Allele-dependent interaction of LRRK2 and NOD2 in leprosy.

Leprosy, caused by Mycobacterium leprae, rarely affects children younger than 5 years. Here, we studied a multiplex leprosy family that included monozygotic twins aged 22 months suffering from paucibacillary leprosy. Whole genome sequencing identified three amino acid mutations previously associated with Crohn's disease and Parkinson's disease as candidate variants for early onset leprosy: LRRK2 N551K, R1398H and NOD2 R702W. In genome-edited macrophages, we demonstrated that cells expressing the LRRK2 mutations displayed reduced apoptosis activity following mycobacterial challenge independently of NOD2. However, employing co-immunoprecipitation and confocal microscopy we showed that LRRK2 and NOD2 proteins interacted in RAW cells and monocyte-derived macrophages, and that this interaction was substantially reduced for the NOD2 R702W mutation. Moreover, we observed a joint effect of LRRK2 and NOD2 variants on Bacillus Calmette-Guérin (BCG)-induced respiratory burst, NF-κB activation and cytokine/chemokine secretion with a strong impact for the genotypes found in the twins consistent with a role of the identified mutations in the development of early onset leprosy.

Conradi-Hünerman-Happle Syndrome and Obsessive-Compulsive Disorder: a clinical case report.

BACKGROUND: Obsessive-Compulsive Disorder (OCD) is a common and chronic psychiatric disorder with significant morbidity characterized by intrusive, uncontrollable and reoccurring thoughts (i.e., obsessions) and/or ritualistic behaviours (i.e., compulsions). Conradi-Hünerman-Happle Syndrome (CHHS) is a rare inherited X-linked dominant variant of chondrodysplasia punctata, a heterogeneous group of rare bone dysplasias characterized by punctate epiphyseal calcifications of complex etiology and pathophysiology that remain to be defined. Available literature reveals a lacuna in regards to the coexistence of the entities with no clinical reports described. CASE PRESENTATION: A 12 year old female patient with diagnosis of CHHS, presents to psychiatric consultation due to aggravation of her OCD clinical picture, with aggravation of hand-washing frequency during the Covid-19 pandemic with significant functional impact. Psychopharmacological treatment aimed at OCD with Selective Serotonin Reuptake Inhibitor (SSRI) and antipsychotic was instituted with favourable, albeit partial response. CONCLUSIONS: The authors aim to describe a clinical case in which the patient presents with Conradi-Hünerman-Happle Syndrome and Obsessive-Compulsive Disorder. Clinical descriptions of CHHS and OCD are not available in the literature. Through this case description the authors aim to present a rare case as well as discuss an eventual association between etiology and/or pathophysiology of the two disorders.

Identification of biomarkers predictive of metastasis development in early-stage colorectal cancer using network-based regularization.

Colorectal cancer (CRC) is the third most common cancer and the second most deathly worldwide. It is a very heterogeneous disease that can develop via distinct pathways where metastasis is the primary cause of death. Therefore, it is crucial to understand the molecular mechanisms underlying metastasis. RNA-sequencing is an essential tool used for studying the transcriptional landscape. However, the high-dimensionality of gene expression data makes selecting novel metastatic biomarkers problematic. To distinguish early-stage CRC patients at risk of developing metastasis from those that are not, three types of binary classification approaches were used: (1) classification methods (decision trees, linear and radial kernel support vector machines, logistic regression, and random forest) using differentially expressed genes (DEGs) as input features; (2) regularized logistic regression based on the Elastic Net penalty and the proposed iTwiner-a network-based regularizer accounting for gene correlation information; and (3) classification methods based on the genes pre-selected using regularized logistic regression. Classifiers using the DEGs as features showed similar results, with random forest showing the highest accuracy. Using regularized logistic regression on the full dataset yielded no improvement in the methods' accuracy. Further classification using the pre-selected genes found by different penalty factors, instead of the DEGs, significantly improved the accuracy of the binary classifiers. Moreover, the use of network-based correlation information (iTwiner) for gene selection produced the best classification results and the identification of more stable and robust gene sets. Some are known to be tumor suppressor genes (OPCML-IT2), to be related to resistance to cancer therapies (RAC1P3), or to be involved in several cancer processes such as genome stability (XRCC6P2), tumor growth and metastasis (MIR602) and regulation of gene transcription (NME2P2). We show that the classification of CRC patients based on pre-selected features by regularized logistic regression is a valuable alternative to using DEGs, significantly increasing the models' predictive performance. Moreover, the use of correlation-based penalization for biomarker selection stands as a promising strategy for predicting patients' groups based on RNA-seq data.

Genetic and microenvironmental intra-tumor heterogeneity impacts colorectal cancer evolution and metastatic development.

Colorectal cancer (CRC) is a highly diverse disease, where different genomic instability pathways shape genetic clonal diversity and tumor microenvironment. Although intra-tumor heterogeneity has been characterized in primary tumors, its origin and consequences in CRC outcome is not fully understood. Therefore, we assessed intra- and inter-tumor heterogeneity of a prospective cohort of 136 CRC samples. We demonstrate that CRC diversity is forged by asynchronous forms of molecular alterations, where mutational and chromosomal instability collectively boost CRC genetic and microenvironment intra-tumor heterogeneity. We were able to depict predictor signatures of cancer-related genes that can foresee heterogeneity levels across the different tumor consensus molecular subtypes (CMS) and primary tumor location. Finally, we show that high genetic and microenvironment heterogeneity are associated with lower metastatic potential, whereas late-emerging copy number variations favor metastasis development and polyclonal seeding. This study provides an exhaustive portrait of the interplay between genetic and microenvironment intra-tumor heterogeneity across CMS subtypes, depicting molecular events with predictive value of CRC progression and metastasis development.

Grupos de terapia ocupacional em telessaúde na pandemia de Covid-19: perspectivas de um Hospital-Dia de Saúde Mental / Occupational therapy telehealth groups in Covid-19 pandemic: perspectives from a Mental Health Day Hospital

Resumo A pandemia de COVID-19 teve sério impacto ocupacional em pessoas com transtornos mentais pré-existentes. Para prestar o cuidado nesse contexto, os grupos de telessaúde foram uma opção terapêutica para terapeutas ocupacionais para o cuidado em saúde mental. Este artigo apresenta uma experiência de terapia ocupacional com grupos de telessaúde no Brasil, sustentada pelo Método Terapia Ocupacional Dinâmica, buscando discutir o uso da tecnologia durante a pandemia de Covid-19, além dos limites e das potencialidades do cuidado em terapia ocupacional diante da necessária mudança do trabalho com grupos. Trata-se de análise crítica da prática sustentada por uma perspectiva de produção de evidências baseadas na prática por meio de uma parceria colaborativa entre profissionais e acadêmicos do Brasil e do Reino Unido. Os profissionais refletiram sobre as habilidades necessárias no contexto online, destacando suas preocupações iniciais e suas descobertas neste novo cenário de prática. A prática de cuidado em grupo de terapia ocupacional em telessaúde na prática de saúde mental requer o uso de múltiplas ferramentas digitais. Além disso, a(o) terapeuta ocupacional precisa entender das questões de desigualdade digital (acesso digital e/ou habilidades digitais), aprimorar-se digitalmente para atender às necessidades das pessoas sob seu acompanhamento, além de possuir referenciais teórico-metodológicos claros que permitam sustentar práticas em telessaúde.

Abstract COVID-19 pandemic had a serious occupational impact on people with pre-existing mental disorders. To deliver care in this context, telehealth groups were a therapeutic option for occupational therapists for mental health care. This paper presents an occupational therapy experience with telehealth groups in Brazil, sustained by the Dynamic Occupational Therapy Method, seeking to discuss the use of technology during the COVID-19 outbreak, the limits and potential of occupational therapy in the face of the necessary change in work with groups. The paper is a critical analysis of practice sustained by a practice-based evidence perspective through a collaborative partnership between practitioners and academics from Brazil and the UK. Practitioners reflected on their professional skills in an online context, highlighting their initial concerns and their discoveries within this new practice scenario. The delivery of telehealth groupwork in occupational therapy in mental health practice requires multiple digital tools, and the occupational therapist needs to understand digital inequity issues (digital access or skills), be digitally upskilled to meet client needs, and also be guided by clear occupational therapy theoretical and methodological frameworks that underpin telehealth practices.

Angioedema com haloperidol: um relato de caso / Angioedema with haloperidol: a case report

O haloperidol é um antipsicótico de primeira geração e um dos medicamentos mais usados dentro dessa categoria. É um potente antagonista de ação central dos recetores de dopamina tipo 2, com baixa atividade anti alfa 1 adrenérgica e sem atividade anti-histamínica ou anticolinérgica, regularmente utilizado em casos de agitação. O angioedema é um efeito colateral especialmente grave, caracterizado por edema acentuado do tecido subcutâneo ou submucoso, e pode afetar várias partes do corpo, podendo até culminar, nos casos mais graves, em morte. Já foi descrito com administração de vários antipsicóticos, como clozapina, risperidona, ziprazidona e clorpromazina, no entanto é raro como resultado da administração de haloperidol, ocorrendo em <1% dos casos. O objetivo deste artigo é descrever o desenvolvimento de angioedema em um paciente com síndrome confusional agudo após a segunda administração de haloperidol IM para controle sintomático da agitação em contexto de serviço de urgência. [au]

Haloperidol is a first-generation antipsychotic and one of the most commonly used drugs within this category. It is a potent centrally acting antagonist of type 2 dopamine receptors, with low anti-alpha-1-adrenergic activity and no antihistaminic or anticholinergic activity, regularly used in cases of agitation. Angioedema is an especially serious side effect, characterized by marked edema of the subcutaneous or submucosal tissue, and can affect various parts of the body, and may even culminate, in the most severe cases, in death. It has already been described with the administration of several antipsychotics, such as clozapine, risperidone, ziprasidone, and chlorpromazine, but it is rare as a result of administration of haloperidol, occurring in <1% of cases. This article aims to describe the development of angioedema in a patient with acute confusional syndrome after the second administration of IM haloperidol for symptomatic control of agitation in an emergency department setting. [au]

Estresse, má qualidade do sono e desfechos negativos a saúde em estudantes de enfermagem / Stress, poor sleep quality and negative health outcomes in nursing students / Estrés, mala calidad del sueño y resultados negativos de salud en estudiantes de enfermería

RESUMO Objetivo: analisar o perfil biossocial-acadêmico, nível de estresse e qualidade de sono em estudantes de enfermagem no primeiro ano do curso. Método: pesquisa longitudinal, prospectiva e quantitativa, realizada em 2016 junto a estudantes de enfermagem do primeiro ano de duas universidades de São Paulo. Ao início das aulas e ao final do ano letivo, aplicaram-se um formulário biossocial-acadêmico, instrumento para avaliação do estresse em estudantes de enfermagem e índice de qualidade de sono de Pittsburgh. Utilizaram-se os testes de Qui-quadrado e exato de Fischer para comparar o estresse e a qualidade do sono. Resultados: O total de 117 estudantes compuseram a amostra em março e 100 em dezembro de 2016. Evidenciou-se aumento no percentual de estudantes com muito e alto estresse, a duração do sono reduziu significativamente de 6,0 para 5,4 horas em média, por noite, e apresentaram dificuldades no gerenciamento do tempo, formação profissional para seguir o curso e atividades teóricas.Conclusão: o ambiente acadêmico apresenta potencial para o adoecimento do estudante, com alto estresse, má qualidade do sono e desfechos negativos à saúde.

ABSTRACT Objective: to analyze the biosocial-academic profile, level of stress and quality of sleep in nursing students during the first year of the course. Method: longitudinal, prospective and quantitativeresearch, carried out in 2016 with first-year nursing students from two universities in São Paulo. At the beginning of classes and at the end of the school year, the following were applied a biosocial-academic \form, an instrument to assess stress in nursing students and a Pittsburgh sleep quality index. Chi-square and Fisher's exact tests were used to compare stress and sleep quality. Results:117 students comprised the sample in March and 100 in December 2016. There was an increase in the percentage of students with high and high stress, sleep duration significantly reduced from 6.0 to 5.4 hours on average, per night, and had difficulties in time management, professional training to follow the course and theoretical activities.Conclusion:theacademic environment has the potential for the student's illness, with high stress, poor sleep quality and its negative health outcomes.

RESUMEN Objetivo: analizar el perfil biosocial y académico, nivel de estrés y calidad del sueño en estudiantes de enfermería durante el primer año del curso. Método: investigación longitudinal, prospectiva y cuantitativa, realizada en 2016 con estudiantes de primer año de enfermeríade dos universidades de São Paulo. Al inicio de las clases y al final del año lectivo se aplicaron un formulario biosocial y académico, un instrumento para evaluar el estrés en estudiantes de enfermería y un índice de calidad del sueño de Pittsburgh. Paracomparar el estrés y la calidad del sueño se utilizaron las pruebas de chi-cuadrado y exacta de Fisher. Resultados:El total de 117 estudiantes conformaron la muestra en marzo y 100 en diciembre de 2016. Hubo un aumento en el porcentaje de estudiantes conmucho y alto estrés, la duración del sueño se redujo significativamente de 6.0 a 5.4 horas en promedio, por noche, y tuvieron dificultades en la gestión del tiempo. formación profesional para seguir el curso y actividades teóricas. Conclusión:el entorno académico tiene el potencial de que el estudiante se enferme, con alto estrés, mala calidad del sueño y sus resultados negativos para la salud.

HERVs establish a distinct molecular subtype in stage II/III colorectal cancer with poor outcome.

Colorectal cancer (CRC) is one of the most lethal malignancies. The extreme heterogeneity in survival rate is driving the need for new prognostic biomarkers. Human endogenous retroviruses (hERVs) have been suggested to influence tumor progression, oncogenesis and elicit an immune response. We examined multiple next-generation sequencing (NGS)-derived biomarkers in 114 CRC patients with paired whole-exome and whole-transcriptome sequencing (WES and WTS, respectively). First, we demonstrate that the median expression of hERVs can serve as a potential biomarker for prognosis, relapse, and resistance to chemotherapy in stage II and III CRC. We show that hERV expression and CD8+ tumor-infiltrating T-lymphocytes (TILs) synergistically stratify overall and relapse-free survival (OS and RFS): the median OS of the CD8-/hERV+ subgroup was 29.8 months compared with 37.5 months for other subgroups (HR = 4.4, log-rank P < 0.001). Combing NGS-based biomarkers (hERV/CD8 status) with clinicopathological factors provided a better prediction of patient survival compared to clinicopathological factors alone. Moreover, we explored the association between genomic and transcriptomic features of tumors with high hERV expression and establish this subtype as distinct from previously described consensus molecular subtypes of CRC. Overall, our results underscore a previously unknown role for hERVs in leading to a more aggressive subtype of CRC.

Meaning-making in occupational therapy interventions: a scoping review / A construção de sentidos nas intervenções em terapia ocupacional: uma revisão de escopo

Abstract Introduction Meaning-making is an experience-centred process. It is an essential element for understanding the impact of occupational therapy interventions focused on fostering processes of becoming, one of the four integrated dimensions of meaningful occupation (along with doing, being, and belonging). Objective This paper aims to explore further some of the aspects that are essential for meaning-making in occupational therapy interventions. Method A scoping review guided by Arksey and O'Malley's methodological framework was conducted. In the initial search, 528 articles were retrieved from three databases; 16 met the criteria for inclusion: articles in English, peer-reviewed, published between January 2008 and December 2017, that addressed some type of occupational therapy intervention, with data related to the meanings of the participants of the studies. Results The articles address a multiplicity of populations, services, and fields of practice, in qualitative studies, with methodologies that prioritise reflection on the lived experience. Thematic analysis highlights the interconnection between being, doing, and belonging to foster meaning-making; implications of professional actions; and meaning-making triggered by reflective processes. Conclusion Meaning-making demands reflection on the lived experience, and is influenced by human and physical environments. Both conditions/limitations and new skills/abilities enhance processes of meaning-making. Implications for future research are considered.

Resumo Introdução A construção de sentidos é um processo centrado na experiência, essencial para a compreensão do impacto das intervenções em terapia ocupacional voltadas para a promoção de processos de transformação/becoming, uma das quatro dimensões integradas da ocupação significativa (juntamente com o fazer/doing, ser/being e pertencer/belonging). Objetivo Este artigo tem como objetivo identificar aspectos essenciais para a construção de sentido em intervenções de terapia ocupacional. Método Foi realizada uma revisão de escopo. Na busca inicial, 528 artigos foram recuperados de três bases de dados; 16 atenderam aos critérios de inclusão: artigos em inglês, revisados por pares, publicados entre janeiro de 2008 e dezembro de 2017, que abordassem algum tipo de intervenção de terapia ocupacional, com dados referentes aos sentidos construídos pelos participantes dos estudos. Resultados Os artigos abordam múltiplas populações, serviços e campos de prática, em estudos qualitativos, com metodologias que priorizam a reflexão sobre a experiência vivida. A análise temática destaca a interconexão entre ser, fazer e pertencer para promover a construção de sentido; implicações para ações profissionais; e construção de sentido desencadeada por processos reflexivos. Conclusão A construção de sentidos demanda reflexão sobre a experiência vivida, é influenciada pelos ambientes humanos e físicos. Tanto as condições limitantes como as novas habilidades adquiridas desencadeiam processos de construção de sentido. Implicações para pesquisas futuras são indicadas.

Pretreatment hemoglobin level as a prognostic factor in patients with locally advanced head and neck squamous cell carcinoma.

AIM: Evaluate pretreatment hemoglobin values as a prognostic factor in patients with locally advanced head and neck squamous cell carcinoma treated with concurrent chemoradiotherapy. BACKGROUND: Anemia is one of the most prevalent laboratory abnormalities in oncological disease. It leads to a decrease in cellular oxygen supply, altering radiosensitivity of tumor cells and compromising therapeutic outcomes. MATERIALS AND METHODS: Retrospective evaluation of patients with HNSCC treated with cCRT. Primary and secondary endpoint was to evaluate the correlation of Hb levels (≥12.5 g/dL or <12.5 g/dL) at the beginning of cCRT with overall survival (OS) and progression-free survival (PFS), respectively. RESULTS: A total of 108 patients were identified. With a median follow-up of 16.10 months median OS was 59.70 months for Hb ≥12.5 g/dL vs. 14.13 months for Hb <12.5 g/dL (p = 0.004). PFS was 12.29 months for Hb ≥12.5 g/dL and 1.68 months for Hb <12.5 g/dL (p = 0.016). CONCLUSIONS: In this analysis, Hb ≥12.5 g/dL correlated with significantly better OS and PFS. Further studies are needed to validate these findings.

Estresse e resiliência em discentes de enfermagem de duas universidades públicas paulistas / Estrés y resiliencia en estudiantes de enfermería de dos universidades publicas paulistas / Stress and resilience in nursing students from two public universities in sao paulo

Objetivo: verificar a relação entre estresse e resiliência em discentes de enfermagem de duas universidades públicas do Estado de São Paulo. Método: trata-se de um estudo transversal realizado em março de 2016 junto a 117 discentes de enfermagem. Aplicaram-se um Formulário para caracterização acadêmica e demográfica, o Instrumento para Avaliação do Estresse em Discentes de Enfermagem e a Escala de Resiliência de Wagnilde Young. Analisaram-se os dados no Statistical Package for Social Sciences, versão 10.0. Resultados: observou-se predomínio de discentes com médio nível de estresse. O gerenciamento do tempo e as atividades teóricas representaram alto nível de estresse para 23,9% e 20,5% da população. 11,1% apresentaram muito alto estresse relacionado ao Ambiente. Os níveis de resiliência foram reduzidos (51%). Não houve correlação significativa entre estresse e resiliência. Conclusão: o ambiente de formação em enfermagem apresenta potencial para o adoecimento dos discentes, embora parte deles já apresente resiliência moderada.

Aim: to verify the relation between stress and resilience in nursing students from two public universities in the State of São Paulo. Method: this is a cross-sectional study conducted in March 2016 with 117 nursing students. We applied academic and sociodemographic forms, the instrument for nursing students stress assessment, and the Wagnild and Young´s resilience scale. Data were analyzed in Statistical Package for Social Sciences, version 10.0. Results: we found a predominance of moderately stressed students. Time management and theoretical activities meant high stress level for 23,9% and 20,5% of the sample. Also, 11,1% showed a very high stress level related to the work environment. Levels of resilience were low (51%). There was not a significant correlation between stress and resilience. Conclusion: nursing education setting shows potential for students ́ illness, although part of them already show moderate resilience.

Objetivo: verificar la relación entre estrés y resiliencia en discentes de enfermería de dos universidades públicas del Estado de São Paulo. Método: se trata de un estudio transversal realizado en marzo de 2016 con 117 discentes de enfermería. Se aplicó un formulario para caracterización académica y demográfica, el Instrumento para Evaluación de Estrés en discentes de enfermería y la escala de resiliencia de Wagnild y Young. Los datos fueron evaluados en el Statistical Package for Social Sciences, versión 10.0. Resultados: se observó el predominio de discentes con nivel medio de estrés. El gerenciamiento del tiempo y las actividades teóricas representaron alto nivel de estrés para 23,9% y 20,5% de la población. 11,1% presentaron muy alto el nivel de estrés relacionado al Ambiente. Los niveles de resiliencia fueron bajos (51%). No hubo correlación significativa entre estrés y resiliencia. Conclusión: el ambiente de formación en enfermería presenta potencial para el padecimiento de los discentes, aunque parte de ellos ya presente moderada resiliencia.

Fatores de estresse associados à sintomatologia depressiva e qualidade do sono de acadêmicos de enfermagem / Stress factors associated with depressive symptoms and sleep quality in nursing students / Factores de estrés asociados a síntomas depresivos y calidad del sueño en estudiantes de enfermería

Objetivo: Analisar os fatores estressores associados à sintomatologia depressiva, qualidade de sono de acadêmicos de enfermagem. Método: Trata-se de uma pesquisa transversal, analítica e de abordagem quantitativa, realizada em março de 2016 junto a 159 discentes da área de saúde de uma instituição pública do estado de São Paulo por meio de instrumentos validados. Os dados foram analisados no Statistical Package for Social Sciences, versão 25.0, por meio de regressão linear. Valores de p<0,05 foram considerados significativos. Resultados: Observou-se, predomínio de alto estresse (50,9%), seguido por médio estresse (46,5%), bem como baixa qualidade do sono (99,4%) e presença de sintomas depressivos (100%) entre os discentes de enfermagem avaliados. Os fatores de estresse Gerenciamento do Tempo e ao Ambiente contribuíram significativamente para a redução na qualidade do sono. Já os fatores Gerenciamento do Tempo e a Realização de Atividades Práticas levaram ao aumento da sintomatologia depressiva entre os discentes. Conclusão: Os fatores de estresse estão significativamente associados à sintomatologia depressiva e à qualidade de sono de acadêmicos de enfermagem, que justifica a necessidade de uma revisão nas ações voltadas ao manejo de tais fatores durante a formação acadêmica.

Objective: To analyze the stressors associated with depressive symptoms, sleep quality of nursing students. Method: This is a cross-sectional, analytical and quantitative study, carried out in March 2016 with 159 students from the health area of a public institution in the state of São Paulo using validated instruments. The data were analyzed in the Statistical Package for Social Sciences, version 25.0, using linear regression. Values of p <0.05 were considered significant. Results: There was a predominance of high stress (50.9%), followed by medium stress (46.5%), as well as low quality of sleep (99.4%) and presence of depressive symptoms (100%) among the nursing students evaluated. The stress factors Time Management and the Environment contributed significantly to the reduction in sleep quality. The factors Time Management and Practical Activities led to an increase in depressive symptoms among students. Conclusion: Stress factors are associated with depressive symptoms and the quality of academic nursing sleep, which justifies the need for a review of actions aimed at treating these factors during academic training.

Objetivo: Analizar los factores estresantes asociados a síntomas depresivos, calidad del sueño de estudiantes de enfermería. Método: Se trata de un estudio transversal, analítico y cuantitativo, realizado en marzo de 2016 con 159 estudiantes del área de salud de una institución pública del estado de São Paulo utilizando instrumentos validados. Los datos se analizaron en el paquete estadístico de ciencias sociales, versión 25.0, mediante regresión lineal. Se consideraron significativos valores de p <0,05. Resultados: predominó el estrés alto (50,9%), seguido del estrés medio (46,5%), así como la baja calidad del sueño (99,4%) y la presencia de síntomas depresivos (100%) entre los estudiantes de enfermería evaluados. Los factores de estrés Gestión del tiempo y el medio ambiente contribuyeron significativamente a la reducción de la calidad del sueño. Los factores Gestión del tiempo y Actividades prácticas llevaron a un aumento de los síntomas depresivos entre los estudiantes. Conclusión: Los factores de estrés están asociados a los síntomas depresivos y la calidad del sueño de enfermería académica, lo que justifica la necesidad de una revisión de las acciones dirigidas a tratar estos factores durante la formación académica.

Nível de tolerância nas relações de amizade em profissionais de saúde durante a pandemia da COVID-19 / Tolerance level in friendly relationships among health professionals during the COVID-19 pandemic / Nivel de tolerancia en las relaciones amistosas entre profesionales de la salud durante la pandemia del COVID-19

Objetivo: Analisar o nível de tolerância nas relações de amizade em profissionais de saúde durante a pandemia da COVID-19. Método: Trata-se de um estudo transversal e descritivo, realizado com 979 profissionais de saúde das cinco macrorregiões brasileiras entre junho e julho de 2020. Aplicaram-se via online um questionário sociodemográfico; um questionário semi-estruturado e o Instrumento de Avaliação da tolerância nas relações de amizade. Utilizou-se a estatística descritiva para a análise dos dados que ocorreu no Statistical Package for Social Science, versão 25,0. Resultados: A tolerância de amizade no ambiente domiciliar é considerada satisfatória (92,2%); os amigos ajudaram a superar as tensões vivenciadas durante a quarentena (84,5%); e houve mudança nas relações de amizade desde o início da quarentena (72,5%). Verifica-se predomínio de alta tolerância nas relações de amizade (90,3%) entre os profissionais de saúde. Os profissionais são mais tolerantes nas seguintes situações: "aceitar os defeitos dos amigos; compreender amizade como aceitar a outra pessoa do jeito que ela é; esforçar-se para encontrar algo bom nas pessoas; entender e manter amizades demanda dedicação extrema; e os amigos considerarem o respondente como flexível e tolerante. Conclusão: A tolerância nas relações de amizade entre os profissionais de saúde durante a pandemia de COVID-19 é considerada alta, mesmo frente as mudanças trazidas por ela

Objective: To analyze the level of tolerance in friendship relationships among health professionals during the COVID-19 pandemic. Method: This is a cross-sectional and descriptive study, carried out with 979 health professionals from the five Brazilian macro-regions between June and July 2020. A sociodemographic questionnaire was applied online; a semi-structured questionnaire and the Tolerance Assessment Tool in friendship relationships. Descriptive statistics were used to analyze the data that occurred in the Statistical Package for Social Science, version 25.0. Results: The tolerance of friendship in the home environment is considered satisfactory (92.2%); friends helped to overcome the tensions experienced during the quarantine (84.5%); and there was a change in friendship relations since the beginning of the quarantine (72.5%). There is a predominance of high tolerance in friendship relationships (90.3%) among health professionals. Professionals are more tolerant in the following situations: "accepting the defects of friends; understand friendship how to accept the other person as they are; strive to find something good in people; understanding and maintaining friendships requires extreme dedication; and friends consider the respondent to be flexible and tolerant. Conclusion: Tolerance in friendly relationships among health professionals during the COVID-19 pandemic is considered high despite the changes brought about by it.

Objetivo: Analizar el nivel de tolerancia en las relaciones de amistad entre profesionales de la salud durante la pandemia de COVID-19. Método: Se trata de un estudio transversal y descriptivo, realizado con 979 profesionales de la salud de las cinco macrorregiones brasileñas entre junio y julio de 2020. Se aplicó un cuestionario sociodemográfico en línea; un cuestionario semiestructurado y la Herramienta de Evaluación de la Tolerancia en las relaciones de amistad. Se utilizaron estadísticas descriptivas para analizar los datos que ocurrieron en el Statistical Package for Social Science, versión 25.0. Resultados: La tolerancia de la amistad en el ámbito familiar se considera satisfactoria (92,2%); los amigos ayudaron a superar las tensiones vividas durante la cuarentena (84,5%); y hubo un cambio en las relaciones de amistad desde el inicio de la cuarentena (72,5%). Se verifica un predominio de alta tolerancia en las relaciones de amistad (90,3%) entre los profesionales de la salud. Los profesionales son más tolerantes en las siguientes situaciones: "aceptar los defectos de los amigos; entender la amistad cómo aceptar a la otra persona tal como es; esforzarse por encontrar algo bueno en las personas; comprender y mantener las amistades requiere una dedicación extrema; y los amigos consideran que el encuestado es flexible y tolerante. Conclusión: La tolerancia en las relaciones amistosas entre los profesionales de la salud durante la pandemia de COVID-19 se considera alta, a pesar de los cambios provocados por ella.

Health alterations in nursing students after a year from admission to the undergraduate course.

OBJECTIVE: To identify health alterations in nursing students after a year from admission to a nursing undergraduate course. METHOD: A longitudinal prospective study with a quantitative approach was carried out in 2016 with first-year nursing students from two universities in the state of São Paulo. The following instruments were applied at the beginning and the end of the first school year: an instrument for Assessment of Stress in Nursing Students, the Center for Epidemiologic Studies Depression Scale, and the Pittsburgh Sleep Quality Index. The ANOVA test for mixed models was used for analysis. RESULTS: The sample was made up of 117 students in March and 100 students in December. A significant increase in stress in all dimensions of the instrument, a reduction in the duration and subjective quality of sleep, and an increase in general stress and depressive symptoms were observed. CONCLUSION: The nursing academic environment presents the potential for students to become ill. Institutions should rethink their curricular elements, promote resilience, and create spaces to promote students' health.

Comparison of stress in freshman and senior nursing students.

OBJECTIVE: To compare stress levels in freshman and senior nursing students. METHOD: A cross-sectional study was carried out in a public federal university of the state of Bahia, with students who answered questionnaires about sociodemographic variables, academic life, and a scale for assessing stress in nursing students. Chi-square and Fisher's exact tests were applied to analyze the relationship between variables. To assess proportional trends between ordinal variables and groups, a chi-square test for linear trend was applied. The significance level was 5%. RESULTS: One hundred and fifty-four students participated in the study. There was a tendency to higher stress levels among students in the last year compared to those in the first year, in four out of six domains: Performance of Practical Activities (p=0.00), Professional Communication (p=0.00), Environment (p=0.00) and Professional Education (p=0.00). CONCLUSION: High levels of stress were observed in students taking the last year. There is a need for broader research that includes other years of the course, an institutional reflection on stress factors and the adoption of an institutional policy that favors a better confrontation of stress factors.

Levels of Circulating Fibroblast Growth Factor 23 (FGF23) and Prognosis in Cancer Patients with Bone Metastases.

The fibroblast growth factor (FGF) signaling pathway plays a key role in tumorigenesis and is recognized as a potential therapeutic target. In this study, the authors aimed to assess the impact of serum FGF23 levels in the prognosis of patients with cancer and bone metastases from solid tumors. A cohort of 112 patients with cancer and metastatic bone disease were treated with bone-targeted agents (BTA). Serum baseline FGF23 was quantified by ELISA and dichotomized in FGF23high and FGF23low groups. Additionally, the association between FGF23 and overall survival (OS) and time to skeletal-related events (TTSRE) was investigated. Baseline characteristics were balanced between groups, except for the median urinary N-terminal telopeptide (uNTX) level. After a median follow-up of 26.0 months, a median OS of 34.4 and 12.2 months was found in the FGF23low and FGF23high groups, respectively (multivariate HR 0.18, 95% CI 0.07⁻0.44, p = 0.001; univariate HR 0.27, p = 0.001). Additionally, TTSRE was significantly longer for patients with FGF23low (13.0 vs 2.0 months, p = 0.04). Overall, this study found that patients with FGF23low at baseline had longer OS and TTSRE. Further studies are warranted to define its role as a prognostic biomarker and in the use of drugs targeting the FGF axis.

Health alterations in nursing students after a year from admission to the undergraduate course / Alteraciones de salud en estudiantes de enfermería un año después del ingreso en la carrera universitaria / Alterações de saúde em estudantes de enfermagem um ano depois do ingresso no curso de graduação

ABSTRACT Objective: To identify health alterations in nursing students after a year from admission to a nursing undergraduate course. Method: A longitudinal prospective study with a quantitative approach was carried out in 2016 with first-year nursing students from two universities in the state of São Paulo. The following instruments were applied at the beginning and the end of the first school year: an instrument for Assessment of Stress in Nursing Students, the Center for Epidemiologic Studies Depression Scale, and the Pittsburgh Sleep Quality Index. The ANOVA test for mixed models was used for analysis. Results: The sample was made up of 117 students in March and 100 students in December. A significant increase in stress in all dimensions of the instrument, a reduction in the duration and subjective quality of sleep, and an increase in general stress and depressive symptoms were observed. Conclusion: The nursing academic environment presents the potential for students to become ill. Institutions should rethink their curricular elements, promote resilience, and create spaces to promote students' health.

RESUMEN Objetivo: Identificar las alteraciones de salud en estudiantes de enfermería un año después del ingreso en la carrera universitaria. Método: Investigación longitudinal, prospectiva y cuantitativa, llevada a cabo en 2016 con estudiantes de enfermería del primer año de dos universidades de São Paulo. En el inicio y el fin del año lectivo, se aplicaron: Instrumento para Evaluación del Estrés en Estudiantes de Enfermería, Center for Epidemiologic Studies Depression Scale e Índice de Calidad de Sueño de Pittsburgh. Para el análisis, se utilizó la prueba ANOVA para modelos mixtos. Resultados: Compusieron la muestra 117 estudiantes en marzo y 100 en diciembre. Se verificó aumento significativo del estrés en todos los dominios del instrumento, reducción de la duración y la calidad subjetiva del sueño y aumento del estrés general y de los síntomas depresivos. Conclusión: El entorno académico de enfermería presenta potencial para que el estudiante se enferme. Se sugiere que los centros repiensen sus elementos curriculares, promuevan la resiliencia y creen espacios de promoción a la salud de los estudiantes.

RESUMO Objetivo: Identificar as alterações ocorridas na saúde de estudantes de enfermagem um ano depois do ingresso no curso. Método: Pesquisa longitudinal, prospectiva e quantitativa, realizada em 2016 junto a estudantes de enfermagem do primeiro ano de duas universidades de São Paulo. No início e no final do ano letivo, aplicaram-se: Instrumento para Avaliação do Estresse em Estudantes de Enfermagem, Center for Epidemiologic Studies Depression Scale e Índice de Qualidade de Sono de Pittsburgh. Para a análise, utilizou-se do teste ANOVA para modelos mistos. Resultados: Compuseram a amostra 117 estudantes em março e 100 em dezembro. Verificou-se aumento significativo do estresse em todos os domínios do instrumento, redução da duração e da qualidade subjetiva do sono e aumento do estresse geral e dos sintomas depressivos. Conclusão: O ambiente acadêmico de enfermagem apresenta potencial para o adoecimento do estudante. Sugere-se que as instituições repensem seus elementos curriculares, promovam a resiliência e criem espaços de promoção à saúde dos estudantes.

Comparison of stress in freshman and senior nursing students / Comparación del estrés en universitarios de enfermería de primer año y egresos de la carrera / Comparação do estresse em universitários de enfermagem ingressantes e concluintes do curso

ABSTRACT Objective: To compare stress levels in freshman and senior nursing students. Method: A cross-sectional study was carried out in a public federal university of the state of Bahia, with students who answered questionnaires about sociodemographic variables, academic life, and a scale for assessing stress in nursing students. Chi-square and Fisher's exact tests were applied to analyze the relationship between variables. To assess proportional trends between ordinal variables and groups, a chi-square test for linear trend was applied. The significance level was 5%. Results: One hundred and fifty-four students participated in the study. There was a tendency to higher stress levels among students in the last year compared to those in the first year, in four out of six domains: Performance of Practical Activities (p=0.00), Professional Communication (p=0.00), Environment (p=0.00) and Professional Education (p=0.00). Conclusion: High levels of stress were observed in students taking the last year. There is a need for broader research that includes other years of the course, an institutional reflection on stress factors and the adoption of an institutional policy that favors a better confrontation of stress factors.

RESUMEN Objetivo: Comparar el nivel de estrés de universitarios de enfermería de primer año y egresos de la carrera. Método: Estudio transversal, desarrollado en una universidad pública federal, del Estado de Bahía, con estudiantes que respondieron a cuestionarios acerca de variables sociodemográficas, vida académica y la escala para la Evaluación de Estrés en Estudiantes de Enfermería. Para valorar las relaciones entre las variables, se emplearon las pruebas de Chi cuadrado de Pearson y Exacta de Fisher. A fin de verificar tendencias proporcionales entre variables del tipo ordinal y los grupos, se utilizó la Prueba Chi cuadrado de Tendencia Lineal. El nivel de significación estadística fue del 5%. Resultados: Participaron 154 estudiantes. Hubo tendencia a un mayor nivel de estrés en estudiantes del último año comparados con los del primero, en cuatro de los seis dominios: Realización de las actividades prácticas (p=0,00), Comunicación profesional (p=0,00), Ambiente (p=0,00) y Formación profesional (p=0,00). Conclusión: Se constataron niveles elevados de estrés en el último año. Se subraya la necesidad de ampliación de la investigación a otros años de la carrera, la reflexión institucional acerca de los factores de estrés y la adopción de una política institucional que facilite un mejor enfrentamiento de dichos factores.

RESUMO Objetivo: Comparar o nível de estresse de universitários de enfermagem ingressantes e concluintes do curso. Método: Estudo transversal, desenvolvido em uma universidade pública federal, do estado da Bahia, com estudantes que responderam a questionários sobre variáveis sociodemográficas, vida acadêmica e a escala para Avaliação de Estresse em Estudantes de Enfermagem. Para avaliar as relações entre as variáveis empregaram-se os testes do Qui-quadrado de Pearson e Exato de Fisher. Para verificar tendências proporcionais entre variáveis do tipo ordinal e os grupos utilizou-se do Teste Qui-Quadrado de Tendência Linear. O nível de significância estatística foi de 5%. Resultados: Participaram 154 estudantes. Houve tendência a maior nível de estresse em estudantes do último ano comparados aos do primeiro, em quatro dos seis domínios: Realização das atividades práticas (p=0,00), Comunicação profissional (p=0,00), Ambiente (p=0,00) e Formação profissional (p=0,00). Conclusão: Constatou-se níveis elevados de estresse no último ano. Ressalta-se a necessidade de ampliação da investigação para outros anos do curso, a reflexão institucional sobre os fatores estressores e a adoção de uma política institucional que propicie melhor enfrentamento dos estressores.

Associação da qualidade do sono e perfil acadêmico com o estresse de estudantes de enfermagem / Asociación de la calidad del sueño y del perfil académico con el estrés de los estudiantes de enfermería / Association of sleep quality and academic profile with stress of nursing students

Objetivo avaliar a associação da qualidade do sono e o perfil acadêmico com o nível de estresse entre discentes de enfermagem. Método trata-se de uma pesquisa transversal, analítica, de abordagem quantitativa, realizada com 117 estudantes de enfermagem por meio de um questionário acadêmico de Avaliação do Estresse em Estudantes de Enfermagem e do Índice de Qualidade de Sono Pittsburgh. Os dados foram coletados em 2016. A análise dos dados foi realizada por meio dos testes de Exato de Fischer e t de Student para amostras independentes. Resultados verificou-se predomínio de nível médio de estresse (51,3%), seguido por nível alto de estresse (42,7%) e má qualidade de sono (94,8%). Os discentes que levavam, em média, mais tempo para chegar à instituição de ensino (p=0,001), estudavam mais horas por dia (p=0,014) e realizavam atividades de trabalho (p=0,013), possuíam maior nível de estresse. Houve associação significativa entre estresse acadêmico e qualidade do sono (p<0,0001). Conclusão além dos fatores acadêmicos, os estudantes vivenciavam situações pessoais e sociais que estavam associadas ao nível de estresse apresentado, o qual impactava negativamente na qualidade do sono e podia afetar o processo de aprendizado.

Objetivo evaluar la asociación entre la calidad del sueño y el perfil académico con el nivel de estrés entre los estudiantes de enfermería. Método este es un estudio transversal, analítico, enfoque cuantitativo, realizado con 117 estudiantes de enfermería por medio de un cuestionario para la evaluación del estrés académico en los estudiantes de enfermería y el índice de calidad del sueño de Pittsburgh. Los datos fueron recolectados en 2016. El análisis de los datos se realizó mediante el test exacto de Fisher y la prueba t de Student para muestras independientes. Resultados hubo un predominio del nivel medio de estrés (51,3%), seguido por un alto nivel de estrés (42,7%) y la mala calidad del sueño (94,8%). Los estudiantes que llevaban, en promedio, más tiempo para llegar a la institución de educación (p=0,001), estudian más horas por día (p=0,014) y la realización de las actividades de trabajo (p=0.013), tenían un alto nivel de estrés. Hubo asociación significativa entre el estrés académico y la calidad del sueño (p<0,0001). Conclusión además de los factores académicos, estudiantes y personal experimentado situaciones sociales que estaban asociados con el nivel de estrés, lo cual impactaba negativamente en la calidad del sueño y podría afectar el proceso de aprendizaje.

Objective to evaluate the association between sleep quality and academic profile with the level of stress among nursing students. Method this is a cross-sectional, analytical research, with quantitative approach, performed with 117 nursing students by means of a questionnaire to evaluate academic stress in nursing students and the Pittsburgh Sleep Quality Index. Data were collected in 2016. Data analysis was performed through Fisher's exact test and Student's t-test for independent samples. Results there was a predominance of medium level of stress (51.3%), followed by a high level of stress (42.7%) and poor sleep quality (94.8%). Students who took, on average, more time to reach the institution of education (p=0.001), studying more hours per day (p=0.014) and performing work activities (p=0.013), had a higher level of stress. There was a significant association between academic stress and sleep quality (p<0.0001). Conclusion in addition to the academic factors, students experienced personal and social situations that were associated with the level of stress, which affected negatively the quality of sleep and could affect the learning process.