Stress Inoculation in Police Officers Using Virtual Reality: A Controlled Study.

Policing is a highly demanding and stressful profession. Virtual reality (VR) has emerged as a promising tool for enhancing stress management programs, including for police officers. The use of VR in combination with biosensors enables measurement of psychophysiological responses such as peripheral temperature (PT) and skin conductance level (SCL). This study investigated the psychophysiological responses of police officers exposed to a VR scenario simulating a car accident. The study included a total of 63 police officers from the Public Security Police. Participants were divided into three groups based on their police divisions: the Investigation Brigade of Traffic Accidents, the Traffic Surveillance Squad (TSS), and a control group from the Lisbon Metropolitan Command. The results indicated that the VR environment effectively induced psychophysiological arousal, particularly in less experienced officers (TSS), that is, there were significant group differences in mean SCL and PT, showing this group with higher SCL and lower PT during the VR exposure. These results support the potential of VR as a stress inoculation strategy for training police officers and highlight the complex nature of stress responses that are influenced by individual factors and psychopathology.

Importância dos Conselhos Consultivos Nacionais de Bioética em tempos de Covid-19: realidade e perspectivas de Angola / Importance of National Bioethics Advisory Councils in Covid-19 times: Angola's reality and perspectives

A Covid-19 trouxe ao mundo uma nova dinâmica de vida, obrigando que os Conselhos Consultivos Nacionais de Bioética de muitos países, principalmente os africanos (Togo, Argélia) e alguns europeus (França e Portugal), se reinventassem para se adequarem ao contexto. Dentro da sua linha de actuação os conselhos apenas opinam, sugerem, analisam e recomendam algumas medidas que poderiam ser tomadas diante de conflitos morais. O objectivodeste trabalho é apresentar o papel dos Conselhos Consultivos Nacionais de Bioética no enfrentamento dapandemia daCovid-19. O texto sustenta-se metodologicamente em um estudo documental e bibliográfico com abordagem qualitativa e de carácter exploratório. Nos resultados, foram encontradas informações sobre Conselhos Consultivo Nacionais de Bioética em África, bem como outros denominados por Comité Nacional de Bioética. Entretanto, constatou-se que de algum modo eles ajudam na manutenção dos conhecimentos sobre como lidar com a Covid-19, embora em alguns países africanos sejainexpressivo. É essencial ressaltar que um Conselho Consultivo Nacional de Bioética tem missão diferente de um Comité de Ética em Pesquisa, uma vez que o Conselho vela por questões de maior magnitude, como projectosque serão convertidos em políticas de Estado. Por fim,vale ressaltar que no caso africano, existe uma ausência de órgãos governamentais atinentes à bioética. E é de suma importância para os países africanos a implementação de órgão dessa dimensão (Conselho Nacional de Bioética) para permitir o diálogo de temas de bioética de complexa resolução como é o caso da Covid-19.

Covid-19 brought a new dynamic to the world, thus forcing the National Bioethics Advisory Councils of many countries, mainly African (Togo, Algeria) and some European (France and Portugal) to reinvent themselves to fit the context. Within their line of action, the councils only give opinions, suggest, analyse and recommend some measures that could be taken in the face of moral conflicts. The aim of this paper is to present the role of National Bioethics Advisory Councils in confronting the pandemic of Covid-19. The text is methodologically sustained in a documental and bibliographical study with a qualitative approach and of exploratory character. In the results, information was found on National Bioethics Advisory Councils in Africa, as well as others called National Bioethics Committee. However, it was found that some how they help in maintaining knowledge on how to deal with Covid-19, although in some African countries it is inexpressive. It is essential to emphasise that a National Bioethics Advisory Council has a different mission from a Research Ethics Committee, since the Council watches over issues of greater magnitude, such as projects that will be converted into State policies. Finally, it is worth noting that in the African case, there is an absence of governmental bodies pertaining to bioethics. And it is of utmost importance for African countries to implement such a body (National Bioethics Council) to enable dialogue on bioethical issues of complex resolution as is the case of Covid19.

Desafios, problemas e dilemas bioéticos em tempos de Covid-19 / Challenges, problems and bioethical dilemmas in Covid 19 times

A gestão das questões bioéticas deve alicerçar-se em princípios e recomendações bem estabelecidas. Neste estudo do tipo bibliométrico, fez-se o levantamento do volume de publicações científicas no âmbito da Covid-19 (e cumulativamente em Bioética), publicados na base de dados (BD) Biblioteca Virtual de Saúde (BVS) durante o período de 1 de Janeiro de 2020 à 31 de Março de 2021, identificando-se diversos tópicos focados, visando disponibilizar aos profissionais e investigadores na área das ciências Médicas e da Saúde, particularmente em Angola, evidências que promovam a eticidade das políticas e práticas no combate a esta pandemia, na atenção às populações e na assistência aos doentes. No período de estudo estabelecido a BD devolvia 118 483 publicações (260/dia) para a expressão "Covid", e 158 (0,35/d) para Bioética e Covid". Destas, foram incluídas no estudo 57 artigos que possuiam como assunto principal o objectivo da nossa pesquisa. Os principais tópicos pesquisados foram ética da pesquisa 11(19,3%), a justiça/injustiça 10(17,5%) e a alocação de recursos escassos 6 (10,5%). As três questões adicionadas as 25 já existentes sobre Bioética e Covid foram: é ético não informar ou desinformar (infodemia)?, é ético o "nacionalismo vacinal"?, é ético penalizar alguém pela não-vacinação ou escolha da vacinação anti Covid-19?). Assim sendo, concluimos que a prevenção, combate e assistência à Covid-19 possui uma profunda dimensão Bioética, unida mas distinta de aspectos legais, organizativos e de gestão. É recomendável promover investigação bioética em Covid-19 e a sua translacção nas políticas e práticas. Deve aprofundar-se o estudo da "Ethosprudência" e elaborar antecipadamente "protocolos de ética médica" para apoiar o processo de decisão.

The management of bioethical issues should be based on well-established principles and recommendations. In this bibliometric study, we surveyed the volume of scientific publications on Covid-19 (and cumulatively on Bioethics), published in the database (DB) Virtual Health Library (VHL) from January 1st 2020 to March 31st 2021, identifying several focused topics, in order to provide professionals and researchers in the field of medical and health sciences, particularly in Angola, with evidence that promotes the ethics of policies and practices in combating this pandemic, in caring for the population and, patients. In the established study period, the DB returned 118 483 publications (260/day) for the expression "Covid", and 158 (0.35/day) for "Bioethics and Covid". Of these, 57 articles that had our research objective as their main subject were included in the study. The main topics searched were research ethics 11(19,3%), justice/injustice 10(17,5%) and allocation of scarce resources 6(10,5%). The three questions added to the 25 already existing on Bioethics and Covid were: is it ethical to not inform or misinform (infodemy)?, is "vaccine nationalism" ethical?, is it ethical to penalize someone for non-vaccination or choice of antiCovid-19 vaccination?). Therefore, we conclude that preventing, combating and assisting Covid-19 has a profound bioethical dimension, united but distinct from legal, organisational and managerial aspects. It is recommended to promote bioethical research on Covid-19 and itstranslation into policies and practices. The study of 'Ethosprudence' should be deepened and 'medical ethics protocols' developed in advance to support the decision-making process.

Impact of soil water regimes and partial root-zone drying in field-grown papaya in semi-arid conditions.

This study aimed to evaluate in the papaya Tainung genotype, the effects of partial root-zone drying (PRD) technique on soil water regimes by using different frequencies of shifting irrigation-side of plant row and the effects of PRD technique on (1) crop agronomic performance, (2) titratable fruit acidity (TA), (3) total soluble solids (TSS), and TSS/TA ratio. Also, we analyze the spatial dynamic of papaya condition using normalized difference vegetation index (NDVI) from different satellite images. The study was conducted in the semi-arid region of Bahia (BA) and Minas Gerais (MG), Brazil. The combination of 100% (Full irrigation-FU), 50%, and 35% in the irrigation depth (WID) and frequencies of shifting plant-row side irrigation of 0 (Fixed Irrigation-FX), 7, 14, and 21 days were applied. Nine treatments were studied in BA and five in MG. The water available in the soil was reduced to 44% for frequencies of shifting plant-row side irrigation of 7 days, 50% for 14 days, and 85% for 21 days, compared to the soil water availability at field capacity. Partial water deficit in the soil through the PRD technique did not significantly reduce the total root length, effective root depth, and root effective horizontal distance of the papaya Tainung genotype. However, PRD treatments showed leaf abscission, which resulted in reduced leaf area and NDVI values, especially in the MG experiment. Papaya yield and fruit quality were not affected. However, except for PRD 21 35%, irrigation water depth reduced to 50 and 35% under PRD increased crop water productivity (CWP) in papaya plants. Thus, the PRD technique may save 35% of WID using the alternation of lateral shift irrigation of crop row every 7 days under water scarcity in semi-arid regions. The NDVI index was important to compare the papaya canopy vigor between the experimental areas studied. We also confirmed the potential of NDVI to monitor the vigor of papaya canopy, since we could notice the sensibility of NDVI to identify water stress in papaya in higher vapor pressure deficit (VPD) conditions occurred in October 2016 and January 2017 in Bom Jesus da Lapa-BA. Therefore, the PRD strategy can be a useful tool to save water in papaya cultivation under semi-arid conditions.

High Prevalence of Metabolic Syndrome in Patients With Psoriatic Arthritis From Northeastern Brazil: Association With Traditional Cardiovascular Risk Factors and Biologic Disease-Modifying Antirheumatic Drugs.

OBJECTIVE: The aims of this cross-sectional study were to evaluate the prevalence of MetS in PsA patients compared with sex- and age-matched healthy controls and to test possible associations with clinical and laboratory variables. METHODS: The prevalence of MetS was determined for 76 PsA patients and 76 sex- and age-matched healthy controls, using the criteria of NCEP/ATPIII and Harmonizing, adjusted for South Americans. Multivariate logistic regression analysis was used to identify independent risk factors for MetS. RESULTS: Metabolic syndrome was significantly more prevalent in the PsA group than in the control group (53.9% vs 18.4%, p < 0.001). Psoriatic arthritis was associated with hypertension, diabetes mellitus, increased waist circumference (WC), elevated body mass index, and raised levels of blood glucose and triglycerides. When comparing MetS and non-Mets PsA patients, MetS was not significantly associated with disease activity, skin involvement, or quality of life. In the logistic regression model, the variables independently associated with MetS were use of biologic disease-modifying antirheumatic drugs (p = 0.001), elevated arterial pressure (p = 0.006), age (p = 0.0015), WC (p = 0.004), and low HDL (p = 0.042). CONCLUSIONS: In this study on PsA patients from Northeastern Brazil, MetS was highly prevalent and associated with biologic disease-modifying antirheumatic drugs use, increased WC, and low HDL.

Clinical, Histopathological and Outcome Analysis of Five Patients With Lichenoid Eruption Following Anti-Tumor Necrosis Factor-Alpha Therapy for Ankylosing Spondylitis: Report of One Case and Review of the Literature.

Tumor necrosis factor-alpha (TNF-ɑ) inhibitors have become the mainstay of therapy for a wide range of autoinflammatory diseases, despite concerns regarding dermatological adverse reactions. In this paper, we describe the clinical and histological findings and outcome of a case of lichenoid eruption (LE) following adalimumab therapy for ankylosing spondylitis (AS) and review four earlier reports concerning this rare clinical association. The time of onset varied considerably (three weeks to 52 months) and lesions varied within the clinical spectrum (from typical lichen planus to psoriasiform), but all had LE-compatible histology, with acanthosis, necrotic keratinocytes and lymphocytic infiltrate as hallmarks. Most patients (3/5) improved with treatment and one experienced full recovery, while in one case the lesions persisted. TNF-ɑ has been implicated in the pathogenesis of lichen planus, making it difficult to explain how TNF-ɑ antagonists can induce lichenoid reactions. The appearance of LE may in some cases justify cessation of therapy.

Prevalence of sacroiliitis and acute and structural changes on MRI in patients with psoriatic arthritis.

Sacroiliac joint involvement is one of the earliest manifestations of psoriatic arthritis (PsA). Magnetic resonance imaging (MRI) is a useful tool in the early diagnosis of axial disease due to its sensitivity for detecting acute and chronic changes associated with sacroiliitis. In this study, we evaluated the prevalence of sacroiliitis, acute and structural image changes on MRI in PsA patients and identified predictive clinical, laboratory and disease activity factors. Cross-sectional study on PsA patients submitted to MRI of the sacroiliac joints. The scans were evaluated by two blinded radiologists and the level of agreement was calculated (kappa). Clinical, disease activity and quality-of-life indices (DAS28, BASDAI, PASI, MASES, HAQ, CRP, ESR) were estimated. The sample consisted of 45 PsA patients with a mean age of 50.1 ± 11.5 years. The prevalence of sacroiliitis was 37.8% (n = 17), 47% of which was unilateral. The kappa coefficient was 0.64. Only 5 (29.4%) of the 17 patients with sacroiliitis on MRI had back pain. The most prevalent acute and chronic changes on MRI were, respectively, subchondral bone edema (26.7%) and enthesitis (20%), periarticular erosions (26.7%) and fat metaplasia (13.3%). CRP levels were higher among sacroiliitis patients (p = 0.028), and time of psoriasis was positively associated with chronic lesions (p = 0.006). Sacroiliitis on MRI was highly prevalent in our sample of PsA patients. Raised CRP levels were significantly associated with sacroiliitis, and longer time of psoriasis was predictive of chronic sacroiliitis lesions. Most sacroiliitis patients displayed no clinical symptoms.

Termos de esclarecimento e responsabilidade à luz da bioética de intervenção / Terms of clarification and accountability in the light of intervention bioethics / Formularios de esclarecimiento y responsabilidad a la luz de la bioética de intervención

Resumo No Brasil, o acesso aos medicamentos do Componente Especializado da Assistência Farmacêutica, no âmbito do Sistema Único de Saúde, ocorre mediante preenchimento e entrega do termo de esclarecimento e responsabilidade nas farmácias especializadas. Estes termos visam a obtenção do consentimento informado do paciente no que diz respeito ao tratamento medicamentoso oferecido. O estudo avaliou-os à luz do referencial teórico da bioética de intervenção com ênfase na garantia da autonomia do paciente e na sua proteção como ente vulnerável. Embora haja dispositivos que resguardem sua privacidade e forneçam informações relevantes para seu empoderamento na relação com o médico, os termos carecem de medidas protetivas nos casos em que ocorrem efeitos indesejáveis. Cabe, portanto, ao Estado fortalecê-los para garantir verdadeira autonomia dos pacientes, balizar sua vulnerabilidade e assegurar medidas de proteção em casos de episódios adversos.

Abstract In Brazil, access to medicines of the Specialized Pharmaceutical Care Program, within the scope of the Brazilian Unified Health System, depends on filling out and delivering the Clarification and Responsibility Form at specialized pharmacies. These forms are intended to obtain the patient´s informed consent concerning the medication being offered. The study evaluated them in the light of the theoretical reference of intervention bioethics, with emphasis on guaranteeing patient autonomy and protection as a vulnerable entity. Though the forms studied consider patient privacy and provide them with information relevant to their empowerment in dealing with doctors, the term lacks enough protective measures in cases where undesirable effects occur. Therefore, it is a State responsibility to strengthen them to guarantee true autonomy for patients, to identify their vulnerability and to ensure protective measures in cases of adverse event.

Resumen En Brasil, el acceso a los medicamentos del Componente Especializado de la Asistencia Farmacéutica, en el ámbito del Sistema Único de Salud, tiene lugar mediante diligenciamiento y entrega del Formulario de Esclarecimiento y Responsabilidad en las farmacias especializadas. Estos documentos procuran la obtención del consentimiento informado del paciente respecto del tratamiento medicamentoso a ser ofrecido. Este estudio los evaluó a la luz del marco teórico de la bioética de intervención con énfasis en la garantía de la autonomía del paciente y en su protección como ente vulnerable. Aunque haya dispositivos que resguarden la privacidad del paciente y proporcionen informaciones relevantes para su empoderamiento en la relación con el médico, los formularios carecen de medidas de protección en los casos de ocurrencia de efectos indeseables. Le compete, por lo tanto, al Estado fortalecerlos para garantizar una verdadera autonomía de los pacientes, demarcar su vulnerabilidad, y asegurar medidas de protección en casos de episodios adversos.