Predictors of physical activity promotion in clinical practice: a cross-sectional study among medical doctors.

BACKGROUND: Physical activity is a major determinant of physical and mental health. International recommendations identify health professionals as pivotal agents to tackle physical inactivity. This study sought to characterize medical doctors' clinical practices concerning the promotion of patients' physical activity, while also exploring potential predictors of the frequency and content of these practices, including doctors' physical activity level and sedentary behaviours. METHODS: A cross-sectional study assessed physical activity promotion in clinical practice with a self-report questionnaire delivered through the national medical prescription software (naturalistic survey). Physical activity and sedentary behaviours were estimated using the International Physical Activity Questionnaire (short form). Indicators of medical doctors' attitudes, knowledge, confidence, barriers, and previous training concerning physical activity promotion targeting their patients were also assessed. Multiple regression analysis was performed to identify predictors of physical activity promotion frequency by medical doctors, including sociodemographic, attitudes and knowledge-related variables, and physical activity behaviours as independent variables. RESULTS: A total of 961 medical doctors working in the Portuguese National Health System participated (59% women, mean age 44 ± 13 years) in the study. The majority of the participants (84.6%) reported to frequently promote patients' physical activity. Five predictors of physical activity promotion frequency emerged from the multiple regression analysis, explaining 17.4% of the dependent variable (p < 0.001): working in primary healthcare settings (p = 0.037), having a medical specialty (p = 0.030), attributing a high degree of relevance to patients' physical activity promotion in healthcare settings (p < 0.001), being approached by patients to address physical activity (p < 0.001), and having higher levels of physical activity (p = 0.001). CONCLUSIONS: The sample of medical doctors approached reported a high level of engagement with physical activity promotion. Physical activity promotion frequency seems to be influenced by the clinical practice setting, medical career position and specialty, attitudes towards physical activity, and perception of patients´ interest on the topic, as well as medical doctors' own physical activity levels.

Peritoneal dialysis is a reasonable option in patients with cardiovascular disease
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INTRODUCTION: Peritoneal dialysis (PD) has been proposed as a therapeutic option for patients with end-stage renal disease (ESRD) and cardiovascular (CV) disease. The study presented here aimed to compare incident PD patients with and without CV disease at baseline, in order to determine the impact of CV disease in the outcomes of long-term PD patients. METHODS: This is a prospective cohort study performed at a single PD unit where 112 consecutive incident patients admitted to the PD program during 5 years were studied. The background of CV disease at PD initiation was defined as: presence of coronary artery disease, cerebrovascular disease, heart failure, or peripheral arterial disease. Laboratory measurements as well as PD adequacy were obtained at the beginning of PD and at the last evaluation. The outcomes examined were patient and technique survival, hospitalization and peritonitis rate. RESULTS: Prevalence of diabetes was higher in patients with CV disease (53.3% vs. 31.7%, p = 0.036). Patients who suffered from CV disease were, on average, older (62.8 ± 13.1 vs. 49.7 ± 15.7 years, p < 0.05). There were no significant differences in other demographic or clinical variables, including hospital admissions (0.99 vs. 0.72 episodes/patient-year, p = 0.057) or peritonitis rates (0.69 vs. 0.61 episodes/patient-year, p = 0.652). The overall rates of PD technique failure were similar between both groups (CV disease patients: 12.7 transfers to hemodialysis (HD)/100 patient-years vs. CONTROL: 13.7 transfers to HD/100 patient-year; p = 0.54). Diabetes and age were independently associated with the presence of CV disease (p = 0.011), in a model adjusted for time on PD. The mortality rate was higher in CV disease patients (14.9 vs. 0.8 deaths/100 patient-years, p = 0.000) and 75% of all-cause mortality occurred in diabetic patients. In a multivariate analysis, diabetes (hazard ratio (HR): 5.5, confidence interval (CI): 0.84 - 36.29, p = 0.049) and age (HR: 1.07, CI: 1.0 - 1.13, p = 0.047) were independent predictors of death in a model adjusted for residual diuresis, body mass index, and time on PD. CONCLUSIONS: This study compared incident PD patients with and without CV disease. CV disease patients were older but clinical and laboratorial targets, peritonitis rates, hospitalizations, and technique survival were similar between both groups, suggesting PD as an effective therapy for patients with CV comorbidities.
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Prognostic Factors of Human Immunodeficiency Virus-Infected Patients on Chronic Hemodialysis.

BACKGROUND/AIMS: The number of human immunodeficiency virus (HIV)-infected patients on hemodialysis (HD) have increased, and their prognostic factors are still poorly clarified. The study aimed to identify factors that can influence the survival of HIV-infected patients on HD. METHODS: We performed a retrospective cohort study of 44 HIV-infected patients on HD. RESULTS: A total of 17 patients (39%) died. Median survival on HD was 30.8 months and the survival rate at 1 and 5 years was 82.5 and 62.9%, respectively. Male (relative risk [RR] 3.1, p = 0.040) and blacks (RR 2.5, p = 0.037) had higher risk of death. The patients who died had a shorter duration of HIV infection (p = 0.028), had a higher viral load (p = 0.044), more opportunistic infections (p = 0.013), and a lower serum albumin (p = 0.009). Lower serum albumin, nonsexual HIV transmission, viral load, opportunistic infections, and usage of catheters were associated with lower survival. CONCLUSION: Several demographic, viral, and dialysis variables may help to predict survival of this population. The intervention in these factors could improve their prognosis.

Holistic Context-Sensitivity for Run-Time Optimization of Flexible Manufacturing Systems.

Highly flexible manufacturing systems require continuous run-time (self-) optimization of processes with respect to diverse parameters, e.g., efficiency, availability, energy consumption etc. A promising approach for achieving (self-) optimization in manufacturing systems is the usage of the context sensitivity approach based on data streaming from high amount of sensors and other data sources. Cyber-physical systems play an important role as sources of information to achieve context sensitivity. Cyber-physical systems can be seen as complex intelligent sensors providing data needed to identify the current context under which the manufacturing system is operating. In this paper, it is demonstrated how context sensitivity can be used to realize a holistic solution for (self-) optimization of discrete flexible manufacturing systems, by making use of cyber-physical systems integrated in manufacturing systems/processes. A generic approach for context sensitivity, based on self-learning algorithms, is proposed aiming at a various manufacturing systems. The new solution encompasses run-time context extractor and optimizer. Based on the self-learning module both context extraction and optimizer are continuously learning and improving their performance. The solution is following Service Oriented Architecture principles. The generic solution is developed and then applied to two very different manufacturing processes.

Peritoneal dialysis as a successful treatment in patients with refractory congestive heart failure: a one-center experience.

INTRODUCTION: Ultrafiltration (UF) technique is a valuable alternative to pharmacological therapy in the treatment of patients with refractory congestive heart failure (HF). The aim of this study was to describe a single-center experience in the treatment of refractory HF patients with peritoneal dialysis (PD). METHODS: Retrospective study of 5 patients included in a single PD Unit, showing symptoms and signs of severe refractory congestive HF to optimal pharmacological therapy (NYHA class IV). Clinical and laboratory parameters, survival, hospitalization, and peritonitis rates were recorded. RESULTS: Patients were followed for 9.36 (± 6.36) months; population mean age was 62 (± 16) years and Charlson's comorbidity index was 7.2 (± 2.1). After PD therapy, functional class of NYHA significantly improved (class IV to class II in 4 patients). Doppler-echocardiography improved in terms of ejection fraction (EF) or systolic pressure of the pulmonary artery (SPPA) in 3 patients. No patient was readmitted due to HF. Hospitalization days substantially decreased in 4 patients. One patient presented with peritonitis episodes. Three patients died but the mean survival was higher than expected according to their comorbidity index. CONCLUSION: PD, applied to refractory HF in addition to optimal pharmacological therapy, improves quality of life and functional class and reduces hospitalization days due to HF.

Prevalence, Clinical Characteristics, and Risk Factors for Non-recording of Alcohol Use in Hospitals across Europe: The ALCHIMIE Study.

AIM: To determine the detection rates, clinical features, and risk factors for lack of registration of alcohol use in medical patients admitted in European hospitals. METHODS: A point-prevalence, cross-sectional, multicenter survey involving 2100 medical inpatients from 43 hospitals from 8 European countries. Patients were screened for current alcohol use, using standardized questionnaires. Alcohol use recording in medical records was assessed. RESULTS: Of the 2100, more than a half reported alcohol use. Significant differences were shown in the prevalence of drinking and the recording rates of alcohol use among the hospitals and countries involved. Overall, 346 patients (16%) fulfilled criteria for alcohol use disorder. Alcohol use was registered in 909 (43%) of medical records, with quantification in 143 (7%). Multivariate analysis showed that women (OR 1.49), older age patients (OR 1.23), patients from the Northern European countries (OR 4.79) and from hospitals with high local alcohol prevalence (OR 1.59) were more likely to have lack of alcohol use registration in their medical files. CONCLUSIONS: A considerable proportion of medical patients admitted in European hospitals fulfill criteria for alcohol use disorders. These patients are frequently overlooked during hospitalization and not appropriately registered in medical records. Women, older patients, and inpatients from European areas with high local alcohol use prevalence are at higher risk associated with a non-recording of alcohol use.

Exercise prescription for patients with type 2 diabetes-a synthesis of international recommendations: narrative review.

BACKGROUND: Physical activity is a cornerstone of type 2 diabetes treatment and control. AIM: We analysed and synthesised the guidelines and recommendations issued by scientific organisations, regarding exercise prescription for patients with type 2 diabetes. METHOD: A systematic bibliographic search in Pubmed, Web of Science and Scopus databases was conducted. Clinical guidelines from major international scientific organisations in the field of diabetology, endocrinology, cardiology, public health and sports medicine were also considered. 11 publications were selected. RESULTS: Published guidelines recommend a weekly accumulation of a minimum of 150 min of aerobic exercise at moderate-to-vigorous intensity spread over a minimum of 3 days per week. Resistance exercise for muscle strengthening is also recommended at least 2 days a week. Flexibility exercises may complement other types of exercise. Combining aerobic and resistance exercise within the same exercise session is recommended by most guidelines. CONCLUSIONS: Exercise prescription for individuals with type 2 diabetes should include specific information on the type, mode, duration, intensity and weekly frequency. The exercise strategies must be adapted for each individual, based on comorbidities, contraindications and realistic personal goals.

Sediment Sampling in Estuarine Mudflats with an Aerial-Ground Robotic Team.

This paper presents a robotic team suited for bottom sediment sampling and retrieval in mudflats, targeting environmental monitoring tasks. The robotic team encompasses a four-wheel-steering ground vehicle, equipped with a drilling tool designed to be able to retain wet soil, and a multi-rotor aerial vehicle for dynamic aerial imagery acquisition. On-demand aerial imagery, properly fused on an aerial mosaic, is used by remote human operators for specifying the robotic mission and supervising its execution. This is crucial for the success of an environmental monitoring study, as often it depends on human expertise to ensure the statistical significance and accuracy of the sampling procedures. Although the literature is rich on environmental monitoring sampling procedures, in mudflats, there is a gap as regards including robotic elements. This paper closes this gap by also proposing a preliminary experimental protocol tailored to exploit the capabilities offered by the robotic system. Field trials in the south bank of the river Tagus' estuary show the ability of the robotic system to successfully extract and transport bottom sediment samples for offline analysis. The results also show the efficiency of the extraction and the benefits when compared to (conventional) human-based sampling.

Prevention of exercise-related injuries and adverse events in patients with type 2 diabetes.

Physical activity is widely recommended as an essential non-pharmacological therapeutic strategy to the prevention and control of type 2 diabetes and cardiovascular risk. Microvascular and macrovascular complications associated with the natural progression of the disease and typical age and anthropometric profile of individuals with type 2 diabetes may expose these patients to an increased risk of injury and acute adverse events during exercise. These injuries and adverse events can lead to fear of new injury and consequent physical inactivity. Preventative measures are essential to reduce risk, increase safety and avoid the occurrence of exercise-related injuries in people with type 2 diabetes. This population can exercise safely if certain precautions are taken and if exercise is adapted to complications and contraindications of each individual. Conditions such as diabetic foot, diabetic retinopathy, diabetic nephropathy, diabetic autonomic neuropathy, cardiovascular risk factors, musculoskeletal disorders, hypoglycaemia, hyperglycaemia, dehydration and interactions between medication and exercise should be taken into consideration when prescribing exercise.

Agri-Food Value Chain Traceability Using Blockchain Technology: Portuguese Hams' Production Scenario.

The globalization of food markets has led companies to buy products not only locally, but also from other corners of the world. This has introduced complexity into supply chains, as products have to move longer distances and pass through more companies before reaching the end consumer. The meat industry has been no different. Events such as animal disease outbreaks have diminished consumer confidence in the industry and the supply chain. Coupled with this, consumers started demanding "more transparent" meat products. This has led companies to think about new traceability systems, which continue to enforce food safety and health rules, but at the same time enhance and make transparent to the consumer the origin and constitution of their products. This article proposes a traceability system in the agri-food (meat industry) with a multi-chain architecture, among them, blockchain. The use of blockchain in the traceability system helped to mitigate the omission of relevant data for the traceability process, allowing us to guarantee the immutability, reliability, and transparency of the data along the value chain. At the same time, the system was able to reduce the time of the traceability process by giving the user the possibility to access the traced information via a unique product identifier.

Fulminant hepatitis during self-medication with conjugated linoleic acid.

The present report describes a 63-year-old female who presented with fulminant hepatic failure requiring liver transplantation caused by a weight loss dietary supplement containing conjugated linoleic acid (CLA). Thorough investigation, including liver biopsy, revealed no other cause of hepatotoxicity. In the last few years, a considerable number of reports have been published on toxic hepatitis, associated with non-conventional products, attributed with weight-reducing properties. We emphasize the importance of taking a cautious approach when consuming herbal supplements for the purpose of weight loss, as all that is "natural" may not always be healthy. Only one report of CLA-induced toxic hepatitis is related in the medical literature.

[Percutaneous thrombus aspiration in renal artery stenosis after renal transplantation]. / Aspiração de trombos por via percutânea em estenose da artéria renal após transplante renal.

We describe the case of a patient with chronic renal failure under hemodialysis for five years who, after renal transplantation, developed acute renal failure and hypertension refractory to medical therapy. Given the clinical and imaging (renal ultrasound and computed tomography) suspicion of renal artery graft thrombosis, invasive angiography was performed, which confirmed the diagnosis. The therapeutic approach consisted of percutaneous thrombus aspiration and subsequent balloon angioplasty of the entire artery, followed by stent implantation in a second procedure. The clinical course was uneventful with improvement of renal function and normalization of blood pressure. The case highlights the importance of percutaneous intervention in the management of patients with vascular complications after transplantation, with successful application of a procedure normally used in the setting of acute myocardial infarction - percutaneous thrombus aspiration and implantation of a drug-eluting vascular stent.

[Renal sympathetic denervation for treatment of resistant hypertension]. / Ablação da atividade simpática renal para tratamento da hipertensão arterial resistente.

Hypertension is an important cardiovascular risk factor and although there have been many improvements in pharmacological treatment, a significant percentage of patients are still considered resistant. The authors describe two cases of radiofrequency renal sympathetic denervation that illustrate the feasibility of this new technique for the treatment of resistant hypertension. The procedure consists of the application of radiofrequency energy inside the renal arteries to ablate afferent and efferent sympathetic renal activity, which has been implicated in the pathophysiology of hypertension.

Radiation proctitis-related lumbar spondylodiscitis due to Actinomyces odontolyticus: a rare finding.

Lumbar spondylodiscitis due to radiation proctitis-related fistula is a rare finding in the literature. After having isolated Actinomyces odontolyticus, a rare finding in the osteomuscular system, we present one of such cases.A 75-year-old patient with a history of rectum adenocarcinoma, submitted to surgery and radiotherapy, presented himself in our emergency department with a 3-month history of lumbar pain radiating to both legs. Physical examination was compatible with cauda equina syndrome and subsequent investigation revealed L4-L5 spondylodiscitis. Despite a 6-month antibiotic therapy regimen, the symptoms recurred. Intravertebral disc biopsy revealed A. odontolyticus and directed antibiotic therapy was started. However, the symptoms recurred after a new 6-month antibiotic therapy regimen, this time with rectal purulent drainage. Additional study revealed two rectal fistulae. It was assumed those were caused by radiation proctitis and constituted the primary cause of spondylodiscitis. Laminectomy was performed with a satisfactory clinical response.

Nosocomial Outbreak of SARS-CoV-2 in a "Non-COVID-19" Hospital Ward: Virus Genome Sequencing as a Key Tool to Understand Cryptic Transmission.

Dissemination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in healthcare institutions affects both patients and health-care workers (HCW), as well as the institutional capacity to provide essential health services. Here, we investigated an outbreak of SARS-CoV-2 in a "non-COVID-19" hospital ward unveiled by massive testing, which challenged the reconstruction of transmission chains. The contacts network during the 15-day period before the screening was investigated, and positive SARS-CoV-2 RNA samples were subjected to virus genome sequencing. Of the 245 tested individuals, 48 (21 patients and 27 HCWs) tested positive for SARS-CoV-2. HCWs were mostly asymptomatic, but the mortality among patients reached 57.1% (12/21). Phylogenetic reconstruction revealed that all cases were part of the same transmission chain. By combining contact tracing and genomic data, including analysis of emerging minor variants, we unveiled a scenario of silent SARS-CoV-2 dissemination, mostly driven by the close contact within the HCWs group and between HCWs and patients. This investigation triggered enhanced prevention and control measures, leading to more timely detection and containment of novel outbreaks. This study shows the benefit of combining genomic and epidemiological data for disclosing complex nosocomial outbreaks, and provides valuable data to prevent transmission of COVID-19 in healthcare facilities.

Salvage of malpositioned and malfunctioning peritoneal dialysis catheters by manipulation with a modified Malecot introducer.

Percutaneous peritoneal dialysis (PD) catheter manipulation successfully corrects displacement and contributes to catheter salvage. We describe a new device for the percutaneous treatment of malpositioned PD catheters, the modified Malecot introducer technique, which is an improvement over previous methods because its flexible consistency also allows the manipulation of swan-neck catheters. Twenty-one patients experienced catheter displacement managed by the new introducer: 12 males, average time in PD 13.7+/-23.2 months, six with "swan-neck" catheter, seven obese, and six with previous abdominal surgery. Catheter manipulation was technically successful in 19 of 21 cases (90.4%) by the end of the first week and in 15 cases (71.4%) at 1 month. An additional eight episodes of malposition occurred ranging from 10 to 300 days after the first manipulation. A second manipulation using the same introducer was performed and resulted in long-term patency in seven patients. No complications were reported. In the long-term follow-up, only one patient removed PD catheter for mechanical dysfunction. Overall survival of manipulated catheters was 32.7+/-23.4 months. Function at 1 month correlated with function by the first week (r=0.513; p=0.017) and the need of a second manipulation with age (r=0.494; p=0.027) but not with obesity or previous abdominal surgery. We conclude that manipulation using the modified Malecot introducer is a simple and effective procedure for the correction of malpositioned PD catheters. It also represents a new alternative for the management of displaced "swan-neck" catheters.

Publisher Correction: Neck circumference is associated with adipose tissue content in thigh skeletal muscle in overweight and obese premenopausal women.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Neck circumference is associated with adipose tissue content in thigh skeletal muscle in overweight and obese premenopausal women.

Neck circumference (NC) has been proposed as a simple and practical tool, independently associated with cardiometabolic risk factors. However, the association of NC with inter-muscular adipose tissue (IMAT) is still to be determined. We aimed to examine the association of NC with thigh IMAT, and visceral adipose tissue (VAT) measured with computed tomography (CT) in overweight/obese women. 142 premenopausal overweight and obese Caucasian women participated in this cross-sectional study. NC was measured with an inextensible metallic tape above the thyroid cartilage according to International Society for Advancement of Kinanthropometry protocol. Thigh IMAT and VAT volumes were measured with a single cross-sectional CT. Regarding the covariates, fat mass (FM) was assessed with dual-energy x-ray absorptiometry and physical activity was objectively measured with accelerometry. NC was positively associated with thigh IMAT and VAT volumes (standardized ß coefficient: ß = 0.45, P-value = ≤0.001, ß = 0.60, P = ≤ 0.001; respectively), which persisted after adjusting for age, height, overall FM or moderate-to-vigorous physical activity. Our findings show that NC is associated with thigh IMAT volume in overweight and obese premenopausal Caucasian women, regardless of the amount of lower-body fatness. These results suggest underscoring the relevance of NC as a marker of adipose tissue content in thigh skeletal muscle.

Reciprocal effects among changes in weight, body image, and other psychological factors during behavioral obesity treatment: a mediation analysis.

BACKGROUND: Changes in body image and subjective well-being variables (e.g. self-esteem) are often reported as outcomes of obesity treatment. However, they may, in turn, also influence behavioral adherence and success in weight loss. The present study examined associations among obesity treatment-related variables, i.e., change in weight, quality of life, body image, and subjective well-being, exploring their role as both mediators and outcomes, during a behavioral obesity treatment. METHODS: Participants (BMI = 31.1 +/- 4.1 kg/m2; age = 38.4 +/- 6.7 y) were 144 women who attended a 12-month obesity treatment program and a comparison group (n = 49), who received a general health education program. The intervention included regular group meetings promoting lasting behavior changes in physical activity and dietary intake. Body image, quality of life, subjective well-being, and body weight were measured at baseline and treatment's end. Mediation was tested by multiple regression and a resampling approach to measure indirect effects. Treatment group assignment was the independent variable while changes in weight and in psychosocial variables were analyzed alternatively as mediators and as dependent variables. RESULTS: At 12 months, the intervention group had greater weight loss (-5.6 +/- 6.8% vs. -1.2 +/- 4.6%, p < .001) and larger decreases in body size dissatisfaction (effect size of 1.08 vs. .41, p < .001) than the comparison group. Significant improvements were observed in both groups for all other psychosocial variables (effect sizes ranging from .31-.75, p < .05). Mediation analysis showed that changes in body image and body weight were concurrently mediators and outcomes of treatment, suggesting reciprocal influences. Weight loss partially mediated the effect of treatment on quality of life and on self-esteem but the reciprocal effect was not observed. CONCLUSION: Changes in weight and body image may reciprocally affect each other during the course of behavioral obesity treatment. No evidence of reciprocal relationships was found for the other models under analysis; however, weight changes partially explained the effects of treatment on quality of life and self-esteem. Weight and psychosocial changes co-occur during treatment and will probably influence each other dynamically, in ways not yet adequately understood. Results from this study support the inclusion of intervention contents aimed at improving body image in weight management programs.

Comparative descriptions of eggs from three species of Rhodnius (Hemiptera: Reduviidae: Triatominae).

The authors describe and compare the morphological and ultrastructural characteristics of eggs from the three most recent described species of the genus Rhodnius Stål, 1859, which have not previously been studied. These species are Rhodnius colombiensis (Mejia, Galvão & Jurberg 1999), Rhodnius milesi (Carcavallo, Rocha, Galvão & Jurberg 2001) and Rhodnius stali (Lent, Jurberg & Galvão 1993). The results revealed that there are similarities in the exochorial architecture of optical microscopy and scanning electron microscopy; these include the predominance of hexagonal cells that are common to all Rhodnius species and variable degrees of lateral flattening, which is common not only to species of this genus, but also to the Rhodniini tribe. Differences in overall colour, the presence of a collar in R. milesi, a longitudinal bevel in R. stali and the precise length of R. colombiensis can be useful distinguishing features. As a result of this study, the key for egg identification proposed by Barata in 1981 can be updated.