Cardiovascular risk assessment in Portugal's primary health care system: SCORE vs. SCORE2.

INTRODUCTION AND OBJECTIVES: The 2021 European Society of Cardiology guidelines on cardiovascular disease (CVD) prevention introduced the more accurate SCORE2 risk model as a replacement for the earlier SCORE, which is still used in primary care software in Portugal. Our objective is to determine whether the difference between risk assessment using SCORE and SCORE2, in the same patient population, is statistically significant. METHODS: A total of 1642 patients aged 40-65 without previous CVD, from the medical records of two Family Health Units, were included in this cross-sectional study. SCORE and SCORE2 were calculated using the variables gender, age, smoking status, lipid profile and systolic blood pressure. A statistical analysis was performed on the results. RESULTS: Using SCORE, 98% of the patients were in the low-moderate risk categories and 2% in the high or very high risk categories. When using SCORE2, the corresponding percentages were 55% and 45%, respectively. Reclassification with SCORE2 into higher categories was more often observed in younger (under 50 years of age) and male patients. With SCORE, 38.61% of patients were within the LDL-C target range; this figure fell to 20.28% with SCORE2. These differences are statistically significant (p<0.0001). CONCLUSION: Our findings show that a significant number of patients in this cohort who were classified through SCORE at lower risk levels were reclassified into higher risk categories with SCORE2. Similarly, the number of patients within the LDL-C target range for LDL-C was also lower using SCORE2.

Assessment of fire resilience in subtropical wetlands using high spatial resolution images.

Resilience is the ability of a system to absorb disturbances, rearrange itself, and adapt in order to maintain its functionality, structure, identity, and feedback. Research involving fire resilience in subtropical wetlands (SW) allows us to understand the dynamics of these ecosystems, measure impacts on fauna and flora, and promote policies for the management and protection. The aim of the present study is to assess the fire resilience of SW. The study was divided into three steps: (i) burned area classification, (ii) vegetation pattern classification, and (iii) temporal analysis of SW fire resilience based on NDVI calculation. Our results show that (a) high resilience potential of emerging plants, which developed green leaves in less than 90 days after the fire; (b) poor recovery of peatlands with underground fire history. Daily coverage of high spatial resolution PlanetScope images has great potential for classification and monitoring of land use in areas where there are rapid changes, such as after a fire event, explosions, and dam ruptures with ore tailings, for example.

Healthy Tissue Damage Following Cancer Ion Therapy: A Radiobiological Database Predicting Lymphocyte Chromosome Aberrations Based on the BIANCA Biophysical Model.

Chromosome aberrations are widely considered among the best biomarkers of radiation health risk due to their relationship with late cancer incidence. In particular, aberrations in peripheral blood lymphocytes (PBL) can be regarded as indicators of hematologic toxicity, which is a major limiting factor of radiotherapy total dose. In this framework, a radiobiological database describing the induction of PBL dicentrics as a function of ion type and energy was developed by means of the BIANCA (BIophysical ANalysis of Cell death and chromosome Aberrations) biophysical model, which has been previously applied to predict the effectiveness of therapeutic-like ion beams at killing tumour cells. This database was then read by the FLUKA Monte Carlo transport code, thus allowing us to calculate the Relative Biological Effectiveness (RBE) for dicentric induction along therapeutic C-ion beams. A comparison with previous results showed that, while in the higher-dose regions (e.g., the Spread-Out Bragg Peak, SOBP), the RBE for dicentrics was lower than that for cell survival. In the lower-dose regions (e.g., the fragmentation tail), the opposite trend was observed. This work suggests that, at least for some irradiation scenarios, calculating the biological effectiveness of a hadrontherapy beam solely based on the RBE for cell survival may lead to an underestimation of the risk of (late) damage to healthy tissues. More generally, following this work, BIANCA has gained the capability of providing RBE predictions not only for cell killing, but also for healthy tissue damage.

Adaptive Pathways: Possible Next Steps for Payers in Preparation for Their Potential Implementation.

Medicines receiving a conditional marketing authorization through Medicines Adaptive Pathways to Patients (MAPPs) will be a challenge for payers. The "introduction" of MAPPs is already seen by the European Medicines Agency (EMA) as a fait accompli, with payers not consulted or involved. However, once medicines are approved through MAPPs, they will be evaluated for funding by payers through different activities. These include Health Technology Assessment (HTA) with often immature clinical data and high uncertainty, financial considerations, and negotiations through different types of agreements, which can require monitoring post launch. Payers have experience with new medicines approved through conditional approval, and the fact that MAPPs present additional challenges is a concern from their perspective. There may be some activities where payers can collaborate. The final decisions on whether to reimburse a new medicine via MAPPs will have more variation than for medicines licensed via conventional processes. This is due not only to increasing uncertainty associated with medicines authorized through MAPPs but also differences in legal frameworks between member states. Moreover, if the financial and side-effect burden from the period of conditional approval until granting full marketing authorization is shifted to the post-authorization phase, payers may have to bear such burdens. Collection of robust data during routine clinical use is challenging along with high prices for new medicines during data collection. This paper presents the concept of MAPPs and possible challenges. Concerns and potential ways forward are discussed and a number of recommendations are presented from the perspective of payers.

Habilidades e destreza manual: tratando da criação no ensino de semiotécnica na enfermagem / Habilidades y destreza con las manos: tratamiento de la creación en la enseñanza de la semiótica en enfermería / Skills and hands ability: dealing with the teaching of semiotics in nursing

Objective: Production of ideas from incentive to imagination that may indicate trouble shooting identified by nursing students and presenting ideas and potential products resulting from their imagination. Method: Carthografic qualitative. The institutional research scenario is a public university in the State of Rio deJaneiro. Sixteen Nursing students were part of this study. Results: Twelve images were produced by Nursing students (73,4%), while only four students (26,6%) did not elaborate any image. The produced data came from three moments: “tracking to play”, “playing to land” and “landing to reconize”. Conclusion:There were identified problems resulting from experience with the families, to the creation of ideas into products or procedures involving innovations soft-hard technologies and building applications, tablets for hospitalized clients.

Objetivo: Produzir ideias, a partir do estímulo à imaginação, que possam indicar solução de problemas identificados por estudantes de enfermagem e apresentar as ideias e os possíveis produtos decorrentes de suas imaginações. Método: Cartográfico de natureza qualitativa. O cenário de investigação institucional consiste em uma universidade pública localizada no estado do Rio de Janeiro. Participaram deste estudo dezesseis estudantes de enfermagem. Resultados: Foram produzidas doze imagens por estudantes de enfermagem (73,4%), enquanto que apenas quatro estudantes (26,6%) não elaboraram nenhuma imagem. Os dados produzidos foram trabalhados em três momentos, intitulados: “rastreando para tocar”, “tocando para pousar” e “pousando para reconhecer”. Conclusão: Identificamos problemas resultantes de experiência com familiares, às criações das ideias transformadas em produtos ou processos envolveram inovações de tecnologias leve-duras e criação de aplicativos, tablets para clientes internados.

Objetivo: Producir de ideas del estímulo a la imaginación que puedan indicar la solución de problemas identificados por los estudiantes de enfermería y presentar ideas y productos potenciales resultantes de su imaginación. Método: Cualitativo de naturaleza cartográfica. El escenario de la investigación institucional era una universidad pública en el estado de Rio de Janeiro. Dieciséis estudiantes de enfermería participaron en este estudio. Resultados: Doce imágenes fueron producidas por estudiantes de enfermería (73,4%), mientras que sólo cuatro estudiantes (26,6%) no produjeron ninguna imagen. Los datos producidos se trabajaron en tres momentos titulados: "rastreando para jugar ", "jugar para posar" y "posando para reconocer”. Conclusión: Se identificaron los problemas derivados de la experiencia con la familia, de las creaciones de ideas en productos o procesos involucrando innovaciones de tecnologías suave-duras y la creación de aplicaciones, tabletas para clientes hospitalizados.