in the light of the Sociology of Professions proposed by Eliot Freidson. Using the author's main concepts, it was sought to understand the professional practice of Nursing in times when its protagonism in the care process becomes even more challenging. RESULTS: Although there are obstacles in the daily work, it is believed that an autonomous practice contributes satisfactorily to the performance of nurses, since by revealing all the potential and leadership they have, they allow their professional autonomy to be legitimized. FINAL CONSIDERATIONS: The reflection clarified the importance of nurses to put their professional autonomy into practice, in order to achieve greater recognition and social appreciation of their work in times of pandemic.

Assessment of short-term intraocular pressure parameters in phakic and pseudophakic patients with primary open-angle glaucoma.

PURPOSE: To investigate intraocular pressure peaks in phakic and pseudophakic patients with primary open-angle glaucoma. METHOD: Overall, 40 patients with primary open-angle glaucoma were assessed. Of these, 20 patients were phakic and 20 pseudophakic. One eye (randomly selected) was included in the study. All patients underwent the intraocular pressure curves test, followed by the water-drinking test. RESULTS: A statistically significant difference was observed between the phakic and pseudophakic patients regarding the mean of the peaks in the intraocular pressure curves (p=0.045). A statistically significant intergroup difference was noted regarding the intraocular pressure peaks in the water-drinking test, with higher values observed in the phakic patients (p 0.004). CONCLUSION: The intraocular pressure peaks in the water-drinking test and intraocular pressure curves were higher in the phakic group than in the pseudophakic group.