Diagnostic accuracy and the first genotype-phenotype correlation in glycogen storage disease type V.

BACKGROUND: Glycogen storage disease type V (GSDV) is an autosomal recessive metabolic condition caused by pathogenic PYGM variants. This is an underdiagnosed condition as it presents with exercise intolerance in children. We reviewed the GSDV cases of a tertiary hospital center to assess diagnostic timing/accuracy, as well as potential clinical/analytical predictors of such factors. METHODS: We retrospectively reviewed all GSDV cases with follow-up in both Pediatric and Adult Metabolic Diseases consultations. We included 28 cases and assessed their hospital record for clinical information. RESULTS: Over 90% of our cases had late diagnoses, with more than 50% being diagnosed in adulthood despite symptom onset in preschool (very late diagnosis). Diagnostic age was lower in patients exhibiting myoglobinuria. Interestingly, patients with a positive family history of GSDV had similar rates of very late diagnoses, likely since the index case was already detected very late in life. Finally, we observe that the R50* variant is associated with increased myoglobinuria and CK elevation, in a dosage-dependent manner. CONCLUSION: We concluded that GSDV is severely underdiagnosed, and that some clinical and analytical aspects of the condition can be more indicative of this diagnosis. Furthermore, we propose for the first time a genotype-phenotype correlation in GSDV. IMPACT: GSDV is a pediatric-onset metabolic disorder that is mostly diagnosed late in the adult age and commonly misdiagnosed. We observed the first genotype-phenotype correlation in GSDV, regarding the common R50* variant. Awareness of GSDV for pediatricians and the overall medical community is vital.

Stent for life initiative in Portugal: Progress through years and Covid-19 impact.

BACKGROUND: During Stent for Life Initiative in Portugal lifetime, positive changes in ST elevation myocardial infarction treatment were observed, by the increase of Primary Angioplasty numbers and improvements in patients' behaviour towards myocardial infarction, with an increase in those who called 112 and the lower proportion attending non primary percutaneous coronary intervention centres. Despite public awareness campaigns and system educational programmes, patient and system delay did not change significantly over this period. The aim of this study was to address the public awareness campaign effectiveness on peoples' behaviour facing STEMI, and how Covid-19 has affected STEMI treatment. METHODS: Data from 1381 STEMI patients were collected during a one-month period each year, from 2011 to 2016, and during one and a half month, matching first lockdown in Portugal 2020. Four groups were constituted: Group A (2011); Group B (2012&2013); Group C (2015&2016) and group D (2020). RESULTS: The proportion of patients who called 112, increased significantly (35.2% Group A; 38.7% Group B; 44.0% Group C and 49.6% Group D, p = 0.005); significant reduction was observed in the proportion of patients who attended healthcare centres without PPCI (54.5% group A; 47.6% Group B; 43.2% Group C and 40.9% Group D, p = 0.016), but there were no differences on groups comparison. Total ischemic time, measured from symptoms onset to reperfusion increased progressively from group A [250.0 (178.0-430.0)] to D [296.0 (201.0-457.5.8)] p = 0.012, with statistically significant difference between group C and D (p = 0.034). CONCLUSIONS: During the term of SFL initiative in Portugal, patients resorted less to primary health centres and called more to 112. These results can be attributed the public awareness campaign. Nevertheless, patient and system delays did not significantly change over this period, mainly in late years of SFL, probably for low efficacy of campaigns and in 2020 due to Covid-19 pandemic.

Clinical and Laboratory Findings on Glycogen Storage Disease Type V: Results from a Retrospective Observational Study in a Tertiary Hospital.

Introduction - Glycogen storage disease type V (GSDV, MIM #232600) is an autosomal recessive metabolic myopathy caused by pathogenic variants in the PYGM gene. The characteristic symptoms of exercise intolerance, myalgia, and cramps, which improve after a few minutes of rest, are frequently unrecognized in affected children. When there is clinical suspicion, the initial approach with a forearm exercise test has diagnostic value by detecting low post-exercise plasma lactate-to-ammonia ratio values. The diagnostic algorithm is followed by genetic testing if the results suggest myophosphorylase deficiency. Methods - This was a retrospective observational study conducted based on reviewing medical records of patients with GSDV in a tertiary hospital. We assessed demographic variables, including the timing of onset and diagnosis, relevant clinical characteristics, and whether genetic testing was performed, including its results. Results/Case Report - Our goal was to review the GSDV cases in our center to assess our cohort's diagnostic timing and clinical and genetic characteristics. We identified 28 patients from 24 families, three with consanguinity. The mean age at the time of the study was 43 years. While most (26/28; 93%) recalled their first symptoms in childhood/adolescence, only 25% (7/28) were diagnosed then. All patients had exercise intolerance and CK elevation, while about half reported the second wind phenomenon. Genetic testing was performed in 22 patients, revealing biallelic PYGM variants (9 homozygous, 13 compound heterozygous) as the most common (p.R50*). Conclusion - GSDV is rare and presents in the pediatric age, with subtle manifestations often underestimated for decades. A late diagnosis may negatively impact the psychosocial development of affected children. It is essential to recognize some unique features that facilitate diagnosis: history of exercise intolerance, the second wind sign, and high resting serum CK levels. Identifying the disease-causing variants in PYGM is currently the gold standard for diagnosis as it is less invasive than performing a muscle biopsy, and may promptly diagnose the condition and avoid wrongful labelling of patients.

An SPG7 mutation as a novel cause of monogenic progressive muscular atrophy.

BACKGROUND: Progressive muscular atrophy (PMA) is a rare adult-onset neurological disease that is characterized by isolated lower motor neuron degeneration. While it is still disputable whether PMA is a subtype of amyotrophic lateral sclerosis (ALS) or an isolated disorder, it is well-established as a clinically defined entity. About 5% of PMA cases are monogenic, and the implicated genes largely overlap with those causing monogenic ALS. CASE DESCRIPTION: Here we describe a 68-year-old female patient with progressive and asymmetric upper-limb weakness throughout an 18-month period, with muscle atrophy, dysphagia and slurring of speech. The lower limbs were unaffected, and there was no sign of upper motor neuron dysfunction. Comprehensive genetic testing for single nucleotide and copy-number variants revealed a pathogenic monoallelic variant c.1529C>T, p.(Ala510Val) in the SPG7 gene. DISCUSSION: Pathogenic biallelic SPG7 variants have been originally associated with hereditary spastic paraplegia, but other phenotypes are nowadays known to be linked to these variants, such as ALS. However, there is no report of this (or any) other SPG7 variant in association with PMA, whether it progressed to ALS or not. In conclusion, we present the first known case of PMA associated with a monoallelic SPG7 mutation.

Effects of maternal methionine supplementation on the response of Japanese quail (Coturnix coturnix japonica) chicks to heat stress.

This study investigated the hypothesis that methionine supplementation of Japanese quail (Coturnix coturnix japonica) hens can reduce the effects of oxidative stress and improve the performance of the offspring exposed to heat stress during growth. For that, the quail hens were fed with three diets related to the methionine supplementation: methionine-deficient diet (Md); diet supplemented with the recommended methionine level (Met1); and diet supplemented with methionine above the recommended level (Met2). Their chicks were identified, weighed, and housed according to the maternal diet group from 1 to 14 d of age. On 15 d of age, chicks were weighed and divided into two groups: thermoneutral ambient (constant temperature of 23 °C) and intermittent heat stress ambient (daily exposure to 34 °C for 6 h). Methionine-supplemented (Met1 and Met2) hens had higher egg production, better feed conversion ratio, higher hatchability of total and fertile eggs, and offspring with higher body weight. Supplemented (Met1 and Met2) hens showed greater expression of glutathione synthase (GSS) and methionine sulfoxide reductase A (MSRA) genes, greater total antioxidant capacity, and lower lipid peroxidation in the liver. The offspring of hens fed the Met2 diet had lower death rate (1 to 14 d), higher weight on 15 d of age, weight gain, and better feed conversion ratio from 1 to 14 d of age. Among chicks reared under heat stress, the progeny of methionine-supplemented hens had higher weight on 35 d, weight gain, expression of GSS, MSRA, and thermal shock protein 70 (HSP70) genes, and total antioxidant capacity in the liver, as well as lower heterophil/lymphocyte ratio. Positive correlations between expression of glutathione peroxidase 7 (GPX7) and MSRA genes in hens and offspring were observed. Our results show that maternal methionine supplementation contributes to offspring development and performance in early stages and that, under conditions of heat stress during growth, chicks from methionine-supplemented hens respond better to hot environmental conditions than chicks from nonsupplemented hens. Supplementation of quail hens diets with methionine promoted activation of different metabolic pathways in offspring subjected to stress conditions.

The deficiency of nutrients such as methionine in the diet of birds is affecting fertility rate, egg production, egg weight, and progeny weight. In addition, the maternal environment influences gene expression through epigenetic mechanisms, where the conditions experienced by the parental generation during embryonic development can produce effects on the progeny. This study investigates how methionine supplementation in the diet of quail hens can reduce the effects of oxidative stress and improve the performance of progeny subjected to heat stress during growth. For that, the quail hens were fed with diets containing three different levels of methionine; and their chicks were created (15 on 35 d of age) into thermoneutral and/or intermittent heat stress ambient. It was observed that methionine supplementation in the quail hens had a positive effect on mortality during the initial phase and greater weight gain in the progeny growth phase. In addition, genetic inheritance was observed through the positive correlation between the expression of genes (maternal and progeny) related to oxidative stress. The results show that methionine supplementation in the maternal diet contributes to the development and performance of the progeny when subjected to heat stress during the growth phase.

The politics and imaginary of 'autonomous vehicles': a participatory journey.

The Connected and Automated Vehicles (CAVs) pilot project set out to explore the alternative mobility imaginaries of participants. These imaginaries challenged the automated vision of the future presented by vehicle and technology companies. This paper takes a post-normal science and digital anthropology approach to the question of automated technology and the role that citizens have in shaping mobility future(s). Through narrative analysis, interviews with stakeholders, and Futures Making Ateliers, this citizen engagement journey deconstructs the technological promises of CAVs, as well as their plausibility and desirability from the point of view of the participants of the participatory journey. Our findings suggest that the technology is solving a different problem than the mobility problem as articulated in policy documents. By investigating the matters of concern of participants, the problem of mobility was redefined in their own terms, and alternative futures were explored. We use the concept of MacGuffin as means to explore the wider relevance of CAVs in mobility futures.

Early impact of the COVID-19 pandemic on promotion of infant activity, strength and communication: A qualitative exploration.

INTRODUCTION: Fostering physical activity, muscle strengthening and communication skills in diverse environments are vital to ensuring healthy infant development; however, promotion of these skills may be impacted by the COVID-19 pandemic. Therefore, the purpose of this study was to explore healthcare workers, parents and childcare providers' perceptions of the pandemic's influence on how they engage with infants to promote physical activity, muscle strength and communication. METHODS: 37 subjects (12 = parents; 12 = childcare providers, 13 = healthcare workers) participated in a semi-structured interview. Data were analyzed via an inductive content analysis. RESULTS: The majority of caregivers identified concerns related to: limitations in social interactions (especially masks impacting communication), lack of access to peer modeling, fewer opportunities for physical exploration, and a need for creative activities in diverse environments (e.g., home/childcare) for infant development during and after the pandemic. CONCLUSIONS: Caregivers are concerned about the role COVID-19 is having on infant development. Additional resources on how to promote infant physical activity, muscle strength and communication despite challenges associated with the COVID-19 pandemic are needed.

What is the relevance of research for nursing students?

Introduction and objectives: The Bologna Process led to the reorganization of the education system into three academic degrees: Bachelor's degree, Master's de-gree and Doctorate, differentiated by focusing on the research area only after the Bachelor's degree. The present study aims to understand the relevance of research in Nursing for undergraduate students. Methodology: Through a mixed descriptive-correlative investigation, the data was collected through an online form, sent via social networks. The sample is made up of 250 students, in the 4th year of the Nursing Bachelor's degree, from 17 higher education institutions in Portugal. Results and discussion: All students consider nursing research important, but 35.2% of the respondents are undecided about contributing to this area and 5.6% do not intend to contribute to it. It was also noted that, although 99.6% of the students reported they had a curricular unit associated to research, 53.2% of the students considered their ability to analyse a scientific article as "Sufficient". The relevance attributed to this component of research analysis is mostly evaluated as "Very im-portant" (42%). Conclusions: Most students value nursing research, and are interested in projects that contribute to the subject and to the development of their personal and pro-fessional skills, but there is a lack of incentive for investment in this area. It is also possible to identify gaps in learning regarding the analysis and interpretation of scientific articles. It is possible to conclude that in the educational system there must be structural and content changes to respond to the students' needs

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Ceratose seborreica em idosos de uma região de savana tropical / Seborrheic keratosis in elderly of a tropical savanna region / Queratosis seborreica em ancianos de una region de savana tropical

Objetivo: verificar a prevalência de ceratose seborreica em idosos residentes em região de savana tropical. Método: estudo descritivo transversal, realizado em Palmas, Tocantins, no primeiro semestre de 2016, com idosos de ambos os sexos. Resultados: participaram do estudo 259 idosos, sendo identificada prevalência de 8,5% de ceratose seborreica, com maior ocorrência no sexo masculino, na faixa etária de 70 a 79 anos, e que se auto declararam negros. Quanto às características da pele dos idosos com ceratose seborreica, a maioria apresentava pele ressecada e com diminuição do turgor cutâneo. Considerações finais: dados relacionados aos fatores ressecamento da pele e diminuição do turgor alertam para a necessidade de maior atenção e cuidados preventivos especificamente voltados a pessoa idosa. Esse estudo, representa o início para compreensão sobre a prevalência de ceratose seborréica em idosos em área de savana tropical, e destaca a importância de realização de outros estudos acerca dos fatores intervenientes, ampliando a compreensão sobre o fenômeno.

Objective: verify the prevalence of seborrheic keratosis in elderly residents of a tropical savanna region. Method: this is a descriptive cross-sectional study, carried out in Palmas, Tocantins, in the first half of 2016, with elderly men and women. Results: a total of 259 elderly people participated in the study, that identified a prevalence of 8.5% of seborrheic keratosis, with the highest occurrence in males, aged 70 to 79 years, and who declared themselves black. As to the skin characteristics of the elderly with seborrheic keratosis, the majority had dry skin and decreased skin turgor. Conclusion: the data related to skin dryness and turgor reduction factors point to the need for greater attention and preventive care specifically to the elderly. This study represents the beginning of an understanding about the prevalence of seborrheic keratosis in the elderly in a tropical savanna area, and highlights the importance of other studies about the intervening factors, increasing the understanding about the phenomena.

Objetivo: verificar la prevalencia de queratosis seborreica en ancianos residentes en la región de savana tropical. Método: estudio descriptivo transversal, realizado en Palmas, Tocantins, en el primer semestre de 2016, con ancianos de ambos sexos. Resultados: participaron del estudio 259 ancianos, fue identificada prevalencia de 8,5% de queratosis seborreica, con mayor ocurrencia en el sexo masculino, en el grupo etario de 70 a 79 años, y que se auto declararon negros. En cuanto a las características de la piel de los ancianos con queratosis seborreica, la mayoría presentaba piel reseca y con diminución do turgencia cutánea. Conclusión: datos relacionados a los factores de resecamiento de la piel y diminución de la turgencia alertan sobre la necesidad de mayor atención y cuidados preventivos específicamente orientados a la persona anciana. Ese estudio representa el inicio para la comprensión sobre la prevalencia de queratosis seborreica en ancianos en área de savana tropical, y destaca la importancia de la realización de otros estudios acerca de los factores intervinientes, ampliando la comprensión del fenómeno.

Resilient futures of a small island: A participatory approach in Tenerife (Canary Islands) to address climate change.

Adaptation to climate change has been considered to be crucial to current societies, especially for small islands. In this paper the case of Tenerife (in the Canary Islands) is analysed. Tenerife is a small island located northwest of the African continent, in the Atlantic Ocean. Tenerife presents a high vulnerability to heatwaves and Saharan dust events as a consequence of its closeness to the Saharan desert. In fact, increasing frequency of heatwaves and Saharan dust events has been reported and could worsen in the future due to global warming. An exploration of adaptation strategies to an increase of the frequency and intensity of these phenomena is therefore needed. Different social actors have been engaged in a participatory process aiming at exploring pathways for adaptation to extreme weather events. Resilience was argued as the relevant framing to address those hazards. Four focus group sessions were carried out in order to explore key transformative elements necessary to make resilient futures for Tenerife. The results highlight the need for broader climate-based policies across all sectors to assure that the island becomes resilient to climatic and non-climatic shocks.

'Do-It-Yourself' Healthcare? Quality of Health and Healthcare Through Wearable Sensors.

Wearable sensors are an integral part of the new telemedicine concept supporting the idea that Information Technologies will improve the quality and efficiency of healthcare. The use of sensors in diagnosis, treatment and monitoring of patients not only potentially changes medical practice but also one's relationship with one's body and mind, as well as the role and responsibilities of patients and healthcare professionals. In this paper, we focus on knowledge assessment of the online communities of Fitbit (a commercial wearable device) and the Quantified Self movement. Through their online forums, we investigate how users' knowledge claims, shared experiences and imaginations about wearable sensors interrogate or confirm the narratives through which they are introduced to the publics. Citizen initiatives like the Quantified Self movement claim the right to 'own' the sensor generated data. But how these data can be used through traditional healthcare systems is an open question. More importantly, wearable sensors trigger a social function that is transformative of the current idea of care and healthcare, focused on sharing, socialising and collectively reflecting about individual problems. Whether this is aligned with current policy making about healthcare, whose central narrative is focused on efficiency and productivity, is to be seen.

Regulação em saúde no setor privado: o caso da ANS no Brasil e da ERS em Portugal / Health regulation in the private sector: The case of ANS in Brazil and ERS in Portugal

Resumo No Brasil, o Sistema Único de Saúde (SUS) vem se consolidando enquanto um subsistema público de saúde que convive com um sólido subsistema privado de saúde suplementar e complementar. O sistema de saúde português, de forma semelhante, caracteriza-se pela presença de três subsistemas assistenciais: o Serviço Nacional de Saúde, um setor de seguros privados e um setor privado em ascensão. Para ambos os países, a questão do setor privado é um dilema e um desafio para as suas respectivas entidades reguladoras, a Agência Nacional de Saúde Suplementar (ANS) e a Entidade Reguladora da Saúde (ERS). Desse modo, objetiva-se compreender como as instituições reguladoras atuam sobre o setor privado, demonstrando o crescimento desse setor, a segmentação dos sistemas de saúde, e o perfil de reclamações dos beneficiários/utentes. Para tal, realizou-se uma sistematização da literatura, levantamento dos gastos em saúde na base da OCDE, IBGE, ANS e ERS. Percebe-se que, com a consolidação de um padrão de empresariamento privado da saúde, inicia-se uma disputa por segmentos de clientela e especializações; o fortalecimento do setor privado preserva suas bases de financiamento público mediante sua presença marcante e cada vez mais organizada nas arenas decisórias públicas, com o Estado, e nos fluxos do mercado.

Abstract In Brazil, the Unified Health System (SUS) has been consolidated as a public health subsystem that coexists with a solid private subsystem supplementary and complementary health. The Portuguese health system, similarly, is characterized by the presence of three health subsystems: the National Health Service, private insurance and rising private sector. For both countries, the issue of the private health sector is a dilemma and a challenge to their respective regulators, the National Supplementary Health Agency (ANS) and the Regulatory Authority of Health (ERS). Thus, we aim to understand how regulatory institutions act on the private sector, demonstrating the growth of this sector, the segmentation of health systems, and the profile of complaints of beneficiaries. To this end, we carried out a systematic literature, survey of health expenditures on the basis of the OECD, IBGE, ANS and ERS. It With the consolidation of a pattern of private health business created a dispute over client segments and specializations; the private sector preserves its public funding base through its strong presence and increasingly organized in public decision-making arenas, with the State, and market flows.

Post-normal institutional identities: Quality assurance, reflexivity and ethos of care.

This paper suggests adopting a 'post-normal science' (PNS) style and practice in scientific advice, and motivate the urgency of this methodological stance with the increasing complexity, and polarisation affecting the use of science-based evidence for policy. We reflect on challenges and opportunities faced by a 'boundary organisation' that interfaces between science and policy, taking as example the European Commission's Directorate General Joint Research Centre, whose mission is stated as that to be the "in-house science service". We suggest that such an institution can be exemplary as to what could be changed to improve the quality of evidence feeding into the policy processes in the European Union. This paper suggests how an in-house culture of reflexivity and humility could trigger changes in the existing styles and methods of scientific governance; at the JRC, taken as example, this would mean opening up to the existing plurality of norms and styles of scientific inquiry, and adopting more participatory approaches of knowledge production, assessment and governance. We submit that the institutional changes advocated here are desirable and urgent in order to confront the ongoing erosion of trust in 'evidence based policy', anticipating controversies before they become evident in the institutional setting in which institutions operate.

PREVALÊNCIA DE CERATOSE ACTÍNICA EM IDOSOS DE UMA REGIÃO NEOTROPICAL / PREVALENCE OF ACTINIC KERATOSIS IN THE ELDERLY OF A NEOTROPICAL REGION / PREVALENCIA DE QUERATOSIS ACTÍNICA EN LOS ADULTOS MAYORES DE UNA REGIÓN NEOTROPICAL

Objetivo: identificar a prevalência de ceratose actínica (CA) em idosos residentes no município de Palmas, TO, Brasil. Método: estudo epidemiológico, observacional, transversal realizado no município de Palmas, no período de janeiro a junho de 2016, com pessoas, de ambos os sexos, com idade acima de 60 anos. Resultados: fizeram parte do estudo 259 idosos, com predomínio na faixa etária entre 60 e 69 anos, média de idade de 72 anos. A prevalência de CA foi de 2,3%, com predomínio no sexo feminino (66,7%), na faixa etária entre 68 e 91, e que se declararam brancos (66,7%). Conclusão: estudos alertam quanto ao risco de desenvolvimento de CA por pessoas idosas, relacionando a exposição solar ao longo da vida. Embora esse estudo não tenha investigado os hábitos de vida quanto ao histórico de exposição solar, os resultados confirmam o risco para idosos. Evidencia a importância de cuidados preventivos com a pele, especialmente quanto a exposição solar, visando a prevenção da CA.

Objective: Identify the prevalence of Actinic Keratosis (CA) in elderly residents in the city of Palmas, TO, Brazil. Method: it is an observational, cross-sectional epidemiologic study, conducted in the city of Palmas from January to June of 2016, with subjects of both sexes, aged above 60 years. Results: two hundred sixty-nine elders were part of this study, most of them aged between 60 and 69 years, with an average age of 72 years. The CA prevalence was 2.3%, mostly women (66.7%), aged between 68 and 91, and who declared themselves white (66.7%). Conclusion: Studies warn about the risk of elderly people developing CA related to solar exposure throughout the life. Although this study did not investigate the life habits related to sun exposure, the results confirm this risk for seniors. This study highlights the importance of preventive skin care, especially related to sun exposure, aiming the CA prevention.

Objetivo: identificar la prevalencia de queratosis actínica (CA) en los adultos mayores residentes en la ciudad de Palmas, Tocantins, Brasil. Método: estudio epidemiológico, observacional, transversal, realizado en la ciudad de Palmas, en el período de enero a junio de 2016, con las personas de ambos sexos, mayores de 60 años. Resultados: los sujetos fueron 259 ancianos, predominantemente con edades comprendidas entre 60 y 69 años, con una edad media de 72 años. La prevalencia de la CA fue de 2,3%, con predominio en mujeres (66,7%), con edades comprendidas entre los 68 y 91, y que se declararon raza blanca (66,7%). Conclusión: estudios advierten sobre el riesgo de desarrollo de CA para las personas ancianas que une la exposición al sol durante toda la vida. Aunque este no estudio ha investigado los hábitos de vida como la historia de la exposición al sol, los resultados confirman el riesgo para ancianos. Destaca la importancia de la atención preventiva de la piel, sobre todo por exposición al sol, con el objetivo de la prevención del CA.

Illness management and recovery in community practice.

OBJECTIVE: To examine provider competence in providing Illness Management and Recovery (IMR), an evidence-based self-management program for people with severe mental illness, and the association between implementation supports and IMR competence. METHOD: IMR session recordings, provided by 43 providers/provider pairs, were analyzed for IMR competence using the IMR Treatment Integrity Scale. Providers also reported on receipt of commonly available implementation supports (e.g., training, consultation). RESULTS: Average IMR competence scores were in the "needs improvement" range. Clinicians demonstrated low competence in several IMR elements: significant other involvement, weekly action planning, action plan follow-up, cognitive-behavioral techniques, and behavioral tailoring for medication management. These elements were commonly absent from IMR sessions. Competence in motivational enhancement strategies and cognitive-behavioral techniques differed based on the module topic covered in a session. Generally, receipt of implementation supports was not associated with increased competence; however, motivational interviewing training was associated with increased competence in action planning and review. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: IMR, as implemented in the community, may lack adequate competence and commonly available implementation supports do not appear to be adequate. Additional implementation supports that target clinician growth areas are needed. (PsycINFO Database Record

Atenção ao climatério realizada por profissionais da estratégia saúde da família / Care by family health strategy personnel during the climacteric / Atención al climaterio realizada por profesionales de la estrategia salud de la familia

Introdução: o climatério representa um período de alterações físicas, psíquicas e emocionais que impactam na qualidade de vida feminina e demanda preparo para a integralidade da assistência. Objetivo: analisar o perfil dos profissionais, conhecimento, dificuldades e atividades realizadas na atenção à mulher climatérica na Estratégia Saúde da Família (ESF). Método: estudo descritivo, transversal com profissionais de saúde de nível superior da ESF de um Distrito Sanitário de Goiânia, Goiás, Brasil, em 2013. Participaram 57 profissionais. Resultados: a maioria (80,8%) dos enfermeiros definiu climatério e menopausa corretamente, com menor taxa de acerto entre os outros profissionais. Deficiências na qualificação profissional foram citadas por 43,9% dos participantes. A maioria (70,2%) referiu realizar orientações em consultório e citaram ausência de atividades educativas multidisciplinares. Conclusão: é preciso fortalecer estratégias de educação permanente e intervenções direcionadas à integralidade da assistência.

Introduction: the climacteric is a period of physical, psychological, and emotional changes that impact women's quality of life, and requires preparation for comprehensive care. Objective: to analyze the profile of Family Health Strategy (FHS) personnel, their skills, difficulties, and actions performed in care provided to climacteric women. Method: this is a descriptive, cross-sectional study. The participants were 57 university graduate healthcare professionals working in the FHS in the Goiania health district, Goias State, Brazil, in 2013. Results: the climacteric and menopausal periods were correctly defined by 80.8% of nurses, with a lower success rate among other personnel. Deficiencies in professional training were cited by 43.9% of participants. The majority (70.2%) reported giving guidance in the consulting room, and cited a lack of multidisciplinary educational activities. Conclusion: continuing professional development strategies need to be reinforced, as do direct interventions to assure comprehensive care.

Introducción: el climaterio representa un período de cambios físicos, psíquicos y emocionales que afectan la calidad de vida de las mujeres y que demandan una preparación para una atención integral. Objetivo: analizar el perfil de los profesionales, conocimiento, dificultades y actividades realizadas en la atención a la mujer en climaterio en la Estrategia de Salud Familiar (ESF). Método: estudio descriptivo, transversal, con profesionales de la salud de nivel terciario de la ESF de un Distrito Sanitario de Goiânia, Goiás, Brasil, en 2013. Cincuenta y siete profesionales han participado del estudio. Resultados: el 80,8% de los enfermeros ha definido correctamente climaterio y menopausia; entre los otros profesionales se vio una menor proporción de aciertos. Un 43,9% de los participantes ha mencionado deficiencias en la calificación. La mayoría (70,2%) informó realizar orientaciones en el consultorio y mencionó la falta de actividades educadoras multidisciplinarias. Conclusión: es necesario fortalecer las estrategias de educación permanente y las intervenciones dirigidas a la integralidad de la atención.

Characterization of fungal communities in house dust samples collected from central Portugal-a preliminary survey.

House dust is a repository and concentrator of many chemical and biological agents including fungi. Considering that dust acts as a long-term reservoir of airborne fungi and that cumulative exposure is more relevant to potential health problems than single-day or short-term exposure, characterization of fungal communities in dust samples is of paramount importance. In the present study, the fungal composition of Portuguese house dust samples was determined. A total of 28 samples were obtained from vacuum cleaner deposits from households located in central Portugal. DNA was extracted from dust samples and fungal communities were analyzed using a culture-independent polymerase chain reaction (PCR)- denaturing gradient gel electrophoresis (DGGE) approach. Cultural analyses were also performed in order to identify the viable fungi species present in selected samples. Fungal diversity, reported as the number of operational taxonomic units (OTU), varied between 9 and 56 OTU. This analysis of viable fungi showed that Aspergillus was the most abundant genus, followed by Penicillium, Mucor, and Rhizomucor. Trichoderma, Chrysosporium, Fusarium, Rhizopus, and Stachybotrys were found in a limited number of houses. Our results demonstrated that dust is, in fact, home for a diverse and heterogeneous fungal community and that some of the species found are known allergic agents with severe negative impacts on human health.

Probing the interaction of oppositely charged gold nanoparticles with DPPG and DPPC Langmuir monolayers as cell membrane models.

The growing use of nanoparticles in a variety of applications calls for detailed studies of their toxicology, which in turn require understanding the interactions between nanoparticles and living cells. Since simulating the interaction with real cell membranes is rather complex, Langmuir monolayers (LMs) have been used to mimic the first barrier encountered by a nanoparticle as it approaches a biological membrane to assess molecular-level interactions. In this study, we show how oppositely charged gold nanoparticles (Au-NPs) interact with monolayers of the zwitterionic dipalmitoylphosphatidyl choline (DPPC) and negatively charged dipalmitoylphosphatidyl glycerol (DPPG). The monolayers were spread on subphases containing two concentrations of either negatively charged Au-NPs coated with citrate anions or positively charged Au-NPs functionalized with the cationic polyelectrolyte poly(allylamine hydrochloride) (PAH). For DPPG, electrostatic effects dominated which depended strongly on the NPs capping agent, being obviously larger for the positive nanoparticles. The in-plane elasticity for DPPG monolayers within the surface pressure range corresponding to real cell membranes increased with adsorption of positively charged NPs, but decreased with the negative ones. For the zwitterionic DPPC, on the other hand, significant effects only occurred for negatively charged NPs, including a decrease in elasticity. Therefore, it is concluded that the nature, namely the charge of the capping agents, is crucial for the interaction of charged NPs with the cell membrane.

A single-source route for the synthesis of metal oxide nanoparticles using vegetable oil solvents.

We report a general method for the synthesis of metal oxide colloidal nanocrystals in sunflower oil using single-source precursors. In this research, iron oxide nanocrystals have been synthesized and characterized though this method can be extended to the synthesis of other common metal oxides such as ZnO and also to other types of vegetable oils as solvents. Using this method, nanoparticles with average diameters of 7 nm and 3 nm were obtained respectively for iron oxide and zinc oxide. The magnetic iron oxide phase was identified using powder XRD, surface enhanced Raman spectroscopy and magnetic measurements as maghemite as the main component. The magnetic measurements demonstrate the superparamagnetic behavior of the iron oxide nanoparticles. This synthetic approach is an interesting way to synthesize metal oxide nanocrystals in eco-friendly solvents of natural origin.