As experiências dos profissionais de saúde no cumprimento da Diretiva Antecipada de Vontade na prática clínica / Health professionals' experiences in complying with the Advance Directive of Will in clinical practice / Las experiencias de los profesionales sanitarios en el cumplimiento de la Directiva Anticipada de Voluntades en la práctica clínica

Resumo Enquadramento: A Diretiva Antecipada de Vontade, permite à pessoa manifestar o seu desejo relativo à sua vivencia no final da vida. Cumprir esta diretiva exige aos profissionais de saúde competências na medida em que envolve vivências de grande complexidade. Objetivo: Identificar as experiências dos profissionais de saúde no cumprimento da Diretiva Antecipada de Vontade, na prática clínica. Metodologia: Estudo qualitativo, exploratório descritivo com recurso a entrevista semiestruturada. Foram incluídos como participantes os profissionais de saúde de um hospital do norte de Portugal. Efetuada análise de conteúdo segundo o referencial de Bardin. Foram respeitados todos os princípios éticos e legais. Resultados: Os participantes do estudo consideram a diretiva antecipada de vontade como um instrumento que especifica os desejos do doente quanto aos cuidados a receber em fim de vida. Enfatizam que no seu cumprimento experienciam uma variabilidade de emoções e sentimentos, medo, impotência, respeito. Conclusão: Para cumprir a diretiva antecipada de vontade é urgente construir critérios para a tomada de decisão perfilhada e partilhada. Para isto, é necessário uma maior aposta na formação.

Abstract Background: The Advance Directive of Will allows the person to express their desire regarding their end-of-life experience. Complying with this directive requires health professionals to have the skills to deal with the complexity of these experiences. Objective: To identify the health professionals' experiences in complying with the Advance Directive of Will in clinical practice. Methodology: A qualitative, exploratory, and descriptive study was conducted using semi-structured interviews. Participants included health professionals from a hospital in northern Portugal. Content analysis was performed according to Bardin's framework. All ethical and legal principles were respected. Results: Study participants consider the advance directive of will as an instrument that specifies the patient's wishes regarding end-of-life care. They emphasize that, when fulfilling these directives, they experience various emotions and feelings, like fear, impotence, and respect. Conclusion: Complying with the advance directive of will demands the definition of criteria for supported and shared decision-making. Thus, a greater commitment to training is necessary.

Resumen Marco contextual: La Directiva Anticipada de Voluntades permite a la persona expresar sus deseos en relación con su experiencia al final de la vida. Cumplir esta directiva exige competencias a los profesionales sanitarios, ya que implica experiencias de gran complejidad. Objetivo: Identificar las experiencias de los profesionales sanitarios en el cumplimiento de la Directiva Anticipada de Voluntades en la práctica clínica. Metodología: Estudio cualitativo, exploratorio y descriptivo mediante entrevistas semiestructuradas. Los participantes fueron profesionales sanitarios de un hospital del norte de Portugal. El análisis de contenido se realizó según el marco de Bardin. Se respetaron todos los principios éticos y legales. Resultados: Los participantes en el estudio consideraron la directiva anticipada de voluntades como un instrumento que especifica los deseos del paciente respecto a los cuidados que debe recibir al final de la vida. Destacaron que, al cumplirla, experimentaron una serie de emociones y sentimientos, como miedo, impotencia, respeto. Conclusión: Para cumplir la directiva anticipada de voluntades, urge construir criterios para una toma de decisiones perfeccionada y compartida. Para ello, es necesario invertir más en formación.

Helicobacter spp. in the Stomach of Cats: Successful Colonization and Absence of Relevant Histopathological Alterations Reveals High Adaptation to the Host Gastric Niche.

In addition to Helicobacter pylori, many non-Helicobacter pylori Helicobacters (NHPH) are able to cause gastric disease in humans. Cats are a natural reservoir for many of these species. Accordingly, living in close and intimate contact with animals has been identified as a risk factor, and an important zoonotic significance has therefore been attributed to NHPH. To determine the prevalence and associated gastric histopathological changes of Helicobacter species, the gastric mucosa of 71 cats were evaluated. Only four presented normal histopathological mucosa with the absence of spiral-shaped organisms. Normal gastric mucosa and the presence of spiral-shaped bacteria were observed in 13 cats. The remaining animals presented histopathological changes representative of gastritis. Helicobacter species were detected in 53 cats (74.6%) by at least one detection method. None of the animals were positive for H. pylori or for H. ailurogastricus. Helicobacter heilmannii organisms were identified in 20 animals, predominantly in the body gastric region. Helicobacter salomonis was the second most prevalent species (57.1%), although it was mainly found in association with other NHPH. Helicobacter felis and H. bizzozeronii were less frequently detected. The great majority of the Helicobacter spp. PCR-positive animals presented normal features regarding fibrosis/mucosal atrophy, neutrophils, eosinophils, or other inflammatory cells and lymphofollicular hyperplasia. Given the controversy and the strong evidence of absence of significant histopathological alterations associated with the presence of Helicobacter spp. in cats, it is possible to hypothesize that these bacteria may be able to adapt to the feline gastric microenvironment or even to comprise part of the gastric microbiome of this animal species. Thus, prudency must be taken when prescribing an antibiotic therapy based solely on the presence of these bacteria in the feline stomach.

Glucose and Lipid Dysmetabolism in a Rat Model of Prediabetes Induced by a High-Sucrose Diet.

Glucotoxicity and lipotoxicity are key features of type 2 diabetes mellitus, but their molecular nature during the early stages of the disease remains to be elucidated. We aimed to characterize glucose and lipid metabolism in insulin-target organs (liver, skeletal muscle, and white adipose tissue) in a rat model treated with a high-sucrose (HSu) diet. Two groups of 16-week-old male Wistar rats underwent a 9-week protocol: HSu diet (n = 10)-received 35% of sucrose in drinking water; Control (n = 12)-received vehicle (water). Body weight, food, and beverage consumption were monitored and glucose, insulin, and lipid profiles were measured. Serum and liver triglyceride concentrations, as well as the expression of genes and proteins involved in lipid biosynthesis were assessed. The insulin-stimulated glucose uptake and isoproterenol-stimulated lipolysis were also measured in freshly isolated adipocytes. Even in the absence of obesity, this rat model already presented the main features of prediabetes, with fasting normoglycemia but reduced glucose tolerance, postprandial hyperglycemia, compensatory hyperinsulinemia, as well as decreased insulin sensitivity (resistance) and hypertriglyceridemia. In addition, impaired hepatic function, including altered gluconeogenic and lipogenic pathways, as well as increased expression of acetyl-coenzyme A carboxylase 1 and fatty acid synthase in the liver, were observed, suggesting that liver glucose and lipid dysmetabolism may play a major role at this stage of the disease.

Advance directives: Portuguese palliative care professionals' views.

Advance directives are a controversial subject in Portugal at present, particularly among health professionals. Although some health professionals consider them to be important tools that are helpful in making proper decisions and promoting patient autonomy, others think that they may interfere with the human and relational dimension of care. It is therefore timely to investigate health professionals' views of advance directives in more detail. This study aimed to identify and reflect on Portuguese palliative care professionals' perspectives of advanced directives and their relevance to end-of-life decision making. A qualitative exploratory methodology was adopted in which interviews were conducted with two physicians, six nurses, two psychologists, and one social worker from four palliative care teams based across Portugal. The findings emphasize the relevance of advance directives to ethical decision-making processes in palliative care. However, debates are needed regarding whether advance directives should be legally binding.