Perspectives on the diagnosis and management of functional cognitive disorder: An international Delphi study.

BACKGROUND: Current proposed criteria for functional cognitive disorder (FCD) have not been externally validated. We sought to analyse the current perspectives of cognitive specialists in the diagnosis and management of FCD in comparison with neurodegenerative conditions. METHODS: International experts in cognitive disorders were invited to assess seven illustrative clinical vignettes containing history and bedside characteristics alone. Participants assigned a probable diagnosis and selected the appropriate investigation and treatment. Qualitative, quantitative and inter-rater agreement analyses were undertaken. RESULTS: Eighteen diagnostic terminologies were assigned by 45 cognitive experts from 12 countries with a median of 13 years of experience, across the seven scenarios. Accurate discrimination between FCD and neurodegeneration was observed, independently of background and years of experience: 100% of the neurodegenerative vignettes were correctly classified and 75%-88% of the FCD diagnoses were attributed to non-neurodegenerative causes. There was <50% agreement in the terminology used for FCD, in comparison with 87%-92% agreement for neurodegenerative syndromes. Blood tests and neuropsychological evaluation were the leading diagnostic modalities for FCD. Diagnostic communication, psychotherapy and psychiatry referral were the main suggested management strategies in FCD. CONCLUSIONS: Our study demonstrates the feasibility of distinguishing between FCD and neurodegeneration based on relevant patient characteristics and history details. These characteristics need further validation and operationalisation. Heterogeneous labelling and framing pose clinical and research challenges reflecting a lack of agreement in the field. Careful consideration of FCD diagnosis is advised, particularly in the presence of comorbidities. This study informs future research on diagnostic tools and evidence-based interventions.

Age shock index as an early predictor of cardiovascular death in acute coronary syndrome patients.

BACKGROUND: The shock index (SI), reflecting heart rate (HR) to SBP ratio, is established for predicting adverse outcomes in acute coronary syndrome (ACS) patients. Exploring the age shock index (ASI), obtained by multiplying SI with age, could offer further insights into ACS prognosis. OBJECTIVES: Assess ASI's effectiveness in predicting in-hospital death in individuals with ACS. METHODS: This study encompassed patients with acute myocardial infarction, drawn from a national registry spanning October 2010 to January 2022. The optimal ASI threshold was established using receiver operating characteristic (ROC) curve analysis. The primary outcome was in-hospital mortality. RESULTS: A total of 27 312 patients were enrolled, exhibiting a mean age of 66 ±â€…13 years, with 72.3% being male and 47.5% having ST-elevation myocardial infarction. ROC analysis yielded an area under the curve (AUC) of 0.80, identifying the optimal ASI cutoff as 44. Multivariate regression analysis, adjusting for potential confounders, established ASI ≥ 44 as an independent predictor of in-hospital death [hazard ratio: 3.09, 95% confidence interval: 2.56-3.71, P  < 0.001]. Furthermore, ASI emerged as a notably superior predictor of in-hospital death compared to the SI (AUC ASI  = 0.80 vs. AUC SI  = 0.72, P  < 0.0001), though it did not outperform the Global Registry of Acute Coronary Events (GRACE) score (AUC ASI  = 0.80 vs. AUC GRACE  = 0.85, P  < 0.001) or thrombolysis in myocardial infarction (TIMI) risk index (AUC ASI  = 0.80 vs. AUC TIMI  = 0.84, P  < 0.001). CONCLUSION: The ASI offers an expedient mean to promptly identify ACS patients at elevated risk of in-hospital death. Its simplicity and effectiveness could render it a valuable tool for early risk stratification in this population.

Trophic Chain Organochlorine Pesticide Contamination in a Highly Productive Upwelling Area in Southeastern Brazil.

Organochlorine pesticides (OCP) are legacy anthropogenic compounds known to persist for several years in the environment. The continuous use of some OCP, such as DDT, after restrictions in developing countries are cause of concern, due to their deleterious effects to marine life and humans. Studies assessing OCP contamination in coastal environments are still scarce in South America and there is a need to understand the impacts from trophic chain accumulation of these pollutants in marine life. In this study, we have assessed OCP levels in muscle and liver and estimated the biomagnification factor in several upwelling system trophic chain members, including fish, squid, and marine mammal from Southeastern Brazil. DDT degradation product DDE was the OCP detected in the highest concentrations in Franciscana dolphins (Pontoporia blainvillei), 86.4 ng·g-1 wet weight, and fish muscle and liver. In general, higher OCP levels were found in liver than in muscle, except for croaker. Biomagnification factors (BMF) of OCP in the top predator P. blainvillei and the carnivorous cutlass fish (Trichiurus lepturus) were on average between 0.2 and 1.8. Continued OCP monitoring in this region is warranted to better understand the distribution and fate of these compounds over time, with the goal to establish strategies for the conservation of local dolphin species and to assess human health risks from local coastal region populations.

Social inequalities in mental and physical health derived from the COVID-19 pandemic in Spain beyond SARS-CoV-2 infection.

BACKGROUND: Understanding the impact of the COVID-19 crisis on health involves conducting longitudinal studies to evaluate the inequalities that may have been exacerbated by the pandemic. The purpose of this study was to estimate differences in physical and mental health derived from the COVID-19 pandemic, beyond SARS-CoV-2 infection, in the Spanish general population according to the participants' level of education; and to assess the evolution of these differences from June 2020 (just after the lockdown) to nine months later (February-March 2021). METHODS: This is a longitudinal prospective study of a representative sample of non-institutionalized Spanish adults, through computer-assisted telephone interviews. Mobility, self-care, usual activities, pain/discomfort and anxiety/depression problems were measured with EQ-5D-5L. Prevalence ratio (PR) between high and low education levels and adjusted PR were estimated by Poisson regression models. Analyses were stratified by gender. RESULTS: A total of 2,000 participants answered both surveys. Individuals with low level of education reported more health problems in both genders, and absolute inequalities remained quite constant (mobility and self-care problems) or decreased (pain/discomfort and anxiety/depression problems). The greatest relative inequalities were observed just after the lockdown, with age-adjusted PR ranging from 1.31 (95%CI 1.08-1.59) for women and 1.34 (95%CI 1.05-1.69) for men in pain/discomfort to 2.59 (95%CI 0.98-6.81) for women and 4.03 (95%CI 1.52-10.70) for men in self-care; aPR decreased after nine months for most dimensions. CONCLUSIONS: Prevalence of health problems increased during the COVID-19 pandemic in all education groups, but the increase was higher in women and men with a high level of education, suggesting that its impact appeared later in this group. Further analysis on the role of governmental economic aid given to vulnerable people might shed light on this evolution.

Factors shaping the gut microbiome of five species of lizards from different habitats.

Background: Host-gut microbiota interactions are complex and can have a profound impact on the ecology and evolution of both counterparts. Several host traits such as systematics, diet and social behavior, and external factors such as prey availability and local environment are known to influence the composition and diversity of the gut microbiota. Methods: In this study, we investigate the influence of systematics, sex, host size, and locality/habitat on gut microbiota diversity in five lizard species from two different sites in Portugal: Podarcis bocagei and Podarcis lusitanicus, living in syntopy in a rural area in northern Portugal (Moledo); the invasive Podarcis siculus and the native Podarcis virescens, living in sympatry in an urbanized environment (Lisbon); and the invasive Teira dugesii also living in an urban area (Lisbon). We also infer the potential microbial transmission occurring between species living in sympatry and syntopy. To achieve these goals, we use a metabarcoding approach to characterize the bacterial communities from the cloaca of lizards, sequencing the V4 region of the 16S rRNA. Results: Habitat/locality was an important factor explaining differences in gut bacterial composition and structure, with species from urbanized environments having higher bacterial diversity. Host systematics (i.e., species) influenced gut bacterial community structure only in lizards from the urbanized environment. We also detected a significant positive correlation between lizard size and gut bacterial alpha-diversity in the invasive species P. siculus, which could be due to its higher exploratory behavior. Moreover, estimates of bacterial transmission indicate that P. siculus may have acquired a high proportion of local microbiota after its introduction. These findings confirm that a diverse array of host and environmental factors can influence lizards' gut microbiota.

Deep learning based synthetic CT from cone beam CT generation for abdominal paediatric radiotherapy.

Objective. Adaptive radiotherapy workflows require images with the quality of computed tomography (CT) for re-calculation and re-optimisation of radiation doses. In this work we aim to improve the quality of on-board cone beam CT (CBCT) images for dose calculation using deep learning.Approach. We propose a novel framework for CBCT-to-CT synthesis using cycle-consistent Generative Adversarial Networks (cycleGANs). The framework was tailored for paediatric abdominal patients, a challenging application due to the inter-fractional variability in bowel filling and small patient numbers. We introduced to the networks the concept of global residuals only learning and modified the cycleGAN loss function to explicitly promote structural consistency between source and synthetic images. Finally, to compensate for the anatomical variability and address the difficulties in collecting large datasets in the paediatric population, we applied a smart 2D slice selection based on the common field-of-view (abdomen) to our imaging dataset. This acted as a weakly paired data approach that allowed us to take advantage of scans from patients treated for a variety of malignancies (thoracic-abdominal-pelvic) for training purposes. We first optimised the proposed framework and benchmarked its performance on a development dataset. Later, a comprehensive quantitative evaluation was performed on an unseen dataset, which included calculating global image similarity metrics, segmentation-based measures and proton therapy-specific metrics.Main results. We found improved performance for our proposed method, compared to a baseline cycleGAN implementation, on image-similarity metrics such as Mean Absolute Error calculated for a matched virtual CT (55.0 ± 16.6 HU proposed versus 58.9 ± 16.8 HU baseline). There was also a higher level of structural agreement for gastrointestinal gas between source and synthetic images measured using the dice similarity coefficient (0.872 ± 0.053 proposed versus 0.846 ± 0.052 baseline). Differences found in water-equivalent thickness metrics were also smaller for our method (3.3 ± 2.4% proposed versus 3.7 ± 2.8% baseline).Significance. Our findings indicate that our innovations to the cycleGAN framework improved the quality and structure consistency of the synthetic CTs generated.

What Influences the Prevalence and Intensity of Haemoparasites and Ectoparasites in an Insular Lizard?

Island biogeography theories predict that characteristics such as island size, age, and isolation interplay in host-parasite dynamics. In this study, we analyzed haemogregarines of the Aegean wall lizard, Podarcis erhardii, to investigate how island characteristics relate to parasite prevalence and intensity. A previous assessment of 19 Greek island populations suggested that isolation time and host population density were key predictors of haemogregarines. Here, by combining microscopy and genetic techniques, we extend this previous study to four additional islands: Syros, Folegandros, Santorini and Nea Kameni. We also recorded the prevalence of ticks and mites, definitive hosts for these parasites. The genetically identified haemogregarines are part of a clade with parasites from other lizard species, including some considered as Karyolysus, but others assigned to Hepatozoon. The prevalence of these parasites differed significantly between islands, while their intensity did not. The presence of ticks was associated with endoparasite prevalence, and males were more frequently infected by haemogregarines than females. Combining our data with that of the previous study, we found no significant impact of the island age and area on parasite prevalence. We also confirmed the presence of the unrelated parasite genus Schellackia through microscopy and DNA sequencing, which is the first record of this genus in this host species. Our results further highlight the complexity of host-parasite systems.

Dysfunction of norepinephrine and its metabolites in Alzheimer's dementia - A review with meta-analysis.

Some studies point locus coeruleus cell loss, the central nervous system main source of norepinephrine, to be one of the earliest neuropathological events of Alzheimer's disease (AD). However, there are conflicting reports regarding the level of norepinephrine and its metabolites (3-Methoxy-4-hydroxyphenylglycol (MHPG), 3,5-dihydroxyphenylglycine (DHPG) and 3,4 -dihydroxyphenylglycolaldehyde (DOPEGAL)) in AD patients. Uncover these alterations may be a key factor for understanding cognitive deficits and AD pathology. We review the literature that compare norepinephrine and its metabolites between AD patients and non-demented controls. A meta-analysis did not reveal significant statistical differences, but there was a trend towards a lower level of norepinephrine of AD, with almost no difference in MHPG in the cerebrospinal fluid. Regarding MHPG in plasma, DHPG and DOPEGAL we only performed a qualitative analyse due to the small or absent number of studies. These findings point to a decrease in norepinephrine, what is in line with locus coeluleus cell loss in AD. The absence of statistical difference and an equal level of MHGP could indicate a compensatory mechanism.

Avaliação do Journal Club como estratégia pedagógica na formação em enfermagem: Perspetiva dos estudantes / Evaluation of the Journal Club as a pedagogical strategy in nursing education: Students' perceptions / Evaluación del Journal Club como estrategia pedagógica en la enseñanza de enfermería: Perspectiva de los estudiantes

Resumo Enquadramento: O Journal Club (JC) é definido como uma reunião educacional na qual, em ambiente informal, se proporciona um fórum de discussão que aproxima consensos, fomenta a partilha e a transferência de conhecimentos, incorporando a evidência científica na prática clínica. Objetivos: Conhecer a perceção dos estudantes de enfermagem sobre a utilização do JC como estratégia pedagógica ao longo do ensino clínico. Metodologia: Trata-se de um estudo descritivo e exploratório, com uma abordagem mista no que diz respeito ao tratamento dos dados. O questionário foi construído e disponibilizado online e contou com a participação de 55 estudantes. Resultados: Os estudantes fizeram uma avaliação positiva desta estratégia de ensino aprendizagem. Como principais vantagens identificaram a aproximação da prática à evidência científica e o desenvolvimento de habilidades de avaliação crítica dos artigos. Como desvantagem apontam a exigência de habilidades de pesquisa entre outras. Conclusão: O JC revelou-se uma estratégia gratificante e promissora na medida que se adequa aos vários desafios que a formação de enfermeiros enfrenta, nomeadamente na integração da evidência científica na prática clínica, no desenvolvimento de habilidades de pesquisa e na síntese da evidência.

Abstract Background: The Journal Club (JC) is defined as an informal educational meeting providing a forum of discussion that seeks consensus and promotes knowledge sharing and transfer while translating scientific evidence into clinical practice. Objectives: To explore nursing students' perceptions of the JC as a pedagogical strategy in Clinical Teaching. Methodology: Descriptive and exploratory study with a mixed-methods approach to data analysis. The sample consisted of 55 students. The questionnaire was designed and made available online. Results: Students made a positive assessment of this teaching-learning strategy. As main advantages, they identified the possibility of bringing clinical practice closer to scientific evidence and developing critical appraisal skills. One of the disadvantages was the requirement of search skills. Conclusion: The JC proved to be a rewarding and promising strategy because it adapts to the various challenges of nurses' training, namely the translation of scientific evidence into clinical practice, the development of search skills, and the synthesis of evidence.

Resumen Marco contextual: El Journal Club (JC) se define como una reunión educativa en la que, en un entorno informal, se proporciona un foro de debate que aproxima consensos, fomenta el intercambio y la transferencia de conocimientos, e incorpora la evidencia científica a la práctica clínica. Objetivos: Conocer la percepción de los estudiantes de enfermería sobre el uso del JC como estrategia pedagógica a lo largo de la enseñanza clínica. Metodología: Se trata de un estudio descriptivo y exploratorio, con un enfoque mixto en cuanto al tratamiento de los datos. El cuestionario fue diseñado y puesto a disposición en línea, y contó con la participación de 55 estudiantes. Resultados: Los alumnos hicieron una valoración positiva de esta estrategia de enseñanza-aprendizaje. Como principales ventajas identificaron la aproximación de la práctica a la evidencia científica y el desarrollo de habilidades de evaluación crítica de los artículos. Como desventaja señalan la exigencia de habilidades de investigación, entre otras. Conclusión: El JC demostró ser una estrategia gratificante y prometedora, ya que se ajusta a los diversos retos a los que se enfrenta la formación de los enfermeros, a saber, la integración de la evidencia científica en la práctica clínica, el desarrollo de habilidades de investigación y la síntesis de la evidencia.

Telehealth Adoption in an Outpatient Oncology Ward: A Best Practice Implementation Project.

Telehealth is increasingly taking place to support the transition of care and self-management of people living with cancer in outpatient oncology settings. Despite its recognised value, the scientific evidence points to disparities with regard to implementation of telehealth that might compromise the equity of access. Following the Joanna Briggs Institute (JBI) implementation approach, this project aims to promote the implementation of best practice recommendations for telehealth adoption in an outpatient oncology setting. Assisted by the Practical Application of Clinical Evidence System (PACES), the implementation process comprises three phases of (i) a baseline audit, (ii) feedback to the healthcare team and establishment of implementation strategies with the Getting Research into Practice (GRiP) tool, and (iii) a follow-up audit. The project is expected to allow the identification of barriers and facilitators for the implementation of telehealth in outpatient oncology and develop a strategy plan for its adoption, with the involvement of end-users and stakeholders. The successful adoption of telehealth according to the best available evidence will likely enhance equity of access to healthcare and quality of care at a distance.

Blood parasite diversity (Apicomplexa: Haemogregarinidae) within the western populations of the European pond turtle Emys orbicularis.

Molecular tools have revolutionized assessments of blood parasites in freshwater turtles. In the Iberian Peninsula and North Africa, two native species of terrapins occur, Emys orbicularis (Linnaeus) and Mauremys leprosa (Schweigger). Both have been identified as hosts for the blood parasite Haemogregarina stepanowi Danilewsky, 1885, which has also been found in related species. However, recent assessments of M. leprosa have identified several distinct genetic lineages of these parasites in this host, while only three haemogregarine lineages were identified in E. orbicularis in Tunisia. Here, we screened 215 individuals of E. orbicularis from the Iberian Peninsula, Menorca Island and Morocco for haemogregarine parasites using partial 18S rRNA gene sequences to estimate relationships. Three unrelated lineages of parasites were detected, one presumed H. stepanowi and two lineages previously known from M. leprosa. A considerable undescribed diversity of parasites exists within these vertebrate host species, while mixed infection and host-sharing is also widespread. Considering that E. orbicularis is near threatened in this region, it is of great importance to identify the parasites infecting it, and to further assess the potential deleterious impact of these diverse parasites on their hosts.

A prática centrada na pessoa: da idiossincrasia do cuidar à inovação em saúde / La práctica centrada en la persona: de la idiosincrasia del cuidado a la innovación en salud / Person-centered practice: from idiosyncrasy of care to health innovation

A prática centrada na pessoa assume um papel preponderante na organização e gestão de sistemas de saúde, bem como na definição de políticas de saúde. Este ensaio teve como objetivo identificar os princípios éticos e estruturas teóricas da prática centrada na pessoa, assim como as diretrizes portuguesas e europeias que sirvam a sua regulamentação. Foi conduzida uma reflexão teórica ancorada na revisão narrativa crítica do estado da arte sobre a prática centrada na pessoa, que visou responder à questão: quais os elementos estruturantes da prática de cuidados centrados na pessoa que a tornam diferenciadora na obtenção de ganhos em saúde? A reflexão crítica contextualiza a mudança de paradigma para a prática centrada na pessoa e identifica os domínios do estado da arte que lhe estão associados: conhecimento filosófico, referenciais teóricos para a prática clínica, ensino e investigação, abordagens para a implementação, e regulamentação. Esses domínios terão de ser necessariamente contemplados para um desenvolvimento e implementação sistemáticos e sustentáveis com efetiva tradução em ganhos em saúde.

La práctica centrada en la persona tiene un papel preponderante en la organización y gestión de sistemas de salud, así como en la definición de políticas de salud. Este ensayo tuvo como objetivo identificar los principios éticos y las estructuras teóricas de la práctica centrada en la persona, así como las instrucciones nacionales portuguesas y europeas que están basadas en su regulación. Se realizó una reflexión teórica con base en una revisión narrativa crítica del estado del arte sobre la práctica centrada en la persona, que buscó responder a la pregunta: ¿Cuáles son los elementos estructurantes de la práctica de cuidados centrados en la persona que la hacen diferenciadora en la obtención de beneficios para la salud? La reflexión crítica contextualiza el cambio de paradigma para la práctica centrada en la persona e identifica los dominios del estado del arte asociados con ella: conocimiento filosófico, marcos teóricos a la práctica clínica, enseñanza e investigación, enfoques de implementación y reglamentación. Estos dominios necesariamente deberán ser contemplados para el desarrollo e implementación sistemático y sostenible que resulte en efectivos beneficios para la salud.

Person-centered practice plays a significant role in the organization and management of health systems, as well as in the definition of health policies. This essay aimed to identify the ethical principles and theoretical structures of a person-centered practice, as well as the Portuguese and European national guidelines establish its regulation. A theoretical reflection was conducted based on the critical narrative review of the state of the art on person-centered practice, which aimed to answer the question: what are the structuring elements of the person-centered care practice that make it distinguished in obtaining health gains? Critical reflection contextualizes the paradigm shift to a person-centered practice and identifies the state-of-the-art domains associated with it: philosophical knowledge, theoretical frameworks for clinical practice, teaching and research, approaches to implementation, and regulation. These areas will necessarily have to be considered for a systematic and sustainable development and implementation with effective transformation into health gains.

Cuidados de enfermagem omissos num contexto hospitalar português: perceção dos enfermeiros sobre estratégias minimizadoras / Missed nursing care in a Portuguese hospital: nurses' perceptions of minimizing strategies / Cuidados de enfermería omitidos en un entorno hospitalario portugués: percepción de los enfermeros sobre estrategias minimizadoras

Resumo Enquadramento: Os cuidados de enfermagem omissos (CEO) são uma problemática existente nos contextos da prática clínica. O conhecimento contextual das razões subjacentes a esta problemática convida os gestores a implementar diretrizes minimizadoras de CEO, redesenhando as práticas dos enfermeiros. Objetivos: Identificar estratégias percecionadas pelos enfermeiros de um hospital de oncologia como minimizadoras de CEO. Metodologia: Estudo exploratório, descritivo, transversal de natureza qualitativa assente em pressupostos do estudo caso. Amostra de meio, constituída por 10 enfermeiros das especialidades médicas de um hospital oncológico, com aplicação de entrevista semiestruturada, entre setembro e outubro de 2018. Obtido consentimento informado dos participantes. Resultados: Os participantes identificaram como ferramentas passíveis de minimizar os CEO e melhorar a qualidade dos cuidados de enfermagem a Conscientização do erro, a Formação, a Comunicação, a Adequação de recursos e a Mudança da cultura organizacional. Conclusão: Os CEO comprometem a qualidade do atendimento e aumentam a vulnerabilidade dos doentes. A adoção das estratégias identificadas poderá constituir uma mais-valia para a organização estudada e melhorar a qualidade dos cuidados prestados.

Abstract Background: Missed nursing care (MNC) is a problematic issue in clinical settings. The contextual knowledge of the reasons underlying it calls for managers to implement guidelines for minimizing MNC and redesigning nurses' practices. Objectives: To identify strategies perceived by the nurses in an oncology hospital to minimize MNC. Methodology: Exploratory, descriptive, cross-sectional study with a qualitative approach based on case study assumptions. Environmental sample composed of 10 nurses from the medical specialties of an oncology hospital. Semi-structured interviews were applied from September to October 2018. All participants gave their informed consent. Results: Nurses identified the following strategies to minimize MNC and improve the quality of nursing care: Error awareness, Training, Communication, Adequacy of resources, and Change in the organizational culture. Conclusion: MNC compromises the quality of care and increase patient vulnerability. Adopting the identified strategies can benefit the organization studied and improve the quality of care.

Resumen Marco contextual: Los cuidados de enfermería omitidos (CEO) son una problemática que se da en los contextos de la práctica clínica. El conocimiento contextual de las razones que subyacen a esta problemática invita a los gestores a implementar directrices minimizadoras de CEO, mediante el rediseño de las prácticas de los enfermeros. Objetivos: Identificar estrategias percibidas por los enfermeros de un hospital de oncología como minimizadoras de CEO. Metodología: Estudio exploratorio, descriptivo, transversal, de naturaleza cualitativa basado en los presupuestos del estudio de caso. Muestra de medio constituida por 10 enfermeros de las especialidades médicas de un hospital oncológico, se aplicó la entrevista semiestructurada entre septiembre y octubre de 2018. Se obtuvo el consentimiento informado de los participantes. Resultados: Los participantes identificaron como herramientas capaces de minimizar los CEO y mejorar la calidad de los cuidados de enfermería la Conciencia del error, la Formación, la Comunicación, la Adecuación de recursos y el Cambio de la cultura organizativa. Conclusión: Los CEO comprometen la calidad de la atención y aumentan la vulnerabilidad de los pacientes. La adopción de las estrategias identificadas podrá constituir un valor añadido para la organización estudiada y mejorar la calidad de la atención prestada.

Invasive lizard has fewer parasites than native congener.

Invasive species can carry parasites to introduced locations, which may be key to understand the success or failure of species establishment and the invasive potential of introduced species. We compared the prevalence and infection levels of haemogregarine blood parasites between two sympatric congeneric species in Lisbon, Portugal: the invasive Italian wall lizard (Podarcis siculus) and the native green Iberian wall lizard (Podarcis virescens). The two species had significant differences in their infection levels: while P. virescens had high prevalence of infection (69.0%), only one individual of P. siculus was infected (3.7%), and while P. virescens exhibited an average intensity of 1.36%, the infected P. siculus individual had an infection rate of only 0.04%. Genetic analyses of 18S rRNA identified two different haemogregarine haplotypes in P. virescens. Due to the low levels of infection, we were not able to amplify parasite DNA from the infected P. siculus individual, although it was morphologically similar to those found in P. virescens. Since other studies also reported low levels of parasites in P. siculus, we hypothesize that this general lack of parasites could be one of the factors contributing to its competitive advantage over native lizard species and introduction success.

A novel receptor for platelet-activating factor and lysophosphatidylcholine in Trypanosoma cruzi.

The lipid mediators, platelet-activating factor (PAF) and lysophosphatidylcholine (LPC), play relevant pathophysiological roles in Trypanosoma cruzi infection. Several species of LPC, including C18:1 LPC, which mimics the effects of PAF, are synthesized by T. cruzi. The present study identified a receptor in T. cruzi, which was predicted to bind to PAF, and found it to be homologous to members of the progestin and adiponectin family of receptors (PAQRs). We constructed a three-dimensional model of the T. cruzi PAQR (TcPAQR) and performed molecular docking to predict the interactions of the TcPAQR model with C16:0 PAF and C18:1 LPC. We knocked out T. cruzi PAQR (TcPAQR) gene and confirmed the identity of the expressed protein through immunoblotting and immunofluorescence assays using an anti-human PAQR antibody. Wild-type and knockout (KO) parasites were also used to investigate the in vitro cell differentiation and interactions with peritoneal mouse macrophages; TcPAQR KO parasites were unable to react to C16:0 PAF or C18:1 LPC. Our data are highly suggestive that PAF and LPC act through TcPAQR in T. cruzi, triggering its cellular differentiation and ability to infect macrophages.

Características de los pacientes con asma severa y de difícil control asistidos en el Servicio de Neumología Pediátrica del Centro Hospitalario Pereira Rossell / Characteristics of patients with severe and difficult-to-control asthma assisted at the Pediatric Pneumology Department of the Pereira Rossell Children Hospital Center / Características dos pacientes com asma grave e de difícil controle atendidos no Serviço de Pneumologia Pediátrica do Centro Hospitalar Pereira Rossell

Resumen: Introducción: el asma es la patología respiratoria crónica más frecuente en la edad pediátrica. El asma severa representa menos del 5% de todos los casos de asma en la infancia. Este grupo representa una gran carga de morbilidad, costos sanitarios e incluso mortalidad. Objetivos: Analizar las características clínicas, funcionales, y comorbilidades de pacientes con asma severa y de difícil control. Material y métodos: estudio descriptivo, analítico, retrospectivo y transversal de los pacientes con asma severa y de difícil control, atendidos en el Centro Hospitalario Pereira Rossell, entre el 1/1/2019 y el 1/1/2020. Criterios de inclusión: niños y adolescentes con edades comprendidas entre 5 -15 años con diagnóstico de asma severa y de difícil control. Resultados: se incluyeron 15 pacientes (9 sexo femenino). La media de edad fue de 10,4 años. En todos los pacientes el inicio de los síntomas fue temprano, en la edad preescolar. Presentaron antecedentes de asma en familiares de primer grado 8/15. Se encontró exposición domiciliaria a tabaco en 8/15 de las historias analizadas. La adherencia al tratamiento fue correcta en 6/15 de los pacientes, mientras que se registró una técnica inhalatoria adecuada en 11/15 de los casos. De las comorbilidades evaluadas la rinitis alérgica se presentó en 12/15 y la obesidad en 3/15. Conclusiones: el asma severa en el periodo analizado correspondió a 3,8% del total de consultas por asma. La mayoría de los pacientes (11/15) presentaron asma de difícil control, debido a factores subyacentes modificables o reversibles que impiden el control del asma.

Summary: Introduction: asthma is the most frequent chronic respiratory disease in children. Severe asthma accounts for less than 5% of all pediatric asthma cases, and shows high morbidity rates, healthcare costs, and even mortality. Objectives: to analyze the clinical and functional characteristics, and comorbidities of patients with severe asthma. Material and methods: descriptive, analytical, retrospective, and transversal study on patients with severe asthma, treated at Pereira Rossell Children Hospital Center between 1/1/2019 and 1/1/2020. Inclusion criteria: children and adolescents of between 5 and 15 years of age with a diagnosis of severe and difficult-to-treat asthma. Results: 15 patients included, 9 females, with a mean age of 10.4 years. All patients showed an early onset of symptoms, beginning at preschool age. 8/15 patients' first-degree relatives had a record of asthma. Tobacco exposure was present in 8/15. Adherence was correct in 6/15. The inhalation technique was adequate in 11/15. Allergic rhinitis was the most frequent comorbidity assessed, present in 12 out of 15 cases, while obesity was present in 3 out of 15 cases. Conclusions: in the period analyzed, severe asthma accounts for 3.8% of all asthma cases. Most were difficult-to-treat asthma cases (11/15) due to underlying modifiable or reversible factors that prevent asthma control.

Resumo: Introdução: a asma é a doença respiratória crônica mais frequente na idade pediátrica. A asma grave é responsável por menos de 5% de todos os casos de asma na infância. Este grupo de casos representa uma grande carga de morbidade, custos de saúde e até mortalidade. Objetivos: analisar as características clínicas, funcionais e as comorbidades de pacientes com asma grave e de difícil controle. Material e métodos: estudo descritivo, analítico, retrospectivo e transversal de pacientes com asma grave e de difícil controle, atendidos no Centro Hospitalar Pereira Rossell, entre 01/01/2019 e 01/01/2020. Critérios de inclusão: crianças e adolescentes de 5 a 15 anos de idade com diagnóstico de asma grave e de difícil controle. Resultados: foram incluídos 15 pacientes (9 do sexo feminino). A média de idade foi de 10,4 anos. Em todos os pacientes o início dos sintomas foi precoce, na idade pré-escolar. 8/15 tinham história de asma em parentes de primeiro grau. Encontramos exposição domiciliar ao tabaco em 8/15 das histórias analisadas. A adesão ao tratamento foi correta em 6/15 dos pacientes, enquanto a técnica inalatória adequada registrou-se em 11/15 dos casos. Das comorbidades avaliadas, a rinite alérgica apareceu em 12/15 e a obesidade em 3/15 dos casos. Conclusões: asma grave no período analisado correspondeu a 3,8% do total de consultas por asma. A maioria dos pacientes (11/15) teve asma de difícil controle, devido a fatores subjacentes modificáveis ou reversíveis que impedem o controle da asma.

Cuidados de enfermagem omissos em oncologia: explorar o problema de um contexto português / Missed nursing care in oncology: exploring the problem of a Portuguese context / Cuidados de enfermería omitidos en oncología: explorando el problema en un contexto portugués

Resumo Enquadramento: Os cuidados de enfermagem omissos (CEO) comprometem a qualidade dos cuidados prestados e a segurança do doente. O conhecimento contextual das razões subjacentes aos CEO permite redesenhar as práticas dos enfermeiros e melhorar a satisfação dos intervenientes no processo de cuidar. Objetivo: Identificar as razões percecionadas pelos enfermeiros de um hospital de oncologia como promotoras de CEO. Metodologia: Estudo exploratório, descritivo, transversal de natureza qualitativa assente em pressupostos do estudo caso. Amostra de meio, constituída por 10 enfermeiros com aplicação de entrevista semiestruturada. Foram cumpridos os pressupostos éticos. Resultados: As razões identificadas para a ocorrência de CEO relacionaram-se com o contexto - Escassez de recursos e a Cultura organizacional - e com o enfermeiro -Negligência/desvalorização, o Dolo e as Crenças. Conclusão: Com o conhecimento produzido, podem-se implementar diretrizes específicas minimizadoras de CEO direcionadas às razões identificadas e consequentemente garantir a melhoria da qualidade dos cuidados prestados.

Abstract Background: Missed nursing care (MNC) compromises health care quality and patient safety. The contextual knowledge of the reasons for MNC allows redesigning nurses' practices and improving the satisfaction of those involved in the care process. Objective: To identify the reasons for MNC perceived by nurses of an oncology hospital. Methodology: Exploratory, descriptive, cross-sectional study with a qualitative approach based on assumptions of the case study research. The sample consisting of 10 nurses with application of semi-structured interviews. All ethical assumptions were met. Results: The reasons for MNC were associated with the context - Scarcity of resources and Organizational culture - and the nurse - Negligence/devaluation, Willful misconduct, and Beliefs. Conclusion: The knowledge produced can contribute to the implementation of specific guidelines directed at the identified reasons for reducing MNC and, consequently, improving health care quality.

Resumen Marco contextual: Los cuidados de enfermería omitidos (CEO) comprometen la calidad de los cuidados y la seguridad del paciente. El conocimiento contextual de las razones que subyacen a los CEO permite rediseñar las prácticas de los enfermeros y mejorar la satisfacción de los implicados en el proceso de atención. Objetivo: Identificar las razones percibidas por los enfermeros de un hospital oncológico como promotoras de CEO. Metodología: Estudio exploratorio, descriptivo, transversal, de naturaleza cualitativa, basado en la hipótesis del estudio de casos. Se utilizó una muestra de 10 enfermeros y se aplicó la entrevista semiestructurada. Se cumplieron todos los presupuestos éticos. Resultados: Las razones identificadas por las que ocurren los CEO estaban relacionadas con el contexto -Escasez de recursos y Cultura organizativa- y con el enfermero -Negligencia/desvalorización, Duelo y Creencias. Conclusión: Con los conocimientos producidos se pueden implementar directrices específicas para minimizar los CEO, dirigidas a las razones identificadas y, en consecuencia, garantizar la mejora de la calidad de los cuidados prestados.

Intimate Relationships as Perceived by Adolescents: Concepts and Meanings.

Adolescence is a period of great changes and the assumption of risk behaviours at the level of sexuality may have implications for health and well-being. Nowadays, adolescents live free from constraints and prioritise freedom, using their own terminology to label their relationships, it becoming in turn important to conceptualise intimacy relationships from their perspective. Therefore, a qualitative, descriptive, and exploratory study was performed. Participants included 109 adolescents aged 14 and 18 years old from public schools in central Portugal. Data were collected using 12 focus groups and a content analysis was undertaken. These terms attributed to intimate relationships by adolescents are, for the most part, mutual for both genders: crush, friendzone, friends with benefits, making out, dating, and similar in terms of meaning. In an intimate relationship, adolescents give priority to factors such as respect, trust, and love. The fear of loneliness, obsession, and low self-esteem are reasons pointed out by adolescents for maintaining an unhealthy intimate relationship. Adolescents' knowledge of language about their intimate relationships is essential to establish effective communication and to build intervention programs in the healthy intimacy relationships field.

Cuidados de enfermagem omissos: perceção de enfermeiros de um hospital de oncologia português / Missed nursing care: perception of nurses from a Portuguese oncology hospital / Cuidados de enfermería omitidos: percepción de los enfermeros en un hospital de oncología portugués

Resumo Enquadramento: Os cuidados de enfermagem, deixados por fazer ou adiados, comprometem a segurança do doente. A prevenção de cuidados de enfermagem omissos (CEO) constitui um dos desafios da atualidade. Objetivos: Identificar os CEO percecionados pelos enfermeiros de um hospital de oncologia. Metodologia: Estudo descritivo de natureza qualitativa assente em pressupostos do estudo caso. A amostra foi constituída por 10 enfermeiros com aplicação de entrevista semiestruturada. Obtido consentimento informado dos participantes. Resultados: Apurou-se como categoria central: CEO, constituída pelas subcategorias, definição, impacto e tipologia. Para os participantes, a definição da problemática acarreta implicações para os diferentes agentes de cuidado causando impacto no doente/família, no enfermeiro e na profissão. Quanto à tipologia, foram reportados como omissos os cuidados relacionados com a dimensão afetiva/relacional do cuidar, componente técnica, atividades interdependentes e de suporte à prestação de cuidados. Conclusão: Obteve-se um conhecimento contextual desta problemática, tornando-se relevante a investigação sobre as razões subjacentes à omissão destes cuidados por forma a que se redesenhem as práticas dos enfermeiros.

Abstract Background: Delayed or unfinished care compromise patient safety. Prevention of missed nursing care (MNC) is one of today's challenges. Objective: To identify MNC perceived by the nurses of an oncology hospital. Methodology: Qualitative descriptive study based on some assumptions of case studies. The sample consisted of 10 nurses. Data were collected through semi-structured interviews after receiving the participants' informed consent. Results: The main category was MNC, and the subcategories were definition, impact, and typology. The participants considered that the definition of this issue has consequences for the several care agents, impacting the patient/family, the nurse, and the profession. Regarding typology, the care related to the affective/relational dimension of caring, the technical component, the interdependent activities, and the healthcare delivery support activities were reported as missed care. Conclusion: This study provided a contextual knowledge of this issue that justified the importance of understanding the reasons for the omission of these aspects of care to redesign nurses' practices.

Resumen Marco contextual: Los cuidados de enfermería, dejados por hacer o pospuestos, comprometen la seguridad del paciente. La prevención de los cuidados de enfermería omitidos (CEO) constituye uno de los desafíos actuales. Objetivos: Identificar los CEO percibidos por los enfermeros de un hospital de oncología. Metodología: Estudio descriptivo de naturaleza cualitativa basado en los presupuestos de los estudios de caso. La muestra consistió en 10 enfermeros y se utilizó la entrevista semiestructurada. Se obtuvo el consentimiento informado de los participantes. Resultados: Como categoría central se constató CEO, constituida por las subcategorías definición, impacto y tipología. Para los participantes, la definición de la problemática conlleva implicaciones para los diferentes agentes de cuidado, que repercuten en el paciente/la familia, en el enfermero y en la profesión. En cuanto a la tipología, se indicó como omitidos los cuidados relacionados con la dimensión afectiva/relacional del cuidado, el componente técnico y las actividades de cuidados interdependientes y de apoyo a la prestación de cuidados. Conclusión: Se obtuvo un conocimiento contextual de esta problemática y la investigación de las razones subyacentes a la omisión de estos cuidados se hizo relevante para rediseñar las prácticas de los enfermeros.